Health Cadres Establishment Through Oral Dental Disease and Drug Use (DAGUSIBU) Education in Srigading Village, Bantul

. One of the community empowerment and involvement in improving health status in the community is the formation of health cadres. Health cadres are expected to be health informants in the community so that health information that is developed in the community is valid. This voluntary work aimed to educate health cadres about oral dental diseases and drug use in Srigading Village, Bantul, Yogyakarta. The voluntary work was carried out by providing education regarding oral dental disease and drug use through the method of Dapatkan , Gunakan , Simpan , dan Buang (Get, Use, Store, and Dispose). Pretests and posttests were conducted to evaluate the understanding of health cadres before and after the education. The assessment showed that the average pretest score was 58.8182, while the average posttest score was 91.0909. Based on the paired t-test, the increase was significant because the p-value was <0.05 (p = 0.000). At the end of the voluntary work, educational books and posters were distributed to 21 integrated service post groups from 20 hamlets in Srigading Village. The donated books and educational posters are expected to be a medium for learning and education by health cadres to the surrounding community.


Introduction
Caries is still one of the world's health problems, including in Indonesia [1].The Ministry of Health of the Republic of Indonesia, through the Basic Health Research/Riset Kesehatan Dasar (RISKESDAS), reported that 45.3% of Indonesians have damaged teeth/caries/toothache [2].During the COVID-19 pandemic, the Indonesian Dental Association as the professional organization of Indonesian dentists called for a restriction on dental and oral services through circular letter Number 2776/PB PDGI/III-3/2020 [3].The purpose of the restriction was to prevent the transmission of COVID-19.The service restriction that was carried out led to limited public access to dental health facilities, so the community was expected to be able to overcome oral health problems with certain conditions independently.
According to the Yogyakarta Special Region Health Profile in 2021, there were 122 dentists and dental specialists in Bantul Regency (103 dentists and 19 dental specialists) [4].In that year, the population of Bantul Regency was 998,647 people, so the ratio between dentists and the population was 1 to 8,185 people.According to the World Health Organization (WHO), this ratio is not ideal, which is 1 in 2,000 [5].Posyandu (Pos Pelayanan Terpadu/Integrated service post) is one of the community-based health efforts.These activities are carried out with the management of from, by, and for the community with the aim of facilitating the community itself in obtaining essential health services to improve public health status, including oral health [6].
Counseling through the use of media is one of the information deliveries that can be used to educate.Providing education using a lecturing method using a tool can increase knowledge related to the information [7,8].Educational topics about caries can be delivered because caries is still a major oral disease.Material on the use of drugs related to oral dental disease can also be provided to promote an understanding of good drug management and use, including basic drugs that can be used by the community to overcome oral dental disease problems independently.DAGUSIBU (Dapatkan, Gunakan, Simpan, Buang -Get, Use, Store, and Dispose) is one of the activities conducted by Gerakan Masyarakat Cerdas Menggunakan Obat (Smart Community Movement Using Drugs) aimed to promote understanding to the public regarding Get, Use, Store, and Dispose of drugs properly and correctly [9].Good drug management can reduce the number of errors in using drugs [10], such as overdosage, poisoning, and even death [11].

Methodology
This community service activity was carried out on February 27, 2023, at the Srigading Village Hall, Bantul, Yogyakarta.The purpose of this activity was to provide education on oral dental diseases and the use of drugs to health cadres consisting of 21 integrated service post (Posyandu) groups from 20 hamlets in the Srigading sub-district.Each Posyandu group consisted of 2-3 representatives.The socialization stage (announcement) was carried out by coordinating Kamituwo (public coordinator), Posyandu representatives, and community service implementers through WhatsApp broadcast messages.
The implementation stage of community service activities was as follows: Figure

Flow chart of community service activities
The problem identification and preparation stage were based on discussions conducted by students of Universitas Muhammadiyah Yogyakarta (UMY) during their community service program involving Posyandu administrators (Figure 2).The results of the brainstorming discussion concluded that many health cadres at Posyandu did not understand oral dental diseases and drug use.Health cadres who were part of the community assumed that basic treatment of oral dental problems could only be done by medical personnel (dentists).Health cadres also still assumed oral health efforts as curative and rehabilitative and did not understand the procedures of managing drugs.All the aforementioned results of the discussion were recapitulated to serve as the basis for making educational topics.
Furthermore, community service was carried out using the counseling (education) method through audiovisual media (Figures 3a and 3b).The oral dental disease materials presented were 1) causes of caries, 2) prevention of caries, and 3) basic management of oral and dental diseases (in simple terms) [12].The topics of drug management/use presented were 1) how to get the appropriate medicine, 2) how to appropriately use the medicine, 3) how to appropriately store the medicine, and 4) how to appropriately dispose of unused medicine [13].Pretests and posttests with the same type of questions were given to 55 health cadres who participated in the education to evaluate the understanding of health cadres before and after the education.Educational media, in the form of 4 types of educational posters and books, were donated (Figures 4a and 4b) to all Posyandu (21 Posyandu) with the hope that they can become learning and educational media by health cadres to the surrounding community.Srigading is an integral part of the Sub-district Sanden area.Srigading sub-district has 757.6 hectares area which is administratively divided into 20 hamlets and 81 neighbourhoods.Topographically, Srigading is a lowland village with an altitude of 2 -10 m above sea level, categorized as a coastal village.The Srigading sub-district area is passed by the small Winongo River which is used for irrigation [14].
Pembinaan Kesejahteraan Keluarga/Family Welfare Development (PKK) is one of the community organizations that contribute to family welfare.Two (2) of the ten (10) main PKK programs are programs related to health and health planning, so the administrators/managers of this organization were recruited as health cadres.Providing education to health cadres from each Posyandu is expected to be a solution related to the need for information on oral dental disease and drug use in the Srigading community.
Through the evaluation, data from 55 health cadres from 21 Posyandu in the Srigading sub-district was obtained (Table 1).

Last Education
Based on the last education, the classification of health cadres is divided into 5; namely health cadres whose last education is elementary school, junior high school, high school, academy/diploma, and undergraduate.Based on Table 1, there are 1.82% with a primary school degree, 10.91% with a junior high school degree, 76.37% with a senior high school degree, 7.27% with a bachelor's degree, and 3.63% with an undergraduate degree.

Occupation
Based on the occupation, the classification of health cadres is divided into 7, namely health cadres with occupations of laborer/farm laborer, housewives, civil servants, health worker, farmers, civil servant/government, and self-employed.Based on Table 1, there are 16.36% of health cadres with the occupation of laborer/farm laborer, 36.36% of health cadres with the occupation of housewife, 1.82% of health cadres with the occupation of civil servant and civil servant/government, 21.82% of health cadres with the occupation of health worker, and 20.00% of health cadres with the occupation of self-employed.
The results of the evaluation of health cadres' understanding regarding the education provision can be seen in Figure 5. Based on Figure 5, all health cadres showed an increase in their understanding related to oral dental disease and DAGUSIBU.The average increase in terms of their understanding is 31.2727points, from the pretest mean score of 59.8182 to 91.0909 in the posttest (Table 2).Furthermore, a paired sample t-test was conducted to evaluate the effect of the education provision on the understanding of health cadres using SPSS software.Data testing was carried out by testing the normality and homogeneity of the data.Normality test results showed that the pretest and posttest data were normally distributed and homogeneous.The paired sample t-test between the pretest and posttest values obtained a significance value of 0.000 (p <0.05).Therefore, it can be concluded that the provision of education influenced the understanding of health cadres before the pretest and after the posttest.The effect of counseling or providing education on increasing understanding is in accordance with previous research [15][16][17].Regarding the provision (grants) of posters and books, it is hoped that they can be used as an educational medium that can further increase the understanding of health cadres and health workers.

Conclusion
The formation of health cadres by providing education on oral dental disease and the use of drugs (DAGUSIBU) was carried out well and smoothly.Based on the data analysis, there was an increase in the understanding.In other words, the provision of education has influenced the understanding of health cadres to increase.Suggestions that can be given are evaluations related to the understanding of oral dental disease and the use of drugs in the community after receiving education from health cadres.

Figure 2 .
Figure 2. Discussion session to identify the problem

Figure 4 .
Figure 4. Profile of pretest and posttest scores of Srigading Village health cadres

Table 1 .
Distribution of respondents (health cadres) in the Srigading sub-district, Bantul, based on age, education, occupation, and average income.

Table 2 .
Paired samples statistics test results (average pretest and posttest scores)