Hrev_master Healthcare in Low-resource Settings 2023; volume 11(s1):11178 The efficacy of Raspberry Pi-based automatic voice message education on knowledge level and prevention behavior of high-risk population Mifetika Lukitasari,1,2 Wahyu Indah Windarti,1 Endah Panca Lydia Fatma,1 Tony Suharsono,1 Dwi Adi Nugroho2 1Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Malang, Indonesia; 2Brawijaya Cardiovascular Research Group, Brawijaya University, Indonesia Abstract Introduction: The number of confirmed COVID-19 cases has increased in Indonesia. Preventive measures are believed to break the chain of transmission of COVID-19. Therefore, increasing knowledge through health education is essential to improve pre- ventive behavior in the community. The study aims to determine the efficacy of implementing health education using Raspberry Pi based automatic voice massages in increasing high risk popula- tions’ knowledge and prevention behavior. Design and Methods: This study was a quasi-interventional method with a pre-posttest research design and a non-equivalent control group, consisting of 30 respondents in each group. Control group received health education through leaflet sharing, while intervention group received health education through Raspberry- pi based automatic voice massages. Results: This study showed that there were no significant dif- ferent in knowledge between control and intervention group after obtaining health education. Meanwhile, the intervention group showed higher score in knowledge regarding COVID-19. Moreover, the prevention behavior was significantly improved in both groups after acquiring health education through leaflets and automatic voice messages. Conclusions: Health education using Raspberry Pi based auto- matic voice messages improved both knowledge and preventive behavior regarding COVID 19 in high risk population. Introduction The incidents of COVID-19 cases is rapidly increasing as it spreads to several nations in a short period. Furthermore, on September 30, 2020, the WHO reported up to 33.5 billion con- firmed cases with 1.01 billion deaths worldwide.1 The Ministry of Health of the Republic of Indonesia reported 287,002 confirmed cases, with 10,729 deaths.1 Based on data from the COVID-19 Task Force in Malang Regency, 899 confirmed cases were report- ed as of September 29, 2020, with a death toll of 59. Karangploso is the fourth-ranked sub-district based on reports on confirmed cases with 52 points and 4 deaths.2 The majority of deaths were caused by the deterioration of health in high-risk population groups with comorbidities. Furthermore, the survey result showed that the death rate was 10%, 7.3%, 6.3%, 6%, 5.6% in patients with cardiovascular, diabetes, chronic respiratory, hypertension, cancer disease, respectively.3 Even though the government has attempted various efforts, such as limiting outdoor activities to prevent the virus trnasmis- sion, the number of confirmed cases continues to increase. This is due to the lack of awareness of the Indonesian citizens towards the dangers of COVID-19 transmission4 and the non-compliance with government recommendations.5 The knowledge and behavior of the community is a measure of the awareness level towards the dangers of virus transmission.6 Consequently, it is essential to increase people’s knowledge and change their non-compliance behavior towards COVID-19 pre- vention. In addition, knowledge plays an essential role in behav- ioral reflection. This fosters a sense of trust, which is then present- ed as the basis for the realization of decision making.7 Promotive and preventive activities through health education improve peo- ple’s understanding of COVID-19 behavior in Kepuharjo Village. Health education is a process of improving one’s health status. As a result, a suitable method is needed for the proper dissemination of health information.8 Computers and communication technologies, with technical advancements, are powerful channels for providing public infor- mation and education. According to Dogba (2019), information and communication technology has great potential to improve education in rural areas.9 Automatic voice message is one of the areas of information and communication technology applied in various healthcare education. The application of information tech- nology in health education minimizes physical contact, thereby enabling educators to conduct their services without meeting face- to-face.10 Therefore, this study aimed to investigate the efficacy of implementing health education using Raspberry Pi based automat- ic voice massages in increasing high risk populations’ knowledge and prevention behavior. Design and Methods This study was a quasi-interventional design with a pre-post test and a non-equivalent control group. Furthermore, a design was used to determine the effect of health education using auto- matic voicemail media based on Rasberry Pi in Kepuharjo Village, Significance for public health This study revealed that the usage of raspberry-pi based automatic voice message improved the high-risk population’s knowledge and preventive behavior in COVID-19. This study provided a new perspective in educating the community during COVID 19 pandemic era while they have to stay at home. Article [page 62] [Healthcare in Low-resource Settings 2023; 11(s1):11178] Non -co mmerc ial us e o nly Malang Regency. Furthermore, the intervention and control groups were given different treatments. The control group was educated through leaflets and automatic voice messages. The population is a high-risk community in Kepuharjo Village, Karangploso District, Malang Regency. A purposive sampling technique obtained 60 respondents with details of 30 and 60 respondents in the interven- tion and control group, respectively. The data collected using the COVID-19 Knowledge question- naire instrument consists of 18 questions on the etiology, symp- toms, risk groups, transmission, and prevention of the virus11. Furthermore, the second questionnaire is the PCIBS (Preventive COVID-19 Infection Behavior Scale), consisting of 6 question items on washing hands, avoiding touching eyes, nose, and mouth, coughing and sneezing etiquette, and keeping distance by staying at home.12 After the translation, the questionnaires were adapted to the study conditions and tested for validity and reliability, where r > 0.338. Therefore, it was reliable, as seen from the Cronbach’s Alpha score > 0.6. Furthermore, it is valid and reliable when the value of r > 0.443 and Cronbach’s Alpha > 0.6 in the PCIS ques- tionnaire. The data were analyzed by paired t-test and Mann Whitney test with p value <0,05 considered as significant result. Results and Discussions Table 1 shows respondents’ characteristics based on gender, age, last education, and sickness history of the intervention and control groups. Furthermore, most respondents were female, with 23 (76.6%) and 25 (83.3%) respondents in the control and inter- vention groups, respectively. Most respondents are adults based on age, with 19 (63.3%) and 40 (70.0%) respondents in the control and intervention group, respectively. In addition, most of the respondents were graduated from elementary school, with 18 (69.0%) and 20 (66.7%) respondents in the control and interven- tion group, respectively. Based on the medical history, hyperten- sion was the most common health problem in the control and inter- vention group, with 19 (63.3%) in each group. Table 2 showed that the average pre-test score of knowledge level is 13.83 lower than the average post-test score of 13.90 with a standard deviation of 1.704 knowledge level pre-test and 2.023 post-tests. Meanwhile, the average pre-test score for preventative behavior was 16.13, higher than the average post-test score of 15.37, with a standard deviation of 1525 and 2,008 for behavioral pre-test and post-test. Table 3 also showed the average pre-test score of knowledge level is 13.77 lower than the average post-test score of 14.20 with a standard deviation of 2.528 and 2.265 for pre-test and post-test, respectively. Likewise, the average pre-test score of preventive behavior was 15.63, lower than the average post-test score of 16.10 with a standard deviation of 1.829 and 2.040 for pre-test and post-test, respectively. No difference in the level of knowledge of COVID-19 between the pre-test and post-test in the control group (p = 0.826; = 0.05) was observed in this study. In contrast, the pre-test and post-test data analysis show a difference in preventive behavior between the pre-test and post-test (p = 0.001; = 0.05). Moreover, no difference in the level of knowledge of COVID-19 between the pre-test and post-test in the intervention group (p = 0.091; = 0.05) was observed. In contrast, the analysis of the pre-test and post-test data on preventive behavior shows a difference between the pre-test and post-test (p = 0.001; = 0.05) Table 3 showed the result of the unpaired t-test on the improve- ment of COVID-19 knowledge level between control and interven- tion groups. There was no significant difference in the level of Article Table 1. Baseline characteristics. Characteristics Control Groups (n=30) Interventional group (n=30) Total n % n % N % Sex Man 7 23.3% 5 16.7% 12 20.0% Woman 23 76.6% 25 83.3% 48 80.0% Age Adulthood 19 63.3% 21 70.0% 40 66.7% Elderly 11 36.7% 9 30.0% 20 33.3% Education Elementary 18 60.0% 20 66.7% 38 63.3% Junior High School 4 13.3% 5 16.7% 9 15.0% Senior High School 6 20.0% 4 13.3% 10 16.7% Bachelor Degree 2 6.7% 1 3.3% 3 5.0% Medical History Hypertension 19 63.3% 19 63.3% 38 63.4% Diabetes Melitus 6 20.0% 8 26.7% 14 23.3% Hypertension and Diabetes Melitus 3 10.0% 2 6.7% 5 8.3% Asthma 2 6.7% 1 3.3% 3 5.0% Total 30 100% 30 100% 60 100% Table 2. Pre-test and posttest results in the control group. Variable Control Group Intervention Group Pre test Post test p value Pre test Post test p value Knowledge 13.83 ± 1.704 13.90 ± 2.023 0.862 13.77 ± 2.528 14.20 ± 2.265 0.091 Attitude 16.13 ± 1.525 15.37 ± 2.008 0.001 15.63 ± 1.829 16.10 ± 2.040 0.001 [Healthcare in Low-resource Settings 2023; 11(s1):11178] [page 63] Non -co mmerc ial us e o nly COVID-19 knowledge improvements between leaflets and auto- matic voice messages through Rasberry Pi groups (p< 0.423). Moreover, improvement of prevention behavior in both control and intervention groups showed significant between the groups. The intervention group had a higher preventive behavior improve- ment compared to that of control group (p < 0.001). The result shows no significant difference in the level of knowledge about COVID-19 between the pre-test and post-test after acquiring health education using leaflet media and automatic voicemail media. Furthermore, most control and intervention group respondents were already informed on the etiology, symp- toms, and transmission of COVID-19. However, most respondents still do not understand the comorbidities issue as well as virus transmission. They believe the infection could not be worsen, except for the elderly population. Previous study suggested that respondents do not know that the virus can penetrate the clothes and mask.13 Meanwhile, 99% of Indonesian people already have good knowledge about social distancing. However, these results are not in line with that of previous study that suggested 83% of the respondents in DKI Jakarta had a good knowledge regarding the prevention of COVID-19.14 Previous study explained that most of the acceptance of the cognitive component in the knowledge aspect is obtained from sensing the eyes and ears. In this research, the control group received health education through leaflet media, characterized by viewing.8 Health education using leaflet media triggers respondents to view and repeat activities while imparting information.15 The decrease in knowledge is based on the respondent’s lack of interest in reading the educational material due to rewards and punishments. Furthermore, the limitations in conducting observa- tions also affect the increase in respondents’ level of knowledge because there is no control over the activities performed. Health education was acquired in the intervention group through an automatic voice message based on Raspberry Pi, which is an outdoor audio educational medium. The information is con- veyed systematically and repeatedly to the targeted respondents to change the intervention targets’ views. Furthermore, individual stimulation is increased by using audio to promote learning, listen- ing, and remembering of health education material.16 The lack of knowledge after health education was due to the majority of respondents’ previous high expertise and the large amount of information conveyed by the government through many educational media. Additionally, the absence of activity restric- tions from respondents also breaks concentration and affects the understanding of the proposed educational material. Knowledge of COVID-19 is also influenced by several factors, including the respondent’s age and education level, since most respondents were adults. Also, age affects a respondent’s mindset and grasping power, which means that age is directly proportional to development and understanding. The study results show that most of the education level is elementary school or equivalent. Previous study suggested that the level of education acquired is directly proportional to the knowledge of the receiver.8 However, there are many sources of information other than formal education, including television, newspapers, radio, and the internet.21-23 Consequently, low education targets do not necessarily have com- mon knowledge. Environmental conditions such as noise and weather affect the transmission of information since health educa- tion media is performed outdoors.25-25 Most respondents in the control and the intervention group were good at health protocols such as washing hands, avoiding touching eyes, nose, and mouth, staying at home when not feeling well, and using masks. However, some did not comply with the cough and sneeze etiquette protocol and the rules of social distanc- ing. This study was supported by previous study that suggested 93% of respondents show good behavior in social distancing.13 The results are also in line with another study that showed 50.46% of respondents obeyed the rules of washing hands using soap, and 72.2% complied with the use of masks.17 Preventive behavior is reviewed based on several components, including perceptions of vulnerability to disease, benefits for change, barriers and ability to change, motivation, environment, and knowledge.18 Conclusions Health education using Raspberry Pi based automatic voice messages improved both knowledge and preventive behavior regarding COVID 19 in high-risk population. Article Correspondence: Endah Panca Lydia Fatma, Department of Nursing, Faculty of Health Sciences, Universitas Brawijaya, Jl. Puncak Dieng, Kunci, Kalisongo, Kec. Dau, Malang, East Java Indonesia 65151, Tel.: +62 341 5080686, Fax: +62 341 5080686, E-mail: endah.fk@ub.ac.id Key words: COVID-19, education, knowledge, behaviour, high-risk population. Acknowledgment: The author thanks to Faculty of Medicine, Brawijaya University, Malang, and Kepuh Harjo Regency, Malang, Indonesia Contributions: The authors contributed equally to this article. EDPL, ML, WIW, conceptualization, methodology; WIW, TS, formal analysis; DAN, EDPL, orig- inal draft preparation; ML, TS, manuscript review and editing. Furthermore, they read and approved the final version of the manuscript and agreed to be account- able for all aspects of the work Conflict of interests: The author declares no conflict of interest. Funding: This study was financially supported by Brawijaya University through a non-competitive research scheme. Clinical trials: Approved by the Ethics Commission from the Faculty of Medicine, Universitas Brawijaya with no 122 / EC / KEPK / 04/ 2021. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Informed consent: Written informed consent was obtained from a legally author- ized representative(s) for anonymized patient information to be published in this article. Conference presentation: Part of this paper was presented at the 2nd International Nursing and Health Sciences Symposium that took place at the Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. Received for publication: 3 December 2021. Accepted for publication: 10 May 2022. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2023; 11(s1):11178 doi:10.4081/hls.2023.11178 Publisher's note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [page 64] [Healthcare in Low-resource Settings 2023; 11(s1):11178] Non -co mmerc ial us e o nly References 1. WHO. Coronavirus disease (COVID-19). Geneva: WHO; 2020. 2. Pemerintah Kabupaten Malang SC 19. Data COVID-19. Malang: Pemerintah Kabupaten Malang; 2020. 3. Direktorat Jenderal Pencegahan dan Pengendalian Penyakit (P2P) KKR. Pedoman Pencegahan Dan Pengendalian Coronavirus Disease (COVID-19). Jakarta, Indonesia: Kementerian Kesehatan RI; 2020. 4. Djalante R, Lassa J, Setiamarga D, et al. Review and analysis of current responses to COVID-19 in Indonesia: Period of January to March 2020. Progress in Disaster Science 2020;6:100091. 5. Kustiandi J, Ilmi AM, Ariansyah AG, et al. SI-TACO: Media Promotif dan Preventif COVID-19 Pada Masyarakat Desa Ngembal Kabupaten Malang. [SI-TACO: Promotive and Preventive Media for COVID-19 in the Ngembal Village Community, Malang Regency.] Jurnal KARINOV 2020;3:147–52. 6. Prihati DR, Wirawati MK, Supriyanti E. Analisis Pengetahuan Dan Perilaku Masyarakat Di Kelurahan Baru Kotawaringin Barat Tentang Covid 19. [Analysis of Community Knowledge and Behavior in Kotawaringin Barat Baru Sub-District About Covid 19.] Malahayati Nurs J 2020;2:780–90. 7. Novita NW, Yuliastuti C, Narsih S. Tingkat Pengetahuan Tentang Tb Paru Mempengaruhi Penggunaan Masker Di Ruang Paru Rumkital Dr. Ramelan Surabaya. [The level of knowledge about pulmonary TB affects the use of masks in the Lung Room at Dr. Rumkital Hospital. Ramelan Surabaya.] J Health Sci 2014;7:486. 8. Notoatmodjo S. Promosi Kesehatan dan Perilaku Kesehatan. Jakarta: Rineka Cipta; 2012. 9. Dogba MJ, Dossa AR, Breton E, et al. Using information and communication technologies to involve patients and the public in health education in rural and remote areas: a scoping review. BMC Health Serv Res 2019;19:128. 10. Lindberg B, Nilsson C, Zotterman D, et al. Using Information and Communication Technology in Home Care for Communication between Patients, Family Members, and Healthcare Professionals: A Systematic Review. Int J Telemed Appl 2013;2013:e461829. 11. Saefi M, Fauzi A, Kristiana E, et al. Survey data of COVID- 19-related knowledge, attitude, and practices among Indonesian undergraduate students. Data in Brief 2020;31. 12. Chang D, Lin M, Wei L, et al. Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China. JAMA 2020;323:1092–3. 13. Yanti B, Mulyadi E, Wahiduddin W, Net al. Community Knowledge, Attitudes, And Behavior Towards Social Distancing Policy As Prevention Transmission Of Covid-19 In Indonesia. Jurnal Administrasi Kesehatan Indonesia 2020;8:4– 14. 14. Utami RA, Mose RE, Martini M. Pengetahuan, Sikap dan Keterampilan Masyarakat dalam Pencegahan COVID-19 di DKI Jakarta. Jurnal Kesehatan Holistic 2020;4:68–77. 15. Nurmala I. Promosi Kesehatan. Airlangga University Press; 2020. 16. Yusantika FD, Suyitno I, Furaidah F. Pengaruh Media Audio dan Audio Visual terhadap Kemampuan Menyimak Siswa Kelas IV. Jurnal Pendidikan: Teori, Penelitian, dan Pengembangan 2018;3:251–8. 17. Fakhira AD, Pawitra AS, Diyanah KC, et al. Awareness of Doing 3M (Wearing Mask, Physical Distancing, Washing Hands) During Pandemic Era in Rural and Urban Families. Jurnal Kesehatan Lingkungan 2021;13:94–101. 18. Mujiburrahman M, Riyadi ME, Ningsih MU. Hubungan Pengetahuan dengan Perilaku Pencegahan Covid-19 di Masyarakat. Jurnal Keperawatan Terpadu (Integrated Nursing Journal) 2020;2:130–40. 19. Rizky I. Cegah Corona, Lampu Merah di Depok Dipasang Audio Imbauan Jaga Jarak [Internet]. 2020 [cited 2021 Nov 28]. Available from: https://jabar.inews.id/berita/cegah-coro- na-lampu-merah-di-depok-dipasang-audio-imbauan-jaga- jarak. 20. Roy D, Tripathy S, Kar SK, et al. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian popula- tion during COVID-19 pandemic. Asian J Psychiatr. 2020;51:102083. 21. Rizky SA, Trisiana A, Ajrur FR, et al. Menumbuhkan Kesadaran Masyarakat Indonesia Untuk Memutus Rantai Penyebaran Wadah Covid-19. Jurnal Ilmiah Global Citizen 2020;9:51–62. 22. Heni A. Analisis: penyebab masyarakat tidak patuh pada pro- tokol COVID-19 [Internet]. 2020 [cited 2021 Nov 22]. Available from: https://theconversation.com/analisis-penye- bab-masyarakat-tidak-patuh-pada-protokol-covid-19-138311 23. Fisipol UMA. Berbagai Respon Masyarakat Terhadap Covid 19 · Fakultas Isipol Terbaik di Sumut [Internet]. Fakultas Isipol Terbaik di Sumut. 2020 [cited 2021 May 20]. Available from: https://fisipol.uma.ac.id/berbagai-respon-masyarakat-ter- hadap-covid-19/ 24. Nanni M, Andrienko G, Barabási AL, et al. Give more data, awareness and control to individual citizens, and they will help COVID-19 containment. Ethics Inf Technol 2021;23:1–6. 25. Ahmed EF, Shehata MAA, Elheeny AAH. COVID-19 aware- ness among a group of Egyptians and their perception toward the role of dentists in its prevention: a pilot cross-sectional sur- vey. Z Gesundh Wiss 2022;30:435–40. 26. Zulkifli, Widjanarko B, Widagdo, L. Analisis Media Audio ter- hadap Perubahan Perilaku Penggunaan Alat Pelindung Diri ( APD ) pada Petugas Laboratorium Kesehatan Kota Banjar. Jurnal Promosi Kesehatan Indonesia 2014;9:218–225 27. Sabarudin, Mahmudah R, Ruslin, et al. Efektivitas Pemberian Edukasi secara Online melalui Media Video dan Leaflet ter- hadap Tingkat Pengetahuan Pencegahan Covid-19 di Kota Baubau: The Effectiveness of Providing Online Education through Video and Leaflet Media on the Knowledge Level of Covid-19 Prevention at Baubau City. JFG 2020;6:15253 Article [Healthcare in Low-resource Settings 2023; 11(s1):11178] [page 65] Non -co mmerc ial us e o nly