p-ISSN 1693-5683; e-ISSN 2527-7146 78 Vol. 19, No. 2, November 2022, pp.78-86 Research Article Preparation of a Questionnaire for Clean and Healthy Behavior and Multivitamins to Measure Knowledge, Attitudes and Behavior as Prevention Efforts During the COVID-19 Pandemic Sisilia Christina Ari Widiastuti1, Yosef Wijoyo2*, Nunung Priyatni3 1 Master of Pharmacy, Faculty of Pharmacy, Sanata Dharma University, Paingan, Maguwoharjo, Depok, Sleman, Yogyakarta 55282, Indonesia 2 Faculty of Pharmacy, Sanata Dharma University, Paingan, Maguwoharjo, Depok, Sleman, Yogyakarta 55282, Indonesia 3 Politeknik Kesehatan TNI AU Adisucipto, Yogyakarta, Indonesia https://doi.org/10.24071/jpsc.003736 J. Pharm. Sci. Community, 2022, 19(1), 78-86 Article Info ABSTRACT Received: 30-09-2021 Revised: 19-07-2022 Accepted: 21-07-2022 *Corresponding author: Yosef Wijoyo email: yosefw@usd.ac.id Keywords: Clean and Healthy Behavior Program; COVID-19; multivitamins; reliability; validity Clean and Healthy Behavior (PHBS) is a movement that aims to improve the quality of the life and health of a person and society. One way to prevent the spread of COVID-19 is to live a clean and healthy lifestyle and increasing a person’s endurance can be done by taking multivitamins. This study aims to develop a PHBS and Multivitamins questionnaire that can be used to evaluate the knowledge, attitudes and behavior of Pelita Bangsa Health Vocational School students. This quantitative research was conducted in two stages. The first stage aimed to develop the PHBS and Multivitamin questionnaire’s framework, and the second stage was to test the validity and reliability. The questionnaire was made in three parts, including knowledge, attitude and behavior. The knowledge parts used the Guttman scale, while the attitude and behavior parts used a Likert scale. Questionnaire statements were considered valid by experts’ judgment. From the results of the validity and reliability tests of the questionnaire using Cronbach's alpha analysis, the results of the questionnaire were declared valid and reliable with a value above 0.60. The resulting questionnaire consists of 25 statements of knowledge, 20 statements of attitude and 20 statements of behavior. This research instrument can be used to measure students’ knowledge, attitudes and behavior in Pelita Bangsa Health Vocational School. INTRODUCTION The stipulation of the COVID-19 pandemic status as a non-natural disaster by the Indonesian government (Presiden RI, 2020) has impacted society by forcing the closure of educational institutions and other public infrastructures in an effort to contain the spread of the novel virus. During the COVID-19 pandemic which has spread throughout the world, including in Indonesia, all learning in schools is required to use online media by prioritizing Information and Communication Technology (ICT)-based learning (Heryanto et al., 2019). Other restrictions include setting safe distances to separate people in close proximity, reducing or not allowing crowds by restrictions on the number of people in an activity location, mandatory wearing of a mask, requiring washing hands with running water and soap, and encouraging people to maintain a healthy immunity by maintaining good nutrition, exercise and hygiene (Arifa, 2020; Gubernur DIY, 2020; Kemendikbud, 2020; Kepala Dinas Dikpora, 2020). Although all learning should be done using an online system, for vocational high school students practical learning cannot be conducted online but is still done with limited face-to-face meetings. Accordingly, students are http://issn.pdii.lipi.go.id/issn.cgi?daftar&1180428136&1&& http://issn.pdii.lipi.go.id/issn.cgi?daftar&1465346481&1&& https://e-journal.usd.ac.id/index.php/JFSK/index https://creativecommons.org/licenses/by/4.0/ https://doi.org/10.24071/jpsc.003736 Journal of Pharmaceutical Sciences and Community Preparation of a Questionnaire for Clean and Healthy Behavior... Research Article 79 Widiastuti et al. J. Pharm. Sci. Community, 2022, 19(2), 78-86 required to stay healthy by following health protocols and maintaining optimal body immunity. To ensure that practical learning can run well, students are required to obey all health protocols. Thus, all students need to be educated on clean and healthy living habits and the correct consumption of multivitamins. The preparation of facilities and infrastructure as well as various educational efforts for the community continues to be reinforced, including at the Pelita Bangsa Health Vocational School educational institution. Pelita Bangsa Health Vocational High School is a vocational high school with an A- accredited Clinical and Community Pharmacy Skills Competency Health Program with 94 students located on Jalan Tambak, Kav-No.24 Ngestiharjo, Sumberan, Tambi, Kec.Kasihan, Bantul, Special Region of Yogyakarta 55184. In the context of preventing COVID-19, schools have prepared hand washing facilities with soap, classroom disinfectant, seats are arranged at a distance of 1 meter, hand sanitizer is provided, and body temperature measurements are made daily. However, there are still students who do not take proper care of themselves and do not meet expectations in carrying out health protocols. The Selviana and Suwarni study (2018) showed that education through film media can increase students’ knowledge and attitudes about healthy living (Selviana and Suwarni, 2018). Similarly, Listyarini and Hindriyastuti (2017) stated that audio-visual media are very effective in improving clean and healthy living behavior in school-age children (Listyarini and Hindriyastuti, 2017). The increased knowledge will typically have a positive impact on a person's quality of life. The addition of information, education and counseling of one's knowledge about health and disease is increasing (Trinovitasari et al., 2020). However, practicing good health habits requires educational processes and cooperation, as well as support and related policies and also changes in knowledge, attitudes and behavior of all school members. Based on the existing arguments, the researchers made an instrument for measuring educational success using the Clean and Healthy Behavior Program (PHBS) and multivitamins questionnaire and multivitamins. This questionnaire was developed with the online media Google Form to obtain an overview of the knowledge, attitudes and behavior of SMK students towards efforts to prevent and transmit COVID-19. The questionnaire was made in three parts, including knowledge, attitude and behavior. The knowledge parts used the Guttman scale, while the attitude and behavior parts used a Likert scale. METHODS This study uses quantitative methods with survey techniques with approval from the Ethics Commission number 1272/C.16/FK/20221 issued by the Faculty of Medicine, Duta Wacana Christian University, Yogyakarta. The validity and reliability tests of the questionnaire were done from March 31 to April 02, 2021 at the Bantul Health Vocational School, Jalan Parangtritis Km 10.6, Neco, Sabdodadi, Kec. Bantul, Bantul, Special Region of Yogyakarta 55185; the institution has type A accreditation. The tools and materials used are in the form of a questionnaire instrument as many as five packages shared with experts for their judgement and an online questionnaire in the form of a Google Form link shared with students. The first stage was done by compiling a questionnaire referring to PHBS material for schools (Kemenkes RI, 2011), multivitamins (Badan POM, 2020a, 2020b, 2020c), minerals (Badan POM, 2020d, 2020e) and DAGUSIBU (Badan POM, 2015). The questionnaire consists of knowledge, attitudes and behavior, which consists of 40 statements of knowledge, 20 statements of attitude and 20 statements of behavior. The questionnaires that were compiled were then tested for validity and reliability. The validity tests included content validity tests by material experts in all parts of the questionnaire aimed at ensuring that all questions in the questionnaire covered the area or scope to be measured (Dewi, 2018; Yusup, 2018). Content validity was conducted by experts, namely a pharmacist and a lecturer at the Universitas Gajah Mada. The aim was to determine whether the questions in the questionnaire can be scientifically justified in their field. The next process was to test the validity and reliability so that the reliability and consistency of the instrument measured can be confirmed and it can be used as a research tool (Heale and Twycross, 2015). The research subjects in this study were students of Bantul Health Vocational School who had the same character as the respondents to be researched. The sample needed for the language comprehension test was 5 respondents and for the reliability test it was 30 respondents who are in classes X, XI and XII. The questionnaire was equipped with an agreement sheet referred to as the informed consent form which is on the main sheet as Research Article Journal of Pharmaceutical Sciences and Community Preparation of a Questionnaire for Clean and Healthy Behavior... 80 Widiastuti et al. J. Pharm. Sci. Community, 2022, 19(2), 78-86 evidence that someone is willing to become a respondent, next is the identity form of the respondents’ characteristics and the next sheet is a knowledge part consisting of 40 questions used to measure the level of individual knowledge by using the Guttman scale. The Attitude and behavior parts each with 20 statements used a Likert scale. Testing the validity and reliability of this research questionnaire used Cronbach's alpha analysis. If the results of Cronbach's alpha analysis show ≥ 0.60, it can be concluded that the variable can be said to be reliable or consistent in measuring a study (Dewi, 2018; Sugiyono, 2013). RESULTS AND DISCUSSION Test Questionnaire Content Validity From the results of content validation on the knowledge questionnaire, there are 40 statement items with two answer choices. The two answer choices consist of correct and incorrect answer choices. The next stage in the form of an attitude questionnaire consists of 20 statements with favorable and unfavorable statements. The behavioral questionnaire consists of 20 statements with answer choices: always (5), often (4), sometimes (3) rarely (2) and never (1). The results of the expert judgments are presented in Table 1. Table 1. Questionnaire Content Validity Test Results by Expert Judgment QUESTIONNAIRE Input by expert judgment Improvements made by researchers KNOWLEDGE A. Knowledge of PHBS 1. In questionnaire number 8 the addition of the word "necessary" Exercise schedule is arranged and carried out regularly Improvements to number 8 have been made. Exercise schedule needs to be arranged and done regularly 2 In questionnaire number 9 the addition of the word "necessary" Weighing is done every month. Improvements to number 9 have been made. Body weight can be used as one of the parameters for the development of our body's health. 3 On questionnaire number 12, this is not a statement of norms, but the result of observing facts in the field. Can't say right or wrong. The sentence is not appropriate if what is expected is an attitude/norm. Teachers and students do not smoke in school. Regarding the norm statement, improvements to number 12 have been made. Smoking can be detrimental to health. 4 At number 13, it is better to be consistent in using statement sentences, not commands Throw garbage in its place. Correcting grammar on number 13 already done. Disposing of waste in an improper place risk inviting unwanted diseases. 5 In number 15, this question is a bit ambiguous, because actually as long as the preservatives are safe and used in appropriate doses, then the food cannot be said to be unhealthy. Healthy food does not contain preservatives. Changes to the statement in number 15 have been made. Healthy food is food that contains nutrients that can make you feel full, healthy, and energized. 6 At number 16, this can also be confusing, because it depends on the rules in each school. For example, a child is used to bringing food supplies from home, meaning from outside the school, is this not allowed? All students are allowed to bring food and snacks from outside the school. Changes to statement number 16 have been made. Snacking carelessly can have a bad impact on health. Journal of Pharmaceutical Sciences and Community Preparation of a Questionnaire for Clean and Healthy Behavior... Research Article 81 Widiastuti et al. J. Pharm. Sci. Community, 2022, 19(2), 78-86 7 At number 17, the addition of the word "must" Routinely the bath and water reservoir are cleaned. Improvements to number 17 have been made. Regularly the tub and water reservoir must be cleaned. 8 At number 18 the addition of the word "may" The bathtub is left dirty and full of mosquito larvae Improvements to number 18 have been made. The bathtub may be left dirty and full of mosquito larvae. 9 In number 19, the sentence is incomplete, who can use it? meaning is not clear. Using the latrine to defecate at school. Changes to the statement in number 19 have been made. After urinating and defecating, the toilet is flushed clean. 10 At number 20 there needs to be an extension of BAK. The latrine at school is only for BAK. Improvements to number 20 have been made. Toilets at school are only for urinating. B. Knowledge of Multivitamins 11 In number 6 needs to be clarified, because vitamin D is actually synthesized by the body (a fat-soluble vitamin) which cannot be obtained directly from sunlight. Sunlight plays a role in providing UVB rays which become energy in the formation of vitamin D in the skin. Vitamin D is a vitamin that can be obtained from sunlight (ultraviolet) that hits the skin. Changes to the statement in number 6 have been made. Vitamin D is a nutrient that is beneficial for bone formation. Attitude 12 At number 6 the addition of the word "I" element If I see a place or tray filled with water, immediately empty the container so it doesn't become a mosquito nest Improvements to number 6 have been made. To prevent dengue fever, I will drain and seal water reservoirs tightly, burying used items that are no longer used. 13 On number 17 what is the difference with question number 15? I always consume fruits and vegetables as a natural multivitamin A change in attitude statement has been made. Eating fruits and vegetables can increase nutritional intake and facilitate defecation. Behavior 14 The questions and answers are out of sync. The “whether” question cannot be answered by agreeing or disagreeing. The answer to this “whether” question is yes or no. Or if you want to make a gradation, use the frequency: Always, often, sometimes, rarely, or never. Selection of respondents' answers: Strongly disagree (1) Disagree (2) Indecisive (3) Agree (4) Totally agree (5). Changes in the selection of respondents' answers have been made. Never (1) Rarely (2) Sometimes (3) Often (4) Always (5). Approved by validator 23 March 2021 Language Comprehension Test This language comprehension test was conducted at the Bantul Health Vocational School, with the following divisions: 2 respondents from class X, 2 respondents from class XI and 1 respondent from class XII. This test Research Article Journal of Pharmaceutical Sciences and Community Preparation of a Questionnaire for Clean and Healthy Behavior... 82 Widiastuti et al. J. Pharm. Sci. Community, 2022, 19(2), 78-86 was done on March 28, 2021 with a limited face- to-face system and a strict process. To minimize contact, the questionnaire was presented by viewing it on a projector screen and then reading the questionnaire statements one by one by the researcher. From the results of the test of understanding the language of the questionnaire, all of the questionnaire statements could be understood by all five respondents. Language comprehension test results presented in Table 2. Reliability test According to Notoatmodjo (2010) in the reliability test, the respondents included as many as 30 students who have the same characteristics as the respondents who will be examined. This test was done on April 1, 2021 by using face-to- face meetings via Zoom media. The questionnaire was distributed via the Google Form link. The explanation of working on the questionnaire was explained in detail through the media zoom then followed by completing the questionnaire via Google Form. After getting data from 30 respondents in filling out the Google Form, the results of the answers were made into tabular form so to facilitate the data processing analysis program. The data table that was made was analyzed using the Cronbach's alpha analysis program. Results of Knowledge Questionnaire Analysis Analysis of the results of the knowledge questionnaire with the Cronbach's Alpha program obtained the results: from 40 knowledge questions that were made as many as 15 items are declared invalid, where the results of the Alpha Coefficient of questions are said to be valid and reliable if r count is greater than or equal to 0.60. The results can be seen in Table 3. Result of Attitude Questionnaire Analysis Result of attitude questionnaire analysis presented in Table 4. Behavioral questionnaire test results Behavioral questionnaire test results presented in Table 5. Table 2. Language Comprehension Test Results No Variable No Statement Number of statements Description Positive Negative 1 Knowledge of PHBS and Multivitamins 23 questions 17 questions 40 questions Can be understood by students 2 Attitude 7 questions 13 questions 2 questions Can be understood by students 3 Behavior 20 questions 0 20 questions Can be understood by students Respondent’s signature 1 A.N. Q 2 U.U.S 3 A. N. I 4 N. S 5 S. M. A Table 3. Knowledge Questionnaire Analysis Results No Statements in the Knowledge Questionnaire Cronbach's Alpha score Valid / Invalid A. Clean and Healthy Living (PHBS) 1 PHBS is Clean and Healthy Life Behavior 0.998 Valid 2 The benefit of PHBS is that the environment becomes unclean and unhealthy 0.512 Invalid 3 All family members must carry out PHBS 0.572 Invalid 4 There are 6 PHBS indicators in the school setting 0.520 Invalid 5 Wash hands with soap and water to keep them free of germs 0.505 Invalid 6 Washing hands after defecating is not important 0.910 Valid 7 Exercise does not need to be done regularly 0.974 Valid 8 Exercise schedule needs to be regulated and carried out regularly 0.914 Valid 9 Weighing needs to be done every month 0.998 Valid 10 Unnecessary weight gain 0.563 Invalid 11 Smoking is allowed at school 0.568 Invalid Journal of Pharmaceutical Sciences and Community Preparation of a Questionnaire for Clean and Healthy Behavior... Research Article 83 Widiastuti et al. J. Pharm. Sci. Community, 2022, 19(2), 78-86 12 Teachers and students are prohibited from smoking in schools 0.521 Invalid 13 Disposing of garbage in an improper place risk inviting unwanted diseases 0.531 Invalid 14 Available trash cans are for decoration only 0.879 Valid 15 Healthy food is food that contains nutrients that can make you feel full, healthy, and energized 0.912 Valid 16 Snacks from outside do not have a bad impact on health 0.933 Valid 17 Regularly the bath and water reservoirs must be cleaned 0.974 Valid 18 The bathtub can be left dirty and full of mosquito larvae 0.910 Valid 19 After urinating and defecating the latrine is flushed clean 0.998 Valid 20 The latrine at school is only for urinating 0.973 Valid B. Multivitamins 1 Supplements are products to complete nutritional needs and to improve health functions, in the form of vitamins, minerals, and amino acids 0.998 Valid 2 Nutrient intake that is not obtained from food can be met only by drinking water 0.914 Valid 3 Multivitamins are not supplements 0.998 Valid 4 Multivitamin is a supplement that consists of vitamins and non- vitamins and non-minerals 0.534 Invalid 5 The benefits of taking multivitamins keep the body's immunity strong 0.931 Valid 6 Vitamin D is a nutrient that is not beneficial for bone formation 0.998 Valid 7 Multivitamins in children should be given according to the dosage listed on the leaflet. 0.515 Invalid 8 The expiration date of the multivitamin does not need to be listed. 0.934 Valid 9 Sources of multivitamins can be obtained from fruits and vegetables 0.933 Valid 10 Multivitamin storage can be anywhere. 0.971 Valid 11 Apart from seeds, citrus fruits are also a good source of Vitamin E. 0.973 Valid 12 Marine animals such as oysters contain a lot of the mineral’s selenium and zinc 0.574 Invalid 13 Vitamin C is also known as ascorbic acid. 0.998 Valid 14 The dose of vitamin C for the body in daily activities is enough 90 mg / day 0.972 Valid 15 The dose of multivitamins for children and adults is the same 0,998 Valid 16 So that the drugs used are not damaged, it is necessary to store them properly according to what is listed on the package. 0.575 Invalid 17 Multivitamins that are damaged and expired can be consumed. 0.534 Invalid 18 Expired drugs should not be disposed of carelessly so as not to be misused by others 0.974 Valid 19 The most secure place to buy medicine is the drugstore and Pharmacy Installation at the hospital. 0.532 Invalid 20 Make sure the drug is used correctly according to the label listed or according to the instructions of the doctor and pharmacist 0.542 Invalid Of the 40 knowledge questionnaire statements made by the researcher, 15 statements were declared invalid with a Cronbach's Alpha value of less than or equal to 0.539 < 0.60. Table 4. Results of Attitude Questionnaire Analysis No A. Clean and Healthy Lifestyle (PHBS) Cronbach's Alpha score Valid / Invalid 1 Before eating I have to wash my hands first with running water and soap. 0.796 Valid 2 After defecating and urinating, it is not necessary to wash hands with clean water and soap. 0.783 Valid 3 I let the garbage pile up because it doesn't cause disease. 0.763 Valid 4 I always throw trash in its place. 0.793 Valid 5 I always exercise every day to keep my body healthy. 0.783 Valid 6 To prevent dengue fever, I will drain and seal water reservoirs tightly, burying used items that are no longer used. 0.780 Valid 7 I never flush with water after urinating in the toilet. 0.762 Valid Research Article Journal of Pharmaceutical Sciences and Community Preparation of a Questionnaire for Clean and Healthy Behavior... 84 Widiastuti et al. J. Pharm. Sci. Community, 2022, 19(2), 78-86 8 I do not smoke because it harms myself and also those around me. 0.777 Valid 9 To maintain my health, I always eat snacks without paying attention to the cleanliness of the food. 0.780 Valid 10 I bought a multivitamin at the drugstore. 0.788 Valid 11 I keep multivitamins in the fridge. 0.796 Valid 12 Before taking multivitamins, I always check the label for the rules for drinking and the expiration date. 0.792 Valid 13 I always dispose of multivitamins that are damaged and expired by destroying them first and throwing them in the trash 0.789 Valid 14 I don't care about the rules for taking the medicine listed in the leaflet 0.774 Valid 15 I always eat vegetables and fruit every day 0.784 Valid 16 To meet the needs of vitamin E, I consume avocado 0.788 Valid 17 Eating fruits and vegetables can increase nutritional intake and facilitate defecation 0.789 Valid 18 I will sunbathe every morning to get Vitamin D for the body 0.796 Valid 19 I consume marine fish to meet the needs of the mineral’s selenium and zinc 0.789 Valid 20 My vitamin C needs are met by drinking water 0.796 Valid Of the 20 attitude questionnaire statements made by the researcher, all items were valid with a Cronbach's Alpha value of all values around 0.794 >0.60 and all questions were declared reliable. Table 5. Behavioral Questionnaire Analysis Results No A. Clean and Healthy Lifestyle (PHBS) Cronbach's Alpha score Valid / Invalid 1 Do you wash your hands before eating with running water and soap? 0.795 Valid 2 Do you wash your hands with running water and soap after defecating? 0.801 Valid 3 I always eat healthy snacks in the school canteen 0.772 Valid 4 Every day I always bring lunch from home. 0.789 Valid 5 Do you always eat vegetables and fruit every day? 0.792 Valid 6 Do you always throw trash in its place? 0.795 Valid 7 Do you use the school toilet to defecate and urinate? 0.761 Valid 8 Do you flush the toilet with clean water after using it? 0.806 Valid 9 I always follow clean Friday as a form of clean culture in the school environment. 0.762 Valid 10 Every week I always follow the picket schedule to clean the class 0.778 Valid 11 Do you choose not to smoke, because it is not good for health? 0.803 Valid 12 Do you buy multivitamins at the pharmacy? 0.813 Valid 13 Do you store multivitamins at room temperature? 0.770 Valid 14 Do you always read the rules for taking medication before taking it? 0.794 Valid 15 Do you always sunbathe in the morning to get vitamin D? 0.792 Valid 16 Do you always check the expiration label before taking your multivitamin? 0.801 Valid 17 Do you always destroy damaged and expired multivitamins before throwing them in the trash? 0.763 Valid 18 I eat tempeh to meet the needs of vitamin E in the body 0.768 Valid 19 I always consume fruits and vegetables as a source of natural multivitamins 0.778 Valid 20 To increase endurance during the COVID-19 pandemic, apart from exercising, I also drink vitamin C 0.777 Valid Of the 20 behavioral questionnaire statements made by the researcher, all items were valid with a Cronbach's Alpha value around the value of 0.806 > 0.60 and all questions were declared valid and reliable. The validity and reliability process were conducted at the Bantul Health Vocational School. Of the 40 questions of knowledge, there were 15 questions that were not considered valid, for attitude 20 questions and behavior 20 Journal of Pharmaceutical Sciences and Community Preparation of a Questionnaire for Clean and Healthy Behavior... Research Article 85 Widiastuti et al. J. Pharm. Sci. Community, 2022, 19(2), 78-86 questions. The number of questions declared valid and reliable is 65 questions. Questionnaire on PHBS knowledge explores students’ understanding of clean and healthy living behavior. PHBS statements include washing hands with soap before and after eating and after urinating and defecating, consuming healthy snacks (always bring lunch from home), using clean and healthy latrines, exercising regularly, eradicating mosquito larvae, not smoke in the school environment, and dispose of garbage in its place (Julianti and Nasirun, 2018). The statements above are important especially for exploring students’ knowledge in maintaining a healthy lifestyle in daily life in an effort to create a healthy school environment, in order to improve the quality of the teaching and learning process between students, teachers and all school communities and families during the COVID-19 pandemic (Karo, 2012) Another questionnaire about knowledge of multivitamins followed this PHBS questionnaire which explores students’ knowledge about how to get, use, store and dispose of multivitamins (Badan POM, 2017). By having this knowledge, students can use and consume multivitamins wisely, so that during face-to-face learning practices at school, students have a good immune system, and they can take part in learning smoothly and are not susceptible to disease. The attitude part in the PHBS and multivitamins questionnaire explores the level of students’ confidence in taking actions or behaviors that will affect healthy lifestyles and use of multivitamins in students in their daily lives with negative or positive statements (Kasnodihardjo, 1993). In this way, the students can determine their attitudes in the application of a healthy lifestyle and the use of multivitamins at school, thus students have a positive mentality in participating in the face-to-face learning process at school in the COVID-19 pandemic situation. Behavioral questionnaires about PHBS and multivitamins explore students’ behavior or actions in implementing PHBS and the use of multivitamins in daily life so that the learning process at school can still continue in this COVID- 19 pandemic condition and the students are able to remain active in learning, by being healthy with clean and healthy living behavior and able to increase body resistance by consuming multivitamins wisely (Colunga Biancatelli et al., 2020). The results of the language comprehension test with the five respondents from Bantul Health Vocational School students in Table 2 showed that all students understood the statements in the PHBS and multivitamin questionnaires with one trial test. The language comprehension test was conducted to determine whether the respondents who would be used as research subjects experienced any difficulties in understanding the questions being asked on the Google Form (Kasnodihardjo, 1993). As a result, the PHBS and Multivitamins questionnaire could be continued for validity and reliability testing using 30 student respondents from Bantul Health Vocational School. This questionnaire instrument can be accessed at the following link: https://forms.gle/Yp87T9G371a6ebDg9. In the reliability test of the knowledge, attitudes and behavior parts of the PHBS and multivitamin questionnaire, most of the Cronbach's alpha values were around the values of 0.958; 0.794; and 0.806 (>0.60), which indicate that the three questionnaires that have been tested are stated to be reliable and consistent and can be used as a measuring tool in do research. With a valid and reliable questionnaire, the instrument can be used repeatedly with similar and reliable results so that it can provide consistent results in research at the future (Heryanto et al., 2019). Furthermore, this valid and reliable questionnaire can be used as a research tool in the process of assessing knowledge, attitudes and behavior in students at Pelita Bangsa Health Vocational School. CONCLUSIONS The Clean and Healthy Living Behavior (PHBS) and Multivitamins questionnaire has been declared valid and reliable and can be used to measure knowledge, attitudes and behavior of students in Health vocational high schools as disease prevention efforts during the COVID-19 pandemic. ACKNOWLEDGEMENTS The researchers would like to thank the Bantul Health Vocational School students who were willing to be respondents, as well as thanks to the main supervisor and assistants who provided input, criticism and suggestions in writing this research article. Thanks also to the Faculty of Pharmacy, Sanata Dharma University, Yogyakarta and the Faculty of Pharmacy, University Gadjah Mada, Yogyakarta. REFERENCES Arifa, F.N., 2020. 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