http://e-journal.unair.ac.id/JNERS | 563 Jurnal Ners Vol. 15, No. 2, Special Issue 2020 http://dx.doi.org/10.20473/jn.v15i2.20544 This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 International License Original Research Health Promotion Strategies in Integrated Healthcare Program Park of Public Health Center Kurniawan Edi Priyanto, Sutrisno Sutrisno, and Mohammad As'ad Effendy Institut Ilmu Kesehatan STRADA Indonesia, Kediri, East Java, Indonesia. ABSTRACT Introduction: One form of community empowerment effort in the field of health is to develop an Integrated Healthcare Program. Integrated Healthcare Program Park in East Java quantitatively until the year 2014 has exceeded as many as 12,227 or an increase of 22.27% from the declaration of movement activities of 10,000 starting from 2012. However, qualitatively in that year there were only 23% in the optimal category. To optimize function of Integrated Healthcare Program Park it is necessary to have a Companion Officer in the monitoring and assisting cadres. This study is to know the implementation of health promotion strategy in Integrated Healthcare Program Park at Public Health Center Methods: Data were collected by in-depth interviews. Implementation of empowerment activities found the training of companion officers and cadres are uneven. Results: Activity of developing the social support found the existence of problems because of the absence of early child development cadres and insufficient means of educational game tools. Advocacy activities conducted policy proposals on the establishment of early child development cadres. Conclusion: Partnership activities have created a good coordination between companion officers with the stakeholders, but there are problems in the mechanism of distributing incentives for companion officers and cadres. ARTICLE HISTORY Received: Feb 27, 2020 Accepted: April 1, 2020 KEYWORDS companion officer; health promotion strategies; integrated healthcare program park CONTACT Kurniawan Edi Priyanto  kedipriyanto@gmail.com  Institut Ilmu Kesehatan STRADA Indonesia, Kediri, East Java, Indonesia. Cite this as: Priyanto, K. E., Sutrisno, S., & Effendy, M. A. (2020). Health Promotion Strategies in Integrated Healthcare Program Park of Public Health Center. Jurnal Ners, Special Issues, 563-568. doi:http://dx.doi.org/10.20473/jn.v15i2.20544 INTRODUCTION Health is a human right as well as an investment, so it needs to be strived for and enhanced by every individual and by all components of the nation, so that people can enjoy healthy life and, ultimately, can realize the optimal health status of society. Integrated Healthcare Program is a strategic step in the development of the human resources quality of the nation of Indonesia in order to build and help itself; therefore, it needs to be enhanced coaching (Ismawati, 2008). In March 2012, East Java Provincial Government launched 10,000 Integrated Healthcare Program Parks in each village. Quantitatively, Integrated Healthcare Program Parks in East Java had, up to 2014, exceeded as many as 12,227 or an increase of 22.27% from the declaration of movement activities in 10,000 Integrated Healthcare Program Parks starting from 2012. However, qualitatively in that year only 23% were in the optimal category, while, in 2015, this reached 40% where the programs and policies implemented were more focused on improving the quality of services in Integrated Healthcare Program Park (Faiq, 2017). To optimize the function of Integrated Healthcare Program Park, it is necessary to assist the cadres to evaluate and develop the Park. Through this facilitation officer, it is expected that Integrated Healthcare Program Park will provide better integrated services. The purpose of this research was to know Implementation of Health Promotion Strategy in Integrated Healthcare Program Park at Public Health Center. The focus of https://creativecommons.org/licenses/by/4.0/ https://creativecommons.org/licenses/by/4.0/ http://dx.doi.org/10.20473/jn.v15i2. K. E. PRIYANTO ET AL. 564 | pISSN: 1858-3598  eISSN: 2502-5791 this research was to know the implementation of empowerment activities, the activity of developing the atmosphere, the advocacy activities and the partnership activities in Integrated Healthcare Program Park at Public Health Center. MATERIALS AND METHODS The type of this research is phenomenological study with qualitative approach with the focus of research directed to know the implementation or implementation of health promotion strategy in Integrated Healthcare Program Park at Public Health Center. The research location is one of the working areas of a Public Health Center and research was conducted in September 2017. Sampling technique in this study used purposive sampling. The inclusion criteria of this research were companion officers of an Integrated Healthcare Program Park at a Public Health Center who were willing to be an informant. The informants in this research are Integrated Healthcare Program Park companion officers at a Public Health Center who have been willing to undertake an in-depth interview, totaling four people. RESULTS From the results of research conducted with purposive sampling techniques four informants were obtained. Informants aged 21-40 years were as many as two informants and aged 41-60 years as many as two informants. All informants are female. Most informants have a high school education, as many as three informants and educated junior high school is one informant. All informants’ job status is non- government employees. Based on the results of the research, it is known that the implementation of health promotion strategy in Integrated Healthcare Program Park at Public Health Center as related to the empowerment activity still running maximally because of the giving of education or training to the Integrated Service Post Park Facilitation Officer and uneven cadre and absence of special means for promotion or socialization of Integrated Healthcare Program Park to the community. Based on the result of the research, it is known that the implementation of health promotion strategy in Integrated Healthcare Program Park at Public Health Center is related to developing the atmosphere and there are obstacles in the process of Integrated Healthcare Program Park activity due to the absence of Early Childhood Education Program cadres in every Integrated Service Post Park so that the role is replaced by Early Childhood Education Program teachers or Integrated Service Post Park escort officers, and there is inadequate means of educational game tools used in the activities of Integrated Healthcare Program Park. There were some minor conflicts between of Integrated Healthcare Program Park officers and the cadres, namely the problem of delay in the presence of cadres or Early Childhood Education Programtutors and the problems of usage or monitoring of educational game tools among the cadres. Based on the result of the research, it is known that in the implementation of health promotion strategy in Integrated Healthcare Program Park at Public Health Center related to advocacy activities and there is potential support and direction toward ideas or suggestions from Integrated Healthcare Program companion officers to the program holder of Integrated Healthcare Program Park in Public Health Center and local government. There is a need for policies to add infrastructure facilities for Integrated Healthcare Program Park activities such as educational game tools and Integrated Healthcare Program equipment, the establishment of Early Childhood Education Program cadres and the need for policies for the addition of cadres so that no double job or duplicate tasks are carried out by the companion officers . Based on the result of the research, it is known that in the implementation of health promotion strategy in Integrated Healthcare Program Park at Public Health Center is related to the partnership activity in that the implementation of coordination goes well between Integrated Healthcare Program Park companion officers with Integrated Healthcare Program Park holders at Public Health Center, City Health Office, Local Technical Implementation Unit of National Education and Family Planning Counseling. Direct communication methods are conducted with community leaders, involving important figures in the community to establish good cooperation, but there is no communicating or involving of NGOs or mass media in the activities of Integrated Healthcare Program Park. There are problems related to the distribution mechanism of incentives for the companion officers of Integrated Healthcare Program Park and cadres. DISCUSSION In this research, the researcher obtained a description related to the implementation of health promotion strategy in Integrated Healthcare Program Park by the companion officers at Public Health Center. From this research, there are four themes: 1) implementation of empowerment activities, 2) implementation of social support activities, 3) implementation of advocacy activities, and 4) implementation of partnership activities. Implementation of empowerment activities in integrated healthcare program park at public health center The concept of empowerment emphasizes that people acquire the skills, knowledge and sufficient power to influence their lives and the lives of others concerned (Putra, 2016). The results of research on empowerment activities found that there was already implemented education or training to the companion officers of Integrated Healthcare Programs, Integrated Healthcare Program Cadres, Early Childhood Education ProgramCadre and Family and Toddler Coaching Cadres, but not evenly given all the JURNAL NERS http://e-journal.unair.ac.id/JNERS | 565 opportunities. Education or training is very important for Integrated Healthcare Program Park companion officers and Integrated Healthcare Program Cadres, Early Childhood Education Programp Cadres and Family and Toddler Coaching Cadres to improve their knowledge and skills in providing services in accordance with their duties and to increase the knowledge and ability to mobilize and empower the community. The results of research on empowerment activities on the implementation of monitoring of Integrated Healthcare Program Park companion officers on the performance of Integrated Healthcare Program, Early Childhood Education Program and Family and toddler Coaching Cadres found that the implementation of the monitoring went well, including attendance observation, recording and documentation and evaluation discussion. Monitoring the performance of cadres is part of the evaluation process to monitor their shortcomings or inability in the implementation of their duties so that they can be followed up as soon as possible with efforts to provide knowledge and increased empowerment to the cadres. Effective communication will lead to the active participation of community members in community development(UNICEF, 2015). The results of research on the implementation of activities to mobilize the community to increase the motivation and the active role of the community in following the activities of Integrated Healthcare Program Park shows that the community mobilization activities conducted by Integrated Healthcare Program companion officers include the delivery of Integrated Healthcare Program activities schedule, socializing in community activities and communicating directly about Integrated Healthcare Program Park activities of. Effective communication with delivery methods that are easily accepted and understood by the community will help increase the motivation of the community to take an active role in supporting the activities of Integrated Healthcare Program Park. The findings of research on the implementation of empowerment activities indicate promotion activities or socialization of Integrated Healthcare Program Park to the community do not use media or facilities. Various means or media need to be used in promoting activities and socialization of Integrated Healthcare Program Park to facilitate the delivery of the purpose and objectives to the community(Sulistyani, 2004). Implementation of Social Support Activities in Integrated Healthcare Program Park at Public Health Center Factors that influence social support should meet physical, social and psychological needs. Establishing an atmosphere in service activities is an effort to create good coordination and effective communication in order to achieve success according to mutually desired goals (Alamsyah & Muliawati, 2013). The findings of the research on the implementation of the activity of developing the atmosphere show that the coordination includes making a schedule of activities, the division of tasks among cadres, recording activities, and that there are constraints in the Early Childhood Education Program because of the lack of designated cadres. In addition to performing the task of being Integrated Healthcare Program companion officers they also double as Integrated Healthcare Program cadres and Family and Toddler Coaching Cadres. The availability of sufficient cadre personnel in accordance with the duties and roles of each cadre will greatly support the smoothness in coordination and service delivery in Integrated Healthcare Program Park activities. Social support is support or assistance that comes from others, such as neighbors, co-workers and others (Julita, 2013). The findings of research on the implementation of community development activities indicate that the communication approach to the community is done directly when there is activity of an Integrated Healthcare Program Park and also there meeting activity in the community in the form of regular social gatherings and Neighborhood Association or Citizens Association meetings. Support and active role of the community is an important element that can determine the success rate of the objectives of a sustainable Integrated Healthcare Program Park activity to provide services to the community. Cultivating an atmosphere is creating a conducive situation to promote the behavior of a clean and healthy life. Clean and healthy life behavior can be created and developed if the environment supports (Efendi & Makhfudli, 2009). The findings of the research on the implementation of the activity of building the atmosphere found that the facilities or methods used in the activities of an Integrated Healthcare Program Park to create a comfortable and conducive environment for the cadres and the community are educational game tools, posters, flipcharts, stage puppets and good sanitation. Educational game tool facilities are insufficient or insufficient in Integrated Healthcare Program Park activities. The method used is to communicate directly with the community at the time of Integrated Healthcare Program Park activities. Such activities will run smoothly and create a comfortable and conducive environment if supported by adequate infrastructure facilities. Social support is an emotional, informational or advisory source provided by people around the individual to deal with everyday problems and crises in life (HSE, 2011). The findings of the research on the implementation of the activity of building an atmosphere found that there is no conflict or major problem either between cadres or with society. Small problems arise when there are cadres who are late in the meeting and the problem of returning educational game tool loans between cadres in the Integrated Healthcare Program service activities. Alternative problem solving is done by communication between cadres and reminding each other. Conflicts or K. E. PRIYANTO ET AL. 566 | pISSN: 1858-3598  eISSN: 2502-5791 problems potentially happen in every relationship or interaction between individuals and groups. Resolving conflicts early and in the right way will be able to minimize conflict that was previously small or light so that it does not become a major conflict. Self- awareness and discipline need to be applied to individual escort personnel and cadres so as not to disrupt the process of task and performance in service activities and so as not to trigger conflict (Iskandar, 2016). Implementation of advocacy (advocacy) activities in integrated healthcare program park at public health centre Advocacy is an attempt to influence public policy, through various forms of persuasive communication. In other words, advocacy is an effort or process to gain commitment, conducted persuasively by using accurate and precise information (Notoatmodjo, 2010). The findings of the research indicated that, in the advocacy work, it was found that the policies of both the Integrated Healthcare Program Park holders in the Public Health Center and the local government supported the performance of the companion officers and cadres of Integrated Healthcare Program, but needed to be re-examined about the policy for the addition of infrastructure for the Integrated Healthcare Program activities and the establishment of Early Childhood Educational Programs Cadres. Strategic policies of stakeholders are needed to improve the shortcomings or constraints in operational activities of Integrated Healthcare Program Park in order to improve the quality of their service to the community. The findings of research on advocacy activities obtained information that there are no policies that hamper or reduce the performance of Companion Officers of Integrated Healthcare Program Park and Cadres, either from the Integrated Healthcare Program Park holders in a Public Health Center and local government. Advocacy is a leadership approach with the aim to develop sound public policy (Efendi & Makhfudli, 2009). The findings of the research on the advocacy activities of the feedback from the Integrated Healthcare Program Park holders in a Public Health Center and local government, on opinions in the form of criticism or suggestions from the Companion Officers of Integrated Healthcare Program Park and the Cadres as well as from the community regarding the established policies found that there is good response from the Integrated Healthcare Program Park holders in Public Health Center and local government to suggestions or suggestions from Companion Officers of Integrated Healthcare Program Park and Cadres. Advocacy is a strategic or planned effort or process to get commitment and support from stakeholders (Dewi & Kiranasari, 2013). Advocacy is directed toward generating support that is a policy (e.g. in the form of legislation), funds, means and others like. Stakeholders in question can be formal community leaders who generally play a role as government policy makers and government funders. It can also be informal community leaders such as religious leaders, traditional leaders and others who can generally act as policy makers (not written) in their field (Kholid, 2015). The findings of the research on advocacy activities showed that there was potential support and direction when there were ideas or suggestions from Integrated Healthcare Program Park companion officers to the Integrated Healthcare Program Park holders in Public Health Center and local government. The policies of the program makers are the key to the implementation of an activity. There is need for reviews by organizers and implementers in the field to conduct monitoring and evaluation to find the inequality that occurs in an activity that raises the potential to provide a proposed policy revision or create a new policy better to improve the positive outcomes which are the main objective of the activity (Machfoedz & Suryani, 2009). Implementation of partnership activities in integrated healthcare program park at public health center A partnership viewed from an etymological perspective is adapted and rooted from the word partner. Partners can be translated as spouse, soul mate, ally, companion, while partnership is translated as fellowship. Partnership in essence is known as cooperation from various parties, either individually or in groups. Partnership is really a necessity for parties with a common orientation who want to save energy and generate multiple benefits(Yusuf, Syafar, & Bahar, 2010). The result of the research shows that the partnership activity in coordinating with Integrated Healthcare Program Cadres, Early Childhood Educational Program Cadres and Family and Toddler Coaching Cadres in terms of activities and follow up activities of Integrated Healthcare Program Park is found to be done during Integrated Healthcare Program Park activities, by conducting a meeting or discussion to evaluate the program activities and make planning for the next activity. Beyond the park activities, coordination is done by using the communication to create a group on WhatsApp social media among the Cadres. Coordination is one of the vital parts in an effort to create a solid partnership relationship. Coordination is important to know the achievements and evaluate the constraints to each other so that it can make improvements to realize success in the direction and common goals. The results showed that the partnership activities in coordination with the program holders of Integrated Healthcare Program Park in Public Health Center, City Health Office, Local Technical Implementation Unit of National Education and Family Planning Counseling in terms of activities and follow up activities of Integrated Healthcare Program Park all went well. Coordination is done at the time of reporting Integrated Healthcare Program Park activity to City JURNAL NERS http://e-journal.unair.ac.id/JNERS | 567 Health Office once every three months and for reporting to Public Health Center once a year and reporting to Family Planning Counseling once a month while scheduling Childhood Educational Programs Cadres in Integrated Healthcare Program Park activity coordinates with Local Technical Implementation Unit of National Education. To build a partnership, it must be based on the following things: common interest or interests, mutual trust and mutual respect, clear and measurable goals and willingness to sacrifice both time, energy and other resources (Putra, 2016). Partnership is a process of interaction of two or more parties that is realized in the form of cooperation. Participating parties include various sectors, such as community groups, government agencies and non-governmental organizations. Some of these parties work together to achieve common goals based on their agreement, principles, and roles . The findings of research on the partnership activities related to the means or methods used by the Companion Officers of Integrated Healthcare Program Park to maintain good cooperation with the community, community leaders, religious leaders, NGOs, mass media and others found that, to establish good cooperation, direct communication methods with community leaders and involving important figures in the community in the activities of Integrated Healthcare Program Park is necessary. During this time, there was no communication or involvement of NGOs or mass media in the Integrated Healthcare Program activities. Partnership is a formal cooperation between individuals, groups or organizations to achieve a certain task or goal (Rezeki, Mulyadi, & Nopriadi, 2013). Meanwhile, the promotion of online health suggests that partnership is a relationship (cooperation) between two or more parties, based on equality, openness and mutual benefit (Dewi & Kiranasari, 2013). The findings of research on partnership activities related to facilities, facilities or awards given to the Companion Officers of Integrated Healthcare Program Park and Cadres by the Integrated Healthcare Program Park holders in Public Health Center and local government in order to develop and improve the Integrated Healthcare Program Park services found that the facilities obtained are monthly incentives as escort officers and cadres, uniform facilities special activities, and incidental transport money when there is an invitation meeting. The obstacles are incentives that are not routinely received every once a month, but given every six months. Partnership principles, which refer to partnerships based on equality, openness and mutual benefit, should be applied in a goal-oriented relationship. The awarding or reward that is in accordance with the achievement of the duty and the mechanism of granting the rights that must be obtained according to the rules and mutual agreement will support the smoothness in the process of activities carried out by each other. CONCLUSION Based on the results of the research, it is known that the implementation of health promotion strategy in Integrated Healthcare Program at Public Health Center, which is related to the empowerment activity still running, is not maximal because the giving of education or training to the Integrated Healthcare Program companion officers and cadres is uneven and there is an absence of special means for promotion or socialization of Integrated Healthcare Program Park to the community. In the activity of developing the atmosphere there are constraints because there are no Early Child Development Services Cadres in every Integrated Healthcare Program Park so that the role is replaced by Early Childhood Educational Program teachers or Integrated Healthcare Program companion officers and inadequate educational game tool facilities are used in the activities of Integrated Healthcare Program Park. There were some minor conflicts between the Integrated Healthcare Program Park companion officers and the cadres, namely the problem of delay in the presence of cadres or Early Childhood Educational Program tutors and the problems of usage or monitoring of educational game tools among the cadres. In the implementation of advocacy activities, there is potential for support and direction to the ideas or suggestions from the officers of Integrated Healthcare Program Park holders in Public Health Center and local government. There is a need for policies to add infrastructure facilities for Integrated Healthcare Program Park activities, such as educational game tools and Integrated Healthcare Program equipment, the establishment of Early Childhood Educational Program Cadres and the need for policies for the addition of cadres so that no double job or duplicate tasks are carried out by Companion Officers of Integrated Healthcare Program Park. However, the partnership activity of coordination implementation went well between Integrated Healthcare Program companion officers and Integrated Healthcare Program Park holder in Public Health Center, City Health Office, Local Technical Implementation Unit of National Education and Family Planning Counseling. It was found that direct communication methods with community leaders and involving important figures in the community to establish good cooperation were conducted but never communicating or involving NGOs or mass media in activities of Integrated Healthcare Program Park. There are problems related to the distribution mechanism of incentives for the Integrated Healthcare Program Park companion officers and cadres. CONFLICT OF INTEREST The authors declare that there is no conflict of interest. K. E. PRIYANTO ET AL. 568 | pISSN: 1858-3598  eISSN: 2502-5791 REFERENCES Alamsyah, D., & Muliawati, R. (2013). Pilar dasar Ilmu Kesehatan Masyarakat. Yogyakarta: Nuha Medika. Dewi, P., & Kiranasari, N. H. (2013). Buku Saku Tugas Pendamping Di Taman Posyandu. Jakarta: Salemba Medika. Efendi, F., & Makhfudli. (2009). Keperawatan Kesehatan Komunitas. Teori dan Praktik dalam Keperawatan. Jakarta: Salemba Medika. Faiq, N. (2017). Gerakan 10.000 Taman Posyandu Melebihi Target. HSE. (2011). The Health Promotion Strategic Frame Work. Ireland: Health Service Executive National Health Promotion Office. Iskandar, M. N. (2016). Pelaksanaan Strategi Promosi Kesehatan dalam Program Perilaku Hidup Bersih dan Sehat (PHBS) Tatanan Rumah Tangga di Puskesmas Puuwatu Kota Kendari Tahun 2015. Universitas Halu Oleo. Ismawati, C. (2008). Posyandu dan Desa Siaga. Panduan untuk Bidan dan Kader. Yogyakarta: Nuha Medika. Julita, D. (2013). “Taman Posyandu Jatim, Gerakan PAUD Berpihak Masyarakat Miskin,” Direktorat Jenderal Pendidikan Anak Usia Dini dan Pendidikan Masyarakat,. Kholid, A. (2015). Promosi Kesehatan. Dengan Pendekatan Teori Perilaku, Media, Dan Aplikasinya. Untuk Mahasiswa Dan Praktisi Kesehatan. Jakarta: Raja Grafindo Persada. Machfoedz, & Suryani. (2009). Pendidikan Kesehatan Bagian dari Promosi Kesehatan. Yogyakarta: Fitramaya. Notoatmodjo, S. (2010). Promosi Kesehatan. Teori dan Aplikasinya. Jakarta: Rineka Cipta. Putra, F. Y. (2016). Strategi Promosi Kesehatan Dinas Kesehatan Kabupaten Kutai Kartanegara Tentang Pemahaman Perilaku Hidup Bersih dan Sehat (PHBS) di Puskesmas Mangkurawang. EJurnal Ilmu Komun., 4(1), 74–87. Rezeki, S., Mulyadi, A., & Nopriadi. (2013). Strategi Promosi Kesehatan Terhadap Peningkatan Perilaku Hidup Bersih dan Sehat Individu Pada Masyarakat Perkebunan di Wilayah Puskesmas Seikijang Kab. Pelalawan. Jurnal Imu Lingkung, 7(1). Sulistyani, A. T. (2004). Kemitraan dan Model-Model Pemberdayaan. Yogyakarta: Gaya Medika. UNICEF. (2015). Unicef’s Strategy for Health (2016- 2030). UNICEF Programme Division. Yusuf, Y., Syafar, M., & Bahar, B. (2010). Analisis Strategi Promosi Kesehatan di Puskesmas Bambalamotu dalam Pembinaan Masysrakat Suku Da’a di Desa Kasolong Kab. Mamuju Utara. J. MKMI, 6(3), 141–145.