18 JNK JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk Clean and Healthy Living Behavior in The Effort to Break the Chain of Transmission of The Covid 19 Dwi Priyantini1, Setiadi2, Dedi Irawandi3 1,2,3Nursing Department, STIKes Hang Tuah Surabaya, Indonesia Article Information Abstract The implementation of disease prevention behavior is influenced by the level of health literacy, which consists of several aspects including information, knowledge, understanding, and decision making. Health information is an important source related to the COVID-19 pandemic, both up-to-date information, prevention of exposure, what to do during isolation, and how to communicate with COVID-19 task force officers. The purpose of this study was to determine the correlation between health literacy and a clean, healthy lifestyle among STIKes Hang Tuah Surabaya students to break the chain. The research design used analytic observation with a cross-sectional approach. Data collection was obtained by participants filling out a questionnaire. Data analysis used the Spearman Rho correlation test with a P- value of 0.05. The results of the study showed that most of the students' health literacy was in the adequate category, and the students' clean and healthy living behaviors were in the high category. The results of the health literacy analysis was related to clean and Healthy Living Behaviors to break the chain of transmission of the COVID-19 pandemic in STIKes Hang Tuah Surabaya students. The research implication is that adequate health literacy will improve students' abilities regarding clean and healthy behavior (PHBS) to break the chain of transmission of the COVID-19 pandemic in STIKes Hang Tuah Surabaya students. History Article: Received, 28/06/2022 Accepted, 21/03/2023 Published, 30/04/2023 Keywords: health literacy, clean and healthy lifestyle (PHBS), covid-19 © 2023 Journal of Ners and Midwifery Correspondence Address: STIKes Hang Tuah Surabaya - East Java, Indonesia P-ISSN : 2355-052X Email : dwipriyantini22@gmail.com E-ISSN : 2548-3811 DOI: https://doi.org/10.26699/jnk.v10i1.ART.p018-024 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) http://jnk.phb.ac.id/index.php/jnk mailto:dwipriyantini22@gmail.com https://doi.org/10.26699/jnk.v10i1.ART.p010-017 Priyantini, Setiadi, Irawandi, Early Mobilization Affected the Daily Living Activity based on … 19 INTRODUCTION The COVID-19 pandemic is still infecting the country of Indonesia with a chain of spread that is so fast. Transmission of the spread of the Corona virus can occur through the air by spreading through droplets, contaminated surfaces, and fecal- oral or human waste (Alam 2020). One of the various efforts to break the chain of transmission of the Corona virus is by implementing a Clean and Healthy Lifestyle (Makruf & Farhan, 2021). There is an "infodemic" associated with the COVID-19 pandemic, where valid and invalid information is so abundant that the ability to access, understand, assess, and apply health information, makes it essential to navigate the COVID-19 information environment (I Komang Agus Widiantara, 2020). Literacy during the COVID-19 pandemic was widely circulated through various media ranging from learning and teaching activities in the world of education, television, cellphones, books, magazines, and also posters installed in various places that can provide health information such as understanding about COVID- 19, prevention of virus transmission, information on the curve of increasing deaths, and recovering from COVID-19 in Indonesia (Sutisna, 2020). There are 548 regular nursing students at STIKes Hang Tuah Surabaya, starting from D3 nursing and undergraduate nursing study programs (data from BAAK STIKes Hang Tuah Surabaya). Based on interviews with 20 students of the STIKes nursing study program, Hang Tuah Surabaya stated that they are fully implemented clean and healthy lifestyle behavior during the COVID-19 pandemic. For example, still, often hang out / get together with friends without maintaining a safe distance, do less exercise, play cell phones more often or spend more time playing social media, and often sleep late at night which will reduce endurance. This data shows that there is still a lack of implementation of a clean and healthy lifestyle (PHBS) to break the chain of transmission for STIKes Hang Tuah Surabaya students during the COVID-19 pandemic. Changing a person's behavior can be done with health literacy so health literacy is an important variable to empower health in individuals in particular and society in general. Health literacy has been recognized as one of the factors of health variables and has become one of the goals of public health development (Rohman & Nurhayati, 2021). Health literacy is a very important thing for every individual to have, especially during the current COVID-19 pandemic, supported by the Indonesian government's efforts to improve health literacy among the community, including efforts to improve health, disease prevention, treatment, and health restoration (rehabilitative). The role of literacy is very important in finding sources of information, one of which is about health and how to maintain it through clean and healthy living behavior, especially during the current COVID-19 pandemic (Akhmad & Suyadi, 2021). Good health literacy will increase a person's level of knowledge about a healthy lifestyle so that individuals, groups, and communities can improve their quality of life during the COVID-19 pandemic (Linggarjati & Parmitasari, 2021). Benchmarks in health literacy should not only be understood but needed to be applied in everyday life. Therefore, researchers are interested in researching on "The Correlation of Health Literacy with Clean and Healthy Living Behaviors to break the chain of transmission in STIKes Hang Tuah Surabaya’s students during the COVID-19 Pandemic period. METHOD The research design used analytic observational with a cross-sectional approach, namely the type of research in which data collection of independent and dependent variables was carried out in one period simultaneously. The population in this study were regular D3 degree nursing students at 1,2,3 degree and S1 levels at 1,2,3,4 at STIKes Hang Tuah Surabaya for the 2020/2021 academic year, totaling 584 people. The samples used in this study were regular nursing students D3 degree 1,2,3 and S1 level 1,2,3,4 Surabaya who met the sample requirements of 237 people. The sampling technique used probability sampling with a simple random sampling approach. The independent variable of the study was health literacy and the dependent variable was clean and healthy living behavior. The data collection instrument used a structured questionnaire which was developed based on the lattice of the research variable components. The Health literacy questionnaire uses a research instrument developed by the HSL-EU Consortium, namely The European Health Literacy Survey Questionnaire (HLS-EU-Q) HLS-EU-Q. The Clean and Healthy Life Behavior Questionnaire during the pandemic contains Clean 20 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 18-24 and Healthy Life Behaviors to measure a student's clean living behavior. The results of the validity and reliability test of the questionnaire was in the expected score range, namely 0.4 to 0.7. The data were analyzed using the Spearman Rho test with a 95% confidence level, and the significance level of P-Value = 0.05 which means that if P-Value is 0.05, then H1 is accepted, which means that there is a correlation between health literacy and Clean and Healthy Living Behavior (PHBS) to break the chain of transmission of Covid 19 in STIKES Hang Tuah Surabaya students. RESULTS 1. Health Literacy Table of characteristics of health literacy for regular nursing students of D3 study program degree 1,2,3 and S1 degree 1,2,3,4 (n = 237) on Juni 8, 2021 – Juni 10, 2021. Health literacy Frequency (f) Percentage (%) Adequate Adequate Enough Inadequate 216 21 0 91.13% 8.87% 0% Total 237 100% The table shows that most of the students' health literacy was in the adequate category, amounting to 216 people (91.13%), and the rest in the quite adequate category, as many as 21 people (8.87%). 2. Clean and Healthy Life Behavior Table of Characteristics of Clean and Healthy Life Behavior in regular nursing students of D3 and S1 study programs (n = 237) on 08 Juni 2021 – 10 Juni 2021 Clean and Healthy Life Behavior Frequency (f) Percentage (%) Good Enough not enough 160 77 0 67.51% 32.49% 0% Total 237 100% The table describes the Clean and Healthy Life Behavior (PHBS) in nursing students, mostly in the high category with 160 people (67.51%) and the rest in the moderate category with 77 people (32.49%). 3. The correlation between health literacy and a Clean and Healthy Lifestyle Table of the correlation between health literacy and Clean and Healthy Living Behavior to break the chain of transmission of covid 19 in STIKES Hang Tuah Surabaya students (n = 237) on 08 Juni 2021 – 10 Juni 2021. Health literacy Clean and Healthy Life Behavior Total Good Enough F % F % F % Adequate 152 70.37% 64 29.63% 216 100% Adequate Enough 8 38.09% 13 61.91% 21 100% Inadequate 0 0% 0 0% 0 100% Total 160 67.51% 77 32.49% 237 100% Statistic test Spearman’s Rho 0.037 (p = 0.05) Value R = 0.128 (Very weak correlation) The table depicts 216 students who have health literacy in the adequate category as many as 152 (70.37%), have a clean and healthy life behavior (PHBS) in the high category (70.37%) and 64 respondents (29.63%) have a clean and healthy lifestyle (PHBS) medium category. In terms of health literacy, 21 respondents have a high level of clean and healthy behavior and 8 (38.09%) students and 13 (61.91%) students have moderate clean and healthy behavior. Based on the Spearman Rho statistical test, showed a value (p-value = 0.037), meaning that statistically there was a correlation between health literacy and Clean and Healthy Life Behavior in Hang Tuah STIKES students in Surabaya. The correlation coefficient value is 0.128, meaning that the correlation between health literacy and Clean and Healthy Life Behavior is very weak. Priyantini, Setiadi, Irawandi, Early Mobilization Affected the Daily Living Activity based on … 21 DISCUSSION 1. Health Literacy in Students Data on student health literacy showed that from 237 students, 216 people (91.13%) have adequate health literacy and 21 (8.87%). These results indicated that most of the students who have health literacy are in the adequate category. The findings of this study explained that students accommodate in meeting the needs of a healthy life. Health literacy is the degree of a person's ability to obtain, process, and understand basic health information and services needed to make appropriate health-related decisions. From this concept it can be said that health literacy plays an important role in the health sector so that achieving health literacy is a shared responsibility at the individual and social levels. Nursing students are individuals with higher levels of education who have more opportunities to be exposed to health information, both from the curriculum studied, through seminars or training (Veddayana et al., 2020). This condition illustrates that an adequate level of health literacy in students comes from access to health information which is the attainment, transition, or acquisition of information with or without going through the media which is a source of liaison between individuals and information (Ul Haq & Sri Sadewo, 2021). A person's health literacy is measured on knowledge, attitudes, motivation, behavioral intentions, personal skills, and health-related self-efficacy so that it leads to new knowledge, greater self-efficacy, positive health behaviors, and better health (Yojana, 2022). For an individual, health literacy is determined by the level of education, culture, and language, besides that, it also requires communication skills and assessing interactions with others related to health and the ability of the media, market, and government to provide correct health information (Moreen Toar, 2020). The result of the distribution of the highest score data is the ease with which students find and receive information regarding covid 19. It is easiest for students to access information related to the symptoms of the COVID-19 disease because Hang Tuah STIKes Surabaya students are health-based students so access to health information is easy to obtain both in teaching and learning activities, seminars, and health posters in the campus environment. This condition supports an adequate level of health literacy in students and showed that the factors that influence health literacy are access to health information which is the achievement, transition, or acquisition of information with or without going through the media which is a source of liaison between individuals, and information if someone does not get access. information, will have an impact on knowledge because of the low literacy they have. The lowest score from the literacy questionnaire answers was student compliance with government policies, namely "I comply with government regulations regarding policies during the COVID-19 pandemic". This shows that students are lacking in applying existing health information related to government policies during the covid 19 pandemic. And this condition can support an adequate level of health literacy. One of the government's policies during the COVID-19 pandemic is that the implementation of health protocols and the implementation of health protocols must be based on self-awareness even though they already know various knowledge related to health protocols or the COVID-19 pandemic, but they have not been able to implement it in daily life (Fitri et al., 2020). 2. Student's Clean and Healthy Life Behavior Clean and Healthy Living Behavior (PHBS) students were 160 students (67.51%) in the good category and 77 students (32.49%) in the enough category. The research findings can be explained that most of the students have a Clean and Healthy Behavior in the good category. most students have a clean and healthy lifestyle which is a good thing because it can prevent them from being exposed to the coronavirus pandemic. Lawrence Green explained that a person's health can be influenced by several factors, namely behavioral factors and factors outside of behavior (Dewi, 2020). Clean and Healthy Life Behavior in STIKes Hang Tuah Surabaya students has the highest score, among others, is the behavior of brushing teeth 2-3 times regularly every day. The COVID-19 virus is found in the oral and oropharyngeal cavity so dental and oral hygiene is very necessary to maintain overall body health (Azizah et al., 2021). In addition to maintaining dental and oral hygiene during the COVID-19 pandemic to avoid 22 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 18-24 toothache or dental problems to minimize the transmission of covid 19 in dental practice. This data illustrates that the level of clean and healthy living behavior of students can maintain personal hygiene in dental and oral health during the COVID-19 pandemic. The second-highest score for student health behavior was the use of masks. This data is in the questionnaire "I wear a mask when meeting other people and when leaving the house". The availability of infrastructures such as medical masks, government policies, and regulations are one of the factors to increase compliance with health protocols. According to (Sianipar et al., 2021) said that infrastructure is all types of work equipment and facilities that function as tools to assist in the implementation of work. So the health protocol will be implemented if there are supporting infrastructure facilities, for example, the availability of clean water for washing hands and masks for activities and others. The lowest score of student health behavior was lack of activity during a pandemic, namely the answer to the questionnaire "I like to lie down rather than do physical activity during school from home" which means that respondents lie down more than doing physical activity during school from home. Lack of physical activity in students during school from home does not support good health behavior. Research (Zata et al., 2020) says that there is a decrease in physical activity in the community due to fear of contracting the covid 19 virus. In actual health, physical activity must be carried out by humans which can be done in and around our homes. 3. The Correlation Between Health Literacy and Clean and Healthy Life Behavior The results of the Spearman's Rho statistical test obtained a p-value = 0.037 (P-value 0.05), meaning that there is a correlation between health literacy and Clean and Healthy Life Behavior in STIKes Hang Tuah students in Surabaya. The findings of this study can be explained that students who have high literacy will be able to carry out Clean and Healthy Life Behavior activities. Every human being has basic needs, namely the need for health information, the need for disease prevention, and the need for treatment when sick. Moreover, supported the pandemic factor to save their lives and their families. In addition to these factors, health workers, in this case, one of them is that student will be encouraged to seek as much information as possible for professional purposes or be prepared if there are questions from the public to ask students about it. Health information is one of the needs to make individuals know about health so that individuals can apply clean and healthy living behaviors in everyday life to achieve optimal health degrees. Health literacy is an individual's capacity to access, understand, assess and apply information and basic health services to improve health (Joint Committee on National Health Education Standards). Health literacy is assessed by the HLS- EU-Q16 which includes 3 indicator domains spread over 16 question items, namely health care, disease prevention, and health promotion (Wahjuni, 2020). CONCLUSION Health literacy among STIKes Hang Tuah Surabaya’s students has been an adequate category in clean and healthy living behavior to prevent the chain of transmission of COVID-19 in STIKes Hang Tuah Surabaya. Furthermore, they have to applied healthy living behaviors as health promotion as well. SUGGESTION Further research is needed using more standardized instrument measurements ACKNOWLEDGEMENT The author would like to thank the Chair of the Hang Tuah Stikes Surabaya and students who participate in this study FUNDING Research funding comes from internal funds from the Stikes Hang Tuah Surabaya campus through research and community service centers which are budgeted annually by each study program. CONFLICTS OF INTEREST The research process is assisted by research assistants to avoid conflicts of interest between researchers and respondents, so researchers do not have direct contact with respondents when collecting data. Before starting research activities, respondents were also informed about the research location, namely interest in existing topics and phenomena encourage researchers to carry out research according to the topic under study. So it can be concluded that every party involved in the research already knows and agrees with this research. Priyantini, Setiadi, Irawandi, Early Mobilization Affected the Daily Living Activity based on … 23 AUTHOR CONTRIBUTIONS Dwi Priyantini as writer 1 is on duty compiling and designing research designs, collect data, analyze, and create script. Setiadi as writer 2 is in charge of helping collect data and help process data. Dedi Irawandi as writer 3 coordinated and collected data. All authors played an active role and provided input and approved the final manuscript. REFFERENCE Akhmad, C. A., & Suyadi. (2021). Literasi Kesehatan dalam Pendidikan Islam: Studi Kasus Dampak Covid-19 bagi Mahasiswa UAD. Fikroh: Jurnal Pemikiran Dan Pendidikan Islam, 14(1), 28–42. https://doi.org/10.37812/FIKROH.V14I1.1 07. Azizah, A. Y., Erawati, S., & Nababan, I. (2021). Pengaruh Edukasi Online Terhadap Perubahan Perilaku Menjaga Kebersihan Gigi Pada Mulut Selama Masa Pandemi. Jurnal Ilmiah PANNMED (Pharmacist, Analyst, Nurse, Nutrition, Midwivery, Environment, Dentist), 16(1), 224–228. https://doi.org/10.36911/PANNMED.V16I 1.1056. Dewi, E. U. (2020). Faktor-Faktor Yang Mempengaruhi Perilaku Masyarakat Dalam Pencegahan Penularan COVID-19. Jurnal Keperawatan, 9(2), 21–25. https://doi.org/10.47560/KEP.V9I2.259. Fitri, B. M., Widyastutik, O., & Arfan, I. (2020). Penerapan Protokol Kesehatan Era New Normal dan Risiko Covid-19 Pada Mahasiswa. Riset Informasi Kesehatan, 9(2), 143–153. https://doi.org/10.30644/RIK.V9I2.460. I Komang Agus Widiantara. (2020). Infodemik Covid-19: Momentum Membangun Kepercayaan Publik Terhadap Media Mainstream. Ilmu Komunikasi, 1(1), 67– 81. Linggarjati, D., & Parmitasari, N. (2021). Studi Deskriptif Literasi Mahasiswa Terkait Covid-19. Praxis : Jurnal Sains, Teknologi, Masyarakat Dan Jejaring, 3(2), 113–119. https://doi.org/10.24167/PRAXIS.V3I2.31 47. Makruf, A., & Farhan, F. S. (2021). Perubahan Perilaku Hidup Bersih dan Sehat Sebelum dan Selama Pandemi COVID-19 pada Mahasiswa Kedokteran Universitas Muhammadiyah Jakarta. Jurnal Kesehatan Andalas, 10(1), 39. https://doi.org/10.25077/jka.v10i1.1674. Moreen Toar, J. (2020). Faktor Yang Mempengaruhi Literasi Kesehatan Pada Penderita Diabetes Melitus Tipe 2 Di Kota Manado. JURNAL KEPERAWATAN, 8(2). https://doi.org/10.35790/JKP.V8I2.32327. Rohman, A., & Nurhayati, F. (2021). Hubungan Literasi Kesehatan Dengan Pola Hidup Sehat Siswa Smp Di Masa Pandemi Covid-19. Jurnal Pendidikan Olahraga Dan Kesehatan, 09(01), 101–106. Sianipar, E., Ridwan, M., Nurwaqiah Ibnu, I., Guspianto, L., & Ode, R. (2021). Faktor- Faktor Yang Berhubungan Dengan Perilaku Cuci Tangan Pakai Sabun (CTPS) Pada Mahasiswa Universitas Jambi Selama Pandemi COVID-19. Jurnal Kesmas Jambi, 5(2), 55–62. https://doi.org/10.22437/JKMJ.V5I2.1369 3. Sutisna, I. P. G. (2020). Gerakan Literasi Digital Pada Masa Pandemi COVID-19. STILISTIKA: Jurnal Pendidikan Bahasa Dan Seni, 8(2), 268–283. https://doi.org/10.5281/zenodo.3884420. Ul Haq, N., & Sri Sadewo, F. (2021). Konstruksi Sosial Tentang Literasi Kesehatan Dalam Merespon Pandemi Covid-19. Jurnal Pendidikan Kesehatan, 10(2), 193–199. https://doi.org/10.31290/JPK.V10I2.2813. Veddayana, C., Anita, F., Rizka, H., & Ningrum, P. (2020). Meningkatkan Literasi Masyarakat Bangko Kanan dalam Menghadapi Pandemi COVID-19. Jurnal Pengabdian UntukMu NegeRI, 4(2), 231–236. https://doi.org/10.37859/JPUMRI.V4I2.21 53. Wahjuni, S. M. dan E. S. (2020). Hubungan Literasi Kesehatan dengan Kualitas Hidup Mahasiswa Fakultas Ilmu Olahraga Universitas Negeri Surabaya. Jurnal Pendidikan Jasmani, 8(3), 37–42. https://ejournal.unesa.ac.id/index.php/jurna l-pendidikan-jasmani/article/view/36932. Yojana, Y. (2022). Gambaran Literasi Digital Tenaga Kesehatan Peserta Pelatihan di Bapelkes Cikarang Kementerian Kesehatan RI. EDUKATIF : Jurnal Ilmu 24 Journal of Ners and Midwifery, Volume 10, Issue 1, April 2023, page 18-24 Pendidikan, 4(2), 2127–2133. https://doi.org/10.31004/EDUKATIF.V4I2. 2262. Zata, J., Nurhadi, L., & Fatahillah, D. (2020). Pengaruh Pandemi Covid-19 Terhadap Tingkat Aktivitas Fisik Pada Masyarakat Komplek Pratama, Kelurahan Medan Tembung. Jurnal Health Sains, 1(5), 294– 298. https://doi.org/10.46799/JHS.V1I5.52.