Journal of Health Literacy

Journal of Health Literacy

Strengthening Health Literacy Using Social Media: A Quasi-Experimental Study on Rice Farmers’ Heat Stroke Risk in Rural Agricultural Areas of Indonesia

Document Type : Original Article

Authors
Aufa Azizah 1
Rismawan Adi Yunanto 2
Baskoro Setioputro 2
Ruris Haristiani 2
Rondhianto Rondhianto 3
Rokhani Rokhani 4
1 Faculty of Nursing, Universitas Jember, Jember, Indonesia
2 Department of Emergency and Critical Nursing, Faculty of Nursing, Universitas Jember, Jember, Indonesia
3 Department of Medical and Surgical Nursing, Faculty of Nursing, Universitas Jember, Jember, Indonesia
4 Department of Agricultural Extension, Faculty of Agriculture, Universitas Jember, Jember, Indonesia
10.22038/jhl.2025.89831.1821
Abstract
Background and Objective: Heat stroke is an emergency condition that can cause death. Heat stroke is prone to occur in agricultural workers. This condition of vulnerability is related to rice farmers' knowledge of exposure to extreme environmental heat. This research aims to determine the effect of increasing health literacy through social media on rice farmers' knowledge, attitude, and first aid practice regarding heat stroke emergencies. 

Materials and Methods: We used a quasi-experimental design with a pretest-posttest control group design. A cluster randomized trial sampling technique was used to select the participants. The education carried out sends visuals, audio, and narrative text via WhatsApp groups. Data were collected using a heat stroke knowledge, attitude, and first aid practice questionnaire, with a Cronbach's Alpha value of 0.73. Data was analyzed using the Wilcoxon test and the Mann-Whitney test to determine the differences within or between groups. 

Result: The results showed no significant change in knowledge, attitude, or first aid practice in the control group (p-values: 0.793, 0.491, and 1.000, respectively, all > 0.05). In contrast, the intervention group showed significant improvements in all three aspects (all p-values = 0.001 < 0.05). The intervention group showed significant improvements in knowledge, attitude, and first aid practice related to heatstroke compared to the control group (all p = 0.001), with the greatest increase observed in knowledge.

Conclusion: This research concludes that increasing health literacy via social media is effective in increasing knowledge, attitude, and first aid practice about heat stroke emergencies among farmers. It is recommended that future studies explore the long-term retention of knowledge, attitude, and practice, and the impact of social media education on behavioral changes in preventing heat stroke among farmers.
Keywords
Farmers
Health Literacy
Heat Stroke
Knowledge Attitude Practice
Social Media

Acknowledgment: The authors would like to express their deepest appreciation to the Faculty of Nursing of the Universitas Jember, the Institute for Research and Community Service of the Universitas Jember, the nurses in the public health centers in Jember, and the rice farmers in the rural areas of Jember, Indonesia for their invaluable support and contribution in the completion of this research.


Availability of data and materials: The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


Conflicts of interest: The authors declare there is no conflict of interest in this study.


Consent for publication: Not applicable.


Ethics approval and consent to participate: This study was approved by the Ethical Committee Review Board for Research No. 330/UN25.1.14/KEPK/2023. Ethical and administrative approval from the Health Ethics Committee, Faculty of Nursing, Universitas Jember. All procedures performed in this study involving human participants were by the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. All participants received complete information about the study and signed a written informed consent form before their participation. 


Funding: This project was supported by the Department for Research and Community Service of the Universitas Jember with Hibah Reworking No:6274/UN25/KP/2025.


Authors' Contribution: All of the authors have agreed and approved the final edited manuscript to submit to the Journal of Health Literacy.  All of the authors have contributed to this manuscript and have credited a statement below: Study conception and design: AA, BS, and RAY. Data collection: AA, RO, and RH. Data analysis and interpretation: RAY, RON, and RH. Drafting of the article: RAY, AA, RON, and RH. Critical revision of the article: RAY, AA, RH.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

  1. Muth CM. Heat-related illnesses. Notfall Rettungsmed. 2020;23(4):299-312. https://doi.org/10.1007/s10049-020-00716-5
  2. Sadiq LS, Hashim Z, Osman M. The impact of heat on health and productivity among maize farmers in a tropical climate area. J Environ Public Health. 2019;2019:9896410 https://doi.org/10.1155/2019/9896410 PMid:31061664 PMCid:PMC6466949
  3. Luque JS, Becker A, Bossak BH, Charleston, Grzywacz JG, Tovar-Aguilar JA, et al. Knowledge and Practices to Avoid Heat-Related Illness among Hispanic Farmworkers along the Florida-Georgia Line John. Agromedicien Journal. 2020;25(2):190-200. https://doi.org/10.1080/1059924X.2019.1670312 PMid:31544652 PMCid:PMC7075471
  4. Smith DJ, Ferranti EP, Hertzberg VS, Mac V. Knowledge of Heat-Related Illness First Aid and Self-Reported Hydration and Heat-Related Illness Symptoms in Migrant Farmworkers. Workplace Health Saf. 2021;69(1):15-21. https://doi.org/10.1177/2165079920934478 PMid:32723031
  5. Elias N, K.P S. A Study to Evaluate the Effectiveness of Structured Teaching Programme on Knowledge Regarding Heatstroke and its Prevention. Indian Journal of Community Medicine. 2022;42(1):626-7 https://doi.org/10.4103/ijcm.ijcm_7_22 PMid:36742965 PMCid:PMC9891030
  6. Centers for Disease Control and Prevention. Heat & Health Tracker [Internet]. 2023 [cited 2023 May 23]. Available from: https://ephtracking.cdc.gov/Applications/heatTracker/
  7. Burt A, English W. Diagnosis and management of heat stroke. 2016;1-8. WFSA Tutorial 341. 2016 Nov 15 [cited 2025 May 12]. Available from: https://resources.wfsahq.org/atotw/diagnosis-and-management-of-heat-stroke/
  8. Kiatkitroj K, Arphorn S, Tangtong C, Maruo SJ, Ishimaru T. Risk factors associated with heat-related illness among sugarcane farmers in Thailand. Ind Health. 2022;60(5):447-58. https://doi.org/10.2486/indhealth.2021-0161
  9. Suter MK, Miller KA, Anggraeni I, Ebi KL, Game ET, Krenz J, et al. Association between work in deforested, compared to forested, areas and human heat strain: An experimental study in a rural tropical environment. Environ Res Lett. 2019;14(8):084012. https://doi.org/10.1088/1748-9326/ab2b53
  10. Marquez D, Krenz JE, Santos EC, Torres E, Palmández P, Sampson PD, et al. The effect of participatory heat education on agricultural worker knowledge. 2023;28(2):187-98. https://doi.org/10.1080/1059924X.2022.2058667 PMid:35345983 PMCid:PMC9573936
  11. Coman MA, Marcu A, Chereches RM, Leppälä J, Van Den Broucke S. Educational interventions to improve safety and health literacy among agricultural workers: A systematic review. Int J Environ Res Public Health. 2020;17(3):1-15. https://doi.org/10.3390/ijerph17031114 PMid:32050565 PMCid:PMC7037762
  12. Jourdan D. A renewed framework for health education | Un cadre renouvelé pour l'éducation à la santé. Soins. 2025;70(896):20-5. https://doi.org/10.1016/j.soin.2025.04.007 PMid:40483092
  13. Misse Issabella C, Heldayasari Prabandari F. The Effect of Online Based Education on Knowledge and Attitude of Pregnant Woman About Maternal and Neonatal Services During the Covid-19 Pandemic in Sleman Regency. Journal of Health. 2020;8(2):151-63. https://doi.org/10.30590/joh.v8n2.p151-163.2021
  14. Chaudhary K, Nepal J, Shrestha K, Karmacharya M, Khadka D, Shrestha A, et al. Effect of a social media-based health education program on postnatal care (PNC) knowledge among pregnant women using smartphones in Dhulikhel hospital: A randomized controlled trial. PLoS One. 2023;18:1-22. https://doi.org/10.1371/journal.pone.0280622 PMid:36662821 PMCid:PMC9858435
  15. Wang X, Xia D, Long X, Wang Y, Wu K, Xu S, et al. Knowledge, Attitudes, and Practices of Military Personnel Regarding Heat-Related Illness Risk Factors: Results of a Chinese Cross-Sectional Study. Front Public Health. 2021;9:707264.. https://doi.org/10.3389/fpubh.2021.707264 PMid:34249854 PMCid:PMC8267788
  16. Abbasian F, Naghizadeh MM, Ahmadian L. Effect of WhatsApp Messenger-based education on the knowledge of health ambassadors about home care for minor illnesses. BMC Health Serv Res. 2024;24(1). https://doi.org/10.1186/s12913-024-11988-9
  17. Anaje CC, Okpala CI, Enechukwu NA, Ezejiofor OI, Malachy DE, Nwiyi OK. The Impact of WhatsApp as a Health Education Tool in Albinism: Interventional Study. JMIR Dermatol. 2023;6:e49950. https://doi.org/10.2196/49950
  18. Okoro ON, Nelson CS, Witherspoon SP, Witherspoon SF, Simmons GE. Culturally Responsive Health Promotion to Address Health Disparities in African American Men: A Program Impact Evaluation. Am J Mens Health. 2020;14(4) :1557988320951321. https://doi.org/10.1177/1557988320951321
  19. Khuancharee K, Suwanchatchai C, Rattanamongkolgul S. Effect of enhancing village health volunteer ability to promote engaged community-based interprofessional education. Int J Med Educ. 2025;16:75-83. https://doi.org/10.5116/ijme.67ab.5af9
  20. Abbasian F, Naghizadeh MM, Ahmadian L. Effect of WhatsApp Messenger-based education on the knowledge of health ambassadors about home care for minor illnesses. BMC Health Serv Res. 2024;24(1). https://doi.org/10.1186/s12913-024-11988-9 PMid:39616347 PMCid:PMC11607794
  21. Martin MC, Forst L, Siciliano M, Xiuhtecutli N, Monaghan P. Dissemination of Heat Safety Practices Among Florida Farmworker Crews. J Occup Environ Med. 2025; 67(8):e518-e524. https://doi.org/10.1097/JOM.0000000000003421
  22. Tseng TS, Gonzalez G. Social media and types with their current applications in public health and healthcare. Effective Use of Social Media in Public Health. 2023. 3-22 p. https://doi.org/10.1016/B978-0-323-95630-7.00007-X
  23. de Vere Hunt I, Linos E. Social Media for Public Health: Framework for Social Media-Based Public Health Campaigns. J Med Internet Res. 2022;24(12). https://doi.org/10.2196/42179 PMid:36515995 PMCid:PMC9798262
  24. Latha K, Meena KS, Pravitha MR, Dasgupta M, Chaturvedi SK. Effective use of social media platforms for promotion of mental health awareness. J Educ Health Promot. 2020;9(1) https://doi.org/10.4103/jehp.jehp_90_20 PMid:32642480 PMCid:PMC7325786
  25. Plackett R, Steward JM, Kassianos AP, Duenger M, Schartau P, Sheringham J, et al. The Effectiveness of Social Media Campaigns in Improving Knowledge and Attitudes Toward Mental Health and Help-Seeking in High-Income Countries: Scoping Review. J Med Internet Res. 2025;27(1). https://doi.org/10.2196/68124 PMid:40408767 PMCid:PMC12144482
  26. Jiang S, Ng AYK, Ngien A. The Effects of Social Media Information Discussion, Perceived Information Overload and Patient Empowerment in Influencing HPV Knowledge. J Health Commun. 2022;27(6):407-15. https://doi.org/10.1080/10810730.2022.2115591 PMid:35996841
  27. Shruti R, Gupta SK. Health Information Sharing and Social Media: Effect on the Female Users During the Pandemic. In: Alareeni B, Hamdan A, editors. Navigating the Technological Tide: The Evolution and Challenges of Business Model Innovation. Cham: Springer Nature Switzerland; 2024. p. 1-8. https://doi.org/10.1007/978-3-031-67431-0_1
  28. Zhao W. Misinformation Correction across Social Media Platforms. In: 2019 International Conference on Computational Science and Computational Intelligence (CSCI). 2019. p. 1371-6 https://doi.org/10.1109/CSCI49370.2019.00256 PMCid:PMC6435701
  29. Ghandour A, Woodford BJ, Almutairy A, Al-Srehan HS. Means to Support the Ends: Forums that Escape the Official Gaze in the Educational Institutions. In: Proceedings 2022 23rd International Arab Conference on Information Technology Acit 2022. 2022. https://doi.org/10.1109/ACIT57182.2022.9994133 PMid:35202359 PMCid:PMC8890771
  30. Abdallah R, Zaitoun E, Mostafa I. A Review Paper on the Current Utilization of WhatsApp for Educational Purposes. In: Proceedings 2023 10th International Conference on Social Networks Analysis Management and Security Snams 2023. 2023. https://doi.org/10.1109/SNAMS60348.2023.10375438
  31. Hoyt G, Bakshi CS, Basu P. Integration of an Audiovisual Learning Resource in a Podiatric Medical Infectious Disease Course: Multiple Cohort Pilot Study. JMIR Med Educ. 2025;11. https://doi.org/10.2196/55206 PMid:39935004 PMCid:PMC11835597
  32. D'Souza RS, D'Souza S, Strand N, Anderson A, Vogt MNP, Olatoye O. YouTube as a source of medical information on the novel coronavirus 2019 disease (COVID-19) pandemic. Glob Public Health. 2020;15(7):935-42. https://doi.org/10.1080/17441692.2020.1761426 PMid:32397870
  33. Rouzfarakh M, Deldar K, Froutan R, Ahmadabadi A, Mazlom SR. The effect of rehabilitation education through social media on the quality of life in burn patients: a randomized, controlled, clinical trial. BMC Med Inform Decis Mak. 2021 Dec 1;21(1). https://doi.org/10.1186/s12911-021-01421-0 PMid:33618721 PMCid:PMC7901117
  34. Xu Y, Chen J, Du J, Jin YY. Knowledge, attitudes, and practices among the general community population toward heatstroke. Front Public Health. 2024;12. https://doi.org/10.3389/fpubh.2024.1373025 PMid:38855448 PMCid:PMC11157029
  35. Marquez D, Krenz JE, Chavez Santos É, Torres E, Palmández P, Sampson PD, et al. The Effect of Participatory Heat Education on Agricultural Worker Knowledge. J Agromedicine. 2023;28(2):187-98. https://doi.org/10.1080/1059924X.2022.2058667 PMid:35345983 PMCid:PMC9573936
  36. Wang Y, Dai Y, Li H, Song L. Social Media and Attitude Change: Information Booming Promote or Resist Persuasion? Front Psychol. 2021 Jun 24;12. https://doi.org/10.3389/fpsyg.2021.596071 PMid:34248729 PMCid:PMC8264363
  37. Chen HT, Ai M, Guo J. The effect of cross-cutting exposure on attitude change: examining the mediating role of response behaviors and the moderating role of openness to diversity and social network homogeneity. Asian J Commun. 2022 Mar 4;32(2):93-110. https://doi.org/10.1080/01292986.2021.2022173
  38. Bennett V, Spasić I, Filimonov M, Muralidaran V, Kemp AM, Allen S, et al. Assessing the Feasibility of Using Parents' Social Media Conversations to Inform Burn First Aid Interventions: Mixed Methods Study. JMIR Form Res. 2024;8:e48695. https://doi.org/10.2196/48695 PMid:39326036 PMCid:PMC11467599
  39. Qiu J, Zhou YL. Quality assessment of heatstroke videos on TikTok. Front Public Health. 2024;12. https://doi.org/10.3389/fpubh.2024.1446003 PMid:39296850 PMCid:PMC11408333
  40. Cowley LE, Bennett CV, Brown I, Emond A, Kemp AM. Mixed-methods process evaluation of SafeTea: a multimedia campaign to prevent hot drink scalds in young children and promote burn first aid. Injury Prevention. 2021 Oct 1;27(5):419. https://doi.org/10.1136/injuryprev-2020-043909 PMid:33093127 PMCid:PMC8461408
  41. Parizh D, Effendi M, Dale E, Slater J. Assessing the Quality and Reliability of Patient Information Regarding First-Aid for Acute Burns on YouTube. Journal of Burn Care & Research. 2021 Mar 1;42(2):228-31. https://doi.org/10.1093/jbcr/iraa135 PMid:32840623
  42. Kien ND, My NHD, Thu DTA, Phong TK, Chau THB, Dung PT. Reducing consequences of extreme heat: The role of weather information access. Dialogues in Health. 2024;4:100177. https://doi.org/10.1016/j.dialog.2024.100177 PMid:39668848 PMCid:PMC11636927
  43. Xu Y, Chen J, Du J, Jin Y. Knowledge, attitudes, and practices among the general community population toward heatstroke. Front Public Health. 2024;12:1373025. https://doi.org/10.3389/fpubh.2024.1373025
  44. Ma X, Sun Y, Guo X, Lai KH, Wang X. Learning First Aid Knowledge Not Only for the Self But Also for Others: Toward a Collective Protection Motivation Theory. Health Commun. 2024 Nov 21:1–14. https://doi.org/10.1080/10410236.2024.2428880
  45. Snyder J. Social media, online learning, and its application in public health. In: Effective Use of Social Media in Public Health. 2023. p. 277–292. https://doi.org/10.1016/B978-0-323-95630-7.00013-5
  46. Nurfathiyah P, Sarwoprasodjo S, Muljono P, Matindas K. The Influence of Environmental factors on the use of social media for e-commerce in ornamental plant farmers. In: BIO Web of Conferences. 2024;123:03007. https://doi.org/10.1051/bioconf/202412303007
  47. Abdulai AR. Are rural smallholders ready for agricultural digitalization? Farmer (In)competencies and the political economy of access in digital agricultural extension and advisories in Northern Ghana. In: Digital Communication for Agricultural and Rural Development: Participatory Practices in a Post-COVID Age. 2024. p. 175-92. https://doi.org/10.4324/9781003282075-13
  48. Landmann D, Lagerkvist CJ, Otter V. Determinants of Small-Scale Farmers' Intention to Use Smartphones for Generating Agricultural Knowledge in Developing Countries: Evidence from Rural India. European Journal of Development Research. 2021;33(6):1435-54. https://doi.org/10.1057/s41287-020-00284-x
  49. Sarku R, Addi F, Attoh E. Improving the usability of new ICTs for the provision of climate information services for farming in Ghana. Clim Serv. 2025;37:100535. https://doi.org/10.1016/j.cliser.2024.100535