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ORIGINALES
Face-to-face classes during COVID-19: implementation of school
health protocols
Clases presenciales durante el COVID-19: implementación de protocolos de salud
escolar
Nunung Siti Sukaesih
1
Ahmad Purnama Hudaya
2
Dedah Ningrum
1
Hikmat Pramajati
3
Popi Sopiah
1
Emi Lindayani
4
1
Graduate in Nursing. Assisstant Professor. Basic Nursing Department. Universitas Pendidikan
Indonesia. [email protected]
2
Graduate in Nursing. Assisstant Professor. Medical Surgical Nursing Department. Universitas
Pendidikan Indonesia.
3
Graduate in Nursing. Assisstant Professor. Disaster Nursing Department. Universitas Pendidikan
Indonesia.
4
Graduate in Nursing. Assisstant Professor. Pediatric Nursing Department. Universitas Pendidikan
Indonesia.
https://doi.org/10.6018/eglobal.554501
Received: 19/01/2023
Accepted: 18/04/2023
ABSTRACT:
Introduction: The opening of schools increases the likelihood of an increase in COVID-19 cases, and
to prepare for this, schools must begin to create various checklists, as indicated in the Joint Decree of
Four Ministers on Guidelines for Implementing Learning During the COVID-19 Pandemic. Safe school
openings are possible provided sufficient planning and mitigation are implemented, such as through the
use of acceptable school opening guidelines.
Objective: The purpose of this study is to examine the compliance of school health protocols during
COVID-19 in West Java, Indonesia, as well as the differences between participants.
Methods: A quantitative cross-sectional study was conducted in an elementary school in West Jawa,
Indonesia. Using a structured instrument, modified from Panduan Penyelenggaraan Pembelajaran di
Masa Pandemi Covid-19 (Guidelines for Implementing Learning During the Covid-19 Pandemic) by the
researchers, containing school characteristics, availability of sanitation infrastructure, hygiene and
health facilities, canteen availability, and Behavior of maintaining health protocols in schools with 27
questions: 11 availability of sanitation, hygiene, and health facilities, canteen availability, and Behavior
of maintaining health protocols in schools The study involved 347 individuals from 29 primary schools.
SPSS software and the Kruskal-Wallis non-parametric test were used to examine the study hypotheses.
Result: The mean score on sub-variable availability of sanitation infrastructure, cleanliness, and health
facilities was high (27.49/5.391). The three sub-variables that were tested were different based on the
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participant's assessment, only the canteen availability sub-variable had no difference in the mean score
between the participants, the value of Sig =.255, which is more than 0.05.
Conclusion: The study's findings revealed that the introduction of health protocols in primary schools
during face-to-face learning was effective, with a high average total score.
Keywords: face-to-face classes, elementary school, health protocol, COVID-19, Return to school
RESUMEN:
Introducción: La apertura de las escuelas aumenta la probabilidad de un aumento de casos de
COVID-19, y para prepararse para esto, las escuelas deben comenzar a crear varias listas de
verificación, como se indica en el Decreto Conjunto de Cuatro Ministros sobre Directrices para
Implementar el Aprendizaje Durante la Pandemia COVID-19. La apertura de escuelas seguras es
posible siempre que se implemente suficiente planificación y mitigación, como mediante el uso de
pautas de apertura de escuelas aceptables.
Objetivo: El propósito de este estudio es examinar el cumplimiento de los protocolos de salud escolar
durante el COVID-19 en West Java, Indonesia, así como las diferencias entre los participantes.
Métodos: Se realizó un estudio transversal cuantitativo en una escuela primaria en West Java,
Indonesia. Utilizando un instrumento estructurado, modificado de las Pautas para implementar el
aprendizaje durante la pandemia de Covid-19 por los investigadores, que contiene características de la
escuela, disponibilidad de infraestructura de saneamiento, instalaciones de higiene y salud,
disponibilidad de comedores y Comportamiento de mantenimiento de protocolos de salud en las
escuelas con 27 preguntas: 11 disponibilidad de instalaciones de saneamiento, higiene y salud,
disponibilidad de comedores y Comportamiento de mantenimiento de protocolos de salud en las
escuelas El estudio involucró a 347 personas de 29 escuelas primarias. Se utilizó el software SPSS y la
prueba no paramétrica de Kruskal-Wallis para examinar las hipótesis del estudio.
Resultado: La puntuación media en la subvariable disponibilidad de infraestructura de saneamiento,
limpieza e instalaciones de salud fue alta (27,49/5,391). Las tres subvariables que se probaron fueron
diferentes en función de la evaluación de los participantes, solo la subvariable disponibilidad de
comedor no tuvo diferencia en el puntaje promedio entre los participantes, el valor de Sig = .255, que
es más de 0.05.
Conclusión: Los hallazgos del estudio revelaron que la introducción de protocolos de salud en las
escuelas primarias durante el aprendizaje presencial fue efectiva, con un puntaje total promedio alto.
Palabras clave: clases presenciales, escuela primaria, protocolo de salud, COVID-19, Regreso al cole.
Funding source: This research was financed by a grant from the Nursing Department
of Universitas Pendidikan Indonesia (UPI) in Bandung, West Java, Indonesia.
INTRODUCTION
After nearly 18 months of school closures to lower the prevalence of COVID-19
transmission, WHO and UNICEF advise schools in Indonesia to resume face-to-face
learning as soon as possible
(1)
. The reopening of schools must be done as soon as
possible, given that COVID-19 cases in Indonesia are beginning to drop and the
extended duration of distance learning creates several physical and emotional
challenges
(2,3)
. Distance learning can also raise the risk of long-term interpersonal
stress and social isolation throughout adolescence
(4)
. Based on these factors, the
Republic of Indonesia's government has decreed that restricted face-to-face learning
would begin in January 2022, with numerous restrictions that must be followed by all
educational institutions
(5)
.
The opening of schools increases the likelihood of an increase in COVID-19 cases,
and to prepare for this, schools must begin to create various checklists, as indicated in
the Joint Decree of Four Ministers on Guidelines for Implementing Learning During the
COVID-19 Pandemic. Safe school openings are possible provided sufficient planning
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and mitigation are implemented, such as through the use of acceptable school
opening guidelines
(6)
. Back-to-school initiatives must review and ensure the education
system's preparation for school reopening, including infrastructure, teaching staff,
pedagogy, students and their families; learning continuity; and system resilience to
foresee and cope with future crises
(7)
. One of the things that the school must prepare
is the Health Protocol. The health protocols that must be implemented are as follows:
a) use a mask under the provisions, namely covering the nose, mouth, and chin; b)
maintain a distance of at least 1 (one) meter between people and/or between
chairs/tables; c) avoid physical contact; d) do not borrow each other's equipment or
learning supplies; e) do not share food and drink, and do not eat and drink together
face to face and close together; f) apply coughing and sneezing etiquette; and g)
regular hand sanitizing
(8)
.
Teachers have not adequately executed health procedures during restricted face-to-
face learning in primary schools, which focused on wearing masks appropriately and
correctly, washing hands, and keeping distance
(9)
, despite the fact that schools are an
excellent location to teach students the discipline of wearing masks
(10)
. There is still a
lack of awareness of the key tasks of the COVID-19 task force in schools; there has
been no official covid-19 task force coaching; coaching is only available through social
media and self-taught; Human resources are still scarce when it comes to adopting
health regulations in face-to-face learning in schools
(11)
. This is most likely the reason
of the threefold spike in COVID-19 cases, or roughly 6000 cases, in August 2022
(12)
.
Face-to-face learning should begin with five critical considerations: reopening schools
in phases, keeping physical and social distance, managing infections using testing and
tracking accessible in schools, protecting children and instructors, and doing research
and assessment
(13)
. Starting with the pre-condition stage, timing, priorities, central-
regional cooperation, and monitoring and evaluation, the process of opening schools
in Indonesia is carried out in stages
(12)
. Based on a survey conducted by Fitriah et
al.(2020) that The majority of principals, teachers, parents, and education offices are
ready to implement face-to-face learning in all aspects, including implementing health
protocols during face-to-face learning, but the condition of supporting facilities and
infrastructure is still inadequate, including poor health data collection. Although,
clinically, children (1-18 years old) exhibit moderate symptoms or no symptoms due to
COVID-19, the number of hospitalized children is likewise minimal and no more
infectious than adults
(15–18)
, Because students, teachers, and other school residents
contact in schools, the transmission of this disease must be monitored. This condition
produces concern in both students' parents and instructors. Furthermore, parents of
students are concerned that their children may spread the disease to their family at
home
(19)
. The reopening of schools during the pandemic has also created concern
among parents and teachers because to the possibility of COVID-19 transmission in
schools, where students often contact with a large number of individuals
(20)
.
During an era of ongoing communicable disease outbreaks, nurses serve as a
valuable resource in preventing and responding to threats to the health of school
populations by teaching prevention and basic but important precautions, with a focus
on respiratory and hand hygiene, as well as other important precautions, due to the
vital roles they play in communication between students, school personnel, and public
health officials
(21)
. Therefore, nurses have an obligation to participate in overcoming
the spread of COVID-19 in school clusters
(22)
.
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Based on this description, it is required to evaluate the application of health protocols
during face-to-face learning, which has been underway for roughly 2 months, to serve
as a foundation for anticipating the expansion of COVID-19 in school clusters.
OBJECTIVE
To ascertain the adoption of school health protocols during COVID-19 in West Java,
Indonesia, as well as the variations in implementation of school health protocols during
COVID-1 across participants.
METHODS
Ethical aspect
The study was carried out in compliance with national and international ethical rules
and was authorized by the Research Ethics Committee of Universitas Pendidikan
Indonesia's Centre of Research and Community Services, whose opinion is attached
to this submission. All participants engaged in the study provided written free and
informed consent. All study data were kept confidential and coded, with only the
research team having access to it. The participants were not named in the published
findings.
Design, period and place of study
This is a cross-sectional design research based on data from 29 primary school
principals, teachers, and students. STROBE-Strengthening the Reporting of
Observational Studies in Epidemiology was used to report the methodological
processes. Participants were sought in August 2022 from 29 primary schools in West
Java, Indonesia.
Population or sample
The cross-sectional survey was carried out between August 6 and 10, 2022. The
school principals, teachers assigned as the person in charge of the health-promoting
school, and students who met the inclusion criteria of (1) being male or female, (2)
being in 5th or 6th grade, and (3) being able to self-report by completing an
anonymous survey questionnaire were the study's target population. The attendees
included all of the school administrators and instructors, for a total of 58 people. The
minimal sample size for students was 290, which was gathered from a total student
population of 792 pupils in grades 5 and 6 who were deemed capable of filling out
questionnaires provided by researchers and calculated based on the slovin formula.
Study protocol
First, a structured instrument was used, which was adopted by the researchers from
Panduan Penyelenggaraan Pembelajaran di Masa Pandemi Covid-19 (Guidelines for
Implementing Learning During the Covid-19 Pandemic) and included school
characteristics, sanitation infrastructure availability, cleanliness and health facilities,
cafeteria availability, and behaviour of maintaining health protocols in schools. To
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represent the degree of implementation on a Likert-type scale ranging from one to two,
one to three, and one to four.
The guidelines questions took about 15 minutes to complete separately. The tool
displays self-reported implementation. It consisted of 11 questions on the availability of
sanitary infrastructure, cleanliness, and health facilities, 8 questions about the
availability of canteens, and the last 8 about the behaviour of keeping health protocols
in schools.
The correlation value between the item score and the overall score of the scale is used
in the validity test utilizing item-total correlation, also known as correlations Pearson
product moment. The value of the item-total correlation for item number 28 is the
correlation of the subject's score in item number 28 with the subject's overall score on
the scale. The validity test concludes that the entire variable item is valid because its
significance value is less than 0.05 (0.05). Alpha-beta reliability tests Cronbach's alpha
coefficient was.873, indicating that the instrument used to acquire the data is
extremely reliable. The overall score ranged from 27 to 104 (the availability of sanitary
infrastructure ranged from 11 to 43, hygiene and health facilities ranged from 8 to 30,
and canteen availability was from 8 to 32).
Analysis of results and statistics
The data was tabulated and verified in pairs to correct any typing errors before being
analyzed with the IBM SPSS Statistics Subscription Trial. First, descriptive statistics
were computed for numerical variables using measures of central tendency (mean,
standard deviation minimum, maximum) and proportions for categorical variables.
Furthermore, SPSS software and the Kruskal-Wallis nonparametric test were used to
examine the study hypotheses.
RESULTS
Demographic data
This research looked at descriptive information regarding the features of the schools
studied. As shown in Table 1, the highest percentage is associated with schools that
implemented face-to-face learning during the pandemic (99.7%), while the lowest
percentage is related to schools that implemented blended learning and online
learning (0%). Learning occurs practically every day (97.8%), and almost all learning
time (85%) is spent in line with the school curriculum (Table 1)
Table 1 Characteristics of school
Characteristic n(%)
Implemented face-to-face learning
a. 100%
b. 75%
c. 50%
d. Online learning
346(99,7%)
1 (0,3%)
0
0
Learning frequency per week
a. Everyday
338 (97,8%)
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b. Switched 9 (2,6%)
Learning duration
a. According to the curriculum
b. ≥ 6 hour/day
c. <6 hour/day
295 (85%)
12 (3,5%)
40 (11,5%)
Descriptive analysis
The mean score on sub-variable availability of sanitation infrastructure, cleanliness,
and health facilities was high (27.49/5.391), with the evaluation of teacher participants
yielding the highest mean score (30.52/4.808). Canteen availability has a mean score
of 18.84 (4.094), with teacher participants receiving the highest score (19.45/4.298).
The last sub-variable, behaviour of adhering to health guidelines, had a mean score of
20.89 (4.641), with the principal's participants having the highest mean score
(22.93/4,363) Table 2.
Overall, from highest to lowest, the evaluation of the implementation of health
protocols in face-to-face learning is an assessment of principal participants 74.29
(13.923), an assessment of teacher participants 71.03 (10.551), and an assessment of
student participants 65.91. (12.316).
Table 2 Descriptive analysis per sub variabel
Participants Sub variables Total
Availability of
sanitation
infrastructure,
hygiene and
health facilities
Canteen
availability
Behavior of
maintaining health
protocols in
schools
Min Ma
x
Mean
(SD)
Mi
n
Ma
x
Mean
(SD)
Min Ma
x
Mean
(SD)
Min Ma
x
Mea
n
(SD)
School
principals
23 40 30.36
(4.56
4)
12 27 19.43
(4.61
4)
18 32 22.93
(4.36
3)
58 99 74.2
9
(13.
923)
56
Teachers 23 40 30.52
(4.80
8)
14 27 19.45
(4.29
8)
18 32 22.59
(4.39
6)
56 95 71.0
3
(10.
551)
Students 14 42 26.91
(5.34
4)
11 28 18.48
(4.02
3)
11 32 20.52
(4.61
6)
43 99 65.9
1
(12.
316)
Total 14 42 27.49
(5.39
1)
11 28 18.64
(4.09
4)
11 32 20.89
(4.64
1)
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Comparison analysis
Hypothesis 1: There is a considerable difference in participants' availability of sanitary
infrastructure, hygiene, and health facilities. The Kruskal-Wallis test was performed to
test the above hypothesis, and the results are shown in the table below: As shown in
Table3, the value of Sig = <.001, which is less than 0.05, is less than 0.05.
Hypothesis 2: There is no statistically significant variation in Canteen availability
among participants. The Kruskal-Wallis test was performed to test the above
hypothesis, and the results are shown in the table below: As shown in Table3, taking
into account the value of Sig =.255, which is more than 0.05.
Hypothesis 3. There is a considerable difference in the behavior of participants in
sustaining health protocols in schools. The Kruskal-Wallis test was performed to test
the above hypothesis, and the results are shown in the table below: As can be seen in
Table 3, the value of Sig =.255 is more than 0.05.
Table 3 Comparison analysis based on partisipants
Variables Participants n Mean rank
Availability of sanitation
infrastructure, hygiene and
health facilities
Test statistic
a,b
Chi-square
df
asymp.sig.
School Principals
Teachers
Students
Total
20.479
2
<.001
28
29
290
347
227.77
229.88
163.22
Canteen availability
Test statistic
a,b
Chi-square
df
asymp.sig.
School Principals
Teachers
Students
Total
2.773
2
.255
28
29
290
347
193.18
194.79
170.07
Behavior of maintaining health
protocols in schools
Test statistic
a,b
Chi-square
df
asymp.sig.
School Principals
Teachers
Students
Total
14.225
2
<.001
28
29
290
347
223.63
215.53
165.05
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DISCUSSION
In general, learning in elementary schools has been almost entirely conducted face-to-
face in the classroom, under the Joint Decree of the Four Ministers, which states that
beginning with the 2022-2023 school year, odd semesters of learning have been
allowed face-to-face by paying attention to the state of the school area at levels 1 and
2 of the PPKM (Implementation of Community Activity Restrictions) and paying
attention to strict health protocols
(23)
. Learning is carried out every day (6 days per
week) with a learning duration that is under the curriculum. Only a tiny fraction of
schools plan to learn in an alternate method (3 days per week) with a maximum
learning time of 6 hours per day or not in compliance with the curriculum. This is
because face-to-face learning is tailored to the capability of classrooms and teachers,
hence some schools cannot conduct 100% face-to-face learning
(24)
.
The application of health protocols in face-to-face learning is separated into three sub-
variables: sanitation infrastructure availability, cleanliness and health facilities,
cafeteria availability, and behaviour of maintaining health protocols in schools. The
average value per sub-variable is relatively high in general. This is because the school
has begun to prepare health protocol infrastructure long before the implementation of
face-to-face learning is fully implemented to ensure that the school remains a safe
place for everyone to learn and that thorough planning and preparation are undertaken
by the principal, teachers, students, parents, and other school personnel
(25)
. Schools
must also carefully plan for the reopening of schools and alter existing buildings and
infrastructure to meet the defined requirements that are required for schools to
reopen
(26)
.
The assessment of the teacher in charge of health protocols in the school or the
teacher of a health-promoting school delivers the highest average score of the first
sub-variable, while the assessment of students generates the lowest average score.
The lowest score on this sub-variable is on question item number 10, which concerns
the availability of the Peduli Lindungi QRCode at the school's entrance and departure.
Almost many schools lack the Peduli Lindungi QRCode as a way of tracing people
who enter a public location, including schools, although obtaining the QRCode is
simple; every school registers to receive the QRCode online
(27)
. QRCode Peduli
Lindungi is also a government initiative to restrict the spread of COVID-19, thus public
facility managers should be aware of this
(28)
.
In the second sub-variable on the administration of school cafeterias during the
COVID-19 pandemic, teachers in charge of health procedures in schools have the
highest average assessment and school students have the lowest. The question item
with the fewest scores is number 12, which is about the capacity of the canteen that
has been opened 100%, implying that practically all school canteens have been
opened properly and the school cafeteria is rarely cleaned regularly. The school
cafeteria has been closed for a long time, and the school finally feels ready to reopen
the canteen; however, some schools are not ready to open the canteen, so the
practicality of the canteen is questionable
(29)
.
The last sub-variable in this study, school health protocol conduct, received the
highest average score from the principal's assessment. Question item number 25 has
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the lowest score of all the question items in this sub-component. This item inquires
about the practice of eating together and facing each other without keeping their
distance, implying that many students still do not retain their distance and face each
other when eating and drinking. This is possible since the school cafeteria has begun
to open completely, resulting in crowds when purchasing and enjoying meals from the
canteen, as the canteen is also a source of crowds that must be considered when the
school opens
(25)
.
In this study, researchers also investigated the differences in each sub-variable based
on participants to reach the results: there were differences in sub-variables of
availability of sanitation infrastructure, cleanliness, and health facilities based on
participants, which suggests that the evaluation between participants in this variable
differs from one another. There is no variation in the Canteen availability sub-factors
per participant, implying that participants' assessments of these sub-variables are the
same. Furthermore, there are variances in the evaluation of sub-variables of the
behaviour of maintaining health protocols in schools based on participation, implying
that the assessment of these sub-variables varies between one set of participants and
another. The equation of the assessment of canteen capacity by each set of
participants demonstrates that the research instruments utilized are fairly reliable.
Limitation of the study
The limitation of this study is that data gathering is not directly observed by the
researcher, thus the correctness of the data collected from the outcomes of
participants filling out the questionnaire cannot be cross-tested.
Contributions to nursing and health
The findings of this study help to broaden nurses' understanding of health promotion
as part of nursing intervention, particularly in health-promoting schools.
CONCLUSION
In this study, administrators, instructors, and students evaluated the adoption of health
protocols during face-to-face learning in primary schools. The study's findings revealed
that the introduction of health protocols in primary schools during face-to-face learning
was effective, with a high average total score. Participants' judgments of the
availability of sanitation infrastructure, cleanliness, and health facilities varied, as do
their assessments of the third sub-variable, the behaviour of upholding health
protocols in schools. Meanwhile, there is no variation in evaluation for the second sub-
variable, canteen availability.
Acknowledgement
All of the authors are grateful to the Sumedang Department of Education for assisting
and granting permission to gather data for this study.
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ISSN 1695-6141
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