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Fiska Silvia Raden Roro; Bambang Sugeng Ariadi Subagyono; Zahry Vandawati Chumada; Trisadini Prasastinah Usanti

Konsensus : Jurnal Ilmu Pertahanan, Hukum dan Ilmu Komunikasi 2025 Asosiasi Peneliti Dan Pengajar Ilmu Sosial Indonesia

A community service program (PKM) entitled "Skincare Product Dispute Resolution" was successfully implemented in Ngadi Village, Mojo District, Kediri Regency, involving village cadres, youth organizations, and community members, particularly housewives as skincare consumers. This PKM aims to provide solutions to skincare product disputes through five stages: outreach, training, technology implementation, mentoring, and sustainability evaluation. The outreach program began with a presentation on halal skincare products and consumer protection against misleading promotional practices, delivered by speakers from the Sharia Research Group (SReG) and the Non-Governmental Consumer Protection Organization. This program also includes in-kind and in-cash contributions, including training to improve customer service quality, ensure raw material quality standards and production processes comply with international standards, and ensure product information transparency. In addition, a loyalty program and transportation cost incentives were provided to affected consumers. PKM partners played an active role in providing information and inviting the community to participate in this activity. The implementation of this activity is expected to strengthen consumer trust and ensure protection of consumer rights related to skincare products.

Fitriani Fitriani; Maria Asyerem; Chiana Endemina Bonsapia; Inggrit Rita Uli Manik

Jurnal Kemitraan Masyarakat 2025 Lembaga Pengembangan Kinerja Dosen

Sambofuar Village in Samofa District, Biak Numfor Regency, faces various maternal health challenges due to limited access to healthcare services, low socioeconomic conditions, and inadequate capacity of posyandu cadres in supporting pregnant women with high-risk conditions. With a population of 954 people and 228 households, only 64% of pregnant women received antenatal care during the second trimester, while 18% did not undergo any pregnancy check-up. To address these issues, the Student Creativity Program was implemented using a community-based cadre empowerment approach. The program was carried out from October 11 to December 9, 2024, involving five posyandu cadres, most of whom were 50–59 years old, had an elementary school education, and had more than five years of experience. The intensive training provided resulted in a significant increase in knowledge, where pre-test scores ranging from 30–50 improved to 70–90 in the post-test. Mentoring activities at the posyandu also showed that all cadres (100%) were able to perform their duties effectively, including providing health education and independently assisting high-risk pregnant women. This program has contributed positively by improving cadre competency, strengthening maternal health literacy, and potentially reducing the risk of pregnancy complications. Overall, cadre empowerment through training and education has proven effective and should be continued to strengthen the maternal health system in Sambofuar Village.

Ardilla, Arista; Zulkarnaini, Zulkarnaini; Sutrisna, Eka; Aulia, M. Kahfi; Maulida, Husna +4 more

Jurnal Pengabdian kepada Masyarakat Wahana Usada (WUJ) 2025 Sekolah Tinggi Ilmu Kesehatan KESDAM IX/Udayana

Background: Stunting remains one of the leading public health problems in Indonesia, including in Blang Teue Village, Lhokseumawe City, where the prevalence reaches 27.6%. Purpose: This community service program aimed to develop an innovative community-based production model for locally sourced complementary feeding (MP-ASI) through the empowerment of PKK women’s groups and Posyandu cadres. The program focused on improving nutritional knowledge, production skills, and digital capabilities related to child growth monitoring. Methods: The Participatory Action Research (PAR) approach was employed through several stages, including identification of local food resources, training on the production of nutrient-dense complementary foods made from mackerel and moringa leaves, and digital education for promotion and child growth recording using Google Sheets. Results: The program demonstrated significant improvements, including an increase in knowledge related to stunting prevention (participants in the “good” category rose from 5% to 72.5%), enhanced production skills for NABUNG complementary food (85%), and improved digital literacy among Posyandu cadres in creating educational media and recording child growth data. Conclusion: This program successfully developed an innovative community-based MP-ASI production model that not only supports stunting prevention but also strengthens digital literacy and fosters community independence in managing child nutrition

Januarti, Luluk; Yulianto, Sofi

Jurnal Pengabdian kepada Masyarakat Wahana Usada (WUJ) 2025 Sekolah Tinggi Ilmu Kesehatan KESDAM IX/Udayana

Community preparedness for disasters and emergencies is an essential component in reducing morbidity and mortality. This community service program aimed to empower the community in emergency response through optimizing the role of tourism actors based on Tourism Health Nursing in Versel Village, Pasean District. The methods implemented included socialization, risk screening, the establishment of health cadres, the development of an emergency response handbook, creation of health education media, as well as training and simulation activities. The training covered topics such as recognizing emergency conditions, management of cardiac arrest and respiratory failure, choking, first aid (P3K), utilization of household materials in emergency response, management of febrile seizures, and stress management. The results showed a significant improvement in cadres’ understanding, where prior to education, training, and simulation, most participants (60%) had low comprehension, while after the intervention, almost all (90%) demonstrated good understanding. These findings indicate that the program successfully enhanced the capacity and preparedness of the community—particularly health cadres—in managing emergencies and disasters within the tourism-based community environment.

Rina Anggraini; Rani Darma Sakti Tanjung; Febri Aulia

Sevaka : Hasil Kegiatan Layanan Masyarakat 2025 STIKES Columbia Asia Medan

The development of information technology offers great opportunities to improve public health services, particularly in managing health data for pregnant women and toddlers. However, at the community level, challenges remain such as manual recordkeeping, limited digital literacy, and the absence of integrated data systems. This community-based digital health data mentoring program aims to enhance the capacity of local cadres and residents to manage health data digitally, accurately, and sustainably. The methods included socialization sessions, training on health data recording applications, and field mentoring over a three-month period in community health posts. The results showed a significant improvement in cadres’ ability to use digital applications (from 45% to 90%) and a 60% reduction in data reporting time. Moreover, the quality of health data collected became more valid and easily accessible to medical staff and local health centers. This program has proven effective in fostering community independence in technology-based health data management and has the potential to be replicated in other regions with cross-sectoral support.

Marni Marni; Ester Novita Desi

Jurnal Pengabdian Sosial 2025 Lembaga Pengembangan Kinerja Dosen

This community service activity aims to strengthen the leadership capacity of youth and congregations at the Faithful Christian Church of Indonesia (GKSI) Ampadi, West Kalimantan, through empowerment programs and training based on spiritual values. The church as a faith community has a strategic responsibility in creating leadership regeneration, but the reality on the ground shows that youth involvement in ministry is still limited. This service activity was carried out with a participatory and qualitative descriptive approach, through stages of observation, literature study, spiritual leadership training, cross-generational mentoring, and direct assistance to participants. The results of the activity showed that the low participation of youth in GKSI Ampadi was caused by a lack of structural development, the dominance of the senior generation, and the absence of a clear cadre system. Through a Bible-based leadership training program, the formation of an inclusive ministry team, and ongoing mentoring, there was a significant increase in youth involvement and synergy between congregations. In addition, this activity produced a leadership cadre roadmap as a strategic guide for the church in developing human resources for ministry. This service activity not only had an impact on improving the quality of service and congregational activity, but also strengthened the process of sustainable leadership regeneration within the local church environment. It is hoped that this empowerment model can be applied contextually by other churches to build dynamic, inclusive, and contemporary service communities.

Hervina Halimi; Sofiansyah Fadli; Ilham Kusuma Jaya; Muhamad Amiza Surya

Jurnal Pengabdian Masyarakat 2025 Lembaga Pengembangan Kinerja Dosen

This community service activity aims to improve the knowledge and skills of parents and posyandu cadres in utilizing the Webalita application as a web-based educational media for monitoring child growth and development. The main problem faced in the community is the limited access and understanding of digital educational tools that can practically and accurately support early childhood growth monitoring. The program was carried out through training and mentoring activities, which included: (1) socialization on the importance of monitoring child growth and development; (2) training on the use of the Webalita application; and (3) evaluation of participants’ understanding through questionnaires and hands-on practice. The results showed an increase in participants’ knowledge and skills in accessing, operating, and utilizing the Webalita application, with a score of 81.5%. Participants also responded positively to the application as it was considered helpful in providing educational information related to child growth and development. Therefore, this training can serve as a solution to support community health digital literacy through technology-based approaches.

Hervina Halimi; Sofiansyah Fadli; Ilham Kusuma Jaya; Muhamad Amiza Surya

Jurnal Pengabdian Masyarakat 2025 Lembaga Pengembangan Kinerja Dosen

This community service activity aims to improve the knowledge and skills of parents and posyandu cadres in utilizing the Webalita application as a web-based educational media for monitoring child growth and development. The main problem faced in the community is the limited access and understanding of digital educational tools that can practically and accurately support early childhood growth monitoring. The program was carried out through training and mentoring activities, which included: (1) socialization on the importance of monitoring child growth and development; (2) training on the use of the Webalita application; and (3) evaluation of participants’ understanding through questionnaires and hands-on practice. The results showed an increase in participants’ knowledge and skills in accessing, operating, and utilizing the Webalita application, with a score of 81.5%. Participants also responded positively to the application as it was considered helpful in providing educational information related to child growth and development. Therefore, this training can serve as a solution to support community health digital literacy through technology-based approaches.

Iman Pasu Marganda Hadiarto Purba; Bambang Sigit Widodo; Siti Makrufah; Silkania Swarizona

Indonesia Bergerak : Jurnal Hasil Kegiatan Pengabdian Masyarakat 2025 Asosiasi Riset Ilmu Teknik Indonesia

Indonesia, as a pluralistic nation, faces significant challenges in maintaining social harmony amidst increasing globalization and cultural disruption. One strategy to strengthen the nation's ideological resilience is through religious moderation based on the values ​​of Pancasila and multiculturalism. This Community Service (PKM) activity was carried out in Widodaren Village, Gerih District, Ngawi Regency, with the aim of fostering tolerance, strengthening national identity, and internalizing the values ​​of religious moderation in community life. The implementation method includes three stages: preparation, implementation, and evaluation. The implementation stage includes Training for Anti-Radicalism and Intolerance Cadre Facilitators (KANIRA), a Religious Moderation Workshop, interfaith mutual cooperation activities, and a Village Diversity Festival. A participatory approach was implemented so that the community is actively involved in the entire activity process. All activities were carried out with a participatory approach so that the community can understand and internalize the values ​​of moderation contextually. The program's implementation has demonstrated the growth of dialogue, interfaith cooperation, and a spirit of togetherness among residents in daily life. The positive response from the community and village officials demonstrates that a value-based approach to religious moderation can be an effective means of strengthening national identity at the local level.

Ryan Agus Faisal; Halimah Tusakdiyah; Ramada Sandi

Sevaka : Hasil Kegiatan Layanan Masyarakat 2025 STIKES Columbia Asia Medan

Stunting is one of the chronic nutritional problems that remains a serious challenge in Indonesia, particularly in rural areas. This condition not only affects children's physical growth but also their cognitive development and long-term productivity. The low level of public awareness regarding balanced nutrition and proper parenting practices is a major factor contributing to the high prevalence of stunting. Therefore, community empowerment through village forums as a platform for advocacy, education, and cross-sector collaboration is essential. This activity aims to enhance the capacity of village communities to understand, prevent, and address stunting through participatory approaches. The methods applied include training for posyandu cadres, group discussions, and the establishment of village stunting forums involving community leaders, health workers, and local government officials. The results indicate a significant improvement in public knowledge and awareness regarding stunting prevention. The village forum also serves as a coordination center for policy advocacy and the implementation of nutrition programs at the local level. Thus, community empowerment through village forums has proven to be an effective strategy to strengthen community participation and enhance synergy between government, health institutions, and local residents in reducing stunting prevalence at the village level.

Rony Kriswibowo; Johan Suryo Prayogo; Danuditya Purna Atmaja; Lusi Fitria Yunani; Sayyidah Hajar Faiqotul Muhimmah +2 more

Nusantara: Jurnal Pengabdian kepada Masyarakat 2025 Pusat Riset dan Inovasi Nasional

The development of wearable technology, especially smartwatches, opens up great opportunities in preventive health monitoring, especially in rural areas such as Sembung Village, Wringinanom, Gresik, where access to health services is limited. However, this technology is still alien to the local community. Preliminary surveys show that the majority of citizens, including health cadres, have never used or even seen a smartwatch in person, and view it as a luxury and irrelevant item. In fact, the potential of smartwatches as “digital health assistants” is huge from tracking heart rate, blood oxygen levels (SpO₂), stress levels, to physical activity reminders that are essential for early detection of health disorders. This service activity aims to improve digital literacy and adoption of smartwatch technology through a participatory educational approach and direct assistance. Implementation methods include: (1) coordination with the village government and health workers, (2) Interactive socialization using local languages, (3) step-by-step practical training, (4) simulation of application in the field, and (5) pre-test and post-test evaluation of 27 participants (25 health cadres, 1 midwife, 1 nurse). The results showed significant improvements: function understanding from the original value of 1.8 increased to 4.2, consumption interest from the original value of 2.1 increased to 4.0, benefit perception from the original value of 1.9 increased to 4.3, self confidence from the original value of 1.5 increased to 3.8, and digital literacy awareness from the original value of 2.0 increased to 4.1. The hands-on approach proved effective in changing participants ' mindset from skeptical to enthusiastic, proving that the digital divide is not due to incompetence, but the lack of access to contextual education. The implication is that smartwatch has the potential to become a strategic tool for village health cadres in early detection and real-time data-based health education, provided that it is supported by sustainable mentoring.

Santy Handayani; Didik Nur Huda

Jurnal Pengabdian Masyarakat Indonesia Sejahtera 2025 STAI YPIQ BAUBAU, SULAWESI TENGGARA

Dengue Hemorrhagic Fever (DHF) is a disease that is often found in Indonesia. Efforts to prevent dengue fever need to be made because this disease is quite deadly. Community service was carried out at the Kebagusan Village Office, South Jakarta, which focused on training in the use of diagnostic kits by JUMANTIK cadres, Kebagusan Village. The method of this activity is in the form of socialization, introduction and training in the use of diagnostic kits for JUMANTIK cadres. This activity was attended by JUMANTIK RT 08 RW 04 cadres thereby increasing insight and knowledge of the use of malat diagnostic kits. The use of this diagnostic kit increases the work quality of JUMANTIK cadres to prevent dengue fever.

Suhardoyo Suhardoyo; A.Sudrajat; Roydawaty Bunga Sihol; Dudi Duta Akbar

POTENSI : Jurnal Pengabdian Kepada Masyarakat 2025 Fakultas Ekonomi dan Bisnis UNDARIS

Maternal and child health is an important indicator of public health development. However, at Posyandu Cendana, Bekasi, the optimal utilization of services remains low. Challenges include limited community knowledge, particularly among mothers, regarding the importance of posyandu services, low awareness of routine check-ups, and insufficient understanding among cadres in delivering clear and accessible health information. To address these issues, this community service program is designed in the form of socialization activities with participatory and educational approaches. The program covers maternal and child health education, practical training on child growth monitoring, the importance of immunization, balanced nutrition, and reproductive health. The stages include problem identification with cadres and posyandu managers, implementation through interactive lectures, group discussions, and field practice, as well as evaluation using pre-tests, post-tests, and observations of community participation. The program involves lecturers, students, posyandu cadres, and local officials to ensure sustainability. The expected outcomes include improved maternal knowledge of posyandu roles and publication of results in mass media and scientific journals.

Ekaviana, Dessy; Trisni Suryarini; Hasan Mukhibad; Nur Anita; Atik Ul Mussanadah +1 more

Nusantara: Jurnal Pengabdian kepada Masyarakat 2025 Pusat Riset dan Inovasi Nasional

Household organic waste production in Thekelan Hamlet has increased along with population density and agricultural activities, potentially having negative impacts on the environment and health. However, this waste actually has the potential to be processed into environmentally friendly products with economic value, one of which is eco-enzymes. This community service activity aims to increase community awareness and skills in processing organic waste into eco-enzymes through a participatory approach, technical training, and live demonstrations. The main partners in this activity are housewives and village environmental cadres, who are the main targets for introducing organic waste processing techniques. During the implementation, participants were trained on the benefits and how to produce eco-enzymes independently. This activity not only provided an understanding of the eco-enzyme production process but also motivated participants to produce eco-enzymes independently at home. The results of this activity showed a significant increase in understanding of the benefits of eco-enzymes as an environmentally friendly product, which can be used as a natural cleaner and organic fertilizer. In addition, participants also began to demonstrate the initiative to produce eco-enzymes independently, which has the potential to reduce household organic waste and increase economic value through the utilization of this product. The findings from this activity demonstrate that community-based waste management can not only be an environmentally friendly solution but also has high economic value. This empowerment model can serve as a sustainable model and be implemented in other areas, providing extensive benefits to the environment and the local economy. Furthermore, this activity introduced the concept of sustainable waste management to the community, providing them not only with new knowledge about organic waste processing but also with the opportunity to apply these techniques in their daily lives.

Ngesti Setyawati; Mohammad Arifin Noor; Indah Sri Wahyuningsih

Jurnal Kesehatan dan Kedokteran 2025 Lembaga Pengembangan Kinerja Dosen

Posyandu plays a crucial role in improving community health, particularly in monitoring the growth and development of children during the golden age. However, limitations in the knowledge and skills of Posyandu cadres are still frequently found, especially regarding anthropometric measurement of toddlers. This study aims to examine the effect of the flipped classroom educational method on the knowledge improvement of Posyandu cadres in anthropometric measurement of toddlers in Bumiharjo Village. This research employed a quasi-experimental design with a pretest-posttest control group. A total of 38 respondents were recruited and divided into two groups: the intervention group, which received education using the flipped classroom method, and the control group, which did not receive the same treatment. Data analysis was conducted using the Wilcoxon Signed Rank Test, Mann Whitney U Test, and ANCOVA to control for baseline differences. The results showed a significant improvement in knowledge in the intervention group after treatment (p=0.000), with the proportion of respondents in the “good” knowledge category increasing from 5.3% to 36.8%. In the control group, improvement was observed but limited (p=0.003), with no respondents reaching the “good” category. The Mann Whitney test indicated significant differences in posttest scores between the groups (p=0.000). Furthermore, ANCOVA analysis confirmed that after controlling for pretest scores, posttest scores remained significantly different (F=6.771; p=0.013). In conclusion, the flipped classroom method effectively improves the knowledge of Posyandu cadres regarding toddler anthropometric measurement. This strategy can serve as an innovative and sustainable alternative for cadre training, ultimately enhancing Posyandu service quality in addressing nutritional and health issues among toddlers.

Fauziyah Almas Janani Widodo; Imelda Febbynatasya; Reni Kusumah Wardani; Devita Sari; Dewi Suryandini +1 more

Jurnal Pengabdian Bidang Kesehatan 2025 PPNI UNIMMAN

Stunting is a chronic nutritional problem that impacts the physical growth and cognitive development of children, one of the causes is inappropriate parenting patterns such as exclusive breastfeeding, diet, and lack of nutritional fulfillment so that children are at risk of malnutrition. In Jember Regency itself, the high rate of stunting is a serious challenge for the government and the community that needs to be addressed. The selection of Gunungmalang Village as the location of community service is based on the high rate of stunting and early marriage as one of the causes of stunting. This community service activity began with training for Family Support Team (TPK) and Posyandu cadres, outreach to pregnant women, parents of infants/toddlers regarding the prevention and treatment of stunting, and a cooking demonstration of vegetable nuggets as an output of the activity by utilizing food ingredients that are easily available in the Gunungmalang community as an initial step to fulfill the nutrition of toddlers. This study uses a descriptive qualitative approach as a method from a case study of scientific paper research that describes factually and in detail related to the activities of the CINTA (Prevent Stunting and Increase Nutrition) work program. The objective of this scientific study is to implement a community service program through collaborative Community Service Programs (KKN) to prevent and address stunting in Gunungmalang Village. Data collection techniques used triangulation (observation, interviews, and documentation). This study demonstrates that the implementation of the community service program has a positive impact on increasing community awareness and changing behavior regarding stunting

Nura Shara Amirza; Nazariah Nazariah; Rina Hasnita; Dharina Baharuddin; Meutia Zahara

Jurnal Riset Rumpun Ilmu Kesehatan 2025 Pusat riset dan Inovasi Nasional

Hypertension is a non-communicable disease (NCD) with a high prevalence in Indonesia and is a major cause of serious complications, such as stroke, kidney failure, and heart disease. The high incidence of hypertension makes this disease a primary focus of NCD control efforts at the primary healthcare level. The Ulee Kareng Community Health Center has implemented a sustainable hypertension control program for the past three years with the aim of reducing the incidence of complications and improving patients' quality of life. This study aims to evaluate the implementation of the hypertension control program using a logic model framework that encompasses five aspects: input, process, output, outcome, and impact. The research method used is descriptive analytic with a mixed methods approach, combining quantitative and qualitative data to obtain a comprehensive overview of program implementation. The results indicate that the hypertension control program at the Ulee Kareng Community Health Center has had a positive impact. In terms of output and outcome, there has been an increase in patient compliance with therapy prescribed by healthcare professionals, a decrease in blood pressure in the majority of patients, and a decrease in the number of hypertension-related complications. This indicates that the program is quite effective in achieving its intended goals. However, several challenges remain. The main problems lie in the suboptimal data recording system and the suboptimal delivery of health education. To improve the program's effectiveness in the future, recommendations include strengthening the monitoring and evaluation system, increasing the capacity of health workers and cadres through training, and developing innovative media and educational strategies to make information more easily understood and applied by the public.

Restuning Prihati, Dyah; Prasetyorini, Heny

Jurnal Pengabdian Bidang Kesehatan 2025 PPNI UNIMMAN

Early detection of kidney disease is measured in terms of positive aspects where patient care can be given at the right time, improving a person's quality of life, and intervention can be given at an early stage of kidney disease, thus saving medical costs. The purpose of this activity is to provide education to health cadres to understand early detection and prevention of kidney disease so that the community understands and has knowledge about kidney disease. The stages of the implementation method, namely the socialization and training methods, aim to provide education to the community about the prevention and early detection of kidney disease. Health cadres who participated in PKM before being given education on prevention and early detection of kidney disease were 70% with a low level of knowledge, after being given education on prevention and early detection of kidney disease, it increased to 90% with a good level of knowledge. This proves that health education can be understood by health cadres. It is important to provide education on how to increase family support to help prevent and detect kidney disease early.

Desy Fadilah Adina Putri; Abdul Hamid; Nadia R. Kaleka; Evi Rosmiana

FUNDAMENTUM : Jurnal Pengabdian Multidisiplin 2025 Asosiasi Peneliti Dan Pengajar Ilmu Sosial Indonesia

The presence of scattered waste in the environment has a significant impact on both environmental sustainability and human health. In Indonesia, the accumulation of waste has reached alarming levels, amounting to approximately 175,000 tons per day, or the equivalent of 64 million tons annually. Household activities are one of the main contributors, producing a wide variety of waste, including organic and non-organic materials. Poto Village is among the areas receiving particular attention regarding this issue due to the challenges it faces in waste management. Improper management of waste not only leads to air, water, and soil pollution but also increases the risk of various health problems within the community. One of the programs designed to address this problem is the 3R program, which emphasizes three main principles: reduce, recycle, and reuse. The purpose of this community service initiative is to improve public knowledge and awareness of effective waste management through the application of 3R practices. The activities were carried out in three main stages, namely preparation, education, and discussion through a question-and-answer session. The process began with a socialization activity that introduced the objectives, purposes, and sustainability aspects of waste management efforts in the village. The educational session was attended by 30 participants, consisting of housewives, farmers, and entrepreneurs, who represented key groups within the community. Furthermore, interviews with local cadres revealed that waste is collected weekly by garbage trucks, indicating the village’s commitment to environmental management. Participants responded enthusiastically throughout the educational sessions, showing a strong interest and positive reception toward the information provided. As a follow-up step, future activities could include hands-on training in waste management using available media and tools, which would allow participants to apply the concepts learned in a practical and sustainable manner.

Jamila; Henna Mei Magdalena Purba; Maris Sembiring

Sevaka : Hasil Kegiatan Layanan Masyarakat 2025 STIKES Columbia Asia Medan

Cervical cancer is one of the leading causes of death among women in Indonesia, yet it is preventable through early detection such as VIA (Visual Inspection with Acetic Acid). Low health literacy and limited access to education remain key challenges in rural areas, including Tanjung Anom Village. This community service aimed to increase knowledge and participation of women of reproductive age in VIA screening through a clinic-based educational approach at Romana Clinic. A participatory method was applied by involving local communities, health cadres, and medical personnel. The results showed a significant increase in participants’ knowledge scores from an average of 54.6 to 78.9 after the training. A total of 39 women underwent VIA screening, and a women’s education group was established to ensure program sustainability. This activity also led to the emergence of local leadership and collective awareness as early signs of social transformation. The clinic-based education model has proven to be effective and suitable for replication in other rural settings.