Indonesian Journal of Community Engagement

Jurnal Pengabdian kepada Masyarakat Vol. 10, No. 2, June 2024, Page. 104-110
DOI: http://doi.org/10.22146/jpkm.92549

Screening Lung Cancer in Sampang Regency, Madura Through

Empowerment and Health Cadres Formation
Resti Yudhawati1,2,3 *, Laksmi Wulandari1,2 , Anna Febriani1,2 , Farah Fatma Wati1,2 ,
Richar Tomy Thendeyas1,2 , Nurul Atika1,2 , Wulan Rahmawati Hariputri1,2 ,
Donny Ardika Novananda1,2 , Shandy Billy Riyanto1,2
1
Department of Pulmonology and Respiratory Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
2
Dr. Soetomo General Hospital, Surabaya, Indonesia
3
Universitas Airlangga Hospital, Surabaya, Indonesia
Submitted: December 28th 2023; Revised: March 08th 2023; Accepted: April 29th 2024

Keywords: Abstract Treatment for lung cancer remains challenging since most of the patients
Community service seek medical advice at an advanced stage of disease. Sampang is one of the regencies
Early detection that refers many lung cancer patients in late stages to Dr. Soetomo Hospital, Surabaya,
Health cadres due to lack of information of lung cancer and early detection. Limited number of health
Lung cancer workers to deliver comprehensive education to all areas requires community volunteers
to fill this gap. The objective of this study was to educate and promote lung cancer
awareness to the health cadres in Sampang as well as training them to early detecting
individuals in the community with high-risk factors, as an attempt to bridge between
the health workers and community, therefore the number of lung cancer early detection
may be improved. Early identification of cancer may result in reduced morbidity and
mortality, and in some cases, if detected early enough, therapy may involve only surgery.
The education was provided for the health cadres by providing information related
to lung cancer and guidance to fill the questionnaire and scoring of lung cancer risk
factors. The participants’ understanding was measured using a pretest-posttest design.
Thirty health cadres have been successfully formed, and they have gained knowledge
of lung cancer and mastered capability to perform early-screening of lung cancer in the
community as shown by the increase of post-test result compared to pre-test. The health
cadres then implemented their knowledge of lung cancer early-screening by distributing
questionnaires of lung cancer risk factor scoring to residents using door to door methods.
The questionnaires’ evaluation collected by the health cadres showed that there were
93 residents with high-risk factors of lung cancer. In conclusion, the health cadres has
been capable to detect high-risk factors individuals in the community which further be
followed up by community health workers comprehensively.

1. INTRODUCTION
Lung cancer encompasses all malignant diseases of worldwide in 2020 (Global Cancer Observatory, 2020b).
the lungs originating from the lungs (primary). In The World Health Organization (WHO) reported that
clinical definition, primary lung cancer refers to malignant lung cancer was the leading cause of cancer deaths in
tumor originating from bronchus (bronchogenic carcinoma) 2020, accounting for 1.80 million death cases. Cancer
(Menkes RI, 2023). According to epidemiological data World Bank identifies lung cancer as the malignancy
obtained from Global Cancer Observatory (GLOBOCAN), that causes the greatest number of mortalities worldwide
the global incidence of lung cancer in 2020 amounted to (Global Cancer Observatory, 2020b; Goodarzi et al., 2019).
2,206,771 cases. This equates to 11.4% of all cancers Meanwhile, in Indonesia, the mortality rate of lung cancer

ISSN 2460-9447 (print), ISSN 2541-5883 (online)

*Corresponding author: Resti Yudhawati
Dr. Soetomo General Hospital, Jl. Prof. DR. Moestopo, Airlangga, Gubeng, Surabaya, Jawa Timur, 60286, Indonesia
Email: [email protected]

Copyright ©2024 Jurnal Pengabdian kepada Masyarakat (Indonesian Journal of Community Engagement)
This work is distributed under a Creative Commons Attribution-ShareAlike 4.0 International License

104 www.jurnal.ugm.ac.id/jpkm Vol. 10, No. 2,

Yudhawati et al. Screening Lung Cancer

in 2020 was 13.2%, or 30,843 death cases reported, community service activity as prevention attempt as well as
according to GLOBOCAN. This data establishes lung early screening of lung cancer by forming health cadres that
cancer as the leading cause of cancer fatalities in Indonesia further will be directly deployed to the people of Sampang
(Global Cancer Observatory, 2020a). The type of lung Regency to help promote lung cancer awareness and the
cancer and the complications that occur determine lung importance of self-health checking to the professionals as
cancer mortality. Comorbidities, infectious conditions, as early prevention and detection.
well as the stage and extent of cancer cell metastasis
contribute to increased morbidity and mortality (Sari et al., 2. METHOD
2019).
This community service activity was carried out in the
In Indonesia, treatment for lung cancer remains
Community Health Center of Camplong Sub-district in
challenging since most of the patients seek medical advice
Sampang Regency, Madura. The knowledge-sharing
at an advanced stage of the disease. This is primarily due to
session of lung cancer awareness was conducted on August
fear and ignorance towards the disease. Patient’s preference
29, 2023, in order to form health cadres for early detection
for using alternative methods, along with the misconception
of lung cancer to the society in Sampang Regency. This
about cancer, will decrease life expectancy and quality of
community service was held by the Community Service
life while increasing mortality (Amin et al., 2017; Jayalie
team from the Department of Pulmonology and Respiratory
et al., 2016). The ignorance and the delay in pursuing
Medicine, Faculty of Medicine, Universitas Airlangga in
medical help make treatment unattainable for these patients.
collaboration with health workers from the Camplong
The mortality and morbidity remain high because most of
Community Health Center. The targets of these activities
the patients present with late-stage cancer (Widjaja et al.,
are adult residents in Camplong Sub-district, Sampang
2019).
Regency, Madura, East Java. There are several steps in this
Sampang is one of the regencies that refers many lung
community service including preparation, implementation,
cancer patients to Dr. Soetomo Hospital, Surabaya, and
and evaluation.
unfortunately, a majority of these patients are already in
late stages of the disease. The risk factor of lung cancer 2.1 Preparation
in the society of Sampang Regency includes active and The preparatory activities were carried out by holding a
passive smoking activity, and indoor pollution. The lack of series of meetings with the health workers of the Camplong
knowledge of the danger of smoking among the Sampang Community Health Center, collaborating and providing
Regency community contributes as one of risk factor for guidance to the health cadres. These health cadres
lung cancer. Knowledge is closely related to the health were selected by one of the health workers in Sampang
awareness of individual (Patila & Sumargi, 2017). Community Health Center, who was the person-in-chief
Furthermore, health workers in Sampang experienced (PIC). The PIC contacted the leaders of each sub-district in
difficulties in the early detection of lung cancer in the Sampang, and each of the leaders selected several residents
community due to the limited number of personnel to cover who speak both Madurese and Indonesian well and have
the comprehensive communication and education to all good public communication as the health cadres.
areas including the marginal. Therefore, it is necessary
to empower community volunteers, referred to as health 2.2 Implementation
cadres, whom healthcare professionals will train to bridge 2.2.1 Community counseling
the gap between healthcare providers and the community.
These health cadres in the future will help the healthcare Community counseling was carried out on August
professionals in educating the community by providing 29, 2023, through providing education on lung cancer,
information related to lung cancer, including its symptoms, including its symptoms, risk factors, and hazards, as well as
risk factors, and hazards as well as collecting data of high- guidance to fill the questionnaire and scoring of lung cancer
risk individuals to be followed-up comprehensively. risk factors as early screening methods of lung cancer.
The formation of health cadres through empowerment The knowledge-sharing session was attended by community
has been performed in various diseases early prevention, leaders, head of community health center, and 30 health
including cervical cancer (Fitriyanti, 2022; Juwita & cadres.
Prabasari, 2023; Lestari et al., 2021), child-stunting The participants’ understanding was measured using
(Ahmad et al., 2023; Friska et al., 2022; Mediani et al., a pretest-posttest design. The pretest was given before
2005), COVID-19 (Agatha & Handayani, 2022), oral dental the session began, while the posttest was conducted by
disease and drug use (Aristiyanto & Harimurti, 2023). asking the participants to complete a questionnaire about
Early detection and prevention is one of the best ways lung cancer after the knowledge sharing was held and
to reduce mortality and morbidity. Based on previous given. Both used the same questions, which consisted of 10
studies, the health cadres have fairly good knowledge of the multiple choice questions. The education given was mainly
diseases and contribute to improving the quality of public about the definition, risk factors, symptoms and dangers of
health status. Thus, this Community Service team from lung cancer.
Department of Pulmonology and Respiratory Medicine, 2.2.2 Post-community counseling
Faculty of Medicine, Universitas Airlangga performed this
Every cadre in their own domicile was required to take

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Yudhawati et al. Screening Lung Cancer

random samples of 15–20 participants who met eligibility 3. RESULT AND DISCUSSION
criteria (more than 17 years old, has an Indonesian identity
card, resides and works in Sampang). The participants in The counseling was held on August 29, 2023, and was
lung cancer early screening included in this study were 577 attended by the head of local health service, head of
people. The health cadres conducted early detection of community health center, and 30 health cadres as shown
lung cancer by distributing questionnaires to the subjects in Figure 1. The event was carried out well and
using door-to-door methods. The questionnaires consisted smoothly thanks to the good cooperation between the
of patients’ identity and lung cancer risk factor scoring, Community Service Team and the Community Health
which was categorized into nine questions as below: Center Committee, as well as the enthusiasm of the cadres
and health workers of the Community Health Center to
1. Gender: male (3); female (1) listen and ask some questions. The counseling program
started at 09.00 WIB and opened with a remark from the
2. Age: >65 years old (3); 45–65 years old (2); <45 Head of Sampang Regency Health Service, the Head of the
years old (1) Camplong Community Health Center, video screening of a
remark by the dean of Universitas Airlangga’s Faculty of
3. Personal history of cancer: yes, >5 years ago (3); yes, Medicine, and remarks from the leader of our community
<5 years ago (2); never (1) service team. Subsequently, the event continued with a
presentation on Increasing Understanding of Lung Cancer
4. Family history of cancer: lung cancer (4); other than Early Detection, question and answer session, and post-test.
lung cancer (2); none (1) The results of the pre-test and post-test are shown in Table 1.
5. Smoking history: active smoker (4); past smoker (3);
passive smoker (2); non-smoker (1)

6. Exposure to carcinogenic chemicals in occupational

site for >5 years: yes (3); not sure (2); no (1)

7. Pollutant exposure in the residential area: yes (3); not

sure (2); no (1)

8. Unhealthy house environment: yes (3); not sure (2);

no (1)

9. Medical history of chronic lung disease: tuberculosis

(3); other chronic lung disease (2); never (1) Figure 1 . Community counseling in Camplong Community
Health Center
The severity of risk factors:
Based on the pre-test and post-test comparison results
• Low: ≤11 in Table 1, the number of health cadres who understood
the topic of lung cancer and its early detection after the
• Moderate: 12–16 presentation increased.
Following the community counseling, early detection
• High: 17–29 was performed by health cadres who had been educated by
distributing lung cancer risk factor scoring questionnaires
2.3 Evaluation to 577 subjects. The cadres were given the opportunity
In evaluating the knowledge of extension health cadres to implement their new knowledge and skills during the
after receiving counseling, the pretest and posttest were knowledge-sharing session by distributing the lung cancer
assessed by dividing them into two categories, namely high risk factors questionnaires to the selected residents in
with a value of more than 80 (>80) and low with a value Sampang via door-to-door method. The results of these
of less than and equal to 80 (≤80), then the results were investigation were evaluated to determine individuals in
compared to see the improvement of knowledge about lung Sampang who have high risk of lung cancer, that further
cancer. will be followed up routinely by Sampang community
The lung cancer risk factor scoring questionnaires health workers in Posyandu (Integrated Health Service
distributed to Sampang residents by health cadres were Post) using Kartu Sehat (Healthy Card) created by our
collected and sent to our team, and the data were processed community service team. If the clinical symptoms
to find patients’ characteristics according to the severity supporting lung cancer suspicion were found, the patients
of risk factors. In the long term, this activity is expected will be referred to the hospital to get better treatment. The
to contribute to the prevention and early detection of results of the questionnaires evaluation were presented on
malignant lung tumors and reduce morbidity and mortality Table 2, from those data it was obtained that 93 people in
due to delayed diagnosis of lung cancer. Sampang has high-risk of lung cancer.

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Yudhawati et al. Screening Lung Cancer

Table 1 . Pre-test and post-test questionnaire results

Pre-Test Post-Test
Variable
High Score Low Score High Score Low Score
Knowledge about lung cancer 30% 70% 86.7% 13.3%
and early detection screening (9 people) (21 people) (26 people) (4 people)

Table 2 . Patients’ characteristics according to questionnaires of scoring severity of risk factors

Risk Factors Severity
No Characteristics
Low (n= 216) Moderate (n= 268) High (n= 93)
1 Gender
Male 15 189 90
Female 201 79 3
2 Age
<45 years 139 139 28
45-65 years 63 108 55
>65 year 14 21 10
3 Ethnicity
Maduranese 213 265 90
Javanese 3 3 3
Others 0 0 0
4 Smoking History
Active smoker 5 136 76
Past smoker 0 7 8
Passive smoker 66 73 7
Nonsmoker 145 52 2
5 Respiratory Symptoms
Chronic cough 4 11 17
Hemoptysis 0 0 2
Shortness of breath 6 26 19
Chest pain 8 16 10
None 199 226 53
6 Non-respiratory Symptoms
Lump 0 3 6
Body weight loss 3 16 14
Weakness 6 28 16
Headache 29 50 22
Seizure 0 2 0
Paralyzed/Limbs weakness 2 7 2
Bone pain 13 27 13
Stomach disorders 1 5 5
Neck and arm swelling 0 0 1
Others 2 17 7
None 174 180 38
7 History of Tuberculosis Treatment
Former TB patients 0 5 7
On treatment 0 2 6
None 216 261 80
8 History of COVID
2020 0 0 0
2021 12 8 1
2022 0 0 0
Never 204 260 92
9 History of Diabetes Mellitus
Yes 6 9 6
No 210 259 87

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Yudhawati et al. Screening Lung Cancer

Early detection involves two important components: to maintain and early detect the disease progression
screening and education to identify symptoms and according to their abilities, because the most important
encourage an early diagnosis. Early cancer detection domain for shaping a person’s behavior is their knowledge
focuses on recognizing symptomatic individuals as soon as and cognitive abilities (Fazrin et al., 2021). According
possible in order to maximize their potential for successful to Hamariyana et al., (2013), cadres who have better
treatment. Early identification of cancer may result in knowledge will do better compared to those who have
reduced morbidity and improved survival, and in some low level of knowledge. This illustrates that the level of
cases, if detected early enough, therapy may involve only knowledge influences how cadres perform their duties.
surgery (Dillner, 2019; Schiffman et al., 2015; World Health In the future, the health cadres who have been formed
Organization, 2023). and empowered are expected to have a role as a provider of
Basic requirements for health cadres to actively education regarding lung cancer, helping to detect people
participate in the early detection of lung cancer include who have high risk factors for lung cancer and people who
knowledge and skills to maximize their respective roles, have already suffered for lung cancer, assisting community
which were expected to improve optimally with high health centers in guiding and motivating public to always
motivation. Empowerment is a systematic process aimed carry out health examinations as early as possible in high
at gaining a comprehensive understanding and control risk populations. The subjects who included in high-risk
over personal, social, economic, and political status to factors will be followed up for further examination at health
enact initiatives that can improve individuals’ health. facilities. In brief, the formation of the health cadres
This definition applies to both personal and community will be able to initiate a social marketing intervention by
settings and is a cornerstone of health promotion, as increasing public awareness, promoting a healthier lifestyle,
endorsed by the World Health Organization (WHO). and encouraging early reporting of symptoms, which is
Empowerment involves strategic approaches encouraging crucial because if lung cancer is discovered at an earlier
active participation, raising awareness, and forming stage, when it is small and has not spread, it is more likely
problem-solving skills, particularly targeting socially to be successfully treated.
disadvantaged groups (Lindacher et al., 2018).
To our knowledge, our project is the first to 4. CONCLUSION
empower community volunteers as health cadres to provide
The team has provided a counseling session for 30 health
a community-based intervention to raise lung cancer
cadres in collaboration with the Camplong Sub-district
screening awareness in the community. Previous study
Community Health Center health workers. The community
by Williams et al., (2021) promoted community awareness
service activity initiative aimed at early detection and
of lung cancer screening among disparate populations
screening of lung cancer was well received by the village
by training community professional health workers, and
government and the community, facilitating its successful
they suggested that community-engaged project found
execution. The post-test results showed that health cadres
were effective in increasing the knowledge of lung cancer
gained additional knowledge after counseling sessions
screening and in changing general cancer knowledge,
regarding the danger of lung cancer and guidance for early
attitudes, and beliefs related to lung cancer.
detection based on scoring risk factors. The success of
The post-test score presented a baseline finding of
forming health cadres was evidenced by their ability to
low knowledge about lung cancer screening, and this
identify 93 Sampang residents at high risk of lung cancer.
is consistent with another study by Smith et al., (2016)
The subjects who included in high-risk factors will be
that collected data from high-risk populations. The
followed up for further examination at health facilities.
intervention (knowledge sharing) effectively increased the
Hopefully, the established health cadres will be able to
basic knowledge of lung cancer risk factors and the ability
share knowledge and early detection of lung cancer with
to perform early lung cancer screening. The success of
the people of Sampang Regency, allowing this program to
forming health cadres was evidenced by their ability to
be implemented regularly every month to provide optimal
identify 93 Sampang residents who were at high risk of lung
intervention.
cancer. The findings of this study are in line with the study
conducted in the working area of the Kakaskasen Health ACKNOWLEDGMENT
Center, North Tomohon Regency, Tomohon City, which
found that there is a correlation between health cadres’ The authors wish to express their deepest gratitude to
knowledge and Posyandu service (Pakasi et al., 2016). the people of Camplong Sub-district in Sampang Regency,
Previous community service activities that provided Madura, for their invaluable support, which ensured the
training for health cadres concluded that educational smooth execution of this community service program. This
methods for the cadres have the beneficial effect of research and community service was funded by Universitas
raising knowledge and skills in sharing knowledge Airlangga through the program Pelaksanaan Pengabdian
regarding lung cancer with the public (Nurbaya et al., Kepada Masyarakat Skema Program Kemitraan Masyarakat
2022). The knowledge of the health cadres is the main 2023 (The 2023 Implementation of Community Service
modality required in promoting health awareness. Cadres’ under the Community Partnership Program Scheme). The
knowledge may increase by participating training program authors are also immensely grateful to Miss Nimas Roro

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Yudhawati et al. Screening Lung Cancer

Gayatri for her assistance in the editing and proofreading //gco.iarc.fr/today/data/factsheets/popu

process. lations/360-indonesia-fact-sheets.pdf

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