The aim of this study was to gather data on condom use among brothel-based female sex workers in Indonesia and to study the reasons for not using condoms in order to provide new and existing condom promotion programs with information to improve their performance. Quantitative data were gathered by KABP surveys (n = 1450) and a condom diary with a sample of 204 female sex workers. Qualitative data were collected by conducting focus group discussions and in-depth interviews among female sex workers and pimps. Around 53% of sexual intercourses were reported to be protected, and 12% of these protected intercourses were preceded by clients' argumentation against it. Only 5.8% of sex workers consistently used condoms for a 2-week period of observation, and this figure decreased to 1.4% for a 4-week period. Reasons for not using condoms from the clients' side, as mentioned by the sex workers, were perceived less pleasure due to the condom and the belief that clients that are acquainted with the sex workers do not need protection against sexually transmitted diseases (STDs) or AIDS. The main reasons of female sex workers for not using condoms were the beliefs that boyfriends, native Indonesians and healthy-looking clients cannot spread STDs. Another reason stated was that sex workers had already taken other preventive measures, like taking antibiotics. The research also showed that pimps were not very supportive of condom use programs in Indonesia. Condom unacceptability is an important reason for not using condoms for both clients and female sex workers, whereas pimps, who are in the best position to encourage condom use, unfortunately consider condom use as a threat to their business. For the successful introduction of consistent condom use, it is necessary to design interventions for both sex workers and clients and to provide appropriate educational materials and preferred brands of condoms. Also, pimps must be involved in intervention programs.

Context: Training alone may not be sufficient to prompt complex and lasting changes in the performance of family planning providers. Affordable and effective reinforcement mechanisms are needed to ensure that providers apply new skills on the job. Methods: In December 1997 and January 1998, 201 providers working at 170 clinics in Indonesia attended a training course on client-centered counseling. They were divided into three subgroups for follow-up. One group (controls) received no reinforcement, one conducted weekly selfassessments and the third attended peer-review meetings in addition to conducting selfassessments. Data were collected before training, immediately afterward and after four months of reinforcement to measure changes in provider and client behavior. Results: In the month after training, counseling sessions were about twice as long as before, and providers offered twice as much information and counseling on medical and family planning issues. The frequency of providers' facilitative communication (which fosters rapport and client participation) doubled from 15 to 30 instances per session, and the number of clients' questions increased from 1.6 to 3.3. After reinforcement, providers' facilitative communication, clients' active communication and clients' ratings of self-expression and satisfaction increased in the selfassessment group, but did not change significantly in the control group. Both providers' facilitative communication and clients' active communication improved further in the peer-review group, but this intervention did not affect clients' perspectives on the counseling experience. Conclusions: Self-assessment and peer review help maintain providers' performance after training and prompt continuous quality improvement. International Family Planning Perspectives, 2000, 26(1):4-12 *These clinic-based midwives should not be confused with village midwives, who are trained in fewer areas of health care and have more limited job responsibilities.

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Dietary patterns high in fibre and green leafy vegetables have shown an inverse association with lower risks of type 2 diabetes mellitus and improved glycaemic control. The study aimed to investigate the effects of increased vegetable intake and conventional diabetes diet on glycaemic control among type 2 diabetic patients. White-collar workers from one telecommunication company with type 2 diabetes were assigned to two treatment groups by cluster randomisation. Individuals with known type 2 diabetes and poor glycaemic control (HbA1c ≥8 g%) were eligible and a total of 84 subjects were recruited. Subjects in the intervention group (n 41) were offered to attend seminars and intensive coaching weekly to encourage them to increase raw vegetable intake. The control group (n 40) followed the conventional diet according to the guidelines of the Indonesian Society of Endocrinology. Glycated haemoglobin (HbA1c), plasma lipids, blood pressure, vegetable intake and anthropometric measurements were assessed at baseline and end line of 12 weeks intervention. A regression analysis was conducted using differences in HbA1C between baseline and 12 weeks as the dependent variable. Student's t test was conducted for the changes of biochemical indicators from baseline to end line during the period of 12 weeks intervention. Glycaemic control improved in the intervention group and mean HbA1C, fasting blood glucose and post-prandial blood glucose in the intervention group decreased significantly along with body weight, waist circumference and total cholesterol. The finding suggested that the intervention which emphasised raw vegetable intake contributed to improved glycaemic control among Indonesian adults with type 2 diabetes mellitus.

Introduction:In Indonesia, most training modules for health paraprofessionals have been adapted from existing foreign modules without assessment. In addition, there have been few studies on training development for this group. We aimed to develop, using a systematic tool, implement and evaluate a training module to improve the competencies of voluntary health workers (cadres) in communicating safe complementary feeding practice to caregivers of young children in Indonesia. Methods: A mixed methods approach was used. A qualitative study employing in-depth interviews, focus group discussions, mini-workshops, documentary reviews and expert validation was used to develop the training module, following a systematic approach. The module's effectiveness for improving the health workers' competencies was evaluated using a quantitative study with a non-equivalent pre-test and post-test control group design that included 70 (intervention group) and 68 (comparison group) voluntary health workers from a peri-urban district. Changes in the workers' cognitive, affective and psychomotor competencies were tested before and after attending a 3-day training module (intervention group) or a half-day event (comparison group). Results: A 24-hour learning session module on communicating safe complementary feeding was developed and used to train voluntary health workers. After the training, a significantly higher proportion of workers in the intervention group than in the comparison group were assessed as competent in the psychomotor and composite domains (psychomotor: 67.1% vs. 20.6%; composite: 74.3% vs. 36.8%; p<0.001). Conclusion: This systematically developed module was effective in improving the competencies of voluntary health workers regarding communicating safe complementary feeding practice to caregivers in Indonesia.