Using a Participatory Learning and Action Approach to Improve Young Papuans and Moluccans’ Knowledge of Herbal Drinks to Increase Immunity During the COVID-19 Pandemic

: The introduction of coronavirus disease (COVID-19) into the human population represents a tremendous medical and economical crisis. The immune system plays a central role in protecting against this novel virus. This activity aimed to empower young generation of Papua and Maluku who lived in Salatiga Central Java using participatory learning and action approach to improve their knowledge about medicinal plants that grow in Indonesia and whose anti-inflammatory, antioxidant, immunomodulatory, and antiviral properties. It was found that most of the participants (94-98%) knew about medicinal plants. This activity also recorded a total of 35 medicinal plant species. Moreover, organoleptic test results showed that Kunyit Asam (consisted of turmeric and ginger) and Tealang (consisted of butterfly pea and lemongrass) were highly favored by panelists. Our results provide valuable information on the medicinal plants used as an immunity booster within the studied community.


Introduction
In early 2020, there was a new public health crises threatening the world with the emergence and spead of a new type of coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 1This COVID-19 has affected many people, not only in China but spreading to almost all countries and teritories in a short time including Indonesia and caused death. 2 systems that will both protect and lead to recovery in the event of infection. 12rbs are traditionally used in many therapeutic practices, if not as the main, then as the accompanying therapy in combination with medications, aimed at boosting immunity for prevention. 13Phytotherapy has repeatedly proven its effectiveness, including its ability to cope with infectious diseases. 14There are medicinal plants whose extracts have an inhibitory effect on viruses such as herpes simplex virus type 2, HIV, hepatitis B virus (HBV), smallpox virus and severe acute respiratory syndrome, as well as on viral strains resistant to conventional antivirus drugs. 15Traditional herbal medicine has been practised for many centuries in the Indonesian community to maintain good health and to treat diseases. 16Much of this knowledge, however, was not recorded and was verbally passed from generation to generation, whic is common in tribes living in remote areas. 17pua and Maluku have vast areas of land and many tribes that usually rely on medicinal plants for their health care. 18However, information about how widely knowledge on medicinal plants is disseminated is still very little.Previous study showed the importance of good documentation of medicinal plants diversity in Papua Islands. 19nother study showed that documentation of traditional knowledge on medicinal plants used by local population of North Maluku was limited. 20In order to conserve the indigenous knowledge and to pevent the extinction of their medicinal plants resources, empowering young Papuans and Moluccans to utilize medicinal plants for strengthening immunity during the COVID-19 pandemic is required.The aim of this community service activity was to improve young Papuans and Moluccans' knowledge on medicinal plants that grow in Indonesia and have been reported to have antioxidant, antiviral, antiinflammatory and immunomodulatory characteristics using participatory learning and action approach.This activity is expected to motivate assisted community members understand the importance of medicinal plants to strengthen the immune system to fight against COVID-19.

Method
This community service activity was held in Salatiga, Central Java for three months using participatory learning and action approach and involving young Papuans and Moluccans living in Salatiga as assisted communities.Based on the participation category,21 this community service activity consisted of 4 stages namely passive participation, participation in information giving, participation by consultation, and functional participation (Figure 1).The passive participation stage was intended to provide information to the assisted communities.Assisted communities participated by being informed by the external professionals about the activities to be carried out, namely the use of medicinal plants, without any hearing to assisted communities' responses.The information being shared belongs only to external professionals.Information about the use of medicinal plants was given though zoom meeting application.
The second stage was intended to explore the initial knowledge of the assisted communities about medicinal plants, traditonal herbal medicines, and their uses.In this stage, the assisted communities participated by answering questions from the external professionals using questionnaire survey.In addition, data were also obtained by conducting semi-structured interviews directly with the assisted communities.The data obtained through interviews were then collected and analyzed using a thematic analysis.
The third stage was intended to listen to the views of the assisted communities on the issue of knowledge and use of medicinal plants and traditional herbal medicines through focus group discussion (FGD) forums.This FGD also used zoom meeting media.Prior to the focus group discussions, the assisted communities receieved additional knowledge from the external professionals about medicinal plants species and traditional herbal medicines, as well as the importance of digitizing local knowledge.
In the fourth stage, the assisted communities formed groups to accomplished the activity goal namely making nutritious herbal drinks that can boost the immunity.These groups were still dependent on external professionals.In this functional participation stage, the assisted communities formed 8 groups.
To measure the acceptability of products from the assisted communities, an organoleptic test of herbal drink products was conducted by involving 10 consumers aged 16-43 years old.The parameters observed were appearance, taste, color, flavor, and texture using a 1-4 Likert scale.In addition, consumers also assessed the level of product innovation using a 1-4 Likert scale.At the of of the activity, reflection was also carried out to measure changes in knowledge and awareness of the assisted communities in utilizing medicinal plants using a questionnaire.

Results
This participatory learning and action activity in community service consisted of four stages.In the first stage namely passive participation, there were 163 young Papuans and Moluccans who were willing to become assisted communities in this activity.The assisted communities consisted of 70 men and 93 women with a distribution of 27 men and 22 women from Papuan ethnicity, and 43 men and 71 women from from Maluku ethnicity.Overall, the members of these assisted communities were between the ages of 20 to 30.
In the second stage namely participation in information giving, from all young Papuans as part of the assisted communities, 46 person (95%) answered that they less know or knew well and 3 person (6%) answered that they did not know about medicinal plants, while from all young Moluccans, 112 person (98%) answered that they less know or knew well and 2 person (2%) answered that they did not know about medicinal plants.The majority of respondents who knew medicinal plants got knowledge on these plants from their families, i.e. 85% and 80% for young Papuans and Moluccans, respectively.In addition, they also got this knowledge from experiences, neighbors/ friends, and the media.Based on the answers to the questionnaire and the results of semi-structured interviews, the number of medicinal plant species recognized by the young Papuans (35 species) was higher than that of the young Moluccans (30 species) (Table 1).There were nevertheless 13 medicinal plant species that recognized by both ethnicities namely cogon grass, liniment tree, ginger, common guava, lime, spadeleaf, drumstick tree, turmeric, Indian mulberry, roselle, bitterweed, citronella grass, and better pepper.
Of all medicinal plant species recognized by both ethnicities, 13 species, i.e. garlic, bitterweed, common fig, lime, true aloe, shoeblackplant, turmeric, Indian mulberry, stonebreaker, neem, mulberry, spadeleaf, and ant plant are plant species that have been shown to boost immunity.Many studies show that these plant species are well known to have anti-inflammatory, antioxidant, immunomodulatory, and antiviral.
Based on the results of the focus group discussion conducted in the third stage namely participation by consultation, the assisted communities were known to have a better understanding of medicinal plant species and traditional herbal medicines.In addition, the assisted communities also understood the importance of digitizing local knowledge on medicinal plant species and traditional herbal medicines.Furthermore, in the focus group discussion forum, some members of the assisted communities (40 young Papuans and Moluccans) expressed their opinion to the external professionals to make herbal drinks based on the knowledge they gained in the second stage of this activity (participation in information giving) and also discussed the ingredients and manufacturing methods.They wanted to combine plant parts used for medicinal ingredients from several medicinal plant species.
In the fourth stage namely functional participation, 40 young Papuans and Moluccans formed 8 groups.The formation of these groups did not involve external professionals.The eight groups of assisted community members made herbal drinks with recipes and manufacturing methods according to the creativity of each group (Figure 2; Table 2).The eight herbal drinks products named Jamu Mioko, Herbal Tim, Tealang, Tealang Plus, Dj Fresh, Kunyit Asam, Jahe Kencur, dan Berat Kencur.The results of organoleptic test on appearance, taste, color, flavor, and texture of the eight herbal drink products (Figure 3) showed that the Kunyit Asam was the most preferred by consumers, although it was considered less innovative by consumers.Tealang was the second herbal drink that was preferred and considered very innovative by consumers.
The reflection was carried out to measure the social changes in the assisted communities about the importance of using medicinal plants to strengthen immunity and avoid complications of COVID-19 infection.According to the result, it showed that majority (>81%) of young Papuans and Moluccans knew the medicinal plant species and plant parts that could be used for sthrengthening immunity.Majority of the assisted community members (>70%) even stated that they would plant or cultivate medicinal plants in their homes because 71-81% of them agreed that medicinal plants were useful for increasing immunity and 66-77% of them agreed that traditional medicines were safe.

Discussion
Herbal medicine hasbeen reported worldwide as an essential component of the cultural heritage of a group or society. 22In the rural areas of developing countries, where medicinal plants are often the only available and affordable treatment, the use of herbal preparations plays a crucial role in the livelihoods of people.23 Participatory learning and action approach was used for empowering young Papuans and Moluccans in utilizing medicinal plants.Although based on the level of community involvement, participation has been categorized into seven stages,24 this community service activity used only four stages ranging from 'bad' form of participation, i.e. passive participation to 'better' forms of participation, such as participation by consultation and functional participation.Functional participation was chosen because it captures the form of participation that is most often associated with efficiency arguments: people participate to meet project objectives more effectively. 25This participation is also the most frequently found type of participation in development. 26The last two participation stages namely interactive participation and self-mobilization were not used in this community service activity due to time and space limitation.
Passive participation is the most inadequate of the seven stages of participation because it is a unilateral announcement by an administration or project management without listening to people's responses.However, through this participation stage this community service activity receieved good responses from the assisted communities which was marked by the large number (163 people) of young Papuans and Moluccans wanted to take part in this activity.However, because passive participation does not even extend as far as consultation or making an input to decisions, the information is even often inaacurate, 27 empowerement require a high level of community participation practice that promotes active involvement of the assisted communities.
Based on the results of the second stage of participation namely participation in information giving, the assisted communities are known to have knowledge of various medicinal plants.The results of the interview also showed that their knowledge of medicinal plants is closely related to the knowledge obtained from family and also related to the resources that grow in their areas (especially gardens/ yards and forests).Other studies also showed the same results. 28However, there are significant differences in the number of medicinal plant species that are known by you Papuans and Moluccans.Young Papuans knew and used a greater number of medicinal plant species, although fewer members of the assisted communities were interviewed compared to the Moluccans.Although local ecologies are important in affecting how people interact with their biological surroundings, the selection of medicines is neither merely a reflection of epidemiological patterns 29 nor simply a function of the diversity and availability of ambient flora and fauna. 30Moreover, it is hypothesized that other factors explaining this knowledge acquisition such as direct observation of the surrounding environment, contact with peers, school programs or personal interest in medicinal plants. 31e highest stages of involvement of the assisted communities in this activity are participation by consultation and functional participation.In accordance with the description, in participation by consultation the external professionals listened to the wishes of the assisted community to make herbal drinks and helped them providing solutions.Furthermore, the assisted communities participated by forming groups to fulfill the predetermined goals related to this activity.In this last stage of participation (functional participation), young Papuans and Moluccans groups were able to make various herbal drinks which are expected to increase immunity.Based on the appearance, taste, color, flavor, and texture of herbal drink products, Kunyit Asam which contained turmeric and ginger, and Tealang which contained butterfly pea flower and citronella grass are the most preferred by consumers.The main ingredients in these two types of herbal drinks are known to have functions such as increasing immunity, antioxidant, anti-inflammatory, and antiviral. 32 Local knowledge of young Papuans and Moluccans about medicinal plant species plays a role not only in providing immune maintenance for local population but also has the potential to be shared outside the regions of the two ethnic groups.Therefore, empowering the assisted communities to understand and be motivated to preserve and develop medicinal plants to maintain immunity during the COVID-19 pandemic is very necessary.In addition, assistance to improve the skills of assisted communities in menufacturing medicinal plants that can boost immunity is also needed.Participatory learning and action approach can be used to empower the assisted communities, although several obstacles need to be considered, such as doubt and fear, lack of information, lack of understanding of the importance of participation, and environmental factors.

Conclusion
Even though research on medicinal plants has receive a lot of attention, collecting and information on the use of traditional medicinal plants and how this knowledge about medicinal plants disseminated among society members is very important.Participatory learning and action approach can be used for empowering the community although several obstacles such as doubt and fear, lack of information, lack of understanding of the importance of participation, and environmental factors need to be considered.
After participating in this community service activity, the assisted communities showed that they have experienced a variety of social changes regarding the importance of using medicinal plants to maintain immunity and avoid complications of COVID-19 infection.For example, the majority of assisted community members become more understood about medicinal plant species and traditional herbal medicine and the need to digitize this knowledge.They also stated that they would plant or cultivate medicinal plants in their homes, agreed that medicinal plants were useful for strengthening immunity, and suggested that traditional medicine was safe.

Figure 1 .
Figure 1.Flowchart of participation stage and their activities.

Figure 2 .
Figure 2. Traditional herbal drink products from assisted communities.

Table 1 .
Medicinal plant species recognized by respondents from young Papuan and Moluccan communities Tabel 2. Ingredients and how to make herbal drinks