Island Settings Research Articles

A Holistic Approach for Coastal–Watershed Management on Tourist Islands: A Case Study from Petra–Molyvos Coast, Lesvos Island (Greece)

Shoreline configurations are a complex outcome of the dynamic interplay between natural forces and human actions. This interaction shapes unique coastal morphologies and affects sediment transport and erosion patterns along the coastline. Meanwhile, ephemeral river systems play a vital role in shaping coastlines and maintaining ecosystem sustainability, especially in island settings. In this context, the present study seeks to develop a holistic approach that views coast and watershed systems as a continuum, aiming to investigate their relationships in an island environment, while accounting for human interventions in the river regime. For this task, the empirical USLE method was employed to quantify sediment production and transport from the catchment area to the coast, while hydraulic simulations using HEC-RAS were conducted to assess sediment retention within flood-affected areas. Moreover, coastal vulnerability to erosion was evaluated by applying the InVEST CVI model in order to identify areas at risk from environmental threats. The coastal zone of Petra–Molyvos, Lesvos, Greece, was selected as the study area due to ongoing erosion issues, with particular emphasis on its interaction with the Petra stream as a result of significant human intervention at its mouth. According to the study’s findings, the examined coastal zone is highly vulnerable to combined erosion from wind and waves, while the river’s mouth receives only a small amount of sediment from water fluxes. Evidently, this leads to an increase in beach retreat phenomena, while highlighting the necessity for integrated coastal–watershed management.

Collaborative Governance Networks Supporting Sustainable Ecotourism: A Case Study of Gili Iyang Island, Indonesia

The development of sustainable ecotourism on Gili Iyang Island, known for its high oxygen levels and unique local culture, requires collaboration among diverse stakeholders through effective governance networks. This study investigates the roles and contributions of key stakeholders—including the Sumenep District Tourism, Culture, Youth, and Sports Office (Dinas Pariwisata, Kebudayaan, Pemuda, dan Olahraga Kabupaten Sumenep or Disparbudpora), the Andang Taruna Tourism Awareness Group (Kelompok Sadar Wisata Andang Taruna or Pokdarwis), village governments, and local communities—in developing ecotourism on Gili Iyang Island, Indonesia. Using a qualitative case study approach, data were collected through in-depth interviews, observations, and document analysis. Findings show that governance networks are crucial in enhancing community empowerment, building local capacity, and improving infrastructure to support ecotourism. Nevertheless, challenges remain, including limited resources, conflicts between villages, and minimal private-sector engagement. Strengthening Pokdarwis’ managerial capacity, fostering inter-community synergies, and attracting private sector involvement are identified as essential strategies to ensure sustainable ecotourism. This research contributes to the broader literature on collaborative governance in remote island ecotourism, offering practical insights for policymakers and stakeholders aiming to create resilient, community-driven tourism initiatives that can be adapted to similar island settings.

Space, Sexuality, and Thornton Wilder’s Villa Rhabani

Abstract Thornton Wilder composed his unfinished play Villa Rhabani—set on the cosmopolitan island of Capri—between 1920 and 1921. This article argues that the play explores the connections between particular spaces and the development of nonnormative sexual identities or practices. It shows how the island setting of Villa Rhabani is crucial to its depiction of queer characters who are associated with both fluid cosmopolitanism and the contestation of sexual binaries. First, Wilder explores how transnational sexual or romantic encounters, cultivated by the shifting cross-cultural exchanges of island life, can produce a flexible attitude to place-based identities. Second, he demonstrates how a mainland–island binary can be used to describe queer identities on the move. His characters’ oscillations between the mainland metropolis of Naples and small-town Capri appear fundamental to the plasticity of their sexual, familial, and national associations. These two dominant modes of portraying character interactions and setting, as well their relation, help reveal the imbricated relationship of space and sexuality. Wilder’s unfinished play, therefore, constitutes a significant contribution to queer transnational literature. The article also contextualizes the play within colonial and Orientalist discourses that have historically linked Southern Italy with same-sex eroticism. While Villa Rhabani draws on a language of exoticization to describe the behaviors of sexually permissive Italian men, it also questions these associations by showing how such practices may be instrumentalized by the economic precarity and desperate social conditions that prevailed in Southern Italy in the early twentieth century.

Implementing a new cyclotron facility: challenges and opportunities for advancing PET/CT imaging in an isolated island setting

Implementing a new cyclotron facility: challenges and opportunities for advancing PET/CT imaging in an isolated island setting

Ivermectin-Based Mass Drug Administration for Scabies in Northern India: A Single-Arm Community Intervention Trial.

Scabies and impetigo cause direct health effects and contribute to severe infectious and immune-mediated complications. Ivermectin-based mass drug administration can reduce scabies and impetigo prevalence in island settings with high prevalence, but the effectiveness in moderate-prevalence settings is not known. We conducted a single-arm, before-after community intervention trial. Mass drug administration was offered to the entire population of 4 villages in Uttarakhand, India. The treatment consisted of 2 doses, given 7 days apart, of oral ivermectin (∼200 μg/kg), or topical 5% permethrin if ivermectin was contraindicated. The primary outcome was the prevalence of scabies at 12 months compared with baseline, as diagnosed using clinical assessment and the 2020 International Alliance for the Control of Scabies criteria. Secondary outcomes included the prevalence of impetigo at each time point. The trial was registered with the Australian and New Zealand Trials Registry (ACTRN12619001712190). In January 2020, 1211 participants were enrolled (100% of the estimated village population). Treatment coverage was high-1204 (99.4%) and 1177 (97.2%) received 1 and 2 doses, respectively. Scabies was diagnosed in 91 participants (7.5%) and impetigo in 15 (1.2%). In February 2021, 1190 (98.3% of baseline) participants re-enrolled, and of these 11 had scabies (0.9%; relative risk reduction, 87.7%; 95% CI, 77.1%-93.4%) and 5 had impetigo (0.4%; relative risk reduction, 66.1%; 95% CI, 7.0%-87.6%). A single round of ivermectin-based mass drug administration substantially reduced the prevalence of scabies and impetigo in this setting with moderate scabies prevalence in northern India.

Mitigating the Threat of Invasive Mosquito Species Expansion: A Comprehensive Entomological Surveillance Study on Kastellorizo, a Remote Greek Island.

The expansion of the tiger mosquito, a vector that can transmit diseases such as dengue, chikungunya, and Zika virus, poses a growing threat to global health. This study focuses on the entomological surveillance of Kastellorizo, a remote Greek island affected by its expansion. This research employs a multifaceted approach, combining KAP survey (knowledge, attitude, practices), mosquito collection using adult traps and human landing catches, and morphological and molecular identification methods. Results from questionnaires reveal community awareness and preparedness gaps, emphasizing the need for targeted education. Mosquito collections confirm the presence of the Aedes albopictus, Aedes cretinus, and Culex pipiens mosquitoes, highlighting the importance of surveillance. This study underscores the significance of community engagement in entomological efforts and proposes a citizen science initiative for sustained monitoring. Overall, this research provides essential insights for developing effective mosquito control programs in remote island settings, thereby emphasizing the importance of adopting a One Health approach to mitigate the spread of vector-borne diseases.

Host-pathogen associations inferred from bloodmeal analyses of Ixodes scapularis ticks in a low biodiversity setting.

Tick-borne diseases, such as Lyme disease, babesiosis, and anaplasmosis, pose significant public health burdens. Tick bloodmeal analysis provides a noninvasive sampling method to evaluate tick-host associations and combined with a zoonotic pathogen assay, can generate crucial insights into the epidemiology and transmission of tick-borne diseases by identifying potential key maintenance hosts. We investigated the bloodmeals of questing Ixodes scapularis nymphs. We found that avian hosts, white-footed mice, and white-tailed deer fed the majority of larval ticks and differentially contributed to the prevalence of multiple tick-borne pathogens and pathogen genotypes in a low biodiversity island setting. Unraveling the intricate network of host-vector-pathogen interactions will contribute to improving wildlife management and conservation efforts, to developing targeted surveillance, and vector and host control efforts, ultimately reducing the incidence of tick-borne diseases and improving public health.

Permanent loss of barrier island resilience due to a critical transition in dune ecosystems

Barrier islands cover a large fraction of US coasts and support unique ecosystems and coastal infrastructure. The ‘barrier’ function of a barrier island depends on coastal dunes that can prevent storm flooding and widespread ecosystem loss. Furthermore, dune-less barriers are more susceptible to breaching and potential drowning under sea level rise. Here we study the transition from richly-vegetated barriers with mature dunes (‘high’ state) to dune-less barren barriers (‘barren’ state) using data from a representative set of barrier islands in Virginia, US. We find that these two states are possible stable solutions of a non-linear stochastic dynamics characterized by a tipping point at which barriers with elevation around beach berms experience a critical transition into a permanently barren state. Our results suggest that frequently-flooded dune-less barren islands are a natural endpoint of barrier’s evolution under sea level rise.

Sacred Isles: Islands as Sites of Religious, Spiritual or Supernatural Exception

The articles in this inaugural publication of the periodic section on ‘Sacred isles: Islands as sites of religious, spiritual or supernatural exception’ in Folk, Knowledge, Place examines the complex interplay between sacred isles, geography and human experience. Through empirical research, theoretical analysis and comparative studies, the papers contribute to island studies by revealing the layers of meaning embedded in island landscapes and their roles in spiritual and cultural life. The three articles in the present issue discuss diverse locations, covering distinct small island settings with sacred connections in England (St Michael’s Mount), Guernsey (Lihou) and the river islands of Guangzhou in China. Drawing from a rich body of scholarly work across island studies, folklore studies, religious studies and geography, this periodic section foregrounds how the inherent spatial characteristics of islands—such as isolation, defined coastlines and unique environmental conditions—imbue them with mystique and sanctity. Such attributes foster a heightened sense of space and intimacy with the environment and enhance their appeal as sacred sites. While highlighting how islands can embody cultural heritage and religious devotion, the articles also explain some of the ways sacred isles can transcend island space, moving between and across islands and related revered settings where a consideration of sacred interconnections becomes necessary for comprehending islands on their own terms.

Using Urban Building Energy Models for the Development of Sustainable Island Energy Systems

This study evaluates the use of City Energy Analyst, an urban building energy modelling tool, to design zero-carbon energy communities in low-industry isolated island settings. The research aims to test the effectiveness of the software during the development of sustainable energy systems in isolated microgrids and compares it with the widely used tool EnergyPLAN. The goal of the study focused on making a community self-sustainable, considering the rooftop area available in the populated settlements to install photovoltaic systems and distributed storage capacity. With this purpose in mind, the evaluated tool estimated the energy consumption of each building and the respective total annual consumption of Corvo Island, a location that is naturally isolated and dependent on fossil fuels. The results demonstrated that City Energy Analyst is an innovative tool to estimate energy consumption and potential energy generation of photovoltaic systems in a remote location, providing additional features to a traditional model and motivating further development of the associated plug-in. However, it requires initial time-consuming efforts to build a reliable model. As a complement, EnergyPLAN can be used to enhance the design, with the integration of the local existing and potential generation sources and to confirm the stability of the overall energy system. This tool introduced additional wind capacity and centralized storage into the model, testing the balance of the system. Therefore, the study proposes a framework combining the strengths of both tools to measure island energy systems, as they can complement each other, to build a strong analysis model.

Managed aquifer recharge in island aquifer under thermal influences on the fresh-saline water interface

Storing and utilizing freshwater in coastal aquifers with managed aquifer recharge (MAR) presents significant challenges, particularly in small island settings where seawater intrusion is a major source of groundwater salinization. Existing studies usually evaluate density-dependent flow under isothermal condition, which neglects the potential impact of temperature on fluid density. To fill the knowledge gap, we performed both laboratory experiments and numerical modeling to investigate the impact of warmer water injection on freshwater storage and extracted water quality for island aquifer. It is found that warmer water (70 °C) injection compromise the “barrier effect” achieved by normal water injection, resulting in a reduced ability to prevent coastal seawater intrusion by, creating an upward hydraulic gradient beneath the injection well. In addition, warm water injection result in a 5 % decrease in freshwater storage capacity for island aquifer. However, by employing a combination of receding tide cycles and intermittent injection-extraction operations, the duration of lowered saline concentration within the extracted water can be extended by approximately 10 % with an 11 % reduction in the overall extracted saline concentration. This study provides valuable insights into the influence of warmer water injection on coastal aquifer quality. The findings from both the laboratory experiments and numerical simulations enhance the understanding of thermal density-dependent dynamics of coastal aquifers, offering valuable guidance for effective freshwater storage and usage in island settings.

Freshwater microbial mud: Punctuated diagenesis during marine transgression in the Florida Everglades, USA

AbstractThis manuscript documents the diagenetic progression from deposition to early burial of freshwater low‐Mg calcite mud within a Holocene sequence of the Everglades and Florida Bay (Florida, USA). During initial, in situ burial, the texturally‐complex, organic‐rich mud, exhibits high susceptibility to alteration, within a primarily dissolution‐driven realm. Seaward, a brackish‐water transitional burial environment currently displays evidence of mixed precipitation and dissolution. This brackish stage burial alteration may be due to fluid exchange (a relatively high fluid‐to‐rock ratio) in a submerged estuary setting. Lastly, the burial environment in Florida Bay records a transgression from freshwater to near‐normal marine conditions. This island setting currently exhibits a diagenetic trend towards low‐Mg calcite precipitation in intervals of both the marine and freshwater mud. Burial of freshwater mud beneath nearly 3 m of marine mud during rising sea level appears to have preserved a considerable amount of original textures, as compared with younger freshwater deposits now within the transitional brackish‐water setting. Geochemical and textural data within the freshwater mud sections suggest that complex early diagenesis begins shortly after burial at the site of formation, and perhaps even during deposition. The findings herein document three major implications for coastal zone paludal carbonates: (i) that incipient textural diagenesis in low‐Mg calcite crystals can be extremely early and the stability and petrographic fidelity of these deposits are vulnerable due to the open, trellis‐like structure of the crystals; (ii) relatedly, the stable isotope signature of the original low‐Mg calcite crystals is also vulnerable to alteration by secondary precipitation within the open crystal structure; and (iii) during marine transgression, the paludal calcite crystals likely experience a shift from interstitial fluids that are dissolution‐dominated (freshwater) to more precipitation‐dominated as marine fluids overtake the pore fluid regime. Because palustrine deposits are used as palaeoenvironmental archives, it is important to understand their diagenetic and preservation potential. This study has implications for those concerned with the deposition, reactivity and preservation potential of continental and microbial carbonates.

Islands and Neurology: An Exploration into a Unique Association.

The current study investigates the intricate connection between neurology and islands shedding light on the historical, epidemiological, and genetic aspects. Based on an elaborate literature review, we identified neurological conditions having a significant clustering in an island(s), confined to a particular island(s), named after an island, and described first in an island. The genetic factors played a crucial role, uncovering disorders like Cayman ataxia, Machado Joseph disease, SGCE-mediated dystonia-myoclonus syndrome, X-linked dystonia parkinsonism, hereditary transthyretinrelated amyloidosis, Charcot Marie Tooth 4F, and progressive myoclonic epilepsy syndromes, that exhibited remarkable clustering in diverse islands. Local customs also left enduring imprints. Practices such as cannibalism in Papua New Guinea led to Kuru, while cycad seed consumption in Guam triggered Lytico-Bodig disease. Toxin-mediated neurologic disorders exhibited intricate island connections, exemplified by Minamata disease in Kyushu islands and atypical parkinsonism in French Caribbean islands. Additionally, the Cuban epidemic of amblyopia and neuropathy was associated with severe nutritional deficiencies. This study pioneers a comprehensive review narrating the genetic, environmental, and cultural factors highlighting the spectrum of neurological disorders in island settings. It enriches the medical literature with a unique understanding of the diverse influences shaping neurological health in island environments.

Volcanic Flank Collapse, Secondary Sediment Failure and Flow‐Transition: Multi‐Stage Landslide Emplacement Offshore Montserrat, Lesser Antilles

AbstractVolcanic flank collapses, especially those in island settings, have generated some of the most voluminous mass transport deposits on Earth and can trigger devastating tsunamis. Reliable tsunami hazard assessments for flank collapse‐driven tsunamis require an understanding of the complex emplacement processes involved. The seafloor sequence southeast of Montserrat (Lesser Antilles) is a key site for the study of volcanic flank collapse emplacement processes that span subaerial to submarine environments. Here, we present new 2D and 3D seismic data as well as MeBo drill core data from one of the most extensive mass transport deposits offshore Montserrat, which exemplifies multi‐phase landslide deposition from volcanic islands. The deposits reveal emplacement in multiple stages including two blocky volcanic debris avalanches, secondary seafloor failure and a late‐stage erosive density current that carved channel‐like incisions into the hummocky surface of the deposit about 15 km from the source region. The highly erosive density current potentially originated from downslope‐acceleration of fine‐grained material that was suspended in the water column earlier during the slide. Late‐stage erosive turbidity currents may be a more common process following volcanic sector collapse than has been previously recognized, exerting a potentially important control on the observed deposit morphology as well as on the runout and the overall shape of the deposit.

Tracing the origins of Plasmodium vivax resurgence after malaria elimination on Aneityum Island in Vanuatu

BackgroundFive years after successful malaria elimination, Aneityum Island in Vanuatu experienced an outbreak of Plasmodium vivax of unknown origin in 2002. Epidemiological investigations revealed several potential sources of P. vivax. We aimed to identify the genetic origin of P. vivax responsible for the resurgence.MethodsFive P. vivax microsatellite markers were genotyped using DNA extracted from archived blood samples. A total of 69 samples from four P. vivax populations was included: 29 from the outbreak in 2002, seven from Aneityum in 1999 and 2000, 18 from visitors to Aneityum in 2000, and 15 from nearby Tanna Island in 2002. A neighbour-joining phylogenetic tree was constructed to elucidate the relationships among P. vivax isolates. STRUCTURE and principal component analysis were used to assess patterns of genetic structure.ResultsHere we show distinct genetic origins of P. vivax during the outbreak on Aneityum. While the origin of most P. vivax lineages found during the outbreak remains unidentified, limited genetic diversity among these lineages is consistent with a rapid expansion from a recent common ancestor. Contemporaneous P. vivax from neighboring Tanna and potential relapse of P. vivax acquired from other islands in 1999 and 2000 are also identified as minor contributors to the outbreak.ConclusionsMultiple reintroductions of P. vivax after elimination highlight the high receptivity and vulnerability to malaria resurgence in island settings of Vanuatu, despite robust surveillance and high community compliance to control measures.

Guam and the Circular Economy: Is the Island Ready? A look at the Phase I (Discovery Phase) Results of an Organization Development Action Research Study

This study presents the preliminary findings of a Phase I, qualitative investigation into the feasibility of implementing a circular economy model in Guam, a Small Island Developing State (SIDS). The purpose of this organization development (OD) research project is to discern the level of interest and receptivity towards the concept of a circular economy in Guam's unique island setting. With 44 participants (n=44) from the local business community and the general population, this study employed interviews and focus groups as part of a qualitative research approach. The research design aimed to gather insights and perspectives on the interest in a circular economy in Guam. The findings indicate a significant level of enthusiasm and interest in the circular economy among both the local business community and the general population in Guam. Stakeholders recognize the potential economic, environmental, and social benefits associated with transitioning to a circular economy framework, as revealed through the interviews and focus groups conducted. This discovery research represents a vital first step in understanding the readiness of Guam to embark on a circular economy journey. The positive response from the participants underscores the importance of further OD research and initiatives in this direction. The study highlights the need for policymakers, businesses, and communities to collaborate and explore the implementation of circular economy principles to maximize the sustainability and resilience of Guam's economy. It also emphasizes the significance of promoting sustainable economic development in Guam and other SIDS facing similar challenges.

How couples negotiate livelihoods in a Danish island setting: the role of history, geography and gender relations

Finding a way to make a living may be difficult if one lives in a small island with few possibilities for regular full-time jobs. Focusing on how co-habiting couples negotiate their livelihood options with each other and with the island setting, the paper shows how the local labour market and its inherent (im)possibilities are shaped by a specific history, geography and set of gender relations. Empirically, the paper draws on couple interviews from the Danish island of Læsø, with approximately 1800 inhabitants. The analysis shows how history, traditions, geography and gender relations impact on livelihoods and possibilities for developing new lines of work. It also shows how these factors continuously interact with one another and are negotiated by both individuals and couples. Underscoring the argument that island labour markets are different from mainland labour markets, the analysis suggests that the need for negotiation may be more obvious in an island setting which is demographically and economically under pressure. Islands cannot simply be treated as ‘smaller’ versions of mainland communities. They pose qualitatively different contexts. The palpable geographic borders of the island community entail that ‘everybody knows everybody’, thus enhancing visibility of individual choices and roles in the local labour market. Therefore, the impact of intangible factors may be enhanced in island settings, where deviations from tradition become immediately observable as people live in close proximity to one another.

Are community health agents the link to integrating care? Lesson from Brazil

Purpose This viewpoint piece will highlight the contribution of trained lay community health workers to the integrated workforce in rural, remote and island settings, drawing on experience from a system strengthening project involving community health agents (CHAs) in four municipalities in Litoral Norte, a remote coastal and island region in the state of São Paulo, Brazil.Design/methodology/approach This viewpoint reflects on experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.Findings CHAs took forward actions that touched the lives of thousands of vulnerable families with low income and complex needs in communities with high levels of social and health inequalities. They acted as a bridge between patients and families at home, primary healthcare professionals and wider community partners and services. Their valuable insight into the healthcare issues and social challenges experienced by the community informed and supported family centred practice and population health goals. The CHAs rapidly pivoted to became an essential public health workforce during the Covid-19 pandemic.Practical implications As the authors establish integrated care systems and embrace proactive care and population health, the conditions are favourable for introducing a similar role in the UK. For psychological safety and avoidance of burnout people in such new roles will require training, supervision and full integration within community teams.Originality/value This viewpoint reflects experiential learning from a unique north–south collaboration that spanned the period of a global pandemic. It adds to the international literature on the value of community health workers in public health and chronic disease management and highlights their potential pivotal role as integrators at point of care.

Development of a decision-making system for transportation in remote inter-island area

The transportation of goods and people between islands poses distinctive logistical hurdles due to the geographical remoteness and varied infrastructure prevalent in island settings. This study introduces a theoretical framework designed to improve the efficiency of selecting and routing hub islands in an inter-island logistics network by utilizing the hub-and-spoke model. The process of identifying potential hub islands involves an initial assessment of several criteria, encompassing geographical, economic, and equipment-related factors. The utilization of Floyd's algorithm was employed in the computation of the shortest distance matrices between islands, with consideration given to the avoidance of ship collisions. The identification of the required hubs is determined by employing a location set covering model, which includes a constraint on the maximum distance for service provision. The p-Median model was employed to ascertain the most efficient hub locations to minimize transportation expenses. The framework provides a quantitative approach to designing efficient logistics networks for inter-island transportation. It considers important factors, such as shipping routes, hub locations, and collision avoidance. The utilization of this methodology holds promise for augmenting connectivity and streamlining resource accessibility in geographically isolated island areas with limited infrastructure.

Model of Health-Promoting Community Health Center in the Islands to Support Healthy Cities in South Sulawesi Province

Purpose: This study aims to find a model of Health-Promoting Puskesmas in the archipelago in supporting healthy cities in South Sulawesi Province.
 
 Theoretical Reference: Some healthy setting thinkers believe that the healthy cities approach as a tool in solving regional health problems is seen as a too broad concept. The Healthy Islands Concept (HIC) is one of the initiatives which has elemental settings to promote health in island people and communities. Healthy Island refers to island settings, one of which is the Community Health Center (Puskesmas). Realizing Health-Promoting Hospitals has become a global movement. Otherwise, realizing Health-Promoting Puskesmas which has a different position and roles and responsibilities in improving health has raised difficulties. Moreover, health problems in Puskesmas in urban areas can be different from Puskesmas on the island.
 
 Methods: This study uses quantitative analysis. There were 700 respondents selected as sample. They were the community that go to the Puskesmas or those in the working area of the Puskesmas. The research locations are in 3 archipelagic regencies/cities, namely islands in Makassar City, Pangkajene Islands Regency, and Selayar Islands Regency. The data were analyzed quantitatively using Confirmatory Factor Analysis (CFA) and then analyzed using Structural Equation Modeling/SEM.
 
 Results and Conclusion: Based on the data collection, it was found that there are 7 dimensions with 28 indicators that can form a model of a health-promoting Puskesmas in the islands. Further, the dimension that has the strongest contribution in establishing the model of a health center in islands is the work group dimension of healthy puskesmas with an average loading factor value for each indicator of > 9 so that it can be illustrated that these indicators are stronger than other indicators existing in other dimensions of the Puskesmas models in the islands. A Puskesmas model that is suitable for archipelagic areas has implications for efforts to prevent and improve health, as well as provide quality health services.
 
 Implication of Research: Thus, this Puskesmas model can improve the health status of the island community.
 
 Originality: The results of this research are expected to be input for the Ministry of Health, the Health Service, Provincial and district/city Governments, and also for society as a whole in realizing a Health-Promoting Puskesmas.