Motivation and Performance of Cadres to Optimize Resilience of Comorbid Diabetes Mellitus in the Covid-19 Pandemic Era

Older adults and people who have a history of chronic disease (comorbid) are more at risk of contracting COVID-19, one of which is diabetes mellitus (DM). The role of cadres is needed to increase the DM patients’ resilience during the pandemic. Optimizing this resilience can be realized in achieving cadres’ performance where motivation is one factor. This activity is performed by increasing information to comorbid diabetes mellitus patients during the pandemic using coaching level, implementation level, and evaluation level. The motivation and performance were measured using questionnaires with observational analysis method. This activity was carried out on December 20, 2020, and was attended by 23 cadres under the guidance of the Candi Sidoarjo Health Center. From the observations and analysis results, it was found that 100% of cadres have high motivation, and 100% of cadres have good performance towards efforts to optimize the resilience of patients with diabetes mellitus comorbid in the Covid 19 pandemic era. Performance is a function of motivation, competence, and work system. The cadres’ self-motivation makes the urge to behave (performance) that provides benefits to others; this will give the cadres some satisfaction (self-actualization) and help to achieve government programs through posyandu activities. The cadres’ involvement is essential in optimizing the resilience of patients with diabetes mellitus comorbid in the Covid 19 pandemic. The motivation and performance of cadres need to be maintained and even increased to create a physically and mentally healthy society.


INTRODUCTION
In Indonesia, the primary COVID-19 was reported on March 2, 2020, in many instances. Records on March 31, 2020, showed 1,528 showed cases and 136 deaths. The mortality price becomes 8,9%; this information is the best in Southeast Asia (Susilo et al., 2020). Covid-19 affected almost all ages.
However, currently available data shows that the older adults and people with a history of chronic disease (comorbid) have a higher risk of developing this disease with worse complications. The chronic disease' history includes hypertension, diabetes mellitus, cardiovascular disease, and chronic lung disease (Perkumpulan Endokrinologi Indonesia, 2020in Simanjuntak et al., 2020. Of the 41 patients treated at Jin Yintan Hospital, China, COVID-19 patients were dominated by men (71%). Less than half have comorbidities, such as diabetes (20%), hypertension (15%), and cardiovascular disease (15%) (Huang et al., 2020dalam Parapasan & Artasya, 2020. The data obtained in 2018 in Sidoarjo Regency recorded 89,456 people suffering from diabetes mellitus (Sidoarjo, 2018 COVID-19 patients with diabetes tend to be twice as prone to develop severe COVID-19 symptoms and twice as likely to die from those symptoms (Kumar et al., 2020). In addition, COVID-19 patients with diabetes have a poor prognosis, so the life expectancy of COVID-19 patients with diabetes is shorter than those without diabetes (Wardani et al., 2022). Comorbidity in patients in the form of diabetes mellitus is also a risk factor for fungal co-infection in COVID-19 patients, which results in increased patient mortality and morbidity (Permana et al., 2020). People with DM have a high risk of contracting covid 19 and a poor prognosis if infected with covid 19. However, most people with DM only focus on preventing covid 19, so they forget to control blood sugar levels (Simanjuntak et al., 2020). The level of public attention to health is still low is likewise the reason for the high occurrence of non-communicable diseases (NCD). High blood strain, weight problems, excessive sugar levels, and high cholesterol are excessive hazard factors for NCD (Imam et al., 2021). Cadres have an important role in the implementation of POSYANDU. The cadres here are in charge of facilitating, preparing, and organizing POSYANDU (Lestari & Ayubi, 2021). Health Education involving health cadres has an essential role in society, considering that diabetes is very risky for the community (Imam et al., 2021). Health workers and health cadres can motivate to increase the participation of individuals, families, and groups in every health effort (Setiyaningsih, 2019). A person's motivation will increase if given an intervention such as counseling (Damawiyah & Septianingrum, 2020). The ability of cadres to mobilize the community can influence the behavior of people with diabetes mellitus to remain active in maintaining health. Therefore, motivation and high performance of cadres are needed to increase the resilience of diabetes mellitus patients in the pandemic era. Community service activities are strengthening cadres' motivation and performance through counseling on optimizing the resilience of diabetes mellitus comorbid patients in the Covid-19 pandemic.

METHOD
This community activity was implemented in the Kalipecabean Sidoarjo, attended by 23 cadres from the Candi Sidoarjo Health Center, carried out for two meetings on December 20, 2020, and December 21, 2021. The method for this community service activity was using three phases: the coaching phase, the implementation phase, and the evaluation phase. At the coaching phase, the team conducts an in-intensity study regarding the need for the topic to take delivery, permits and the implementation date. The second phase is the implementation phase of team strengthening motivation and education related to the management of diabetes mellitus patients, which was carried out on-site in the Kalipecabean Sidoarjo and by observing Health protocols (distributing masks, hand sanitizers, and vitamins). The final phase of this activity is the evaluation phase by assessing and distributing questionnaires regarding the motivation and performance of cadres related to the material provided.

RESULT AND DISCUSSION
Motivation is the dominant factor that consistently affects cadres' performance (Afifa, 2019). Compared to the number of people they serve, the limited human resources in public health causes the role of cadres to be significant in various health efforts or activities, especially in POSYANDU (Djuhaeni et al., 2010).
The Role of cadres in surveillance of sicknesses and fitness issues is to peer, pay attention, take notes to find signs and health troubles, locate, document, and make simple prevention and treatment efforts (Setiyaningsih & Ningsih, 2019).
Community service activities in the Kalipecabean, Sidoarjo, received a good response from the cadres.
The participants' enthusiasm is evidenced by the activeness of asking about the given topic. The results of our community service regarding the motivation of cadres are showed in Table 1. It can be seen that all cadres have high motivation (100%). Motivation shows the desire to try as hard as possible to achieve a goal (Husniyawati & Wulandari, 2016). Cadres with high motivation will try to increase citizen participation, especially people with diabetes mellitus, to improve their health status. Many cadres ask questions about diabetes management obtained from their experience doing POSYANDU. The cadres also paid close attention to the material, took notes, and no one left the room. Some coaching helps the cadres to build their motivation. Motivation established the cadres' personality to be more passionate about carrying out their duties and obligations. It is essential to form and maintain a conducive environment for the cadre by providing moral support from the closest family or the environment around cadres, for example, health workers (Afifa, 2019). Performance is a result of work in quality and quantity achieved by a person in carrying out his following the responsibilities that have been given. Performance can be seen or measured using performance appraisal (Khamida & Mastiah, 2015). Table 2 shows that all cadres have good performance (100%). Research conducted by (Nuryani et al., 2010)

CONCLUSION
Community service carried out in Kalipecabean Sidoarjo went fluently, attended by 23 cadres The activities included 3 stages, the material presented related to cadre motivation and diabetes mellitus, motivation measurements were carried out with 100% good results, and cadre performance measurements with 100% good scores. Enthusiastic participants are evidenced by the activeness of asking and answering questions. It is hoped that cadres will maintain and even increase motivation to continue to perform actively in delivering education to the public to improve health status, especially people with diabetes mellitus in the COVID-19 pandemic era.

UNKNOWLEDGEMENTS
We express our deepest gratitude to the Head of Stikes Hang Tuah Surabaya, for the help and support and the opportunity to serve. We also thanked the Head of Kalipecabean Sidoarjo, the head of Candi Sidoarjo Health Center, and the team and cadres for their support and good cooperation so that community service implementation can be implemented carried out smoothly. Thanks to the head of LP3M and the team for the support and opportunities. Hopefully, what we do gets ridho from Allah SWT. a b