A Study Of Sustainable Marketing After Pandemic Era In Indonesia

. The present study reports the first comprehensive study about rebuilt the business resilience is very important to achieve the rise healthcare industry especially hospital, because of their important role in the national economy. Most business organizations in Indonesia have experienced disruption caused by the covid-19 pandemic, not a few have ended up bankrupt and unable to survive. This research aims to formulate a framework for hospital marketing and business revival during and after a crisis like covid-19. The aim of this research is to analyze the influence of perceived benefits and culture in affecting clean and healthy living behaviors (PHBS) for patients, with the mediation of religiosity. This study is classified as quantitative research aimed at testing hypotheses statistically. The research subjects are drawn from 150 patients in a shariah hospital using survey research, resulting in the in-patient informant from two group of moslem hospitas group with the questionare. The research findings indicate that perceived benefits and culture, have significant impact on religiosity and PHBS. Religiosity plays a mediating role connecting perceived benefits and culture to PHBS in the shariah hospital. It is hoped in the future that hospital can restore their business conditions and be able to revive after the pandemic with the sustainable marketing.


INTRODUCTION
The development of the pandemic is the latest thing that cannot be predicted in the role of health services, for example one of the health service provider institutions (such as hospitals).In this case, sustainable bussiness and marketing after pandemic era, in Indonesia it is still not optimal and adequate in providing information about health [1].Eventhough health service actions in promoting disease, the consequences of disease, and overcoming them have been carried out since the beginning of the 2020 pandemic [2], [3].The health industry in the future is in line with the 17 government program targets in the signing of the 2030 SDG's Goals [4].It has been agreed at the United Nations (UN), that it must be sustainable to implement and maintain it [4].In general, sustainable health services are seen as health services that are better quality, more affordable, and have less impact on the planet, and can be accessed by everyone equally and efficiently.Sustainable provider health services like hospitals are often referred to as green health, which means providing health services, in an environmentally friendly manner that aims to improve health while providing a positive impact on society [5], [6].Sustainable health services can be implemented in various health institutions such as hospitals.In its implementation, hospitals also need to determine strategies to survive in business competition, such as implementation of business strategy management within the scope of sustainable competitive advantage in the hospital industry [7].Implementation of health promotion programs is very important to maintain desired health benefits, community capacity, and to optimize resources and investment [8].
Indonesia is one of the countries that has begun to implement a dual hospital system consisting of a conventional hospital system and a sharia (religious-based) hospital system which has begun to emerge in accordance with the Indonesia [9]  Sharia Principles [10].The existence of this sharia hospital is also very good for encouraging Muslim patients, for example those who are going to perform the Umrah or Hajj (Healthcare Tourism and Travel Medicine), to believe that medical treatment is also in accordance with Islamic rules and regulations.
Considering that currently there are many calls circulating in society not to trust medical treatment and to replace it with alternative treatment under the guise of religion.Recently, the Indonesian Islamic Health Efforts Council (MUKISI) which oversees sharia hospitals and encouraged the existence of a fatwa issued by the National Sharia Council (DSN) since 2016 which has become a reference for sharia hospitals [11].Islamic or Sharia hospitals can be health institutions that provide education and counseling to the public about the importance of maintaining healthy behavior in accordance with Islamic teachings.Health behavior is stated as any activity or behavior that is believed to be, and carried out to be healthy as well as behavior carried out by healthy individuals to prevent disease.In maintaining the health of patients in hospitals, it is necessary to have patient awareness which can be demonstrated in clean and healthy living behavior (PHBS) [12].This research discusses measuring community behavior in achieving a clean and healthy lifestyle by utilizing the role of religiosity which can increase perceptions of usefulness, trust, and minimize the risk of disease in the community on health, as well as promoting positive behavioral changes [13].Thereby collaborating and complementing marketing, and health promotion which is still conventional [14].In society, religious views can also influence someone in making decisions about one of the factors that influence consumer behavior are social factors which contain religious elements in them.Religious activities are closely related to religiosity, not only occurring when carrying out worship rituals but also other activities that are driven by inner strength.Responses, observations, thoughts, feelings, and attitudes towards obedience that are colored by religious feelings are called religiosity.Religiosity can be seen from religious activities in daily life which are carried out routinely and consistently [15].Clean and Healthy Living Behavior (PHBS) can have a significant role in the field of health marketing.Health marketing is an effort to promote products, services, or messages related to health and healthy living behavior to the public [13].PHBS can be the focus or important part of a health marketing strategy.Health marketing can focus on providing accurate and useful information about PHBS to the public, so it becomes important to ensure that health marketing related to PHBS is not only commercial, but also supports the welfare and interests of society.
Honest, accurate and educational communication is the key to designing an effective health marketing strategy [16], [17].In general, the previous research above shows the importance of religion in human social life.Religiosity influences tastes and dislikes in carrying out healthy living behavior.Religiosity also influences consumer orientation regarding healthy and halal food consumption patterns to achieve a healthier level of life [12].In the study of consumer behavior in health, clean and healthy living behavior (PHBS) is one of the things that everyone does all the times.The definition of healthy living behavior is often limited to what can be seen from the outside, relating to physical or psychomotor activities.Behavior from a biological aspect is defined as an activity or activity of the organization or living creature concerned [18].All living creatures, including humans, have behavior, because all living creatures have their own activities.Some of these behaviors can be observed directly and indirectly.From a medical and biological perspective, behavior is all human activities or activities, both those that are directly observed and those that cannot be observed by outside parties [19].This behavior occurs through the process of providing a stimulus to the organism and then the organism responding.This limitation indicates that health behavior is a person's response to stimuli or objects related to health and illness, disease and factors that influence health such as health services, food, drink, and the environmen [20].The PHBS concept has also been researched about healthy and clean behavior includes improving morals, health responsibility, exercise, nutrition, interpersonal relationship and stress management.These characteristics also place family medicine in a privileged position to address healthy hygiene behavior [21].

II. METHODS
Research was conducted with the approach used is a positivistic approach, namely a paradigm in scientific research that is based on the philosophy of positivism.This approach assumes that knowledge can http://ijstm.inarah.co.id 288 be obtained through objective observation, measurement, and analysis of empirical data [22].This study aims to examine the influence of perceived benefits, and the implementing a cultural health protocol on sustainable clean and healthy living behavior mediated by the religiosity variable.Thus, the research design used is survey research using a questionnaire [23].This research uses a purposive sampling technique, where the samples selected are patients who have met the inclusion and exclusion criteria set out in the research, so that the analysis results only apply to samples that have the same characteristics as those in this study.The research implementation, when researchers can exercise reflexivity in their quantitative research, that is open recognition of the complex influences among researchers, research topics and subjects about research results [24].The quantitative research method in this research uses questionnaire techniques and hypothesis testing as a form of testing the influence of each research variable, with the mediating variable religiosity of health consumers (or patients).In quantitative research it is also necessary to have transferability or relevance which refers to how useful the findings are in the context and phenomenon studied.The research uses a descriptive research design, which is a research method aimed at describing existing phenomena that are taking place at this time.Quantitative research methods are a systematic approach to designing, implementing, and analyzing research that uses data in the form of numbers or statistics to understand the phenomenon being investigated [25].

III. RESULT AND DISCUSSION
This study obtained respondents in this study were 150 patients who were described as follows.The patients who were respondents in this study were women with a percentage reaching 53.3%.Patients aged between 25 -39 years were the largest with a percentage reaching 54.7%.Meanwhile, according to the level of education, it is known that the patients are high school graduates with a percentage reaching 45.3% and only 2% of patients have taken a master's degree.Most of the patients who were research respondents in this study were also mostly moslem, this was due to the choice of research location, namely sharia hospital.The end results of data processing from the following list are the research informants.R-square R-square adjusted Sustainability PHBS 0,800 0,797 Religiosities 0,594 0,589

Fig 1.
Testing R Square Evaluation, source: researcher, data processed with SmartPLS The R Square value of 0.594 means that the variance in the variables of perception of benefits, and culture, has been able to contribute in explaining the variance of the religiosity variable of 59.4% while the rest is explained by other variables outside the model.The R Square value is 0.800.This means that the variance in the variables of perception of benefits, culture, and religiosity has been able to contribute in explaining the variance in the variable of clean and healthy living behavior by 80% while the rest is explained by other variables outside the model.

Hypothesis Testing 1
Based on the results of the PLS analysis, a statistical t value was obtained of 7.307 with a significance probability of 0.000.The statistical t value is > 1.96 and the p value is < 0.05 so that H1 is accepted, meaning that the perception of benefits has a positive and significant effect on Clean Healthy Living Behavior.This finding is strengthened by a coefficient value of 0.268, where every increase in the perception of benefits variable can increase Clean Healthy Living Behavior by 0.268 points assuming the other variables are constant.

Hypothesis Testing 2
Based on the results of the PLS analysis, a statistical t value was obtained of 6.976 with a significance probability of 0.000.The t statistical value is > 1.96 and the p value is < 0.05 so that H5 is accepted, meaning that culture has a positive and significant effect on Clean Healthy Living Behavior.This finding is strengthened by a coefficient value of 0.274, where every increase in the cultural variable can increase Clean Healthy Living Behavior by 0.274 points assuming the other variables are constant.Patients who have a culture of clean and healthy living can raise the need for clean and healthy living in Sharia-based hospitals.

Hypothesis Testing 3
Based on the results of the PLS analysis, a statistical t value was obtained of 4.727 with a significance probability of 0.000.The t statistical value is > 1.96 and the p value is < 0.05 so that H5 is accepted, meaning that perceived benefits have a positive and significant effect on religiosity.This finding is strengthened by a coefficient value of 0.264, where every increase in the benefit perception variable can increase religiosity by 0.264 points assuming the other variables are constant.Patients who consider cleanliness and health to be important to themselves will increase their religiosity in Sharia-based hospitals.

Hypothesis Testing 4
Based on the results of the PLS analysis, a statistical t value was obtained of 3.073 with a significance probability of 0.002.The t statistical value is > 1.96 and the p value is < 0.05 so that H8 is accepted, meaning that culture has a positive and significant effect on religiosity.This finding is strengthened by a coefficient value of 0.175, where every increase in the cultural variable can increase religiosity by 0.175 points assuming the other variables are constant.Patients who have a culture of maintaining cleanliness and health will increase their religiosity in Sharia-based hospitals.

Hypothesis Testing 5
Based on the results of the PLS analysis, a statistical t value was obtained of 3.317 with a significance probability of 0.001.The t statistical value is > 1.96 and the p value is < 0.05 so that H13 is accepted, meaning that religiosity has a positive and significant effect on Clean and Healthy Living Behavior.This finding is strengthened by a coefficient value of 0.192, where every increase in the religiosity variable can increase Clean Healthy Living Behavior by 0.192 points assuming the other variables are constant.Patients who have a high level of religiosity will give rise to the need for a clean and healthy life in a Sharia-based hospital.

Fig 2.
Testing Mediation Effects, source: researcher, data processed with SmartPLS The test results above show that the direct effect coefficient value of the influence of the perceived benefit variable on Sustainable PHBS is 0.268 and significant, while the indirect effect coefficient value of the influence of the perceived benefit variable on Sustainable PHBS is 0.051 and significant.There is a decrease in the coefficient value, this shows a form of partial mediation, meaning that religiosity partially mediates the influence of perceived benefits on Sustainable PHBS.The test results show that the direct effect coefficient value of the influence of cultural variables on Sustainable PHBS is 0.274 and significant, while the indirect effect coefficient value of the influence of cultural variables on Sustainable PHBS is 0.034 and significant.There is a decrease in the coefficient value, this shows a form of partial mediation, meaning that religiosity partially mediates the influence of culture on Sustainable PHBS.

The Influence of Perceived Benefits on Sustainable Clean Healthy Living Behavior
The results of the hypothesis test stated that perceived benefits was accepted, meaning that the perception of benefits had a positive and significant effect on Clean Healthy Living Behavior.Perception of benefits can significantly increase Clean Healthy Living Behavior.Patients who consider cleanliness and health to be important to themselves will have a need for a clean and healthy life in a Sharia-based hospital.Perceived benefits have a positive influence on clean and healthy living behavior because people tend to take actions that are considered good for their health if they believe that these actions will provide significant benefits.If patients believe that clean and healthy living behavior will improve their health, they will be more inclined to take this action.On the other hand, if patients believe that clean and healthy living behavior will not provide significant benefits, they will be more inclined not to take these actions.The results of this research are in line with various studies which state that there is an influence between perceived benefits on behavior.In health behavior theory, it is also stated that risk perception can influence healthy behavior through healthy living beliefs.http://ijstm.inarah.co.id 290 The Influence of Culture on Sustainable Clean Healthy Living Behavior The test results were hypothesized that culture was accepted, meaning that culture had a positive and significant effect on Clean and Healthy Living Behavior.Cultural variables can increase Healthy Clean Living Behavior significantly.Patients who have a culture of clean and healthy living can raise the need for clean and healthy living in Sharia-based hospitals.Culture has a positive influence on clean and healthy living behavior because culture can provide social norms that determine what is considered good and bad behavior.Culture can provide social support and social pressure to carry out clean and healthy living behavior.
If patients grow up in a culture that emphasizes the importance of health and self-care, they are more likely to adopt clean and healthy living behaviors.Apart from that, culture can also provide different ways of maintaining health, such as traditional or herbal ones that are accepted in society.Culture can also determine which activities are considered forms of exercise and health, thereby influencing individual choices in maintaining health.Therefore, culture can play an important role in encouraging clean and healthy living behavior in patients.The results of this research are in line with various studies which state that there is a cultural influence on behavior.In the theory plan behavior model, cultural aspects are also mentioned as factors underlying behavior.

IV. CONCLUSION
The results of this research are in line with various studies which state that there is an influence between perceived benefits and culture on behavior.In health behavior theory, it is also stated that risk perception can influence healthy behavior through healthy living beliefs [26].It is hoped that for further research the results can be widely generalized, for all above reasons, it is recommended to use probability sampling techniques or unconditional sampling, if there is indeed a new Indonesia Health Law Number 17 of 2023, new policies, as well as a new Presidential Regulation from the government on the Program BPJS and hospitals in serving future patients, especially on the "single class and single bed" policy.The future research that conducts studies by taking patients as research samples, it is recommended to provide full assistance when filling out the questionnaire, so that the research data obtained will be more accurate according to the actual conditions experienced by the patient.
Based on the findings of this research, there are several suggestions for managerial parties, related health agencies.This research found that the variable that has the most dominant influence on clean and healthy living behavior is the cultural variable [27].Efforts to increase patient awareness to behave in a clean and healthy lifestyle in the medium term can be through providing information to patients regarding the importance of maintaining cleanliness and health along with the benefits obtained by maintaining cleanliness for the patient's physical health.This can be done through activities such as: Understanding Local Culture Management must conduct research or studies about the local culture in the place where PHBS will be implemented.This includes understanding the values, beliefs, and cultural norms that may influence health behaviors in patients.

Provision of Facilities and Facilities
Creating an environment that supports PHBS, including providing infrastructure facilities such as sports venues, shower facilities, bathrooms and access to clean water as well as providing rubbish bins with clear colors and instructions.

Education and Awareness
Hospital management can immediately start a short educational campaign to raise awareness about the health benefits of PHBS.This could be a short seminar, announcement, or easily accessible educational material.

Clear Health Communications
Management must provide a clear and structured message about the health benefits that will be obtained by following PHBS.These messages should be easy to understand and relevant [28].

Health Promotion Policy
Encourage the implementation of company or community policies that support PHBS, such as providing rest time for physical exercise, offering healthy food in the canteen, or facilitating regular health checks. V.
Ulema Council (MUI) since 2016 which issued a fatwa regarding hospital implementation guidelines.National Sharia Council (DSN) MUI fatwa number: 107/DSN-MUI/X/2016 dated, 1 October 2016.This is one of the references for the health industry, especially hospitals, if they want to be sharia-based in providing health services to patients, based on result of International Islamic Healthcare Conference & Expo, Indonesia in 2023.Apart from that, it is strengthened by Law Number 44 of 2009 article 19 concerning Special Hospitals and Legislative Regulations Directory of Decisions of the Supreme Court of the Republic of Indonesia of in year 2016, concerning Guidelines for Organizing Hospitals based on http://ijstm.inarah.co.id 287