Syntax Literate: Jurnal Ilmiah Indonesia p�ISSN:
2541-0849
e-ISSN:
2548-1398
Vol.
7, Special Issue No. 1, Januari 2022
THE
RELATIONSHIP OF KNOWLEDGE, ATTITUDE AND BEHAVIOR EARLY DETECTION OF CERVIC
CANCER IN MIDWIFES IN PUSKESMAS SURABAYA
Fransisca Wiga Alda Maretha 1, Reny
I�tishom2, Pungky Mulawardhana3
1 Midwifery Study
Programme, Faculty of Medicine, Universitas Airlangga,
Indonesia
2Departement of Biomedical Science, Faculty of Medicine, Universitas Airlangga,
Indonesia
3Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Airlangga, Indonesia
Email: [email protected] [email protected],
Abstract
Background:
Cervical cancer is the second most common type of cancer after breast cancer.
Cervical cancer is a special concern of the government to support the success
of the SDGs (Sustainable Development Goals). The government established a
cervical cancer prevention program for 2015-2019 in collaboration with public
health centers and local governments in detecting cervical cancer early in the
community. Midwives have an important role in tackling cervical cancer, but
there are still few studies in Indonesia that discuss the relationship between
knowledge of midwives in attitudes and behavior to carry out early detection of
cervical cancer for themselves. The purpose of this study was to determine the
relationship between knowledge, attitudes, and behavior of early detection of
cervical cancer in midwives at Puskesmas Surabaya.
Methods: This research method is observational analytic with the cross-sectional
approach. The number of samples is 94 with the random sampling technique. The
independent variables are knowledge and attitudes and the dependent variable is
behavior. The instrument used is a questionnaire. Using chi-square and fisher
test. Results: There were 72 people (78.7%) who had good knowledge at the
Surabaya Public Health Center, 52 people (55.3%) with a good attitude, and 49
people (52.1%). The results of the statistical test of knowledge with behavior
p = 0.221 (p> 0.05), knowledge with attitude p = 0.039 (p <0.05), and
behavior with attitude p = 0.042 (p <0.05). Conclusion: There is a
relationship between knowledge of cervical cancer and attitudes towards early
detection of cervical cancer, there is a relationship between attitudes towards
early detection of cervical cancer and behavior for early detection of cervical
cancer and there is no relationship between knowledge of cervical cancer and
behavior of early detection of cervical cancer.
Keywords: early detection;
knowledge; attitude; cervical cancer; midwife
Introduction
Cervical cancer sufferers are the 2nd
most cancer patients after breast cancer. Until now, cervical cancer is still a
health problem in Indonesia and even the world with a higher incidence and
mortality rate (Globocan, 2021). Cervical cancer is
the fourth most common cancer in women in the world. Based on WHO (World Health
Organization) 2018 as many as 570,000 women were diagnosed with cervical cancer
and 311,000 women died from this disease. Cervical cancer is an abnormal cell
located in the cervix or cervix. Almost all cervical cancers are caused by
infection with the Human Papilloma Virus (HPV). Cervical cancer can experience
complications due to the spread of cancer to other organs of the body. Life
expectancy in cervical cancer follows how severe the stage experienced, the
larger the stage experienced, the lower the hope for life (Kessler, 2017).
Cervical cancer sufferers are a
special concern of the government and support the success of the SDGs
(Sustainable Development Goals). In PERMENKES number 34 of 2015 concerning the
prevention of cancer and cervical cancer, the reason cervical cancer is always
increasing is due to the lack of detection programs that aim to detect cancer
before it (Kemenkes, 2015). The government created a
program in the prevention of cervical cancer 2015-2019 in collaboration with
public health centers and local governments in detecting cervical cancer with
IVA (Visual Acetate Inspection).
Midwives at puskesmas
are an important profession in educating and detecting cervical cancer early in
the prevention of cervical cancer. Midwives know about cervical cancer so they
are expected to influence the attitudes and behavior of WUS in early detection
(Istiqomah, 2017). Apart from that, midwives have an
important role in the prevention of cervical cancer, but there are still few
studies in Indonesia that discuss the relationship between midwifery knowledge
in attitudes and behavior for early detection of cervical cancer for
themselves.
Method
This study uses an observational
analytic research type with a cross-sectional approach. The population in this
study was Puskesmas in Surabaya there were 63 of puskesmas with a sample of 487 midwives working at Puskesmas. The calculation technique using Lemeshow is 81 people by adding 10% to avoid risk factors
so that a minimum of 91 people is needed for this study. Sampling by looking at
inclusion: Working at Puskesmas in Surabaya, Willing
to be a respondent, Married. The technique of taking the subject of this
research is random sampling, which is taking the health center randomly. The
subjects of this research were all midwives from public health centers who had
been randomly assigned.
The instrument used in this study was
a questionnaire. Research subjects will answer questions on a questionnaire
regarding knowledge, attitudes, and behavior. This knowledge assessment
consists of 10 questions, midwives who have good knowledge if they answer
correctly at least 7 questions, midwives who have less knowledge if they answer
correctly are less than 6 questions. In the assessment of the attitude
variable, if the score T > the group mean then the attitude is more
favorable, meaning the value is positive. if the T score < mean group means
having a less favorable attitude means a negative attitude. Assessment of
behavioral variables, midwives behave positively if they do early detection of
cervical cancer at least once in the last 3 years, behave negatively if they
never do early detection of cervical cancer in the last 3 years.
Results and Discussions
The following is data on the
characteristics, knowledge, attitudes, and behavior of midwives.
Table 1
Presentation Of
Variable Data
|
Variable |
Frequency |
Precentage (%) |
|
Age |
|
|
|
|
51 |
54,3 |
|
>35 tahun |
43 |
45,7 |
|
Total |
94 |
100,0 |
|
Length of work |
|
|
|
|
54 |
55,3 |
|
>10 tahun |
40 |
44,7 |
|
Total |
94 |
100,0 |
|
Last Education |
|
|
|
D3 |
73 |
77,7 |
|
>D3 |
21 |
22,3 |
|
Total |
94 |
100 |
|
Knowledge |
|
|
|
Good |
74 |
78,7 |
|
Less |
20 |
21,3 |
|
Total |
94 |
100 |
|
Attitude |
|
|
|
Positive |
52 |
55,3 |
|
Negative |
42 |
44,7 |
|
Total |
94 |
100 |
|
Behavior |
|
|
|
Positif |
49 |
52,1 |
|
Negatif |
45 |
47,9 |
|
Total |
94 |
100,0 |
Based on the analysis of table 1, it
can be seen that the majority of respondents' age is less than 35 years as many
as 51 people (54.3%). The majority of midwives worked for less than 10 years as
many as 54 people (55.3%). The most recent education of midwives at the
Surabaya Public Health Center was D3 as many as 73 people (77.7%). In the 3
main variables (knowledge of attitudes and behavior) there is the majority of
good knowledge as many as 74 people (78.7%), positive attitudes as many as 52
people (55.3%), and behavior as many as 49 people (52.1%).
Tabel 2
Relationship Of Characteristics With
Knowledge
|
Characteristic |
|
knowledge |
P value |
|||
|
good |
less |
|||||
|
f |
% |
f |
% |
|||
|
Last Education |
D3 |
53 |
71,6 |
20 |
100 |
0,005 |
|
>D3 |
21 |
28,4 |
0 |
0 |
||
|
Length of work |
|
43 |
58,1 |
11 |
55 |
0,803 |
|
>10years |
31 |
41,9 |
9 |
45 |
||
|
Age |
|
39 |
52,7 |
12 |
60 |
0,561 |
|
>35 years |
35 |
47,3 |
8 |
40 |
||
The results of statistical analysis on
the last education with knowledge obtained results of 0.005 (p <0.05), which
means that there is a relationship between the last education and knowledge of
cervical cancer. some D3 midwives have good knowledge as many as 53 midwives
with a percentage of 71%, and there are more than D3 (D4-S2) midwives as many
as 21 midwives have good knowledge and there are 0 midwives who have less
knowledge. According to Mabarak 2007, education is
one of the factors of knowledge. Education is the guidance of knowledge to
someone about something to know and understand something. The higher the
education of the midwife, the more knowledge she will have and the easier it
will be to receive new information.
The results of the 2nd and 3rd
statistical analysis showed that there was p = 0.803 for the length of work and
p = 0.561 ((p>0.05) so it can be interpreted that there is no relationship
between the length of work and age with knowledge. There are 43 midwives with
working years of less than 10 years who have good knowledge, and there are 31
midwives with more than 10 years of service who have good knowledge. In
addition, there are 11 midwives with less than 10 years of work having less
knowledge and 9 midwives with more than 10 years of experience having less
knowledge there are 8 people (40%) aged over 35 years but have less knowledge.
Whereas the factor of knowledge according to Mubarak 2007 is, the length of
work, the length of work a person will get experience. The longer in the world
of work the more experience and knowledge one gains. obtained. When there is a
piece of new knowledge, someone reacts to it more maturely. Most likely heresy The clinic only holds basic knowledge, in general, t. o
carry out its clinical duties, so that the theoretical knowledge gained is
never used and is not remembered anymore.
Tabel 3
Relationship Of Knowledge With
Attitude
|
Knowledge |
Attitude |
P
Value |
|||
|
Positive |
Negative |
||||
|
f |
% |
f |
% |
||
|
Good |
45 |
86,5 |
29 |
69 |
0,039 |
|
Less |
7 |
33,5 |
13 |
31 |
|
In the results of statistical
analysis using the Chi-Square test, it was found that the p-value was 0.039
which indicated that there was a relationship between knowledge of cervical
cancer and the attitude of early detection of cervical cancer because p
<0.05. Table 3 shows that 45 good knowledges midwives had a positive
attitude (86.5%). 7 midwives who good knowledge have a positive attitude, but
29 midwives with good knowledge may have a negative attitude. Attitudes will
arise due to several factors, namely knowledge from personal experience,
educational institutions, culture, information from the media, and the
influence of others according to Azwar in Ninik 2011. Knowledge of IVA and cervical cancer are basic
competencies that respondents need to master to be able to provide midwifery
services including counseling (Rochwati, 2016) so
that all midwives should have an attitude that is following their knowledge or
have a positive attitude.
Tabel 4
Relationship Of Knowledge With
Behavior
|
Knowledge |
Behavior |
P
Value |
|||
|
Positive |
Negative |
||||
|
f |
% |
f |
% |
||
|
Good |
41 |
83,7 |
33 |
73,3 |
0,221 |
|
Less |
8 |
16,3 |
12 |
26,7 |
|
This research shows that there is a
relationship between knowledge and attitude. It is possible that 29 midwives
had good knowledge but had a negative attitude. Attitudes will arise due to
several factors, namely from personal experience, educational institutions,
culture, information from the media, and the influence of others according to Azwar in Ninik 2011. Knowledge of
IVA and cervical cancer should be a basic competency that needs to be mastered
by respondents as midwives to be able to provide services includes counseling (Rochwati, 2016) so that all midwives have an attitude that
is following their knowledge or has a positive attitude.
Tabel 5
Relationship Attitude With
Behavior
|
Attitude |
Behavior |
P
value |
|||
|
Positive |
Negative |
||||
|
f |
% |
f |
% |
||
|
Positive |
32 |
65,3 |
20 |
44,4 |
0,042 |
|
Negative |
17 |
34,7 |
5 |
55,6 |
|
In table 5 of this study, there is a
relationship between the attitude of early detection of cervical cancer with
the behavior of early detection of cervical cancer, p = 0.042 (p <0.05).
There are 32 midwives (65%) who have a positive attitude or agree with the
cervical cancer early detection program also detect cervical cancer or positive
behavior, but there may be 17 midwives who have a negative attitude (34.7%) but
early detection of cervical cancer. In Notoatmodjo's
2012 theory regarding these attitudes and behaviors, it can be interpreted that
if a midwife is given a stimulus (knowledge) there is a possibility that 2
attitudes will occur, namely, an attitude of acceptance (positive) or
supporting programs or movements for early detection of cervical cancer
according to government knowledge and direction and does not accept (negative)
or does not support such knowledge. The attitude of the midwife has an
important influence on the midwife in conducting early detection of cervical
cancer. The midwives have negative behavior but have a positive attitude as
many as 20 people. The reason for the negative behavior of midwives in Stressno et al's 2017 research on
interview results is because they are embarrassed when they check their friends
and 2 respondents do not do early detection of cervical cancer because they are
afraid, afraid because the results if they get bad (positive) results and are
afraid of being in pain because they have to be included. Speculum.
Researchers see continuity in the
midwife's process of positive behavior or early detection of cervical cancer.
The midwife's last education is an important basis for positive behavior, the
higher the midwife's last education, the more experience, and knowledge will be
gained. Knowledge is one of the important factors that shape a midwife's
attitude. In that attitude, the midwife will decide what kind of behavior for
herself.
Conclusion
In this study, it can be concluded that there is a
relationship between knowledge of cervical cancer and the attitude of early
detection of cervical cancer, there is a relationship between attitudes of
early detection of cervical cancer and behavior of early detection of cervical
cancer and there is no relationship between knowledge of cervical cancer and
behavior of early detection of cervical cance.
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Copyright holder: Fransisca Wiga Alda Maretha,
Reny I�tishom, Pungky Mulawardhana (2022) |
|
First publication right: Syntax Literate: Jurnal Ilmiah
Indonesia |
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