INTRODUCTION
Pre-eclampsia
is a complication in the pregnancy process whose incidence tends to increase
over time and is one of the causes of morbidity and death in pregnant women (Billington & Mandy, 2010). Pre-eclampsia has
been in first place since 2012 which causes maternal deaths in East Java
Province, the number of pre-eclampsia cases in 2016 was 165 (30.90%) (Dinkes Provinsi Jawa Timur, 2017). Based on a workshop held at the Jember Regency
hall on 13 August 2019, the trend of maternal deaths in Jember Regency from
2016 to 2017 increased from 33 to 49 deaths, although in the following year
(2018) maternal deaths decreased by 41 people. In 2016, 10 mothers died due to
pre-eclampsia, and in 2017, maternal deaths due to pre-eclampsia increased to
19 people. Even though in 2018 maternal deaths due to pre-eclampsia in Jember
decreased to 7 people, this is something we need to be careful about so that
deaths do not increase. According to information from the Jember Health Office
in 2019, the number of maternal deaths due to pre-eclampsia from January to
August has reached 7 maternal deaths, this shows that the number of maternal
deaths due to pre-eclampsia may remain or increase until its peak at the end of
2019.
Pre-eclampsia
is often detected too late due to a lack of public awareness of carrying out
examinations (Situmorang, Damantalm, & Januarista, 2016). Examination of
pregnant women is very important so that pregnant women who are currently
experiencing pre-eclampsia do not fall into a condition such as eclampsia,
because the consequences of this disease can range from mild to severe. In
mothers, damage to body organs such as the brain, lungs, liver or kidneys can
occur which can cause death in the mother, while in babies it will result in
asphyxia, low birth weight or death (Icesmi Sukarni & Margareth, 2013). Lack of awareness
among pregnant women will reduce their own level of health, so there is a need
for a way to change this behavior. According to Notoatmodjo (2012) changing someone's
behavior can be done in two ways, namely coercion andeducation. In order to improve
health behavior, a more appropriate effort is to use an approacheducation namely through health promotion. Health promotion is any planned
effort to influence other people, whether individuals, groups or communities,
so that they do what is expected by health promotion actors (Notoatmodjo, 2012). ). By using this method, it is hoped that
pregnant women will have lasting good behavior.
In
previous research, researchers conducted research with the title "Midwife
Health Promotion Model (Promkes) for Pre-Eclamptic Pregnant Women Based onStage of Change� (Bowden & Bassett, 2016). Is a health promotion model
that has been innovated based onThe Trans Theoretical
Model in which there are five stages in changing a person's behavior, and
at each stage there are efforts or treatments that can be done to reach the
next stage, the five stages arepreconteplation, conteplation, preparation,
Action, andmaintenance (Lenio, 2006). In this research, the
material presented and the efforts made to promote health were based on the
stages of behavior of pre-eclamptic pregnant women, treatment based on model
theories that had been innovated. Because traditional health promotion programs
are often not designed according to the stages of change in patient behavior,
the researchers created an innovative promotional model so that pregnant women
really gain knowledge about preseclampsia and realize
the importance of understanding their pregnancy and knowing the basic needs of
pregnant women, both physical and psychological needs in particular. pregnant
women with pre-eclampsia (Maryani, Respati, & Astirin, 2016).
The results of previous research, namely the first stage
after being given treatment, showed that the majority of respondents' behavior
change stages were at 28%action, and
the level of preparation is 26.7%, as well as the levelcontemplation of25.3%. If the data before and after treatment shows that the
change in behavior stages is from the preconteplation
stage by 39% to 0%, the conteplation stage from 25%
to 19%, the preparation stage from 11% to 35%, and the action stage from 0% to
21% .
Based
on data from the Kalisat and Sumberjambe
health centers, these health centers are the health centers that have
contributed to maternal deaths since 2016 (Yudhia F. Syafrudin, 2009). In the working area
of the Kalisat health center there was
1 maternal death in 2016 due to pre-eclampsia, 2 maternal deaths in 2017 and 1
mother has not yet ended 2019. has died. The number of cases of pregnant women
who were at risk of experiencing pre-eclampsia in 2018 was 334 with the number
of cases of mothers who were pre-eclamptic as many as 56 people, from 2019 to
April the number of pregnant women who were at risk of pre-eclampsia was 193
people with the number of pregnant women who were pre-eclamptic. eclampsia by
35 people. Meanwhile, in the Sumberjambe Community
Health Center working area, 1 maternal death was recorded in 2017 and as of
August 2019, 1 mother had died. In 2018, 808 pregnant women were at risk of
developing pre-eclampsia, while 72 pregnant women were experiencing pre-eclampsia.
In 2019 up to April, 268 people were recorded as being at risk of
pre-eclampsia, while 18 pregnant women were recorded as having pre-eclampsia.
Based on previous research data and results, the
researchers wanted to test the effectiveness of the health promotion model for
pre-eclamptic pregnant women based on the transtheory
model. In this follow-up research (second stage) researchers will conduct
trials on products that have been provided in previous research, namely
promotions innovated at the Jember Regency Regional Health Center, namely Kalisat and Sumberjambe as an
effort to see the effectiveness of the products that have been designed by
researchers. Based on the above background, the research problem can be
formulated as follows: What is the effectiveness of the Transtheory-Based
Health Promotion Model (Promkes) on Pre-Eclampsia
Prevention Behavior in Pregnant Women in Jember Regency Regional Health
Centers.
Analyzing the effectiveness of the transtheory-based
health promotion model (Promkes) on pre-eclampsia
prevention behavior in pregnant women at the Jember District health center
(Phase 2).
This
research has a number of benefits that have an impact on various parties. For
educational institutions, the results of this research can be used as a
reference for the development of science and technology. Meanwhile, for the
Jember District Health Service, this research provides valuable input in
efforts to improve the quality of human resources, especially midwives in their
work area (Sutriyani, 2015). For midwives
themselves, this research helps improve the quality of antenatal care services,
especially in providing health information to patients in their work area.
Apart from that, the benefits of this research are also felt by the public,
especially pregnant women, who can avoid the risk of pre-eclampsia thanks to
the results of this research. Thus, this research makes a significant contribution
in improving the quality of health services and safety for pregnant women in
the work area of the Jember District Health Service.
METHOD
The research method
used is quantitative, which is a method that can be used to answer research
problems related to numbers and statistical programs (Wahidmurni, 2017). Using designquasi experimentwith
approachcross sectional namely a comparative
analytical research design which aims to determine the differences before and
after treatment between variables (Dharma, 2011). This research isResearch and Development (R&D) used to develop and validate educational
products Borg & Gall (1983) in Silalahi (2018). R&D
in this research is the development of a health promotion model for pre-eclamptic patients based onStage of Change (The Transtheoritical Model). This research is a method that
deliberately aims to develop and test the effectiveness of certain models that
are more effective, efficient, productive and meaningful. This step is known as
the R&D cycle consisting of: reviewing the results of previous treatment,
then continuing with developing it into a product, testing the designed
product, and reviewing and correcting the product based on the test results (Prawirodirjo, 2014).
RESULTS
AND DISCUSSION
Respondent characteristics
In
this section, we will describe the characteristics of the 60 respondents who
were pregnant women in the Kalisat and Sumberjambe Community Health Center areas. The respondents
in this study were pregnant women who were preeclamptic and at risk of
preeclampsia and the researchers involved doctors, villages and regional
coordinator midwives to assess and obtain recommendations for the instruments
made by the researchers.
Tabel
1
General
characteristics of respondents to research on the effectiveness of health
promotion (Promkes) based modelstranstheory model on pre-eclampsia prevention behavior in pregnant women in
Jember Regency regional health centers in 2019
|
No
|
Respondent Characteristics
|
Parameter
|
|
∑
|
%
|
|
1
|
Age
|
< 20 years
|
|
15
|
25
|
|
|
|
20 � 35 years
|
|
35
|
58,3
|
|
|
|
> 35 years
|
|
10
|
16,7
|
|
|
|
|
Total
|
60
|
100
|
|
2
|
Education
|
Not completed in primary school
|
|
4
|
6,7
|
|
|
|
SD
|
|
25
|
41,7
|
|
|
|
Junior High School
|
|
14
|
23,3
|
|
|
|
SMA
|
|
14
|
23,3
|
|
|
|
D4/S1
|
|
3
|
5
|
|
|
|
|
Total
|
60
|
100
|
|
3
|
Work
|
Doesn't work
|
|
49
|
81,7
|
|
|
|
Officer
|
|
2
|
3,3
|
|
|
|
Self-employed
|
|
5
|
8,3
|
|
|
|
Farmer
|
|
4
|
6,7
|
|
|
|
|
Total
|
60
|
100
|
|
4
|
Parity
|
Primipara
|
|
23
|
38,3
|
|
|
|
Multiparous
|
|
15
|
25
|
|
|
|
Grande is multiparous
|
|
22
|
36,7
|
|
|
|
|
Total
|
60
|
100
|
Table
1 informs the characteristics of respondents from several factors, namely in
terms of age, education, employment and parity. The results showed that the
majority of respondents were aged 20-35 years (58.3%), some respondents (41.7%)
had elementary school education, almost the majority of respondents (81.7%) did
not work (housewives), the majority of respondents first pregnancy was (38.3%).
This shows that the respondents of this study fall into the category of factors
that trigger pre-eclampsia, so health promotion needs to be carried out so that
pre-eclampsia can be treated.
Tabel
2
Stages
of behavior change (Stage of Change)
in pregnant women before and after being given treatment at the Kalisat and Sumberjambe health
centers in 2019
|
Stage
Change
|
Before
|
After
|
|
Frequency
�(n)
|
Presentase (%)
|
Frequency
(n)
|
Presentase (%)
|
|
Precontemplation
|
32
|
53,3%
|
2
|
3,4%
|
|
Contemplation
|
14
|
23,3%
|
3
|
5%
|
|
Preparation
|
12
|
20%
|
19
|
31,6%
|
|
Action
|
2
|
3,4%
|
20
|
33,3%
|
|
Maintenance
|
0
|
0%
|
16
|
26,7%
|
|
Total
|
60
|
100
|
60
|
100
|
From
table 2 it shows that changes in behavior stages before and after being given a
promotion are from stageprecontemplation
by 53.3% to 3.4%, stagecontemplation
from 23.3% to 5%, stagepreparation
from 20% to 31.6%, and levelaction from 3.4% to 33.3% and the last one frommaintenance which was previously 0% became 26.7%.
Tabel
3
Distribution
of each stage of behavior change (Stage
of Change) in pregnant women before and after being given treatment at the Kalisat and Sumberjambe health
centers in 2019
|
Previous
stages
|
∑
|
Stages
after
|
∑
|
|
Precontemplation
|
Contemplation
|
Preparation
|
Action
|
Maintenance
|
|
Precontemplation
|
Contemplation
|
Preparation
|
Action
|
Maintenance
|
|
|
32
|
|
|
|
|
32
|
2
|
3
|
17
|
8
|
2
|
32
|
|
|
14
|
|
|
|
14
|
|
0
|
2
|
8
|
4
|
14
|
|
|
|
12
|
|
|
12
|
|
|
0
|
4
|
8
|
12
|
|
|
|
|
2
|
|
2
|
|
|
|
0
|
2
|
2
|
|
|
|
|
|
0
|
0
|
|
|
|
|
0
|
0
|
|
32
|
14
|
12
|
2
|
0
|
60
|
2
|
3
|
19
|
20
|
16
|
60
|
Table
3 shows that the distribution of each stage of behavior change (Stage of Change) before and after being
given the health promotion is from the stageprecontemplation amounting to 32
people distributed intocontemplation
as many as 3 people,preparation as many as 17 people,action as many as 8 people,maintenance
2 people, but there are those who remain at the stageprecontemplation as much as 2 people. Of the 14
people previously in level contemplation distributed to bepreparation 2
people andaction
as many as 8 people andmaintenance
4 people. From stagepreparation
a total of 12 people were distributed into 4 people in stagesaction and 8 people inmaintenance.
Next, the 2 people who were previously inaction
after receiving the health promotion, move tomaintenance. The table shows that after being given the health promotion,
there was a change in the stages of the respondents. In previous research, the
methods used were less varied. For this research, experts recommended adding
methods in the stages of change. Finally, we were challenged to develop a
method based on the transtheoretical model.
Previous
research entitled health promotion model (Promkes)
for midwives for pre-eclamptic pregnant women based on stage of change,
researchers only intervened with respondents using an average of one method.
From the precontemplation to contemplation stage, the researcher used the
Consciousness raising method which contained (lectures and discussions) as well
as dramatic relief in the form of videos containing testimonials. Contemplation
to preparation stage using methodSelf-reevaluation berupa branstorming
by using the snake and ladder Om Telolet Om, stagepreparation theaction researchers useSelf liberation such as recommendations for
more frequent ANC visits and the last stageaction themaintenance researchers useReinforcement management (in a complimentary way) andHelping relationship (cadre assistance). The
following is a model table used in previous research (stage 1)
|
Precontemplation
|
Contemplation
|
Preparation
|
Action
|
Maintenance
|
����������� ��������� Because
stage 1 is considered less effective in increasing the stages of change in
respondents' behavior, researchers are trying to add/develop methods. At stageprecontemplation
go to stagecontemplation,
to increase awareness of the stagecontamplation Researchers still use two methods, namely
through processconsciousness raising (increased awareness) anddramatic relief. However, there is method
development, inconsciousness raising The
researchers used additional methods in the form of screening pre-eclampsia
videos, which previously only consisted of lectures and discussions, then the processdramatic relief researchers use testimonial method by directly
presenting one of the respondents to tell about the conditions they have
experienced.
Next is the second stage, namelyContemplation
(Contemplation). At stagecontemplation
thepreparation
there is one process namelySelf-reevaluation, In
this case the researcher attempts to use methodsbrainstorming and self-evaluation. Methodbrainstorming used is by playing snakes and ladders which is
given the title �OM TELOLET OM�
Figure
1
Game
picture Snakes and ladders�OM
TELOLET OM�
�������������������� Snakes and ladders �OM TELOLET OM" can be played by at least two people guided
by a facilitator (midwife). On the snake and ladder board there are start and
finish signs which end at number 33. There are 6 cards available with 2
different colors, namely red and yellow. Before the game starts the cards are
placed according to the color of the cards on the snake and ladder board. The
player who has the first turn can roll the dice, then move the pawn according
to the dice number that comes out. Next, if the pawn goes up the ladder or down
the ladder, the player must take a card according to the color on the snake and
ladder board. On the cards there are questions that players must answer.
Questions asked about what preeclampsia is, causes, risks and how to prevent
preeclampsia. The game ends until the player reaches the finish. In this case,
the facilitator is tasked with providing a more complete explanation regarding
the answers given by the players, the researcher can also add more if the
explanation is considered incomplete.
�������������������� After the game "OM TOLELOT OM" the
researcher carried out the second method, namely self-evaluation, the
respondents were gathered, then the researcher brought the atmosphere to a calm
and comfortable state, then brought the respondents to evaluate themselves. The
third stage is stagepreparation
theaction,
to get to that stage only by meansSelf liberation.
At this stage the researcher explained the importance of adhering to the
schedule and type of examination, apart from that the researcher added
providing leaflets on preeclampsia and establishing a connection to a health
education class in the form of a Whats App group for
healthy mothers.
����������� ��������� Meanwhile, the final stage is stageaction up to
a levelmaintenance has several processes. In an effort to
increase the effectiveness of the model, researchers use processesreinforcement management and helping
relationship. Reinforcement
management is a reward and processhelping relationship
whereas in previous research the assistance was provided by cadres, this time
the assistance was changed to regional midwives and respondents were also
included in the Whats App group for healthy mothers
so they could get counselors and friends to discuss. This method is applied in
order to maintain the positive behavior that you already have. The following is
the development of the transtheoretical model in stage 2.
|
 Precontemplation
|
 Contemplation
|
 Preparation
|
 Action
|
Maintenance
|
Analisis Data SPSS
Results of statistical test analysisPaired T-Test for each stage of behavior change before and after
treatment is given:
1.
LevelPre
Contemplation
H0 = There is no
difference in valuePre Contemplation before andPre Contemplation after
Decision: H0 is
rejected because the calculated t value (-8.857) is greater than the t table
0.05 (1.671). and Asymp. Sig. (2-tailed) 0.000 is
smaller than α 0.05
Conclusion: There is a
significant change between the valuespre conteplation before andpre conteplation after which means there is
an influence of the use of the method in increasing the respondent's stage.
2.
LevelContemplation
H0 = There is no
difference in valuecontemplation
before andcontemplation
after.
Decision: H0 is
rejected because the calculated t value (10.713) is greater thant0.05 (1.671)
and Asymp. Sig. (2-tailed) 0.000 is smaller than
α 0.05
Conclusion: There is a
significant change between the valuescontemplation before andcontemplation after which means
the use of the methodbranstorming
and self-evaluation can improve the respondent's stage.
3.
LevelPreparation
H0 = There is no
difference in valuepreparation
before andpreparation� after.
Decision: H0 is
rejected because the calculated t value (15.513) is greater thant0.05 (1.671)
and Asymp. Sig. (2-tailed) 0.000 is smaller than
α 0.05
Conclusion: There is a
significant change between the valuespreparation before andpreparation after which means
there is an influence of the method used in increasing the respondent's stage.
4.
LevelAction
H0 = There is no
difference in valueaction� before andaction� after.
Decision: H0 is
rejected because the calculated t value (13.812) is greater thant0.05 (1.671)
and Asymp. Sig. (2-tailed) 0.000 is smaller than
α 0.05
Conclusion: There is a
significant change between the valuesaction before andaction after which means the use of praise and mentoring
methods applied can increase the respondent's level.
5.
LevelMaintenance
H0 = There is no
difference in valuemaintenance
before andmaintenance
after.
Decision: H0 is
rejected because the calculated t value (8.651) is greater thant0.05 (1.671)
and Asymp. Sig. (2-tailed) 0.000 is smaller than
α 0.05
Conclusion: There is a
significant (meaningful) change between the valuesmaintenance before andmaintenance
after, which means there is an influence of the method used in increasing the
respondent's stage with an average cumulative increase before and after of
6,400.
6.
Overall Level (cumulative)
H0 = There is no
difference in valuemaintenance
before andmaintenance
after.
Decision: H0 is
rejected because the calculated t value (9.978) is greater thant0.05 (1.671)
and Asymp. Sig. (2-tailed) 0.000 is smaller than
α 0.05
Conclusion: There is
an average difference between the cumulative stage scores before and the
cumulative stage after, which means there is an influence of the use of all
methods used in increasing the respondent's stag.
Discussion
����������� Developing a health promotion model
for pre-eclamptic pregnant women that is innovated based on the level of
behavior change
Before
carrying out model socialization, researchers developed an innovative health
promotion model. as we know that Prochaska and Di Clemente in their theoryTrans Theoritacal Model
identifying a process that a person will undergo as long as that person
undergoes a change in behavior (Bowden & Manning, 2011). This model tries to
explain a person's readiness to change to healthy behavior and until this
behavior becomes a habit. InTrans Theoritacal Model There are five stages, namelypreconteplation, conteplation,
preparation, action, dan maintenance (Faradhina Syafrudin, 2009). These stages have different
methods to get to the next level.
����������� ����������� The earliest stage, namelyprecontemplation
is the stage where the respondent has not thought about changing behavior
because the respondent does not yet know that there is a problem with him. At
this stage, information is needed to raise awareness of its needs.. Bowden & Manning (2011) explain that to raise
awareness in respondents we can use health advice and gentle, non-judgmental
questions. At stageprecontemplation
lead tocontemplation
There are three efforts that can be made, namely with effortconsiousnesss raising, dramatic relief andenvironmental reevaluation. To increase awareness of the stagecontemplation Researchers used
two methods, namely through processconsciousness raising
(increased awareness) anddramatic relief. Consciousness raising is an effort to change a person's behavior by
increasing their awareness of the negative consequences that arise if
preeclampsia is not treated, so it is necessary to provide information such as
counseling using lectures (power points), discussions and through showing
preeclampsia videos, then in the processdramatic relief researchers
use Testimonial method, the method
used is to bring one of the respondents forward to tell about their condition
from when the mother was pregnant and diagnosed with preeclampsia until the
mother experienced eclampsia (seizures). In this way, it is hoped that it can
touch the feelings and emotions of other respondents, and after the respondent
is aware we can proceed to the next stage.
The
second stage is stagecontemplation
(contemplation), at this stage we know that someone intends to start changing
their behavior, the respondent already has the motivation to change. However,
respondents still behave incorrectly regarding their health but are aware that
their actions are risky, for this reason communication is needed so that
respondents remain motivated and can make specific plans. If they are at this
stage, it means that the respondent is already at the stage of initiating
change. At stagecontemplation
thepreparation
there is only one process vizself-reevaluationis a reassessment of oneself. Where
respondents assess what they feel and think about the behavior that has been
carried out and the hope is that respondents will become aware of their
behavior. In this case the researcher attempted to use methodsbrainstorming and self-evaluation. Methodbrainstorming
which is implemented is with the snake and ladder game which is given the title �OM TELOLET OM� :
OlahragaMminimum 3
times/week
THEqueen of
inspection visits
Ldetect as
early as possible
Oobesity is
avoided
LPay
attention to your body's condition with adequate rest
ANDdukasi
Tavoid
stress
Othat's itMfood that
enters the body
With
this game, it is hoped that mothers can assess their own behavior, so that they
better understand that changes are needed for a better life. After the snakes and ladders game, the
researcher carried out the second method in the form of self-evaluation, in
this case the respondents were gathered first and then invited to close their
eyes, the researcher brought the atmosphere to a calm and comfortable state,
then brought the respondents to evaluate themselves, regarding the behavior
that the respondents had carried out so far. and trying to make respondents
aware that the behavior they have carried out will have a negative impact in
the future if it is not immediately corrected. After this activity, it is hoped
that respondents will be able to reassess themselves and that respondents'
hearts will be touched to change.
The
third stage is stagepreparation is the stage where respondents intend
to take action, respondents begin to make action plans such as consulting with
experts, taking health education classes or buying health books. This action
plan is used as an alternative solution to get rid of bad behavior (Lenio, 2006).� To move up a stageaction There is only one effort
that can be used to change someone's behavior, namely the processSelf liberation namely, there is a commitment to the trust that the
respondent already has. At this stage the researcher explained the importance
of complying with the recommended examination schedule and the importance of
complying with the types of examinations related to pregnancy with preeclampsia
(I Sukarni & Margareth, 2013). In the case of
preeclamptic mothers, the visit schedule should be more frequent than the
normal pregnancy schedule. The minimum visit for a normal pregnant woman is 4
times. In this study, researchers innovated examinations for preeclamptic
pregnant women with a schedule for TM I to be carried out 3 times (once a
month), TM II to be carried out once every 2 weeks, and then TM III to be
carried out once a week, and mothers were instructed to immediately check at
any time. if any danger signs appear. This aims to determine the condition of
pregnant women with preeclampsia so that with more routine examinations the
mother will be better monitored and detected earlier. Apart from that, the
researcher provided leaflets on preeclampsia material so that respondents could
read at any time and the researcher created a health education class group in the
form of a Whats App group for healthy mothers, in
this group respondents could consult about their condition, researchers or
regional midwives could provide information and provide motivation to
respondents.
Meanwhile
on stageaction, In this
stage, actions can be observed, respondents have made efforts to modify their
behavior, with the experience they have gained and a supportive environment,
respondents can overcome problems. they behave according to the action plan
that has been made. This action stage requires commitment from the respondent
because it requires sufficient time and energy to try to behave well, from this
effort the respondent gets recognition from the social environment (Lenio, 2006). For stageaction up to
a levelmaintenance There are several processes that can be
taken, namely:Reinforcement
management, Helping relationship,
Counter conditioning, and Stimulus
control. In an effort to increase the effectiveness of the model,
researchers use a processreinforcement management and helping relationship. Reinforcement
management is giving rewards to pregnant women with preeclampsia related to
the actions they take. The rewards given are in the form of praise in public,
for example regarding the mother's habit of checking regularly and on time
because this is considered an award. Apart from that, researchers also use processeshelping relationship with give support to change
behavior, for example having a companion to use as a friend to discuss
problems. In this research, assistance was provided by regional midwives, and
respondents were also included in the Whats App group
for healthy mothers to get counselors and friends to discuss. This method is
applied in order to maintain the positive behavior that you already have.
Implementing a health promotion model for
preeclamptic pregnant women that is innovated based on the level of behavior
change
In
implementing the health promotion model that has been developed, it is carried
out through 3 stages of activity, the first stage is identifying the level of
behavior change in preeclamptic pregnant women before being given the
innovative health promotion, the second stage is implementing the innovated
health promotion model and the third stage is identifying the level of behavior
change in Preeclamptic pregnant women after being given innovative health
promotion
Identifying
the level of behavioral change in pregnant women before being given innovative
health promotions
From
the results of this research data, it shows that before being given treatment
with the innovative health promotion model, the stage of behavior change for
most of the respondents, 53.3%, was at thePrecontemplation, level conteplation as big as 23,3%, action by 3.4%.
Skiner
(1938) in the book Notoatmodjo (2012) said that behavior is
a person's response that arises because of external stimulation. Meanwhile, in
the world of health, behavior can be interpreted as a person's response to
stimuli related to illness, disease, service systems, food and drink and one's
environment. Even though we know that behavior is a form of response,
responding will vary because it depends on the characteristics of each person.
So it can be concluded that even though the stimulus given is the same, the
response can be different. These different responses can be caused by intrinsic
factors such as intelligence level, emotional level and external factors which
often influence a person's behavior including the physical, social, economic
and cultural environment.
Notoatmodjo (2003) explains that
knowledge is the result of knowing, some knowledge is obtained from the five
senses. The higher a person's knowledge and understanding of health, the more
their perspective on health will improve. This level of knowledge is related to
the level of education a person has, the higher the level of education a person
has, the wider their knowledge (Rahardjo & Wati, 2017). As we know,
education is a teaching and learning process, the result of this education is
behavior change.
In this study, the education level of some of the
respondents was 41.7% who had completed elementary school, 23.3% each from
junior high school and high school, 5% bachelor's degrees and 6.7% of
respondents who had not completed elementary school. From this it is known that
education greatly influences a person's behavior. Higher education will
influence a person's behavior and decision making, because the higher a
person's education, the greater the opportunity for understanding information.
This is reinforced by research conducted by Rahardjo & Wati (2017) regarding the
relationship between education level and Kadarzi's
behavior, which states that there is a relationship between education and
behavior, because someone with higher education is more open and accepts new
things more easily (De Bruijn & Heuvelhof, 2002).
Implement
an innovative health promotion model
After
obtaining the respondent's stage, the researcher grouped the respondents based
on the stage they had, obtained data on respondents in the Kalisat
health center area, namely that there were 13 respondents in the stageprecontemplaton,
9 respondents leveledcomtemplation,
7 respondents at the levelpreparation, and 1 leveled respondentaction. Meanwhile, for the respondents who are in the Sumberjambe
health center region, 19 respondents are at the levelprecontaplaton, 5 respondents leveledcomtemplation,
5 respondents at the levelpreparation, and 1 leveled respondentaction.
From this data we can see that respondents are spread
across all stages, therefore researchers will use all methods to improve the
stages that respondents belong to. After the respondents were grouped, they
were given socialization regarding the innovative health promotion model that
would later be applied to them. Each researcher is responsible for two groups, groupsprecontemplation
andcontemplation
held by the first researcher and the grouppreparation andaction held by the second
researcher.
In
implementing the model, the researcher first carried out the intervention to
the group that had the initial stages, namelypreconteplation in the form of
lectures, discussions, video screenings and then testimonials. Meanwhile,
pregnant women are at this stagecontemplation Wait a moment and listen to the explanation
given by the researcher. Likewise in the second research group. Researchers
carried out interventions at group stagespreparation first and then
proceed to the group stagesaction.
�In practice, the mother listened very
enthusiastically, especially during the testimonial activities. From the Kalisat community health center area, testimonials were
given by mothers who had experienced seizures during pregnancy, where the
mother was referred to the hospital and finally underwent surgery, and received
postpartum care in the hospital for 10 days, meanwhile the baby was not crying
at birth and was immediately taken to action space (Maryani et al., 2016). In the Semberjambe area, the testimony was delivered by a mother
who had experienced severe preeclampsia but did not have seizures. At 37 weeks
of gestation, the mother received treatment in hospital for 3 days until finally
surgery was carried out and the baby was born weighing 2550 grams.
From
this testimony, the researcher added about the situation experienced by the
mother, namely that the mother experienced preeclampsia and even fell into a
state of eclampsia which could be dangerous for the mother and the fetus she
was carrying. As we know, the baby born to the mother in the first testimony
experienced asphyxiation (the baby did not cry), while the other baby was born
with a fairly small body weight. This is in accordance with the theory put
forward by Sukarni & Margareth (2013) that the consequences
of preeclampsia or eclampsia can range from mild to severe, apart from
occurring in the mother, the consequences of this disease can affect the baby,
such as the baby can experience asphyxia, experiencing excessive weight gain.
low and can lead to death.
After
the first group was finished, the researcher continued the intervention in the
other groups. In the snakes and ladders game Om Tolelot
Om there were 9 mothers who were invited to play, who were divided into 2
groups. The first group was coordinated by the researcher, while the second
group was coordinated by the regional midwife (Lalita, Manueke, & Alow, 2019). During the game,
pregnant women feel very happy and enjoy themselves, apart from understanding
more about pre-eclampsia, mothers can reminisce about their childhood.
Identifying
the level of behavior change in pregnant women after being given innovative
health promotion
After
conducting socialization in the form of implementing the health promotion model
that had been innovated, analysis was carried out and the results showed that
there was a change in respondent behavior to a certain extentaction amounted to (33.3%),preparation (31,6%), maintenance
(26,7%), conteplation
(5%), but there were still respondents who did not experience changes,
remaining in the stageprecontamplation
namely (3.4%).
����������� In this
study, all health promotion program models were used to improve respondents'
behavioral stages, different from the previous year which only used three
stages. Previous research conducted on 75 respondents obtained results from 39
respondents who were at stagepreconteplation after receiving the health promotion, they
rose to the stageconteplation
as many as 19 respondents and 20 respondents to the levelpreparation. Meanwhile, the current research consists of 32 respondents who
are in the early stages (preconteplation) After receiving the intervention, it
was distributed to 2 respondents who remained at the stagepreconteplation, 3 respondents are in the contemplation
stage, 17 respondents are in the preparation stage, 8 respondents are in the
action stage and 2 respondents are in themaintenance. Likewise at other
stages, there were 25 respondentsconteplation in previous research, distributed in stagespreparation
as many as 15 respondents and 10 respondents were rankedaction. Meanwhile, in this study,
14 respondents were in the stagedistributed contemplationat
the level ofpreparation �as many as 2
respondents, 8 respondents to the levelaction and 4 level respondents maintenance. From these data we can see
that the distribution of changes in
stages is becoming more comprehensive, this shows that with the development of
the methods used, respondents understand better and can move them to change
their behavior so that this model can be said to be more effective in achieving
goals.
Even though we know that in this
study there were 2 respondents who remained at stagepreconteplation, Where This respondent was a respondent who had not finished elementary
school and was 25 years old with her third pregnancy. Meanwhile, another
respondent finished elementary school at the age of 38, pregnant with her third
child. From this data we can draw the conclusion that a person's level of
education and possessions also influence the behavior they carry out. Even
though the same intervention is given, the response can be different (Notoatmodjo, 2012).
Evaluate
the results of developing a health promotion model
At
the activity stage of evaluating the innovated health promotion model, post test activities were carried out to determine changes
in behavior in preeclamptic pregnant women before and after being given the
innovated health promotion. The changes in behavioral stages that occurred in
respondents before and after receiving the innovative health promotion showed
positive things. If we compare the percentage of respondents before and after
being given the health promotion, we can see that the changes are quite
significant from stage to stageprecontamplation 53,3%, after being given an innovated health promotion it
became 3.4%, tadapconteplation 23,3% become 5%, level preparation from 20% to
31.6%, level action 2.4% changed to 33.3%,
�and the last level maintenance which there is no 0% to
16%.
Test
analysis resultspaired t-test by using spss
it shows that at each stage the decision H0 is rejected which can be concluded
that there is a significant change between the before and after values.
Likewise with the cumulative analysis of all stages, after testing the
calculated t result is greater than the t table (9.978 > 1.671) with the Asymp value. Sig. (2-tailed) 0.000 is smaller than α
0.05, which means that the cumulative stages before and after experiencing
significant changes, with an average of (mean)
the cumulative value before and after increased by 6,400 so there was an
influence on the use of the method applied. Based on the analysis above,
treatment by providing health promotion has been developed based onTranstheoritical model effectively used to change or
improve the stages that respondents have (LaMorte, 2019).
Recommendations from the development of a
health promotion model
At
this stage, the researcher held a joint discussion with the head doctor of the
Community Health Center, the village head and the coordinating midwife as a
basis for the researcher's study in providing recommendations (Manuaba, 2010). The purpose of this
discussion is to discuss and share the conditions of respondents before and
after implementing the innovative health promotion, as well as to find out
their opinions about the methods used. From the results of discussions with
doctors, it was clear that this health promotion model was good enough to be
implemented and could possibly be continued with several additions. An addition
that could be implemented might be to activate babinsa
so that if there is a pregnant woman who does not want to be examined while the
mother is in the risk category, then babinsa can
accompany her and take her to health services. The solution that can be offered
is coordinating with the village head so that babinsa
can be empowered.
Based
on the results of discussions with doctors and midwives, the research
coordinator can submit an analysis and recommendation that the researcher will
discuss with the village head regarding the empowerment of babinsa
in overseeing pregnancy checks for high-risk pregnant women. It was suggested
to the head doctor of the community health center that activities such as
health promotion could be carried out in pregnant women's classes every month.At this stage, the researcher held a joint discussion
with the head doctor of the Community Health Center, the village head and the
coordinating midwife as a basis for the researcher's study in providing
recommendations (Prawirohardjo, 2010). The purpose of this
discussion is to discuss and share the conditions of respondents before and
after implementing the innovative health promotion, as well as to find out
their opinions about the methods used. From the results of discussions with
doctors, it was clear that this health promotion model was good enough to be
implemented and could possibly be continued with several additions. An addition
that could be implemented might be to activate babinsa
so that if there is a pregnant woman who does not want to be examined while the
mother is in the risk category, then babinsa can
accompany her and take her to health services. The solution that can be offered
is coordinating with the village head so that babinsa
can be empowered.
Based
on the results of discussions with doctors and midwives, the research
coordinator can submit an analysis and recommendation that the researcher will
discuss with the village head regarding the empowerment of babinsa
in overseeing pregnancy checks for high-risk pregnant women. It was suggested
to the head doctor of the community health center that activities such as
health promotion could be carried out in pregnant women's classes every month.
CONCLUSION
����������� Based
on the research results and discussions and recommendations obtained, several
important points can be concluded. First, the behavioral stages of pregnant
women at risk of pre-eclampsia before being given health promotion that has
been innovated are mostly at the precontemplation stage. Second, creating a
health promotion model that has been innovated based on the level of behavior
change requires improvement to reach the desired level of perfection. Third,
after being given innovative health promotion, there was a positive change in
the level of behavioral change in pre-eclamptic pregnant women, most of whom
were at the preparation and action stages. Fourth, there are significant
changes in the behavioral stages before and after implementing the health
promotion model. Finally, the results of recommendations from competent experts
are very valuable and provide input and suggestions that can be used to improve
the next research stage. Thus, this study provides a better understanding of
behavioral changes in pregnant women with pre-eclampsia and opens the door to
the development of more effective health promotion models in the future.
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Prevention Behavior In Pregnant Women In The Jember
Regional Puskesmas
