TERM PAPER

THE DIFFERENCES BETWEEN VIDEO TOOLS AND CARTOON FLIPCHART

FOR HEALTH EDUCATION TOWARDS KNOWLEDGE AND ATTITUDE ABOUT
HAND WASHING WITH SOAP OF SCHOOL-AGED CHILDREN

In partial fulfillment of the requirement of the course:

NURSING THEORY

Submitted by:
APOLONIA ANTONILDA INA

ARELLANO UNIVERSITY
GRADUATE SCHOOL OF NURSING

May 19, 2014

Introduction
Since the majority of the nations children are enrolled in elementary
school, school-based health promotion programs can be implemented to
increase the health-promoting behaviors among children before certain
behavior patterns solidify. Schools should be health-enhancing environment
that build resilience and assist children to develop healthy behaviors, such as
hand hygiene. Health promotion programs attempt to induce changes in
health-related behavior to prevent diseases. Health promotion behavior is
acquired more readily in childhood, when routine and habits are being formed.
Habits or a behavior developed in childhood is more likely to persist as an
integral part of ones lifestyle than changes made in health behaviors later in
adult years. Development of healthy behaviors in children is critical to
increasing the prevalence of healthy lifestyles in the total population (Pender,
Murdaugh and Parsons, 2006). Health education is any combination of
learning experiences designed to help individuals and communities improve
their health, by increasing their knowledge or influencing their attitudes (WHO,
2014).
One of health promotion is hand hygiene. Hand hygiene is the primary
measure to reduce infections (WHO,2009). Hand washing with soap is one
way to keep the body healthy because this action scientifically proven can
prevent infectious diseases, such as diarrhea and upper respiratory tract
infection and avian influenza (Indonesia Department of Health, 2010).
Medical evidence suggests that the hands are the main transmitters of

diarrhea and respiratory infections. As such, they constitute disease vectors

carrying respiratory microorganisms and fecal material into the domestic
environment of the susceptible child.8 Health experts recommend hand
washing with soap as a critical action in protecting public health because it is a
mainstay in infection control. Yet, rates of hand washing with soap at critical
times remain low throughout the world, even when both soap and water are
available.
Hand washing with soap is among the most effective and inexpensive
ways to prevent diarrheal diseases and pneumonia, which together are
responsible for the majority of child deaths. Yet, despite its lifesaving potential,
hand washing with soap is seldom practiced. Around the world, the observed
rates of hand washing with soap at critical moments range from zero percent
to 34 percent. Although people wash their hands with water, very few wash
their hands with soap at critical moments. Washing hands with soap after
using the toilet and before handling food can reduce rates of diarrheal
disease, including some of its more severe manifestations, such as cholera
and dysentery, by 48-59 per cent and rates of respiratory infection by about
one-quarter. Washing hands with water alone is significantly less effective
than washing hands with soap in terms of removing germs. (UNICEF, 2008).
According to UNICEF, 600.000 children dying in each year and over 1.7
billion cases because of diarrhea diseases and also associated with a higher
risk of stunting (low weight for age and developmental delay) and take a huge

toll on society. However, one of the simplest and most inexpensive barriers to
infection is hand washing with soap. Health promotion about hand washing
with soap is needed to solve this problem.
In order to give health education about hand washing with soap, needed
media visual or audio-visual to support that activity. The reason why video
(audio-visual media) and cartoon flipchart (visual media) used as media in
health promotion about hand washing with soap because as visuals are used
effectively to strengthen communication, visuals help people remember what
they see and help memory, for a majority of people it is easier to remember
pictures than to remember just words.
Based on WHO, to facilitate the process of starting the project and its
following implementation activities. it is very important to ensure that training
sessions are accompanied and supported by educational material such as a
guideline summary, leaflets, brochures, information sheets and flipcharts
(WHO, 2009). The WHO Implementation toolkit includes an extensive range of
tools for education, including a slide presentation, a brochure summarizing
why, when, and how to perform hand hygiene, a leaflet containing the core
recommendations of the guidelines, a practical pocket leaflet and a training
film (WHO, 2009).
In general, media for health promotion can be categorized into four
different types, they are audio-visual broadcast media such as television,
radio; audio-visual non-broadcast media such as video, CD, DVD, self-help

packages; print media such as newspaper, magazine, leaflets, flipchart, mail

shots, billboards; digital media such as internet, mobile phones (Dixey, 2013).
Health learning materials are those teaching aids that give information and
instruction about health specifically directed to a clearly defined group or
audience. Flip charts are useful to present several steps or aspects that are
relevant to a central topic, such as health education about hand washing with
soap.
Audio-visual materials combine both seeing and listening, as the name
implies. These materials include TV, films or videos which provide a wide
range of interest and can convey messages with high motivational appeal.
They are good when they are accompanied with interactive methods. Audiovisual health learning materials can arouse interest if they are of high quality
and provide a clear mental picture of the message. They may also speed up
and enhance understanding or stimulate active thinking and learning and help
develop memory.
Based on the previous research by Elfian Zulkarnain, Leersia Yusi,
Nikmatul Farida in 2009 about effectiveness difference between speech
method with flipchart and video compact disc in increasing pregnant mothers
knowledge and attitude toward early breastfeeding initiation. The result from
this research is there is significant difference using video and flipchart in
increasing knowledge and attitude of pregnant mothers

The researcher believes that through this study, the aforementioned

concerns in nursing care can possibly be addressed. The result of this study
will guide the researcher in giving the best way of health education for
children. Further, it may improve the knowledge and attitude of school-aged
children in hand washing with soap, increase awareness of children in hand
washing and prevent infectious diseases.
This study will utilize the theory of Nola J. Pender about health
promotion behavior. A health promoting behavior is an end point or action
outcome that is directed toward attaining positive health outcomes such as
optimal well-being, personal fulfillment and productive living and the theory
from Dorothea Orem about self care deficit (Alligood and Tomey, 2010). With
heath education can increase awareness and ability in self care to prevent
illness.
Background of Study
One of the factors that influence the health of society is behavioral
factor. With doing healthy behavior can reduce morbidity rate. One of behavior
factors is hand washing. In Indonesia, the number of people that doing hand
washing rightly in 2013 is 47%, it is higher than in 2007 is 23,2%. In East
Nusa Tenggara in 2013 the number of people doing hand washing rightly is
38,1% (Riskesdas, 2013). Hand washing with soap alone averts 0.5-1.4
million death per year, yet hand washing levels seems to be low among
school-aged children (Peltzer & Pengpid, 2014).

Hand washing rightly is hand washing with soap before prepare foods,
when their hand is dirty (e.g. hold money, pets or farming), after bowel
movement, after using pesticide/insecticide and before breastfeeding. Hand
washing with soap is the activity of cleaning the palms and fingers to clean
and kill germs that cause disease (Health Promotion,2011).
According to Indonesia Health Profile 2011, diarrhea is an endemic
disease in Indonesia. Diarrhea is defined as the passage of three or more
loose or liquid stools per day (or more frequent passage than is normal for the
individual. Diarrhea is usually a symptom of an infection in the intestinal tract,
which can be caused by a variety of bacterial, viral and parasitic organisms.
Infection is spread through contaminated food or drinking-water or from
person to a person as a result of poor hygiene (WHO,2013). Interventions to
prevent diarrhea, including safe drinking-water, use of improved sanitation and
hand washing with soap can reduce disease risk. In Basic Health Research
2013, the incidence and prevalence diarrhea in Indonesia is 4,3% and 10.9%.
Based on Ngada Regency Health Profile 2009, the scope of health
service for preschool-aged, school-aged and teenagers is 76,42% whereas
the target is 90%. The scope of health service in elementary school in 2009 is
64,07% whereas the target is 100%. In 2009, diarrhea is included in ten
diseases in Ngada Regency. The number of patient with diagnose diarrhea as
many as 2.488 cases. In 2009 the morbidity of diarrhea is 18 per 1000 people
and in 2008 the morbidity of diarrhea is 19,4 per 1000 people. Compared to
2008, the number of diarrhea in 2009 is decrease. Diarrhea becomes

outbreak usually in area where the risk-factor control is still low. A significant
proportion of diarrhea disease can be prevented through safe drinking-water
and adequate sanitation and hygiene.
These findings have encouraged and behooved the researcher to
conduct an experimental study on differences between video tools and
cartoon flipchart for health education towards knowledge and attitude about
hand washing with soap of school-aged children In Lebijaga Elementary
School, Ngada Regency, East Nusa Tenggara, Indonesia. It is hope that the
result on the study will help gain the upper hand in prevent illness.
Theoretical Framework
This study will utilize the theory of Jean Piaget about cognitive
development. Jean Piaget explored how intelligence and cognitive functioning
develop in children. He believed that human intelligence progresses through a
series of stages based on age, with the child at each successive stage
demonstrating a higher level of functioning than at previous stages. The four
stages, include: sensorimotor (birth to 2 years); preoperational (2 to 6 years);
concrete operations (6 to 12 years), in this stage the child begins to apply
logic to thinking, understand spatiality and able to apply rules; and formal
operations (12 to 15 years and beyond). The nurse may better understand
what the child means if the nurse is aware of his or her level of cognitive
development. Also, teaching for children is often structured with their cognitive
development in mind (Videbeck, 2011).

This study will also utilize the theory of Nola J. Pender about health
promotion behavior. A health promoting behavior is an end point or action
outcome that is directed toward attaining positive health outcomes such as
optimal well-being, personal fulfillment and productive living (Alligood and
Tomey, 2010).
The study is anchored on Orems Theory of Self Care and Self Care
Deficit Theory of Nursing. According to Orem, self care is the performance of
practice of activities that individuals initiate and perform on their own behalf to
maintain life, health, and well-being. When self care is effectively performed, it
helps to maintain structural integrity and human functioning, and it contributes
to human development (Tommey, 2008).
The researcher will combine the theories above. Knowing the cognitive
development of child is important for researcher to select the material in health
education and use the simple word in share information, so that the children
will easy to understand. Orem said that nursing has a special concern for
mans needs on such factors as self care action and the provision and
management of it is on a continuous basis in order to sustain life and health,
recover from disease on injury and cope with their respective effects. When
self care is not maintained, illness, disease or death will occur. Nurses
sometimes manage and maintain required self care continually for persons
who are totally incapacitated. In other instances, nurses help persons to
maintain required self care by performing some but not all activities, by

supervising others who assist patients and by instructing and guiding

individuals as they gradually move towards self care.
Thus, the goal of Penders theory is about preventing illness, persons
can modify cognitions, affect, and the interpersonal and physical environments
to create incentives for health actions while the goal of Orems theory is
helping the client perform self care and the goal of Piagets theory is knowing
cognitive developmental of children based on the age. For the reason, modify
these theories can increase awareness of school-aged children because after
they get information about hand washing with soap, school aged children
decide to do hand washing with soap, Orem is said to be moving towards self
care because it is performing actions which would prevent illness of children.