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EVIDENCE BASED PUBLIC HEALTH

PENUGASAN INDIVIDU BLOK 4.4 KESEHATAN MASYARAKAT

Oleh:
Zara Desriana Widia
14711082
Kelompok Tutorial 7

Program Studi Pendidikan Dokter


Fakultas Kedokteran
Universitas Islam Indonesia

2018
I. Kasus
Memutus Mata Rantai Kematian Ibu
Dokter Nina adalah seorang kepala puskesmas di Kecamatan Banyuasin, baru
saja menghadiri rapat koordinasi dengan dinas kesehatan terkait laporan kematian
ibu di wilayah kerja puskesmasnya. Ibu yang meninggal tersebut merupakan
multigrandegravida, kehamilan ke-8, saat persalinan hanya ditolong suami.
Keluarga menganggap kematianadalah hal yang natural dan sudah kehendak
Tuhan. Kematian ibu melahirkan terjadi di sebuah wilayah yang terdapat sebuah
pesantren di dalamnya. Pesantren tersebut dipimpin oleh tokoh agama yang sangat
disegani oleh masyarakat sekitar dan bersikap menolak program KB. Petugas
kesehatan terkait pernah melakukan edukasi ke wilayah tersebut namun gagal.
Dokter Nina tergerak lebih lanjut untuk mngetahui factor apa saja yang
menyebabkan penolakan terhadap KB dan bagaimana strategi pendekatan yang
efektif bagi kelompok masyarakat yang menolak KB.

II. PICO
Question Part Question Term Synonyms
Patient/Problem KB Kontrasepsi
Intervention Agama Islam, Perpektif Agama
Comparisson - -
Outcome Persepsi tentang KB Penolakan KB,
Penerimaan KB,
Penggunaan
Kontrasepsi.
Dari analisis PICO di atas, maka dapat disimpulkan pertanyaan PICO pada
kasus ini adalah sebagai berikut: “Bagaimana agama mempengaruhi persepsi
tentang KB?

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III. Searching Keywords
Pencarian jurnal dengan menggunakan kata kunci sesuai dengan kalimat dalam
PICO beserta kata kunci tambahan lainnya, yakni (family planning OR
contraception OR contraceptive) AND (islam OR islamic OR religiosity OR
religious OR religion) AND (qualitative OR case control OR cohort) AND
(maternal death OR maternal mortality OR birth)
IV. Artikel Jurnal
Teknik pencarian Pencarian menggunakan perangkat bantuan Pubmed dengan
kata kunci tersebut di atas.
Jurnal yang didapat
Judul Tulisan The family planning conundrum in Afghanistan
Penulis Hemat Shafiqullah, Ayako Morita, Keiko Nakamura, dan
Kaoruko Seino
Nama jurnal dan Oxford Health Promotion International, 2016
tahun

V. Form Isian Qualitative Research Critical Appraisal

Screening Questions
Can't
No Questions Yes No
tell
1 Was there a clear statement of the aims of the √
research?
Consider:
a. What was the goal of the research √
Pada bagian abstrak dan akhir pendahuluan dijelaskan “The aim of this study was
to investigate the perceptions of reproductive-aged married women, their
husbands, their mothers-in-law, religious scholars and 50 healthcare providers in
various places in Afghanistan towards family planning and contraceptive use”

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b. Why it was thought important? √
Pada bagian pendahuluan dalam setiap paragrafnya menjelaskan mengenai
beberapa poin penting yang dapat mempengaruhi keputusan dalam perencanaan
keluarga serta bagaimana pengaruhnya. Hal ini termasuk dalam penjelasan
mengenai latar belakang penelitian dan bagaimana pentinya latar belakang
tersebut, tercantum dalam kalimat “In order to understand the socio cultural
phenomena about family planning and contraceptive use in Afghanistan, it is
important to investigate the perceptions of multiple-stakeholders including
mothers-in-law, religious scholars and health communities in a nation-wide
context”
c. Its relevance √
Berkaitan dengan latar belakang dan pentingnya latar belakang, pada kalimat yang
sama juga sekaligus mengungkapkan relevansi hal tersebut “In order to understand
the socio cultural phenomena about family planning and contraceptive use in
Afghanistan, it is important to investigate the perceptions of multiple-stakeholders
including mothers-in-law, religious scholars and health communities in a nation-
wide context”

2 Is a qualitative methodology appropriate? √


Consider :
a. If the research seeks to interpret or illuminate the √
actions and/or subjective experiences of research
participants?
Pada bagian methods sub bagian study design dijelaskan bahwa “…to explore
perceptions of married women of reproductive age, their husbands, mothers-in-
law, religious scholars and healthcare providers towards family planning and
contraceptive use”
b. Is the qualitative research the right methodology for √
addressing the research goal?

3
Pada tujuan penelitian untuk menilai bagaimana persepsi, penelitian kualitatif
merupakan penelitian yang sesuai.
3 Was the research design appropriate to address the √
aims of the research?
Consider
a. If the researcher has justified the research design √
(e.g have they discussed how they decided which
method to use?)
Pada penelitian ini tidak dibahas mengenai bagaimana peneliti memutuskan
metode yang akan digunakan dalam penelitian. Hanya disebutkan bahwa untuk
penelitian ini, dilakukan dengan design studi kualitatif.

4 Was the recruitment strategy appropriate to the aims of √


the research?
Consider
If the researcher has explained how the participants √
were selected
Pada bagian method sub bagian study sites and participants dijelaskan bahwa
“Married women aged between 15 and 49 years who 70were ‘not currently
pregnant’ and ‘had not given birth within the previous 40 days’, and their
husbands and mothers-in law were approached by a snowball method starting
with village elders”
If they explained why the participants they selected √
were the most appropriate to provide acces to the type
of knowledge sought by the study
Pada bagian method sub bagian study sites and participants dijelaskan bahwa
“From each target province, 1–4 villages with reasonable security were
identified by consultations with key officials and influential persons”, “In
addition, we used a peer esteem snowball technique to recruit religious scholars
who were famous for their knowledge, a good public speaker and able to

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encourage people to adopt proper behaviour. Healthcare providers who provided
family planning services to many clients and were accessible through
consultations with the field the relevant directorates of the Ministry of Public
Health and non-government organizations (NGOs) at national and provincial
levels were also approached”
If there are any discussion around recruitment (e.g why √
some people choose not to take part)
Pada penelitian ini tidak disebutkan tentang ada atau tidaknya peserta atau calon
peserta yang menolak untuk mengikuti penelitian ini beserta alasannya.
5 Was the data collected in a way that addressed the √
research issue?
Consider

a. If the setting for the data collection was justified √

Pada bagian method sub bagian study sites and participants dijelaskan mengenai
tempat dan waktu penelitian, bahwa
“The study was conducted between May and June 2013 in urban and rural
settings of five major provinces of Afghanistan: Balkh (northern province),
Kandahar (southern province), Nangarhar (eastern province), Hirat (western
province) and Kabul (central province with the capital)”
b. If it is clear how data were collected √

Pada bagian method sub bagian study design dijelaskan bahwa “A qualitative
approach using focus group discussions and semi-structured interviews was
undertaken”, pada bagian lain juga menyebutkan mengenai bagaimana
pengumpulan data tersebut dilakukan, yakni “The data collection process was
designed to create a culturally comfortable setting for the participants to talk
about sexual issues…”, “a trained note taker took verbatim notes on every
statement the participants made in the focus group interview instead of using an
audio recorder” dan selebihnya dijelaskan dalam sub bagian data collection
procedures.

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c. If the researcher has justified the methods chosen

Pada bagian yang sama dan pernyataan yang sama dengan poin di atas dijelaskan
mengenai metode yang digunakan dalam penelitian ini “A qualitative approach
using focus group discussions and semi-structured interviews was undertaken”
d. If the researcher has made the methods explicit (e.g. √
for interview method, is there an indication of how
interviews were conducted, or did they use a topic
guide)?
Pada bagian terakhir data collection procedures, dijelaskan mengenai topic apa
saja yang ditanyakan dan bagaimana topic tersebut dikelompokkan dan
ditanyakan berdasarkan partisipannya, “Topics explored among the women,
husbands and the mothers-in-law included personal and family attitudes
regarding family planning and contraception……Topics explored among the
religious scholars included interpretations of the Quran and the hadith,
preaching to the followers……topics explored among the healthcare providers
included provision of modern contraceptives and communication with clients….”
Pada bagian lain juga dijelaskan “….. identified segments of interview text
related to the study objective using the interview guide as our initial framework
(i.e. religious interpretation, medical interpretation).”
e. If methods were modified during the study. If so, √
has the researcher explained how and why?
Pada penelitian ini tidak dilakukan perubahan metode selama penelitian
berlangsung.
f. If the form of data is clear (e.g. tape recordings, √
video material, notes etc)
Pada sub bagian data collection procedures dijelaskan bahwa “a trained note
taker took verbatim notes on every statement the participants made in the focus
group interview instead of using an audio recorder”
g. If the researcher has discussed saturation of data √

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Pada bagian data analysis dijelaskan bahwa “We continued the FGDs and
interviews in each study site until no new codes emerged.”

6 Has the relationship between researcher and √


participants been adequately considered?
Consider
a. If the researcher critically examined their own role, √
potential bias and influence during (a) Formulation of
the research questions (b) Data collection, including
sample recruitment and choice of location
Pada bagian terakhir data collection procedures, dijelaskan mengenai topic apa
saja yang ditanyakan, bagaimana pertanyaannya, dan bagaimana topic tersebut
dikelompokkan dan ditanyakan berdasarkan partisipannya. Pernyataan lainnya
yakni, “….process was designed to create a culturally comfortable setting …. to
avoid the potential for stifling openness, a trained note taker took verbatim notes
on every statement the participants made in the ….. Notes were checked for
accuracy by trained FGD facilitators or interviewers immediately after each
session.”
“We translated the collected data into English, read them repeatedly to consider
possible meanings, and identified segments of interview text related to the study
objective using the interview guide as our initial framework (i.e. religious
interpretation, medical interpretation).”
“Two coders independently analyzed the segments, coded and grouped them into
a particular theme or category.”
“Accuracy of interpretation and classification were discussed together with the
other re45 searchers, and similarities and differences across subgroups…”
b. How the researcher responded to events during the √
study and whether they considered the implications of
any changes in the research design

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No Questions Yes Can't No
tell
7 Have ethical issues been taken into consideration? √
Consider
a. If there are sufficient details of how the research √
was explained to participants for the reader to assess
whether ethical standards were maintained
Dalam penelitian hanya dijelaskan bahwa penelitian telat disetujui oleh
Institutional Review Board of the Ministry of Public Health, Afghanistan dan telah
melakukan informed consent tertulis kepada para partisipan. “The study was
conducted with the approval of the Institutional Review Board of the Ministry of
Public Health, Afghanistan, and after obtaining written informed consent from all
the participants.”
b. If the researcher has discussed issues raised by the √
study (e.g. issues around informed consent or
confidentiality or how they have handled the effects of
the study on the participants during and after the study)
Tidak dijelaskan.
c. If approval has been sought from the ethics √
committee
“The study was conducted with the approval of the Institutional Review Board of
the Ministry of Public Health, Afghanistan and after obtaining written informed
consent from all the participants.”
8 Was the data analysis sufficiently rigorous? √
Consider
a. If there is an in-depth description of the analysis √
proces
Pada bagian data analisis dijelaskan dengan cukup detail bagaimana analisis
dilakukan terhadap data.

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b. If thematic analysis is used. If so, is it clear how the √
categories/themes were derived from the data?
Pada paragraph terakhir data collection procedures dijelaskan bahwa ada
beberapa topik dalam wawancara yang dilakukan pada kelompok subjek yang
diwawancara. Pada bagian data analysis dijabarkan pula mengenai hal ini
“….and identified segments of interview text related to the study objective using
the interview guide as our initial framework (i.e. religious interpretation, medical
interpretation)”
c. Whether the researcher explains how the data √
presented were selected from the original sample to
demonstrate the analysis process.
Pada data analysis dijelaskan tentang proses analisis data yang didapat.
d. If sufficient data are presented to support the √
findings
Pada bagian results and discussion dipaparkan mengenai hasil wawancara,
penjelasan dan data pendukungnya (berupa pernyataan subjek).
e. To what extent contradictory data are taken into √
account

f. Whether the researcher critically examined their own √


role, potential bias and influence during analysis and
selection of data for presentation

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Pada bagian akhir dijelaskan mengenai kelebihan dan kekurangan penelitian,
salah satunya meliputi analisis data “ Furthermore, our snowball sampling
method and employment of an open discussion style among the female
participants might have excluded minority opinions”, “….the interviews were
transcribed verbatim rather than recorded, thus limiting the selection of
illustrative quotations and the analysis to the researchers who did not conduct
interviews”

No Questions Yes Can't No


tell
9 Is there a clear statement of findings? √

Consider
If the findings are explicit? √

Hasil temuan penelitian telah dijelaskan lengkap dan eksplisit dalam hasil dan
pembahasan.
If there is adequate discussion of the evidence both for √
and against the researchers arguments
Pada dasarnya, selama penjelasan mengenai hasil penelitian dan pembahasan
dalam results and discussion, penelitian ini menyajikan data dari kedua belah
pihak, baik yang setuju beserta persepsinya, dan yang tidak setuju beserta
persepsinya.
If the researcher has discussed the credibility of their √
findings (e.g. triangulation, respondent validation,
more than one analyst)
Pada bagian data analysis dijelaskan bahwa “We translated the collected data into
English, read them repeatedly to consider possible meanings, and identified

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segments of interview text related to the study objective using the interview guide
as our initial framework (i.e. religious interpretation, medical interpretation). Two
coders independently analyzed the segments, coded and grouped them into a
particular theme or category”,
“Accuracy of interpretation and classification were discussed together with the
other researchers, and similarities and differences across subgroups (i.e. group,
sex, age) in relation to contraceptive use were also explored and checked by the
local interview supervisor and stakeholders (i.e. local and international NGOs,
Ministry of Public Health).”
If the findings are discussed in relation to the original √
research question
Hasil temuan dalam penelitian ini didiskusikan sesuai dengan tujuan penelitian di
awal yakni untuk melihat bagaimana persepsi perempuan yang telah menikah
dengan usia reproduktif, suami, ibu mertua, pemuka agama dan penyedia layanan
kesehatan terhadap keluarga berencana dan bagaimana perspektif mereka dibahas
dalam pembahasan.
10 How valuable is the research?
Consider
If the researcher discusses the contribution the study √
makes to existing knowledge or understanding e.g. do
they consider the findings in relation to current
practice or policy?, or relevant research-based
literature?
Pada bagian kesimpulan ini dikorelasikan dengan bagaimana keadaan saat ini dan
manfaatnya untuk meningkatkan penggunaan KB. “Public health campaigns to
communicate the benefits of contraception and small families with 95support from
Islamic religious scholars, and a system that ensures appropriate counselling and
a steady supply of contraceptives across the nation are likely to increase
contraceptive utilization in Afghanistan.”

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b. If they identify new areas where research is √
necessary
Telah dijelaskan pada bagian strength and limitation bahwa “In the future,
further research is needed to investigate the magnitude of each effect and
possible interactions among the identified themes; this will help design effective
interventions to promote family planning and contraceptive use in Afghanistan”
If the researchers have discussed whether or how the √
findings can be transferred to other populations or
considered other ways the research may be used

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