FACTORS AFFECTING WOMEN AGE BEHAVIOR DOING INVESTIGATION OF VISUAL ACID ASSETS

(IVA) IN THE WORKING AREA OF PUSKESMAS BATU AJI BATAM CITY IN 2017

Mona Rahayu Putri

STIKes Mitra Bunda Persada Batam. Raya Seraya Street No. 1 Teluk. Tering, Batam, Kepulauan Riau, 29444
Email: monarahayuputri@rocketmail.com

ABSTRACT/ ABSTRAK

Ministry of Health Republic of Indonesia in 2015 states cervical cancer and breast cancer is a disease with
the highest prevalence in the year 2013, namely cervical cancer of 0.8%. Riau Islands provinces, North
Maluku, and DI Yogyakarta have the highest prevalence of cervical cancer. screening with Visual Inspection
of Acetic Acid precisely applied in Indonesia to detect cervical cancer.This study aims to determine the
factors that affect women of childbearing age perform IVA examination in the working area of Batu Aji
Puskesmas 2017. This type of research use analytical method with cross sectional approach. The population
in this study were fertile-age women who numbered 13.434 respondents with the sample in this study
amounted to 388 women of childbearing age. Data were analyzed using Chi-Square test.The result of
research shows that the most influential presdisposing factor is the parity with the value of Exp (B) 2,734
which means WUS multigravida has two chance to do IVA examination, the most influencing factor is the
availability of facilities and infrastructure with Exp (B) 2,624 which means Puskesmas has complete facilities
and infrastructure is likely to conduct IVA examination 2,624 times larger and the most influential
Reinforsing factor is the support of health workers with an Exp value of 8.745 which means women of
childbearing age get support from health personnel is likely to perform IVA examination 8,745 times more
big. The conclusion in this research is there is relationship between presdisposing factor, enabling, and
reinforcing with woman behavior of fertile age in doing IVA examination.

Keyword : IVA examination, Cervical Cancer, Women of childbearing age

Introduction
Cervical cancer is the second most common form of cancer in Asia and more than half of Asian
women die of cervical cancer. Of the 226 thousand diagnosed with cervical cancer, 143,000 cause death or in
other words every four minutes, women in Asia die of cervical cancer.
Indonesia has 15,000 new cases with 8,000 deaths every year, it is estimated that 1 woman dies
every hour. The Ministry of Health of the Republic of Indonesia in 2015 says cervical cancer and breast
cancer is the highest prevalence disease in 2013, ie cervical cancer of 0.8% . Riau Islands Province, North
Maluku and DI Yogyakarta have the highest prevalence of cervical cancer. Cervical cancer cases at the
General Hospital of Embung Fatimah City of Batam from January 2013 to July 2014 found 24 cases of
74,876 visits both outpatient and inpatient and most cases are advanced cervical cancer.
Visual Acetic Acid method is chosen because of its low cost. This method can be implemented at
Puskesmas, Puskesmas Pembantu, Rumah Sakit, Maternity Hospital and Village Midwife. Examination of
Visual Acetic Acid method is an examination by observing directly the cervix that has been rubbed with
acetic acid or vinegar (3-5%).
In relation to cervical cancer prevention programs, the Ministry of Health has targeted until 2025
that 80% of women aged 30-50 have early detection of cervical cancer. Based on these data, suspect cancer
of the uterine cervix as many as 840 people (1.3 per 1000 population). In an effort to achieve the target, the
government expanded the implementation of early detection of Cervical Cancer to 140 districts in 31
provinces implemented by 500 puskesmas from a total of 9500 puskesmas throughout Indonesia. Data of
Batam City Health Office 2016 was obtained from 98518 target number only 906 examined and obtained
visual inspection result of positive acetic acid at age of 30-50 years counted 21 people and at most in Batu
Aji Puskesmas counted 4 people. The number of these sufferers increased when compared to the year 2015
of 17 positive people from 812 people examined.
Research Design and Methodology
The research design used in this research is analytical research design with cross sectional approach,
that is the type of research that emphasizes the measurement time or observation of independent and
dependent variable data only once at one time. This research is done in Work Area of Batu Aji Puskesmas
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Batam This research was conducted in March to October 2017. The population in this study is all women of
childbearing age in the working area of Batu Aji Puskesmas 13,434 people .. Samples of 388 people.

Findings and Discussion

The result of this research is that 273 respondents (70,4%) have age 41-65 year while respondent having age
18-40 year is 115 respondent (29,6%). Respondents who have a high education as many as 128 respondents
(33.0%) while respondents who have low education level as many as 260 respondents (67.0%). Respondents
have good knowledge as many as 173 respondents (44.6%) while respondents who have less knowledge as
much as 215 respondents (55.4%). Multiple respondents were 322 respondents (83.0%) while primipara
respondents were 66 respondents (17.0%).
Respondents who said distance were 180 respondents (46,4) and close distance were 208 (53,6)
respondents, respondents said that facilities and infrastructure owned by Puskesmas were 44.1% while 55,9%
was incomplete. Respondents were able to fulfill transportation cost as much as 179 (46.1) respondents and
less well off as many as 209 (53.9) respondents. Respondents' perception on the skill of health workers is not
good as much as 241 (62,1%) and good as much 147 (37,9%).
The respondents who got the support of husband as much as 150 respondents (38,7%) while the
less respondent got husband support 238 respondents (61,3%), while the respondent got support from health
officer 59,3% and less support 40, 7%. Respondents who received support from cadres of health as much as
43.0% and less support as much as 57.0. Based on the result of univariate distribution of behavior of IVA test,
there were 175 respondents (45,1%) who had good IVA test behavior while respondents who had bad IVA
test behavior were 213 respondents (54,9%).

Age relationship with WUS Behavior against IVA Examination

The result of age correlation analysis with WUS behavior on IVA examination was obtained p =
0,001 (p <0,05) so that there can be relation between age with WUS behavior toward IVA examination.
From OR analysis result obtained OR value of 2,155 which means respondent with age 41-65 year have
chance twice to conduct IVA examination compared to respondent who is 18-40 years old.
This research is in line with research of Sakanti (2007), there is a significant correlation between age with the
behavior of woman of child-bearing age in conducting examination of cervical cancer detection with p value
0,020. Women who did the examination of cervical cancer detection as much as 78.57% aged over 35 years.
This is in accordance with the MOH recommendation that IVA examination is focused on women aged 30-
50 years.33

Relationship of Education with WUS Behavior against IVA Examination

Result of analysis of education relation with behavior of WUS to examination of IVA got value p =
0,006 (p <0,05) so that can be stated there is correlation between education with behavior of WUS to
examination IVA. From OR analysis result obtained OR value 1.868 which means that respondent with high
education level have 2 chance to conduct IVA examination compared to respondent having low level of
education.
The results of this study show results that are in line with the study conducted Lestari (2012), that
there is a significant relationship between maternal education level with the behavior of early detection of
cervical cancer IVA method with p value 0.017 (<0.05). Mothers who have higher

Knowledge Relationship with WUS Behavior on IVA Examination

Result of analysis of knowledge relation with behavior of WUS on examination of IVA got value p
= 0,006 (p <0,05) so it can be stated there is correlation between knowledge with behavior of WUS to
examination IVA. From OR analysis results obtained OR value of 1.806 which means respondents with a
good level of knowledge have a chance of 2 times to conduct an IVA examination than respondents who have
less knowledge level.
The results of this study in accordance with the research Sakanti, Anggiasih 2007 that people who
know good, as much as 85.71% perform IVA examination. In line with the results of research Yuliwati (2012)
that there is a significant relationship between knowledge and behavior check IVA in Prembun Puskesmas
Area with p value = 0.000.33

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Relationship of Attitudes with WUS Behavior against IVA Examination
Result of analysis of attitude relationship with behavior of WUS on examination of IVA got value p
= 0,006 (p <0,05) so it can be stated there is relation between attitude with behavior of WUS to examination
IVA. From OR analysis result obtained by OR 1,880 value which means respondent with positive attitude has
2 chance to perform IVA examination compared to respondent having negative attitude.
Research conducted by Mas'adah, Susilorindi get more than 50% of respondents have a positive attitude
(Good) that is 21 (55.26%) who conduct IVA examination. This is because most of the WUS are well
knowledgeable about IVA. research conducted by Mas'adah, Susilorin, the number of respondents who have
negative abilities caused by the lack of knowledge of female EFA about pap smear.40

Parity Relationships with WUS Behavior on IVA Examination

The result of parity relationship analysis with the behavior of WUS on IVA examination was
obtained p = 0,001 (> 0,05) so that there could be relation between parity with WUS behavior toward IVA
examination. From OR analysis result obtained OR value 2,487 which mean multipara respondent have
chance twice to conduct IVA examination than primipara respondent.
The results of this study showed results in line with research conducted by Fera (2011) conducted on
mothers in the work area of Puskesmas Merigi Kepahiang showed that there was a significant relationship
between mother parity with IVA examination

Relationship of Distance Affordability with WUS Behavior to IVA Examination

The result of the analysis of the relationship of distance affordability with the behavior of WUS to
the examination of IVA, p = 0,002 (p value <0,05) means that there is a significant difference of proportion
between the behavior of IVA examination of respondents who have distant jurisdiction with Puskesmas with
close range with Puskesmas there is a relationship between affordability with IVA examination behavior).
From OR analysis result obtained OR value 0,513 which means that respondent have long distance and close
to Puskesmas have equal opportunity to do examination IVA.
The results of this study show results that are in line with the research conducted by Yuliwati
(2012) that there is a significant relationship between the affordability of distance with IVA examination with
P = 0,000. Affordability reaching the place of service strongly supports a person to perform the action of IVA
examination, the closer the distance it will be more easy WUS to perform IVA.42 examination

Relation of Facilities and Infrastructure with IVA Examination

The result of the analysis of the relationship between the availability of facilities and infrastructure
with the behavior of WUS on the examination of IVA found that p = 003 (p value <0.05) means that there is a
significant proportion difference between the behavior of the IVA of the respondents whose facilities and
infrastructure at the Puskesmas complete with the facilities and infrastructure Puskesmas is not complete
(there is a relationship between the availability of facilities and infrastructure with the behavior of IVA
examination).
Based on the results of the research disclosed by informant I, for facilities and infrastructure that are
tools and supporting materials such as speculum examination, gynecological bed, swabs and so on to carry out
the examination is available and in good condition but the number is not suitable if held mass examination
that patient more of 15 people. This is in accordance with the results of observations made by researchers

Relationship of Costs Affordability with WUS Behavior to IVA Examination

The result of the influence of the relation of transport cost affordability with the behavior of WUS
to the IVA examination found that p = 0,005 (p value <0,05) there is no significant difference between
behavior of IVA examination of respondents who able to produce transportation cost and less able to
examination IVA no the relationship between affordability of transport costs and IVA examination. Based on
OR analysis result obtained OR value 1.824 Which means that respondents able to meet the cost of
transoortasi have 2 chance to conduct IVA examination if the respondent can not afford for transportation
cost.
Research conducted by Rahmawati states that there is an important relationship between the affordability of
the cost with visual examination of acetic acid, which is in accordance with the decisive theory of factors that
allow a person to perform visual motinspeksi acetic acid.

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Perception Relation to Health Care with WUS Behavior against IVA Examination

Result of analysis of health behavior relationship with behavior of WUS on examination of IVA got
value p = 0,004 (p value <0,05) there is significant difference between behavior of IVA examination of
respondent that have good perception and perception which is not good (there is relation between perception
skill health with IVA inspection guidelines). From the OR analysis results obtained OR value of 1.835 Which
means that respondents have a good perception of the ability of health have a chance 2 times to perform IVA
examination than respondents who have poor perception.
The results of this study indicate the results of existing research conducted yuliwati (2012) that there
is a significant relationship between perceptions of health skills with the behavior.

Relationship of Husband Support with WUS Behavior against IVA Examination

The result of analysis of husband support relationship with WUS behavior toward IVA examination
got p value = 0,004 (<0,05) so that can be stated there is relation between husband support with behavior of
WUS against IVA examination. From OR analysis result obtained OR 1,880 value which means that
respondent have good husband support have chance 2 times to conduct IVA examination compare to
respondent who have husband support less good compared to respondent who do not get husband support.
The results of this study show results that are in line with the research conducted by Yuliwati
(2012) that there is a significant relationship between husband / family support with IVA examination with P
= 0,000.

Relationship of Health Personnel with Behavior of IVA Inspection

Result of analysis of health personnel support relationship with WUS behavior toward IVA
examination got p value = 0.000 (<0,05) so it can be stated there is relation between support of health worker
with WUS behavior toward IVA examination. From OR analysis result obtained OR value 8,223 which mean
respondent having good health support have 8 chance to do IVA examination than respondent having less
support from health worker.
Based on the results of research obtained from informants that the extension is given to the
community in the local health center at PKK or posyandu meeting. Posyandu cadres who have been given
counseling then submit back to the community in their respective areas - however extension is not done
routinely. Counseling is provided only a few times a year. This is in line with research conducted by fitria
(2013) that only 32.7% of Puskesmas do routine counseling and the rest do not conduct routine counseling.

Relationship of cadres Support with Behavior of IVA Inspection

Result of analysis of health personnel support relationship with WUS behavior toward IVA
examination got p value = 0,001 (<0,05) so it can be stated there is relation between health cadre support with
WUS behavior toward IVA examination. From OR analysis results obtained OR value of 2,040 which means
respondents who have good health cadres have 2 times chance to perform IVA examination than respondents
who have less good cadre support.

Relationship of Information Exposure with Behavior of IVA Inspection on

IVA Examination

Result of analysis of exposure relationship of information with behavior of WUS on examination of

IVA got value p = 0,004 (> 0,05) so it can be stated there is no relation between information exposure with
behavior of WUS against IVA examination. From OR analysis results obtained OR value of 1.914 which
means that respondents have good information exposure have 2 times chance to perform IVA examination
than respondents who have less good information exposure
The results of this study are in line with the research conducted by Arini et al (2008) on factors
affecting low IVA examination in Puskesmas Pasar Atas Durian Depun showed p value = 0.001, thus showing
health information exposure related to IVA examination. The results of this study indicate that the information
received

Factors that influence in conducting IVA examination

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 The result of this research shows that p value of wald variable parity test is 0,001 which means
there is influence of facility and infrastructure to the behavior of IVA examination. The more complete
facilities and infrastructure of puskesmas makar mother increasingly also the behavior of examination
The relationship was statistically significant (OR = 2,624; 95% CI 1.490 to 54.622; p = 0.001).
The result of this research shows that p value of wald variable parity test is 0.000 which means there is
influence of health personnel support to IVA examination behavior. The better the support of health workers
hence emakin increased also checking behavior of women of childbearing age. The relationship was
statistically significant (OR = 8,745; 95% CI 4,714

Conclusion
Based on the results of research and discussion that have been done, the conclusion of this study is
that the majority of women of childbearing age aged 41-65 years, low education, less knowledge,
negative attitude, multigravida parity, affordability, availability of facilities and complete
infrastructure, affordability lack of support, lack of support from a health worker, and lack of cadre
support and age, knowledge, parity, education, information exposure, attitudes, affordability,
affordability of transportation costs, availability of facilities and infrastructure, perceptions of skill of
health officer, husband support, health officer support, and health cadre to IVA examination
behavior. The most influential factor of presdiposition toward IVA examination behavior is parity
factor, the most influential factor of influence dadap IVA examination is the factor of availability of
facilities and infrastructure and the most influential amplifier of IVA examination

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Biography (in paragraph)
Mona Rahayu Putri was born on Januarai 20st 1986 in Barulak, West Sumatra.
She earned her Bachelor’s degree from D-IV Midwifery in STIKes Fort De Kock
in 2012. After the graduation, she was accepted as an Midwifery Lecture at
STIKes Mitra Bunda Persada Batam. She earned her Master’s Degree in Institut
Helvetia Medan. Mona Rahayu Putri is now the Lecture at STIKes Mitra Bunda
Persada Batam