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FAKTOR PERSONAL, SELF EFFICACY DAN UPAYA PENCEGAHAN

KANKER SERVIKS PADA PEREMPUAN USIA PRODUKTIF

(Personality Factor, Self Efficacy and Prevention Of Cervical Cancer In Women Of


Childbearing Age)

Ni Ketut Alit Armini, Iqlima Dwi Kurnia, Fani Lailatul Hikmah


Faculty of Nursing Universitas Airlangga
Kampus C Jl. Mulyorejo Surabaya, Telp. 031 5913754,
E-mail: nk.alita@fkp.unair.ac.id

ABSTRAK
Pendahuluan: Kanker serviks menjadi penyebab utama morbiditas dan mortalitas di seluruh
dunia. Program pencegahan kanker serviks yang kurang baik menyebabkan keterlambatan
penanganan sehingga sebagian besar responden mengalami kanker serviks stadium lanjut.
Penelitian bertujuan untuk mengetahui hubungan faktor personal, self efficacy dengan upaya
pencegahan kanker serviks pada wanita usia produktif. Metode: desain penelitian ini adalah
deskriptif korelatif dengan pendekatan cross sectional. Populasinya adalah semua wanita usia
produktif di wilayah Puskesmas Kenjeran Surabaya. Besar sampelnya adalah 64 responden wanita
usia produktif dengan menggunakan Probability Simple Random Sampling. Variabel independen
adalah faktor personal dan self efficacy. Variable dependen adalah upaya pencegahan primer dan
sekunder. Data dianalisis menggunakan uji statistik Spearman’s rho untuk mengetahui variable
yang berhubungan dengan upaya pencegahan kanker serviks. Hasil: hasil penelitian menunjukkan
hubungan antara faktor personal dan upaya pencegahan kanker serviks menghasilkan p = 0,025 (α
≤ 0,05). Sedangkan variable hubungan self efficacy dengan upaya pencegahan kanker serviks pada
wanita usia produktif menghasilkan p = 0,094 (α ≤ 0,05). Diskusi: Faktor personal berhubungan
dengan upaya pencegahan kanker serviks pada wanita usia produktif sedangkan self efficacy tidak
berhubungan dengan upaya pencegahan kanker serviks pada wanita usia produktif. Untuk peneliti
selanjutnya dapat menggunakan variabel lain dari teori Health Promotion Model untuk melakukan
upaya pencegahan kanker serviks.

Kata kunci : wanita usia produktif, kanker servik, self efficacy, faktor personal.

ABSTRACT
Introduction: Cervical cancer as the most common cause of morbidity and mortality around the
world. The worse cervical cancer prevention program might lead to delayed treatment of cancer.
Furthermore patient who suffered cervical cancer in women of childbearing age. Method: The
study design was descriptive cross sectional approach correlation. The population were women of
childbearing age who involved the region of Puskesmas Kenjeran Surabaya. The number of
sample were 64 respondents who taken by using simple random sampling. The independent
variables were factor of personal and self efficacy. The dependent variable was the primary and
secondary prevention of cervical cancer. The data was analyzed by using statistic tests
Spearmans’s rho to know correlation of independent variable with prevention measures of cervical
cancer. Result: The result of relationship between the personal factors and cervical cancer
prevention showed value p=0.025 (r=0.280). The relationship between self efficacy with
prevention of cervical cancer in women of childbearing age showed value p=0.094 (r=0.211).
Conclusion: Personal factors associated with prevention of cervical cancer in women of
childbearing age. Self efficacy had no relationship with prevention of cervical cancer in women
of childbearing age. The further study was recommended to develop health promotion model
factors to increase the prevention of cervical cancer.

Keywords: childbearing age women, cervixal cancer, self efficacy, personal factors.

1
INTRODUCTION cancer, which amounted to 4.1 ‰.
Cancer affects all levels of Based on the estimated number of
society from lower to higher, old and cervical cancer is the cancer with the
young, educated low or high (Depkes, highest prevalence in Indonesia in 2013,
2011). Risk population requires which amounted to 0.8 ‰ of cervical
prevention efforts as early as possible in cancer. Based on the estimated number
order to implement healthy behavior of cervical cancer are highest in the
(Anthony et al., 2010). Cervical cancer province of East Java and Central Java
is a malignant tumor that grows in the Province. The incidence of cervical
the lowest part of the uterus that cancer in Surabaya each year has
attached to the top of the vagina. decreased, the estimation Surabaya City
Theory nursing that focuses on Health Office in 2011 approximately
prevention and promotion of health 17.97%, in 2012 amounted to 17.13%,
behaviors is the Health Promotion and 14.31% in 2013. According to
Model Nolla J Pender. Health previous research, the behavior of
promotion model (2002) encourages the cervical cancer prevention is affected
use of integrative model of health, because of their holistic and complex
which takes a broad view on the interaction of the individual with the
biopsychosocial phenomenon of human environment in the surrounding areas
health. Clinical indicators in theory (Chusairi, A & Hartini, Nurul, 2003: 30)
HPM is interpersonal behaviors, social these things that influence the decision
support, socioeconomic status, mood, to take precautions.
complaints, hormone levels, antibody In addition there are other
status. Human responses determine factors that can influence the behavior of
indicators of healthy or less healthy. prevention, namely internal and external
HPM theory is a theory that explains factors of patients, such as beliefs,
and predicts the interaction between spiritual encouragement, confidence,
factors-environmental factors and financial condition and culture that had
perceptions can affect health. been used in the search for prevention
Cervical cancer is a major cause efforts. Cultural backgrounds have an
of morbidity and mortality in the world, important influence on aspects of
according to World Health Organization community life, including their beliefs,
(WHO) estimates that in 2012 the behaviors, perceptions, emotions and
incidence of cancer is about 14 million attitudes to the disease that has
new cases and 7.6 million deaths. significance for health (Helman, 1990).
Figures Cervical Cancer Incidence Self-efficacy affects the motivation and
varies greatly. Cervical cancer is the confidence of every woman to perform
second most common cancer to strike on cervical cancer prevention (Cromie,
women in developing countries is 2000). WHO said in developing
expected in 2012 about 270,000 women countries cervical cancer is ranked top
die from cervical cancer. In Indonesia, among various types of cancer that
the prevalence of cervical cancer cases causes death in women in the world who
is quite high. Globocan based on data attack the childbearing age. The main
from 2008, found 20 cases of cervical cause of cervical cancer is infection
cancer deaths every day. The disease is Human Papilloma Virus (HPV).
also a cause of death number seven in HPV infection can strike women,
Indonesia (Herman, 2014). Nationally, ranging from 20-year-old woman until
the prevalence of cancer in the women are no longer in the childbearing
population of all ages in Indonesia in age. Some of the risk factors of infection
2013 was 1.4 ‰ or estimated to be HPV among others, women who
around 347 792 people. Yogyakarta married at the age of 18 years are at risk
province had the highest prevalence of 5-fold infected with HPV, women with

2
sexual activity high and have multiple disagree, strongly disagree.
partners, smokers, have a history of Questionnaires primary and secondary
venereal disease, parity (number of prevention efforts related to healthy
births) , use of oral contraceptives in the check regularly, avoiding smoking,
long term. There is a significant regular physical activity, a balanced diet,
relationship between the level of adequate rest, stress management which
education, occupation, income, contains 6 questions with answer
knowledge and attitudes of women EFA choices often, rarely, never. This
with a Pap smear in Banda Aceh research was conducted in Puskesmas
(Nurhasanah, 2008). Health Promotion Kenjeran Surabaya. Any data will be
Model is a model for nurses to explore measured using Spearman's rho that if
the complex biopsychosocial processes, the set value of significance  ≤ 0,05.
which motivates people to behave in
certain ways, which is intended to RESULT
improve the health status (Tommey and Table 1. Respondent characteristic
M.R. Alligood, 2006). Decrease the (n=64)
severity of cervical cancer is very No Responden F %
1 Age 18-35 years old 36 56,3
important, especially the prevention of 36-50 years old 28 43,7
cervical cancer in Women of 2 Activity Wife 39 60,93
childbearing age. Communities with low Comerce 8 12,5
socioeconomic have less opportunity to Labour 4 6,25
Swasta 13 20,31
do prevention by Pap smear (Wilopo, 3 Education Not School 3 4,68
2010). IVA test and Pap smears in Elementary 19 29,6
Women of childbearing age are still not JHS 23 35,9
SHS 17 26,5
maximized due to fear and shame to University 2 3,125
double check the cervix rechildbearing 4 Salary ≤Rp. 3.045.000 58 90,6
organs against health workers >Rp. 3.045.000 6 9,4
(Candraningsih, 2011).
According to the table 1 above
METHOD concerning the characteristics of
This research uses descriptive respondents shows that in the age range
correlational design with cross sectional 18-35 years there are 36 mother with a
approach. Population in this study as frequency (56.3%). Ages 18-35 have the
many as 193 people to sample as many opportunity to multiply to cervical
as 64 people. The sampling technique cancer prevention efforts. Most jobs of
used in this study is simple random most respondents is to be a housewife
sampling. The independent variables in mother with a frequency of at least 39
this study are personal factors (60.93%). Most housewives around
(biological, psychological, and puskesmas Kenjeran have good social
sociocultural) and self efficacy. The relationships so that health information
dependent variable in this study is about cervical cancer prevention can be
primary and secondary prevention. seen easily. Last Education respondents,
Instruments in this study was a 35.9% (23 persons) have SMP. This
questionnaire. Questionnaires personal resulted in a lack of information
factors associated with a domain obtained in formal education, so that
statement to measure biological, could affect prevention efforts. Family
psychological, and sociocultural income in one month there were 90.6%
containing 10 items of questions with (58 people) ≤ Rp 3.045.000 million.
answer choices strongly agree, agree, This has an impact on the behavior of
neutral, disagree, strongly disagree. primary and secondary prevention
Self-efficacy questionnaire containing efforts of local residents Kenjeran PHC
10 items of questions with answer Surabaya.
choices strongly agree, agree, neutral,

3
Respondents who have a weak self-
efficacy will affect both primary and
Table 2. Reproduction history (n=64) secondary prevention of cervical cancer.
No Characteristic Criteria f % This is influenced largely neutral
1 Child 0-2 children 47 73,4 respondents chose the answer 1-2
>2 children 17 26,5 statements in the questionnaire. Primary
2 Information No 42 65,6
about cancer and secondary prevention of cervical
Yes 22 34,4 cancer either are 33 acceptors (52%). So
3 Check IVA/Pap No 63 98,5 most of the respondents were able to
Smear
Yes 1 1,5 reduce the incidence of cervical cancer
4 Vaksin HPV No 64 100 in Puskesmas Kenjeran Surabaya. Most
of the respondents had never received
According to the table 2 on the counseling about cervical cancer is that
rechildbearing history of Respondents it can improve healthy behaviors for the
that the number of children, knowledge prevention of cervical cancer increases.
of cervical cancer, IVA examination /
Pap, HPV vaccine. There is a 73.4% (47 Table 4. Correlation between personality
persons) have 0-2 children, from these factor and cervical cancer prevention
results indicate that the risk of cervical
cancer due to high parity, is able to Person Prevention Total
ality less good
reduce the incidence of cervical cancer Factor F % f % Σ %
in the region Kenjeran Surabaya. Negativ 19 61,2 11 33,3 30 46,8
Knowledge of cervical cancer are 65.6% e
Positive 12 38,8 22 66,7 34 53,2
(42 people) do not know about cervical Total 31 100 33 100 64 100
cancer. There is a 98.4% (63 people) Spearman rho p = 0,025 r = 0,280
have never done IVA examination / Pap
Smear. There is 100% (64 people) have Based on Table 6 shows that
never done the HPV vaccine. From respondents with a positive personal
these data, the majority of Women of factors and prevention less were 12
childbearing age have less prevention acceptors (38.8%) and amounted to 22
efforts. acceptors (66.7%) had a good
prevention efforts. Statistical test results
obtained Spearman rho p = 0.025 (α ≤
Table 3. Personal factor, Self efficacy, 0.05) then H1 accepted which means
cervical cancer prevention (n=64) that there is a relationship between
personal factors and the prevention of
Variable Cathegory f %
Personal Negative 30 47
cervical cancer in Women of
Factor Positive 34 53 childbearing age. On the table is
Self Efficacy Weak 43 67 obtained r 0.280, which means that the
Strong 21 33
Prevention less 31 48
variable personal factors and prevention
Good 33 52 of cervical cancer in Women of
childbearing age have a low closeness of
From Table 3 shows that Personal the relationship.
factor in cervical cancer prevention in
the health center Kenjeran Surabaya Tabel 5. Correlation between self
most of the respondents who have a efficacy and cervical cancer prevention
positive personal factors as much as 34
Self Prevention Total
acceptors (53%). Respondents have a effiacy less good
positive personal factors so that the f % f % Σ %
behavior of cervical cancer prevention Weak 24 77,4 19 57,5 43 67,1
can be done well. a number of self- Strong 7 22,6 14 42,5 21 32,9
Total 31 100 33 100 64 100
efficacy is weak acceptor 43 (67%). Spearman rho p = 0,094 r = 0,211

4
2003). Personal factors related to the
Based on Table 7 shows that prevention of cervical cancer because
respondents who have weak self inividu with positive personal factors
efficacy and prevention efforts have less such as avoiding marriage under 18
number of 24 acceptors (77.4%) and the years of age, not using hormonal birth
respondents have good prevention control in the same period of 5 years,
efforts acceptor number of 19 (57.5%). avoiding cigarette smoke, and so can
Respondents with a strong self-efficacy increase an individual effort to prevent
and prevention less number 7 acceptors cervical cancer.
(22.6%) and the number of 14 acceptors There are several reasons that
(42.5%) had good prevention efforts. make the 12 respondents have
Statistical test results obtained Spearman prevention efforts less despite having
rho p = 0.094 (α ≤ 0.05) then H1 personal factors were positive for
rejected, which means there is no respondents deem that the Pap smear is
relationship between self-efficacy and only performed on women who change -
the prevention of cervical cancer in change sexual partners this is in
Women of childbearing age. accordance with the respondent's answer
questionnaire data personal factor
DISCUSSION number 4 though in category overall
Based on the results in Table 4 good personal factors. From
of personal factors have been associated demographic data obtained contained 42
with the prevention of cervical cancer in respondents who do not know about
Women of childbearing age in cervical cancer, 63 respondents had
Puskesmas Kenjeran Surabaya. Most never perform secondary checks pap
respondents have the positive personal smears and nearly all respondents have
factors. Primary prevention and never done the HPV vaccine. Problems
secondary prevention efforts fraction has that arise from the above results due not
bad and most people have a good received information about the
prevention. Personal factors can prevention of cervical cancer in Women
improve a woman to take steps to of childbearing age, can not manage
prevent cervical cancer. One of the stress well and has never made a
components in the personal factor is age. secondary examination of cervical
The demographic data were obtained by cancer. There were 11 respondents with
the majority of respondents aged 18-35 a negative personal factors but has a
years and 36-50 years old fraction. Age good prevention efforts due to the
affects prevention with increasing personal factors questionnaire
knowledge acquired. At middle age respondents many wrong answers to the
people will be more actively involved in question number 4 on individuals who
community and social life (Rahayu et al, should conduct a secondary examination
2014). of cervical cancer and have a good
Good prevention efforts in the answer on the questionnaire prevention
region can be caused by as many as 22 efforts.
people in the region have followed the Respondents who had positive
cervical cancer education. Jobs personal factors and prevention efforts
respondents mostly as housewives were both as many as 22 people. This caused
able to influence the level of knowledge the housewife is able to make the
for social interaction into successful interaction among fellow Women of
healthy behavior of each individual. childbearing age and have the desire to
Social and cultural interaction increase keep them healthy so Women of
the prevention of cervical cancer childbearing age feel able to do the
because it can provide an emotional prevention of cancer as early as
benefit or affect the behavior included in possible. The statement was supported
preventive medicine (Supartiningsih, by research conducted by Ika Nur

5
(2009) states that Behavior can be efficacy and a small portion of
influenced by many factors, including respondents have a strong self-efficacy.
factors outside of the individual and the On the results of self-efficacy
individual factors. This is reinforced by questionnaire conducted showed that the
Bandura in Social Learning Theory, respondents are sure to do the primary
which states that behavior is a reciprocal and secondary prevention of cervical
interaction between personal and cancer, so the respondents can improve
environmental factors. self efficacy and did not experience
In this study, respondents many anxiety in prevention efforts. Self-
prevention efforts because of behavior efficacy is the belief to perform a
that made the day - day in accordance desired action, self-efficacy is the
with primary prevention, such as background for someone to perform an
avoiding smoking, regular physical action or control certain situations
activity, diet as needed, adequate rest (Bandura, 1994). Experience and family
can reduce the incidence of cervical support also affects the primary and
cancer. It has never been done by the secondary prevention of cervical cancer.
respondent in the prevention of cervical The majority of respondents have 0-2
cancer is the Pap examination IVA or children and a small proportion of
pitcher. A small portion of respondents respondents have more than two
had experienced rechildbearing children. This affects the respondents
problems so that they have the initiative who have children >2, the risk of
to take precautions against the cervical cancer will be increased. So the
possibility of early rechildbearing role of motivation, self-efficacy, and
problems especially cervical cancer. self-confidence is an important part of
Family support and cadres to carry out healthy behaviors (Rosenstock, 1990).
health action was very influential in the Self-efficacy was instrumental to the
local area, because the majority of the way a person healthy behavior, such as
study area around the behavior, if it has the prevention of cervical cancer every
been communicated to the family and woman of childbearing age through
important people around. There is a primary and secondary prevention in the
relationship between personal factors health center Kenjeran Surabaya.
and prevention of cervical cancer, due to There were respondents with
personal factors that positively every self-efficacy is weak but able to take
respondent would seek to improve steps to prevent cervical cancer.
health and prevention efforts. Besides Educational background and do not yet
the need for routine counseling program know how to prevent cervical cancer is a
so that every woman age Kenjeran factor supporting the respondents have a
roduktif in the region to understand the weak self-efficacy. In addition to the
prevention of cervical cancer and self-efficacy questionnaire number 10
perform routine daily primary respondents chose to answer the neutral,
prevention and secondary prevention of impartial effort to make secondary
the examination of IVA or regular Pap prevention of cervical cancer every 3-5
smears. years. Respondents who have strong
Research results in Table 5 self self-efficacy but less prevention efforts
efficacy has no relation to the prevention because the respondents did not know
of cervical cancer in Women of about cervical cancer prevention, has
childbearing age in Puskesmas Kenjeran less rest time of less than 8 hours per
Surabaya. A study of 64 respondents day and less in managing stressors.
was motivated some respondents do not When viewed from the level of anxiety,
understand how to prevent cervical the respondents had lower levels of
cancer in Women of childbearing age. anxiety. It is able to influence the
Most respondents have a weak self- prevention of respondents. Although
respondents were self-efficacy is less

6
but still there is a sense to maintain the of respondents experienced increased
health and prevention efforts, especially anxiety before performing a secondary
primary prevention of cervical cancer. examination of cervical cancer. This
Respondents who have strong self- caused the respondents still do not
efficacy and better prevention efforts as undergo the inspection process IVA or
many as 14 people. One of the pap smear associated with efforts
supporters of that education respondents penceghan cervical cancer. Although the
are mostly middle and high school results of this study no relationship but
graduates. Education is a tool that can be if there is a strong self-efficacy that
used to fix itself in the hold of social someone will be able to increase
life. The level of education a person confidence, reduce the level of anxiety,
influential in giving a response that improving preventive health measures
comes from outside. People who have on yourself.
higher education will provide a more In accordance with previous
rational response than the low education studies conducted by Endang, et al
or no education at all. Second, the (2012), showed that no significant
information obtained from both formal relationship between self-efficacy with
and non formal education can provide treatment-seeking behavior in breast
short-term effect resulting in a change or cancer patients at Ibn Sina Hospital of
an increase in knowledge. Innovation or Gresik. External factors can influence
new information that emerged from the occurrence of treatment-seeking
cognitive can provide a foundation for behavior. Self-efficacy was instrumental
the formation of knowledge about it to the way people behave in healthy, as
(Good, 2014). Mothers in the area begin well as to prevent the incidence of
to understand to maintain rechildbearing cervical cancer in self.
health. This indicates that the knowledge
of the mother - the mother of cervical CONCLUSIONS AND
cancer are still able to be delivered SUGGESTIONS
properly so as to improve the
individual's desire to keep them healthy Conclusion
so Women of childbearing age and is Women of childbearing age
able to prevent cancer as early as have a good prevention efforts in the
possible. According Erfandi (2009) prevention of cervical cancer . Women
factors that affect a person's level of of childbearing age who have a positive
knowledge among them in terms of personal factors tend to have good
education, media, environment, prevention. Women of childbearing age
experience, age, socio-cultural and who have strong self-efficacy tend to
economic. have less prevention.
We conducted the interview,
respondents are sure to maintain good Suggestion
health and will take steps to prevent Knowledge of Women of childbearing
cervical cancer as early as possible. This age in Puskesmas Kenjeran still needs
indicates that respondents have a good to be improved because a lot of people
self efficacy. Respondents many who still do not know about cervical
prevention efforts because they feel cancer, in fact many people who want to
uncomfortable if you already know the take action to prevent cervical cancer
results of cervical cancer. There is a through examination IVA but because of
relationship between behavioral the lack of information obtained so
prevention with good self efficacy, due many women who have anxiety.
to the high value of self-efficacy an For Women of childbearing age
individual is able to direct people to a should pay more attention to the
behavior that is followed by the majority education of cadres on the prevention of
of Women of childbearing age. Average cervical cancer related to the increased

7
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