Hrev_master Healthcare in Low-resource Settings 2024; volume 12:12021 Android-based Kasih Ibu application for postpartum mothers using the research and development method Subriah Subriah,1 Zulaeha A. Amdadi,1 Andi Wilda Arianggara,2 Agustina Ningsih1 1Department of Midwifery, Poltekkes Kemenkes Makassar, Makassar; 2Department of Midwifery, STIKes Bina Bangsa Majene, Majene, Indonesia Abstract Endorphin massage is a light massage technique performed to help milk production. The purpose of this study is to develop the application of Kasih Ibu as a medium of education that can sup- port the application of Endorphin Massage. The method used in this study is Research and Development (RnD) with Brog and Gall models. The subjects of the research are two media experts, two material experts, and 40 postpartum mothers. The results showed that the validation test results from material experts aver- aged 92% and validation results from media experts averaged 87%, which showed that the Kasih Ibu application was very feasi- ble to use. Test user validity using a TAM (Technology Acceptance Model) questionnaire. Small-scale trials resulted in 95% and large-scale trials resulted in 96% with the very Worth it category. The Kasih Ibu application as a medium of Education and Communication is very worthy of use and can be accepted by postpartum mothers. Introduction Regulation of the Minister of Health Number 23 of 2014 con- cerning Efforts to Improve Nutrition. The implementation of bal- anced nutrition efforts for each family must be able to recognize, prevent, and overcome the nutritional problems of each family member. One of the efforts made is by breastfeeding newborns up to 6 months of age without additional food or drink.1 Breast milk contains complex nutrients, which contain colostrum which is rich in protein as an antibody so breastfeeding can reduce the risk of infant death due to infection. Breast milk also contains immunoglobulins, proteins, fats, calories, and lac- tose. In addition to containing food substances, breast milk also contains absorbent substances in the form of enzymes that will not interfere with enzymes in the intestine. Formula milk does not contain enzymes so the absorption of food depends on the enzymes present in the baby’s intestine.2,3 Based on the results of nutritional status monitoring in 2017, the percentage of infants who get exclusive breastfeeding in Indonesia is 35.73%. For South Sulawesi Province it is 42.13%, while for Makassar City it is 45.8%.2 The factor that becomes a problem in breastfeeding is the intensity of breastfeeding which is less so that it affects milk expenditure. This is due to the lack of stimulation of the hormone oxytocin which is a hormone that plays a role in the production of breast milk. Some studies prove that the work of the hormone oxy- tocin is influenced by psychological states. So a method is needed that can control the mother’s psychology so that she can relax, and not worry excessively, the mother is happy, calm, and confident because this is very instrumental in the breastfeeding process.4,5 Endorphin Massage is a light massage technique performed at certain points of the body, namely on the neck, back, and arms to create a sense of relaxation, and confidence and reduce stress in nursing mothers. With a feeling of pleasure, calm, relaxed, and confident, breast milk will come out smoothly. Endorphin mas- sage in several studies is influential in the release of the hormone oxytocin which plays a role in the process of milk secretion.4–6 Previous studies have scientifically proven the effects of Correspondence: Subriah, Department of Midwifery, Poltekkes Kemenkes Makassar, Makassar, Indonesia. E-mail: subriah@poltekkes-mks.ac.id Key words: application; Kasih Ibu; endorphin massage; TAM; RnD. Contributions: SS conceptualization, data curation, formal analysis, methodology, validation, visualization; ZA conceptualization, investiga- tion, methodology, validation; AW conceptualization, methodology, for- mal analysis, validation, and writing – original draft, review & editing; AN resources, investigation, and writing –review & editing. Conflict of interest: the authors declare no conflict of interest. Ethics approval and consent to participate: the research has received eth- ical approval from the Health Research Ethics Committee Health Polytechnic Makassar, based on ethical certificate 080/-KEPK- PTKMS/III/2022. During the research, the researcher pays attention to the ethical principles of information to consent, respect for human rights, beneficence, and non-maleficence. Patient consent for publication: written informed consent was obtained for anonymized patient information to be published in this article. Funding: this research was supported by a research grant from Daftar Isian Pelaksanaan Anggaran (DIPA) of Health Polytechnic Makassar with contract number LB.02.03/4.3/0018/2023. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Acknowledgment: we are thankful to Health Polytechnic Makassar for their valuable insights and contributions to this study. Received: 24 October 2023. Accepted: 30 April 2024. Early access: 21 May 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:12021 doi:10.4081/hls.2024.12021 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12:12021] [page 333] Non -co mmerc ial us e o nly endorphin massage. A study conducted by Masning (2017) found that endorphin massage affects breast milk expenditure with a value of p = 0.000. The results of the above research are in line with the results of research conducted by Tri Budi Rahayu (2019), based on the results of the study it can be analyzed that endorphins massage has an effect on the length of breast milk expenditure with a value of p = 0.026, the results showed that mothers with endor- phins massage intervention, milk expenditure earlier/faster than the control group, which is <24 hours. Research conducted by Nurfaizah Alza (2020) found that endorphin massage affects breast milk production in breastfeeding mothers with a value of p = 0.0001.7–9 Based on the description above, it can be concluded that endor- phins massage is a non-pharmacological alternative that can be applied to helping mothers succeed in breastfeeding. This research is ongoing. Based on previous research, it was found that the endorphin massage module is very feasible to use and is very influ- ential in increasing knowledge. So researchers want to develop the results of the research into an application that contains more com- plex education.10 Along with the development of the digital world, people’s need for information is easily obtained by accessing news or sources from the media, one of which is by using smartphones or smartphones. Research by Rizky et al., shows that the use of Android application-based learning media has a significant influ- ence on student learning outcomes and has a positive influence of 80.05%. The results of this study are supported by research by Nisa et al., providing conclusions that Android-based health applica- tions can add understanding, are interesting to use, easy to under- stand and the material is easy to remember. This shows that the dis- semination of information today can take place quickly through information technology that can be applied through the use of mobile applications.11,12 Based on the description above, researchers consider it necessary to design an Android-based appli- cation as an effective and efficient educational and communication medium for Postpartum mothers. Materials and Methods Research design This study used Research and Development (RnD). RnD design is intended for creating and developing new products. This product development process adopts the Brog and Gall develop- ment theory, where the stages in this research begin research and information collecting, planning, developing a preliminary form of the product, preliminary field testing, main product revision, main field testing, operational product revision, operational field testing, final product revision, and dissemination and implementation). The product is declared suitable for use after going through prod- uct feasibility trials using the TAM (Technology Acceptance Model) questionnaire.13–17 However, the research method used was only able to create the product and analyze product acceptance from users and was not able to describe the effectiveness of the product in increasing the knowledge and skills of breastfeeding mothers in carrying out endorphin massage. Study participants The participants of the research are two media experts, two material experts, and 40 postpartum mothers for small and big group examinations. Variable, instrument, and data collection The variables in this study are as described in Table 1. The research instrument used a questionnaire previously tested for validity and reliability and was declared valid and reliable. The instrument used a 5-point Likert scale: strongly agree = 5, agree = 4, mediocre =3 disagree = 2 and strongly disagree = 1. Data Analysis The assessment in this development research is determined by scoring product test questionnaires (Table 2) The results of the validation test will then be compared against the range of application eligibility values. To determine the feasi- bility value of the product, the following formula is used: Feasibility criteria Feasibility criteria are discussed in Table 3. Ethical clearance The research has received ethical approval from the Health Research Ethics Committee, Health Polytechnic Makassar, based on ethical certificate 080/KEPK-PTKMS/III/2022. During the research, the researcher pays attention to the ethical principles of information to consent, respect for human rights, beneficence, and non-maleficence. Results This research uses Research and Development (RnD) Methods to produce products in the form of the “Kasih Ibu” Application. In the RnD method, there are 6 stages of development as follows. Article Table 1. Variables. No Variable Operational Definition 1 Independent Variable: Application Kasih Ibu Kasih Ibu is an application developed as a medium of education and communication for postpartum mothers which is equipped with an Education menu consisting of Endorphin Massage modules and videos and communication media with live chat features that can directly connect postpartum mothers and health workers 2 Dependent Variable: Postpartum Mother's Acceptance The energy of Postpartum mothers is the feasibility of the application which reviews 5 aspects, namely perceived ease to use, perceived usefulness), attitude toward), behavioral intention, and actual usage [page 334] [Healthcare in Low-resource Settings 2024;12:12021] Non -co mmerc ial us e o nly Research and information collecting (needs analysis) Based on the results of the needs analysis, 8 out of 10 postpar- tum mothers consider it necessary to be able to access all forms of information related to the postpartum period and breastfeeding without being limited by space and time. So that an application is needed that can be accessed by Postpartum mothers effectively and efficiently. So researchers consider it necessary to design an android-based application as an effective and efficient educational and communication medium for postpartum mothers. Planning Product design The Kasih Ibu application is designed with 3 main menus, namely: i) endorphin massage module; ii) video of endorphins massage practice iii) live chat; iv) material preparation. The material is prepared based on a pre-arranged module enti- tled “Application of Endorphins Massage to Postpartum Mothers” and standardized Endorphins massage SOPs. Develop a preliminary form of product (early products created) As for the initial products that have been applied for Kasih Ibu, we display as depicted in (Figures 1 and 2). Validation test The feasibility assessment of the Kasih Ibu Application is car- ried out through three validation processes, namely media expert validation, material expert, and user validation. The assessment results were obtained by filling out media expert validation ques- tionnaires, material expert validation questionnaires, and TAM (Technology Accepted Model) questionnaires for user validation (postpartum mothers). The following is the data from the eligibility validation of the Kasih Ibu Application. Material expert validation Based on the graph of the results of material expert research, the average result of the assessment of aspects of content, presen- tation, language, and contextual aspects in 1st material expert is 94%, and in 2nd material expert is 91% so that can be interpreted that the eligibility criteria for the application are in the category very worthy of use (Figure 3). Media expert validation Based on the results of the assessment of media experts from the aspects of display, programming, and presentation of media, the Article Table 2. Validation questionnaire scoring conditions table. Answer Score Strongly agree 5 Agree 4 Mediocre 3 Disagree 2 Strongly disagree 1 Table 3. Feasibility criteria. Category Percentage Very worth it 85-100 Proper 69-84 Pretty decent 53-68 Less decent 37-52 Not worth it 20-36 Very unworthy 0-19 Source: Novaeni et al. 201832: https://creativecommons.org/licenses/by-nc-nd/4.0/ Figure 1. Main view. Figure 2. Main menu. [Healthcare in Low-resource Settings 2024;12:12021] [page 335] Non -co mmerc ial us e o nly results of the assessment of 1st media experts amounted to 82% with feasible criteria, and the results of the assessment of 2nd media experts amounted to 92% with very worth it criteria to use (Figure 4). User validation (postpartum mothers) User validation (Postpartum mothers) is carried out through two stages, namely small-scale trials and large-scale trials. The validation results are described in graphic form as follows (Figures 5 and 6). A small-scale trial was conducted on 10 Postpartum mothers using the TAM (Technology Accepted Model) question- naire. The results of the small-scale trial are described in graphic form (Figure 5). The percentage of eligibility for the Kasih Ibu Application is viewed from five aspects, namely easy to use by 95%, usefulness by 94%, Attitude Toward by 97%, Behavioral Intention by 96%, and Actual Usage by 97%. The average percent- age of the five aspects is 95%, so it can be concluded that the Kasih Ibu Application as a learning medium, is very feasible to use. A large-scale trial was conducted on 30 postpartum mothers using the TAM (Technology Accepted Model) questionnaire. The results of the small-scale trial are described in graphic form as described in Figure 6. The percentage of eligibility for the Kasih Ibu Application is viewed from five aspects, namely easy to use by 94%, usefulness by 94%, Attitude Toward by 97%, Behavioral Intention by 97%, and Actual Usage by 97%. The average percent- age of the five aspects is 96%, so it can be concluded that the Kasih Ibu Application as a learning medium, is very feasible to use. Discussion This research was conducted to design to produce an educa- tional media and communication media that can be used as a forum that can connect postpartum mothers and health workers and post- partum mothers who are in the working area of the puskesmas where she is. This product development process adopts the Brog and Gall development theory, where the stages in this research start from needs analysis, development design, learning model develop- ment, evaluation or trial, implementation, and final product.16,18–20 The feasibility test of the Kasih Ibu Application was carried out using the Technology Acceptance Model (TAM) questionnaire. Several studies show that the use of TAM can predict the accep- tance of information technology. TAM includes aspects of per- ceived ease of use, perceived usefulness, attitude toward attitude, behavioral intention, and actual usage.17,21–28 Some previous studies have also used TAM to describe the per- ception of user acceptance of an information system or technology that has been designed. Some previous studies such as Rahimi’s research (2018) which used the Technology Acceptance Model (TAM) approach to analyze the acceptance of the use of health information systems23 Jeffrey Campbell (2017) analyzed the use of TAM as a proposed acceptance of Mobile Health Intervention technology29 Then in Bagot’s study (2019) which used TAM to analyze user acceptance of acute stroke telemedicine services with the results obtained that from the aspect of perceived benefits, it Article Figure 3. Material expert validation results. Figure 4. Media expert validation results. Figure 5. Graph of small-scale trial results. Figure 6. Graph of large-scale trial results. [page 336] [Healthcare in Low-resource Settings 2024;12:12021] Non -co mmerc ial us e o nly was found that there were clinical improvements and patient care. From the aspect of ease of use, convenience is obtained in terms of clinical, technical, and consulting relationship aspects.13 The feasibility test on the Kasih Ibu Application is carried out in two stages, namely small-scale feasibility tests and large-scale feasibility tests. The results of the feasibility test on a small scale resulted in 95%, While in large-scale tests obtained was 96%, so it can be concluded that the Kasih Ibu Application as an educational medium is very feasible to use and acceptable to users. The percentage of the five aspects, namely, easy to use, use- fulness, attitude toward, behavior intention, and actual usage, can describe user acceptance of the Kasih Ibu Application. 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