E:\IBUK\NERS DESEMBER 2021\17-- 373Retnosari, Titisari, Sendra, The Correlation of Maternal Age and the Incidence of ... The Effect of Health Education to The Active Presence of Mother to Take Their Toddlers to Posyandu Maria Ulfa1, Laily Prima Monica2 1,2Midwifery Department, STIKes Patria Husada Blitar, Indonesia JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk JNK History Article: Received, 03/11/2021 Accepted, 22/12/2021 Published, 26/12/2021 Keywords: Health Education, Active Presence Article Information Abstract The decrease of the active presence of toddlers at the posyandu has become a problem for health workers in monitoring the health and development of infants and toddlers in their working areas. This is due to several reasons, one of which is from the mothers who are lazy and do not know what is the benefits they will get when they are taken to the posyandu. The purpose of this study was to determine the effect of health education to the active presence of mothers to take their toddlers to posyandu. Methods: This study used a “Pre-Experimental” design. The sample was 30 respondents taken by using purposive sampling technique. The independent variable was health education and the dependent variable was active presence of mother to take their toddler to posyandu. The instrument used health educa- tion materials and observations on the respondent’s attendance book in the last 8 months. Result: the sattistical Wilcoxon rankTest showed p value = 0.05. This meant that health education affected the active presence of moth- ers in bringing their toddlers to join the posyandu at Polindes Semen, Gandusari District. Based on the result, it is expected to all mothers to be active in joining Posyandu so that they can get education on how to stimu- late and check their children’s growth and development. For health workers, the results of this study can be used as an input so that they can improve the provision of counseling during posyandu activities and the target of achiev- ing the presence of infants and toddlers in the areas can be achieved. © 2021 Journal of Ners and Midwifery 373 Correspondence Address: STIKes Patria Husada Blitar – East Java, Indonesia P-ISSN : 2355-052X Email: ulfamaria845@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v8i3.ART.p373–377 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) https://crossmark.crossref.org/dialog/?doi=10.26699/jnk.v8i3.ART.p373-377&domain=pdf&date_stamp=2021-12-26 374 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 373–377 INTRODUCTION In order to reduce the child mortality rate, the government really expects the community partici- pation, one of which is through Posyandu activities. Posyandu is established with the aim of reducing infants and toddlers mortality rates (Utami, et al, 2016). The number of Posyandu in East Java until the end of 2018 reached 46,733 unit. The coverage (visits) of infants in East Java Province in 2018 reached 96.6% and there were 22 districts/cities that did not reach the specified target (97%). There were still 6 districts and cities that need to be im- proved in order to achieve PURI strata > 60%. They were Sumenep Regency, Pamekasan Regency, Bangkalan Regency, Blitar Regency, Lumajang Regency and Surabaya City. The achievement of the presence of infants and toddlers in joining Posyandu still did not meet the target so that the health development goal was not aacomplished (East Java Health Office, 2018). Posyandu is a form of community-based health effort (UKBM) which is managed and organized from, by, for and with the community in the imple- mentation of health development in order to em- power the community and provide convenience to the community in obtaining basic health/basic so- cial services. This is done in order to accelerate the decline in maternal mortality and infant mortality. The low number of visits by toddlers to posyandu can cause various problems. Some of the problems that exist are the cases of unmonitored growth and development of children, immunizations that are not on the schedule, the nutritional status of toddlers which is not properly monitored and undetected abnormalities or diseases of toddlers (Indonesian Ministry of Health, 2015). The achievement rate for weighing toddlers in East Java in 2017 was 78%. This indicated that the targets of each posyandu area had not been fully achieved. Many things cause that problems, one of which was the lack of knowledge and awareness of parents, especially mothers, to take their chil- dren to posyandu (East Java Health Office, 2018). The results of the survey on March 1-10 2018 in the working area of PKM Gandusari, there were 25 toddlers. Each area was divided into several posts for the implementation of posyandu. Pos I (70% achieved), post II (60% achieved), post III (65% achieved), post IV (70% achieved). The achievement target for each region was still around 60-70% which meant the government target of 100% was unaccomplished. So there needs to be intensive monitoring by PKM Gandusari on several posyandu with low achievements. In addition, there is a need for improvements in the management of the implementation of the PKM Gandusari related to the separation of immunization implementation. Based on those problems, the authors were interested in conducting study on the effect of health education to the active presence of mothers in bring- ing their toddlers to posyandu in Polindes Semen, Gandusari sub-district, Blitar district. The aim was to identify the active presence of mothers before and after the treatment; providing health education. METHODS This study used a “Pre-Experimental” design. The subject was 30 respondents selected by pur- posive sampling with direct observations at the time of providing health education. We gradually visited each posyandu to assess the number of attendance of each posyandu at Polindes Semen District Gandusari Kab. Blitar on March 2018. This study uses a questionnaire with closed questions to de- termine the activen presence of mothers to take their toddlers to posyandu. The independent vari- able was health education and the dependent vari- able was the activity of mothers to take their tod- dlers to the posyandu. The data analysis used the Wilcoxon Signed Rank Test with the significance level of 0.05. RESULT Tabel 1 The Frequency Distribution of the Effect of Health Education of Mothers to take Their Tod- dlers to Posyandu at Polindes Semen, Gandu- sari District, Kab. Blitar on March 2021 No. Characteristics f % 1. Age 18-26 years old 70 46,7 27-35 years old 30 20 >35 years old 50 33,3 2. Educational Background Elementary school 60 40 Junior high School 30 20 Senior High School 30 20 University 30 20 3. Occupation Employed 60 40 Housewive 90 60 375Retnosari, Titisari, Sendra, The Correlation of Maternal Age and the Incidence of ... After being given health education, most of the respondents (73%) were in the active category. 4. Posyandu Information Yes 60 40 No 90 60 Total 150 100 No. Characteristics f % Tabel 2 The Identification of Active Presence of Mother to take Their Toddlers to Posyandu Before Be- ing Given Health Education at the Semen Polindes, Gandusari District, Kab. Blitar in March 2018 No Category f % 1. Inactive 120 80 2. Active 30 20 Total 150 100 Before being given health education, most of the respondents (80%) were in the inactive cat- egory. Tabel 3 The Identification of Active Presence of Moth- ers to take their toddlers to Posyandu After being given Health Education at the Semen Polindes, Gandusari District, Kab. Blitar on March 2018 No Category f % 1. Inactive 40 26,7 2. Active 110 73,3 Total 150 100 N Z value Sebelum Perlakuan 150 - 2.828 0.005 Sesudah Perlakuan = 0,005 = 0,05 Tabel 4 The Analysis of the effectiveness of Health Edu- cation to the Active Presence of mothers to take their toddlers to Posyandu at Polindes Semen, Gandusari District, Kab. Blitar in March 2018with Wilcoxon Signed Rank Test DISCUSSION The Active Presence of Mother to take Their Toddlers to Posyandu before Being Given Health Education at the Semen Polindes, Gandusari Dis- trict, Kab. Blitar in March 2018 The results of the study showed that the active presence of mothers to take their toddlers before being given health education was mostly (73.3%) in the active category. This was very possible be- cause almost half of the respondents (46.7%) were 18-26 years old. In terms of age, it was clear that the maturity of a mother’s in age affected the un- derstanding of the care patterns, child care, the need for examination and monitoring of the child growth and development and also the stage of learning to adapt in roles changing. From the results of the study, it was also found that 40% of respondents’ educational background was in the elementary school category. Low ma- ternal education affected the reception of informa- tion so that knowledge about posyandu was ham- pered or limited. 60% as housewive and 60% had never received information about what posyandu was, what was in posyandu, and what was the im- portance of bringing their children to posyandu. This was in line with the results of research conducted by Cholifah et al., 2017 which showed the factors that toddler visits to posyandu are influ- enced by good knowledge (86%), positive attitude (89.7%), secondary education (76.3%), unemployed status ( 57.7%), maternal age 35 years (82.5%), routine visits (75.3%). The giving of understanding and knowledge to mothers with elementary education and only as a housewive required more patience and persistence in providing the information compared to mothers with university educational background and em- ployed. The information giver with the condition of the community with various backgrounds should not only focus on health workers, but also with the help of cadres and a direct approach to the family. The result of this study illustrated the activity of active presence of mothers to take their toddlers to posyandu was still low and had not reached the government’s target of 85% (Kemenkes RI, 2015). The Active Presence of Mother to take Their Toddlers to Posyandu after Being Given Health Education at the Semen Polindes, Gandusari District, Kab. Blitar in March 2018 The results of the study showed that the active 376 Jurnal Ners dan Kebidanan, Volume 8, Issue 3, December 2021, page 373–377 presence of mothers to take their toddlers after being given health education was mostly (73%) in the active category. This was because of the provision of appropriate information, media for providing in- formation which wass fun, clear and easy to un- derstand, providing repeated information, persua- sive approaches, affected the pattern of acceptance and understanding of respondents. Several factors which affected the success of government programs in increasing maternal visits in bringing their toddlers to the posyandu to ensure the health of children, it was very necessary to pay more attention to the local government, especially health workers. This was in line with the research conducted by Endra Amaila et al., 2018 which showed that there were factors that affected the visit of moth- ers to take their toddlers to the posyandu. From 76 mothers, 52.5% were in the category of lack of family support, 86.1% were in the good category and received family support. The Chi Square sta- tistical test, obtained p value = 0.001. It could be stated that there was a significant correlation be- tween family support and active presence of mother to take their toddlers to posyandu. The role factor of cadres, 51.2% in the category of not getting the attention of cadres, 85.7% in the good category getting the attention of cadres, from the Chi Square statistical test, obtained p value = 0.002. It could be concluded that there was a significant correlation between the role of cadres on the visit of mothers to take their toddlers to Posyandu. For employed mothers, 51.2% were in the poor category, while 87.9% were not in the good category. From the Chi Square statistical test, it was obtained p value = 0.001. It could be concluded that there was a sig- nificant correlation between mother ’s work and mother’s visit to Posyandu. . From the results of research conducted by Meivy I and Jesica Y, 2020, the results of the Spearman rank statistical test with a probability value (p) = 0.000 with a correlation coefficient value of 0.465 (interval r between 0.26 - 0.50 is a moderate correlation) which stated that there was a correla- tion between work and active visits of mothers un- der five in posyandu activities at Posyandu X Surabaya, with moderate strength of the correla- tion. This was due to the most of the mothers who work were constrained by not having free time to take their toddlers to visit the posyandu compared to mothers of toddlers who do not work (Sugiyanti, Aprilia and Suci Hati, 2014). The Effect Of Health Education To The Ac- tive Presence Of Mother to take Their Tod- dlers To Posyandu Based on the Wilcoxon signed rank statistical test, it was found that p value = 0.05, so that p value < 0.005 which meant there was an effect on the active presence of mothers taking their toddlers to the posyandu before and after being given health education. Providing health education with various approaches to mothers was very helpful in under- standing the level of mother’s understanding, inter- est in each activity in the implementation of posyandu. By having a good understanding, the awareness of mothers to be more active in coming to take their children to the posyandu every month was increased. There were so many benefits that could be obtained from the provision of health edu- cation, such as changing the mindset of the com- munity, especially mothers who had toddlers, to be even more active in checking the growth and de- velopment of childr en every month since in posyandu was not only for weighing but also check- ing children’s growth and development, providing nutrition to children, giving vitamins, immunization according to stages and providing knowledge to mothers through counseling activities by health workers. This was in line with the results of the research conducted by Siti Nur, LS, et al which stated that there was a significant correlation between mother’s knowledge towards toddlers and the compliance to visit Posyandu in Sumberejo Village, Mranggen District, Demak Regency (p = 0.000). Since the p value was less than 0.05 with an r value of 0.645, it could be stated that there was a strong correlation between one’s knowledge of obedience and the acive presence of a mother to take their toddler to posyandu. In this case, the provision of education greatly affected the pattern of one’s thinking. Edu- cation was a learning process for individuals to gain knowledge and understanding of something so that it will change the mindset, attitude, behavior for the better (Nazri et al., 2016). The increased knowledge of mothers about the importance of taking their toddlers to posyandu needed to be improved. This was the first step in monitoring the growth and development of toddlers so that they got more attention and they will be 377Retnosari, Titisari, Sendra, The Correlation of Maternal Age and the Incidence of ... awared to take their toddler to Posyandu (Mardiana, Yusran and Erawan, 2016). CONCLUSION The results of the study illustrated that (1) Be- fore being given health education, 80% of respon- dents were in the inactive category (2) After being given health education 73.3% of respondents were in the active category (3) The data analysis using the Wilcoxon Signed Rank test resulted in p value = 0.005 which meant that the provision of health edu- cation affected the active presence of mothers to take their toddlers to posyandu. SUGGESTION It is expected to parents, especially the mother, to be more active in finding and searching informa- tion related to the growth and development of their toddlers. By joining the posyandu program, children can socialized and communicate with their peers who is good to stimulate the growth and develop- ment. REFERENCES Amalia, Endra, dkk. 2018. Faktor Mempengaruhi Kunjungan Ibu Membawa Balita ke Posyandu Kelurahan Tanjung Pauh Tahun 2018. Jurnal Kesehatan Perintis (Perintis’s Health Journal) Vol- ume 6 Nomor 1 Tahun 2019. pp 60-67. 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