28 JNK JURNAL NERS DAN KEBIDANAN (JOURNAL OF NERS AND MIDWIFERY) http://jnk.phb.ac.id/index.php/jnk The Correlation of Knowledge and Attitude of Pregnant Women and The Compliance of Birth Planning and Complication Prevention Program (P4K) in Ringinpitu Kecamatan Pelemahan Kabupaten Kediri Ratna Feti Wulandari1, Ratih Kusuma Wardhani2, Maria Ulfa3 1,2Midwifery Department, STIKes Pamenang Kediri, Indonesia 3Midwifery Department, STIKes Patria Husada Blitar, Indonesia Article Information Abstract Maternal mortality rate (MMR) is an indicator of the assessment of maternal health programs and the degree of public health. The program launched by the government in an effort to reduce MMR was the Maternity Planning and Complications Prevention Program (P4K) which aimed to monitor pregnancies into safe and secure deliveries. In order to accomplish the importance of planning for delivery and preventing the complications, it is necessary to conduct research on the knowledge and attitudes of pregnant women and the compliance in implementing P4K. The purpose of the study was to analyze the correlation of knowledge and attitudes of pregnant women and the compliance of birth planning and complication prevention program (P4K). This research used a cross sectional design with an analytical survey. The research was conducted in Ringinpitu Village from March to October 2020. The population was pregnant women in Ringinpitu Village. The sampling technique used simple random sampling with the total sample of 26 people. The data collection used primary data. The instrument used a questionnaire. The data was processed by Spearmen rank test with correlation analysis. Based on the results of the research, it was found that the knowledge of pregnant women about P4K was in the fair category (42.3%). The attitude of pregnant women about P4K showed a positive attitude (65.4%). The compliance of pregnant women in implementing P4K was (38.5%). There was a correlation between knowledge of pregnant women and P4K compliance (p value = 0.0000) p <0.05 correlation coefficient r = 0.671 which meant there was a strong level of correlation and there was a correlation between the attitude of pregnant women and compliance to P4K (p value = 0.001) p < 0.05 correlation coefficient r = 0.604. Compliance with P4K will greatly help the government in reducing maternal mortality and infant mortality History Article: Received, 24/01/2022 Accepted, 17/03/2022 Published, 15/04/2022 Keywords: knowledge, attitude, compliance, birth planning and complication prevention program (p4k) © 2022 Journal of Ners and Midwifery Correspondence Address: STIKes Pamenang Kediri – East Java, Indonesia P-ISSN : 2355-052X Email: regianaia2014@gmail.com E-ISSN : 2548-3811 DOI: 10.26699/jnk.v9i1.ART.p028-033 This is an Open Access article under the CC BY-SA license (http://creativecommons.org/licenses/by-sa/4.0/) http://jnk.phb.ac.id/index.php/jnk mailto:regianaia2014@gmail.com https://doi.org/10.26699/jnk.v9i1.ART.p028-033 Wulandari, Wardhani, Ulfa, The Correlation of Knowledge and Attitude of Pregnant Women … 29 INTRODUCTION The maternal mortality rate (MMR) is an indicator of the assessment of maternal health programs and the degree of public health. MMR is the ratio of maternal mortality during pregnancy, childbirth and the puerperium caused by pregnancy, childbirth, and postpartum or its management but not due to other causes such as accidents or incidentals in every 100,000 live births (Ministry of Health of the Republic of Indonesia in 2009). The success of midwifery services is reflected in the decline of maternal mortality rate to the lowest level. The maternal mortality rate in Indonesia in 2019 was 4,221 with the most causes of maternal death was bleeding (1,280 cases), hypertension in pregnancy (1,066 cases), infection (207 cases) (Ministry of Health of the Republic of Indonesia in 2009). The maternal mortality rate in East Java Province in 2019 reached 89.81 per 100,000 live births with the cause of death was Preeclampsia 31.15% or 162 people, bleeding 24.23%, other causes 23.1% or 120 people and the cause of infection was 6.73% or 35 people (East Java Provincial Health Office. 2019). The number of maternal deaths in Kediri in 2019 was 14 people while the biggest cause of death was dominated by bleeding 28.57%, preeclampsia 21.43%, and the remaining was comorbidities, namely heart and others as much as 14.29% (Kediri Health Department, 2019). Health data from Ringin Pitu Village showed one infant death because of the mother had a high-risk history of heart disease, 2 abortions, preeclampsia, maternal age more than 35 years and distance between children more than 10 years. Those data indicated that midwifery services had not been fully successful. Therefore, a program that is able to reduce maternal mortality rates to the lowest level is needed. One of the programs launched by the government is the Maternity Planning and Complications Prevention Program (P4K) which aims to monitor pregnancies leading to safe and safe deliveries with the target being all pregnant women. According to research conducted by Sarli, D. and Ifayanti, T. (2018) Several factors that influence the success of implementing P4K are the knowledge of pregnant women, the role of the family, the role of cadres and the role of the midwife. The importance of birth planning and preventing complications is necessary so that research on the knowledge and attitudes of pregnant women with compliance in implementing P4K should be done. Mother's knowledge in preventing pregnancy complications determines their attitude when problems occur during pregnancy so that they can overcome the problems quickly and will not cause death. METHODS The type of the research used an analytic survey with a cross sectional design. The research was conducted in Ringinpitu Village from March to October 2020. The population was pregnant women in Ringinpitu Village. The sampling technique used simple random sampling with the total sample of 26 people. The data collection used primary data. The instrument used a questionnaire. The data was processed by Spearmen rank test correlation analysis. RESULT Table 1: The Frequency Distribution of the Correlation of Knowledge and Attitude of Pregnant Women and the Compliance of P4K in Ringinpitu Village Kec. Pelemahan Kab. Kediri on October 2020. No. Characteristics f % 1. Age 16-20 years old 21-25 years old 26-30 years old 31-35 years old 36-40 years old 3 9 7 5 2 11,5 34,6 26,9 19,2 7,7 2. Educational background Elementary Junior High Senior High College 4 6 15 1 15,4 23,1 57,7 3,8 3. Occupation Housewife 21 80,8 30 Journal of Ners and Midwifery, Volume 9, Issue 1, April 2022, page 28-33 Private employee Entrepreneur 4 1 15,4 3,8 Total 26 100 Based on table 1, most of the respondents are 21-25 years old (34.6%) with most of the educational background on junior high school (57.7%) and the highest occupation is housewives (80.8%). Table 2: The Identification of knowledge of pregnant women about the P4K program in Ringinpitu Village, Kec. Pelemahan, Kab. Kediri on October 2020. Based on table 2 the highest number of pregnant women knowledges about the P4K program is in fair category (42.3%). Table 3: The identification of attitude of pregnant women about the P4K program in Ringinpitu Village, Kec. Pelemahan, kab. Kediri on October 2020 Attitudes Frequency (n) Percentage (%) Positif 17 65,4 Negatif 9 34,6 Total 26 100 Based on table 3, The highest number of attitudes about the P4K program is positive attitudes (65.4%). Table 4: The Identification of pregnant women's compliance to the P4K program in Ringinpitu Village Kec. Pelemahan Kab.Kediri on October 2020 Compliance Frequency (n) Percentage (%) High 10 38,5 Fair 7 26,9 Low 9 34,6 Total 26 100 Based on table 4. The highest number of compliances of pregnant women in implementing P4K is in the high category (38.5%). Table 5: Cross tabulation of knowledge and compliance to the P4K program Knowledge Obedience Total P-Value High Fair Low n % n % n % n % 0,000 Good 7 26,9% 2 7,7% 0 0% 9 34,6% Fair 3 11,5% 5 19,2% 6 11,5% 11 42,3% Less 0 0% 0 0% 3 23,1% 6 23,1% Total 10 38,5% 7 26,9% 9 34,6% 26 100,0% Table 5 shows α= 5%= 0.05, p<α which means Ho is rejected, meaning that there is a correlation between knowledge and compliance. The correlation between knowledge of pregnant women and the compliance to the P4K program is showed with (p value = 0.0000) p <0.05 and correlation coefficient r = 0.671 which means there is a strong level of correlation. Knowledge Frequency (n) Percentage (%) Good 9 34,6 Fair 11 42,3 Less 6 23,1 Total 26 100 Wulandari, Wardhani, Ulfa, The Correlation of Knowledge and Attitude of Pregnant Women … 31 Table 6: The result of cross tabulation between attitude and compliance to the P4K programs Attitude Obedience Total P-Value High Fair Low n % n % n % n % 0,001 Positive 1 3,8% 7 26,9% 9 34,6% 17 65,4% Negative 9 34,6% 0 0% 0 0% 9 34,6% Total 10 38,5% 7 26,9% 9 34,6% 26 100,0% Based on table 6, 5%= 0.05, p<α shows Ho is rejected, meaning that there is a correlation between attitude and compliance. There is a strong correlation between the attitude of pregnant women with compliance to the P4K program with (p value = 0.001) p < 0.05 correlation coefficient r = 0.604. DISCUSSION Knowledge and attitude of pregnant women about birth planning and complication prevention program The results of the research showed that the knowledge of pregnant women about birth planning and complication prevention program was mostly sufficient (42.3%) this indicated that pregnant women who had less knowledge were only 23.1%, meant that respondents already knew and understood about the birth planning and complication prevention program. The results of this research were supported by research conducted by Aliyanto, D and Rosmadewi (2014) which showed that the knowledge of pregnant women about P4K was in the good knowledge category 54.1%. It was also supported by other research conducted by Prabawati about the description of pregnant women's knowledge about P4K. The results showed that the majority of pregnant women in Kalasan Health Center had good knowledge of P4K. A person's knowledge can be affected by experience, education, beliefs, facilities, income and socio-culture Notoadmojo (2003) in Sukesi (2015). Good knowledge of pregnant women is also influenced by the role of health workers, namely midwives in implementing the program. This is supported by research conducted by Dwijayanti (2013) which stated that the factors that influence the successful implementation of P4K program by the Midwife were as effective and maximally effective implementation of Communication, Resources, Disposition and Structure as possible. The results showed that most of the attitudes of pregnant women about P4K were positive attitudes (65.4%). Attitude could be realized into an action required supporting factors. Factors which influenced the attitudes were the existence of sources of information, sources of information can be obtained from homes, schools, organizational institutions, print media, television, health care places Notoadmojo (2003) in Sukesi (2015). Pregnant women obtained information about P4K from the counseling of health workers, posyandu cadres and the role of the family. Research conducted by Sukesi. Utami and Sari (2015) concluded that there was an effect of counseling on knowledge and attitudes of pregnant women about P4K stickers. Purwandari's research (2017) stated that there was an effect of using video media and flipcharts in health education on compliance with P4K implementation in pregnant women. Ningsih and Vovira (2020) stated that cadre empowerment was effective in increasing the knowledge and attitudes of pregnant women about the birth planning and Complications Prevention (P4K) program. Pregnant women who were assisted by cadres were able to independently maintain their health and that of their families. The implementation of the delivery planning program and the prevention of complications cannot be separated from the role of the family of pregnant women, if the family does not support it, this program will not be able to be implemented properly. This is supported by the research of Mukharrim, Ahri, and Yusriani (2019) the implementation of the P4K program has been implemented but is not optimal where families do not prepare prospective blood donors, village ambulances, maternity savings, maternal social funds, etc. so that the role of the family is not fully maximize yet. The compliance of birth planning and complication prevention program (p4k) The results showed that the majority of pregnant women were in the high category in implementing P4K (38.5%). Respondents were said to be obedient to P4K when the delivery preparation sheets in the MCH book and P4K 32 Journal of Ners and Midwifery, Volume 9, Issue 1, April 2022, page 28-33 stickers had been filled out completely and had pasted the P4K sticker in a place that was easily seen by the public. Several factors that influence the level of compliance are education, accommodation, modification of environmental and social factors, interaction of health professionals, knowledge and age. According to the results of Ashar Hadi's research (2018), stated that pregnant women with higher education, mothers who receives complete ANC and mothers with complete health care facilities during prenatal check-ups will comply with 2.2 to 2.3 times of planning for delivery and delivery complications. Another factor that affects compliance with P4K is the husband's support where the husband has a role in planning safe deliveries for pregnant women so that they can prevent pregnancy complications (Ulfah. Sonda, M. and Hidayati. 2020). The correlation of knowledge and attitude of pregnant women with compliance to the birth planning and complication prevention program The results of the research that had been carried out showed that there was a correlation between knowledge of pregnant women and compliance to P4K with positive correlation, the better the knowledge of pregnant women, the more obedient pregnant women were in carrying out birth planning and complications prevention program (P4K). The more positive the attitude, the more obedient in carrying out P4K. Knowledge of pregnant women about P4K is everything that pregnant women know about birth planning to optimize the mental and physical health of pregnant women so that they are able to face childbirth and the postpartum period without complications. Knowledge of pregnant women is related to compliance in implementing the Childbirth Planning and Complications Prevention Program (P4K). Good knowledge will increase compliance in implementing P4K. Low knowledge causes lower compliance (Pramasanthi, 2016). Another research conducted by Ulfah. Sonda, M. and Hidayati. (2020) explained the results of his research that there was a relationship between knowledge of pregnant women and the implementation of P4K. Sarli and Ifayanti (2018) explained that pregnant women who had high knowledge would apply P4K 1,728 times better, while pregnant women with low levels of knowledge 1,728 times would not apply P4K. The higher a person's level of knowledge, the better the person will apply something or apply something. Someone behavior and will is influenced by knowledge. By knowing and understanding something, someone will take an attitude and will in accordance with what is desired (Notoadmodjo 2003). A positive attitude will influence pregnant women to obediently carry out delivery planning and prevention of complications. This research was supported by research by Julianti, R. (2017), there was a correlation between the level of knowledge and attitudes of mothers about birth planning and complication prevention program and the achievement of installing P4K stickers. Pertiwi research (2013) in Ulfa et al (2020) showed there was a correlation between knowledge and attitudes of pregnant women about P4K as an effort to prevent pregnancy complications. CONCLUSION The results showed that: (1) The highest number of knowledge of pregnant women about P4K was in the fair category (42.3%) (2) The highes number of attitudes of pregnant women about P4K was Positive attitudes (65.4%) (3) Most of the mothers' compliance to carry out P4K program was (38.5%) (4) There was a correlation between knowledge of pregnant women and compliance to carry out P4K program (5) There was a correlation between attitude of pregnant women and compliance to carry out P4K program. The more positive the attitude, the more obedient in carrying out P4K program. SUGGESTION Knowledge and attitudes play a very important role in the compliance of pregnant women in carrying out P4K program. Health workers, especially midwives, should not only stop at providing counseling, but also reach the level of understanding of each pregnant woman. ACKNOWLEDGMENT We thank the respondents who have helped in this research, we also thank the head of Ringinpitu Village and the Ringinpitu Village Midwife for their permission and support in this research. REFERENCE Aliyanto, W dan Rosmadewi. 2014. Pengetahuan Ibu Hamil Tentang Program Perencanaan Persalinan dan Pencegahan Komplikasi Wulandari, Wardhani, Ulfa, The Correlation of Knowledge and Attitude of Pregnant Women … 33 (P4K) Pada Antenatal Care. Jurnal Keperawatan. Vol X No (1) diakses dari Antoni, A. 2018. Gambaran Tingkat Pengetahuan Ibu Hamil Tentang Pencegahan dan Penatalaksanaan Resiko Tinggi Kehamilan di Kelurahan Tabing Wilayah Kerja Puskesmas Lubuk Buaya Padang. MENARAIlmu.Vol Xii No (3). Ashar. H, Fuada, N. Rahmat, B. dan Setiadi, T. 2018. Hubungan Karakteristik Ibu, Intensitas Pemeriksaan Kehamilan Dan Fasilitas Pelayanan Kesehatan Yang Diterima Dengan Kepatuhan Perencanaan Persalinan Dan Pencegahan Komplikasi Di Indonesia. Jurnal Kesehatan Reproduksi Vol 9 No (1). Dinas Kesehatan Kabupaten Kediri. 2019. Profil Kesehatan Kabupaten Kediri Tahun 2019 diakses dari 2019 https://dinkes.kedirikab.go.id/?hal=dprofilke sehatan&id=54. Dinas kesehatan Provinsi Jatim.2019. Profil kesehatan Provinsi Jatim diakses dari https://dinkes.jatimprov.go.id/userfile/doku men/Profil%20Kesehatan%20Jatim%20201 9.pdf. Dwijayanti, P. 2013. Analisis Implementasi Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) Oleh Bidan Desa di Kabupaten Demak. Jurnal Kesehatan Masayarakat. Vol 2 No (1). Dwikanti, R. Darwanty, J. dan Dumilah, R. 2020. Dukungan Suami Dan Perilaku Pemeriksaan Kehamilan Di Puskesmas Rawamerta Kabupaten Karawang. Jurnal Penelitian Kesehatan Suara Forikes. Vol 11 No (1). Julianti, R. 2017. Hubungan Tingkat Pengetahuan Dan Sikap Ibu Hamil Tentang Program Perencanaan Persalinan dan Pencegahan Komplikasi (P4K) dengan Pencapaian Pemasangan Stiker P4K di Wilayah Kerja Poskesri Batang Arah Puskesmas Tapan. UNES Journal Vol 2 No (2). Kamidah dan Yuliaswati, E. 2018. Program Perencanaan Persalinan Dan Pencegahan Komplikasi (P4k) Sebagai Upaya Menurunkan Angka Kematian Ibu. GASTER Vol XVI No (1). Kementerian Kesehatan RI. 2019. Profil Kesehatan Indonesia Tahun 2019. https://pusdatin.kemkes.go.id/resources/dow nload/pusdatin/profil-kesehatan- indonesia/Profil-Kesehatan-indonesia- 2019.pdf Mukharrim, M, S. Ahri, R, A dan Yusriani. 2019. Pelaksanaan Program Perencanaan Persalinan Dan Pencegahan Komplikasi (P4k) Melalui Peran Keluarga Di Kabupaten Gowa. Jurnal Ilmiah Kesehatan. Ningsih, L dan Vovira, D. 2020. Upaya Peningkatan Pengetahuan dan Sikap Ibu hamil dalam program perencanaan persalinan dan pencegahan komplikasi (P4K) melalui pemberdayaan kader. Jurnal Kesehatan Vol 11 No (3). Prabawati, S dan Indriyawati, V. 2017. Gambaran Pengetahuan Ibu Hamil Tentang Program Perencanaan Persalinan Dan Pencegahan Komplikasi Di Puskesmas Kalasan Sleman. Jurnal Kesehatan Samodra Ilmu. Vol 08 No (01). Pramasanthi, R, I. 2016. Hubungan Pengetahuan Ibu Hamil Dan Dukungan Suami Dengan Kepatuhan Melaksanakan Program Perencanaan Persalinan Dan Pencegahan Komplikasi (P4k) Di Kota Salatiga. Tesis Program Pascasarjana Universitas Sebelas Maret Surakarta. Purwandari, A, D. 2017. Pengaruh Penggunaan Media Video Dan Lembar Balik Dalam Pendidikan Kesehatan Terhadap Kepatuhan Pelaksanaan P4k Pada Ibu Hamil Di Desa Banyusidi Kecamatan Pakis Kabupaten Magelang. Skripsi Jurusan Kebidanan Politeknik Kesehatan Kemenkes Semarang. Sarli, D. dan Ifayanti, T. 2018. Faktor-faktor yang berpengaruh terhadap penerapan program perencanaan persalinan dan pencegahan komplikasi (P4K) di kelurahan balai gadang padang. Jurnal Ilmu Kesehatan (JIK). Vol 2 No (1). Sukesi. Utami, S dan Sari, A, P. 2015. Pengaruh Penyuluhan Terhadap Pengetahuan Dan Sikap Ibu Tentang Stiker P4k. Vol Vi. No (1). Ulfah. Sonda, M. dan Hidayati. 2020. Dukungan Suami, Pengetahuan Ibu Hamil Trimester Iii Dengan Pelaksanaan P4k Di Puskesmas Kassi-Kassi Makasar. Media Kesehatan Politeknik Kesehatan Makasar. Vol XV No (2). https://dinkes.kedirikab.go.id/?hal=dprofilkesehatan&id=54 https://dinkes.kedirikab.go.id/?hal=dprofilkesehatan&id=54 https://dinkes.jatimprov.go.id/userfile/dokumen/Profil%20Kesehatan%20Jatim%202019.pdf https://dinkes.jatimprov.go.id/userfile/dokumen/Profil%20Kesehatan%20Jatim%202019.pdf https://dinkes.jatimprov.go.id/userfile/dokumen/Profil%20Kesehatan%20Jatim%202019.pdf https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/Profil-Kesehatan-indonesia-2019.pdf https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/Profil-Kesehatan-indonesia-2019.pdf https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/Profil-Kesehatan-indonesia-2019.pdf https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-indonesia/Profil-Kesehatan-indonesia-2019.pdf