Analysis of Knowledge, Attitude, and KIA Book Utilization Regarding Emergency Signs and Symptoms in Pregnancy

Abstract


INTRODUCTION
Maternal and infant mortality in Indonesia remains high compared to other Asian nations.The MMR in Indonesia is 359 per 100,000 live births, according to the 2019 SDKI (Indonesian Health Demographic Survey).On the other side, 32/1,000 live births are the IMR in Indonesia, according to the 2019 SDKI [1].Human resources development effort by optimizing children's growth and development potential can be implemented evenly if community-based service systems such as posyandu can be implemented effectively and efficiently and can reach all those who need child development services [2].Integrated Service Post (Posyandu) is a form of Health Effort Community Resources (UKBM) which is formed and managed by and for the community with technical support from health workers whose target is the entire community [3].
Nurrizka stated that Indonesia's MMR target under the 2019 MDGs (Millennium Development Goals) is 102/100,000 live births.Given that the country's MMR was 359/100,000 live births in 2012, the government will have an adamant time achieving the 2019 MMR reduction target.As of right now, Indonesia's IMR target is at 23 per 1,000 live births as per the 2015 MDGs.
More extraordinary accelerated efforts and collaboration across healthcare professionals are required to meet this goal [4].as one arrives at a medical facility [7].
One of the indirect causes of maternal death is late recognition of the danger signs of pregnancy.To be able to anticipate this, efforts are needed to recognize pregnancy complications or danger signs of pregnancy.
One way is by using the KIA book, which contains information about the danger signs of pregnancy.To be able to recognize the dangerous signs of pregnancy, pregnant women need to be given knowledge so they can have a positive attitude and be able to take appropriate action when they encounter dangerous signs of pregnancy [7].

RESULTS
General data from the study include education level, employment, and gravida status (Table 1).Of the 80 respondents, 10 people had primary school education (12.5%), 12 people had junior high school (15%), 53 people had high school (66.3%), and five people had tertiary education (6.3%).Judging from occupation, it appears that the majority of respondents were housewives (50%), and the lowest working as civil servants (10%).
Almost half of the respondents were primigravidas (40%), and more than half (60%) were multigravidas.More than half of the respondents, 41 people (51.3%) had a fair level of knowledge.
A small percentage of 18 people (22.5%) had a low level of knowledge.Knowledge is what arises when someone does something sensing an object, and this is the result of knowing someone [6].Knowledge is the basis for influencing an action or behavior.Knowledge is one of the factors that influences the formation of attitudes of somebody [12].
Education and knowledge are important things for humans, who can change perceptions about something.The higher a person's education, the easier it is to receive information that plays a role in a person's behavior [10].The mother's knowledge greatly influences the mother's behavior when attending visits to posyandu with her child.Health education, as part of public health, functions as a medium or means to provide socio-psychological conditions in such a way that individuals or communities behave following the norms of healthy living.
In other words, health education aims to change the knowledge, attitudes, and actions of individuals or communities.So that it complies with healthy living norms.Health education will influence health behavior, and then health behavior will influence increasing public health indicators as an outcome of health education [12] Good knowledge will contribute to good attitudes and behavior.
The majority of respondents have good knowledge, supported by their productive age range and education level.
The attitude variable showed that more than half of the respondents, 52 people (65%), have a fair attitude, and five respondents (6.3%) have a good attitude.Behavior is formed by three factors, one of which is predisposing factors, which include knowledge, attitudes, beliefs, beliefs, and values that are not good regarding understanding of posyandu [7].Attitude is a driving factor in creating behavior.
In the utilization variable, it appears that the majority of respondents (53.8%) have a good level of utilization of KIA books.
Posyandu is a communication forum for technology transfer in health services carried out by the community.Posyandu is a meeting point between professional services from health workers and community participation in overcoming public health problems.As one of the most important targets, toddlers can be an indicator of the community's level of use of posyandu.It is stated that there is a significant relationship between family support and toddlers' visiting behavior at posyandu [8].
Utilization of posyandu services is a crucial element in efforts to improve public health.
Knowledge is a very important domain for the formation of a person's behavior.
There is a significant relationship between knowledge about posyandu and the mother's behavior in using posyandu.Knowledge will form attitudes as the basis for creating behavior [12].Other sources stated that the lack of public knowledge about health services at Posyandu greatly influences the intensity of visits to Posyandu [13].Age and education are factors that influence knowledge and thus influence the behavior of visiting posyandu for toddlers.At a mature age, it is easy to receive and digest the information that is obtained, as well as with a good education the breadth of knowledge is obtained so that someone who knows accepts the information and can apply it in his life [13].
Knowledge has a strong relationship as a predisposing factor for utilization behavior.
This is thought to be related to age, education level, and the respondent's exposure to information.
It was found that the higher the mother's attitude and knowledge, the more significant it would comply with coming to Posyandu [14].This is in contrast to Neni's (2022) research that there is no connection between attitude and posyandu utilization.
Respondents may agree with Posyandu services, but they have not taken any action.
Motivating respondents in the form of regular assistance can increase posyandu visits [15].
Attitudes might contribute to behavior, but it seems that they must be supported by other factors, such as mentoring and motivation.
The lack of public knowledge about health services at Posyandu greatly influences the intensity of visits.knowledge is one of the predisposing factors of a person's behavior, so that is people's knowledge of [16].If the Posyandu is lacking, the person's behavior will also be the same as their level of knowledge.Good knowledge can also be influenced by education.The higher a person's education, the better their knowledge about the benefits of their toddler posyandu [17].In other literature, it is stated Policies and various government efforts to reduce maternal and infant mortality rates include Gerakan Sayang Ibu (GSI), the Making Pregnancy Safer Strategy, and the provision of Maternal and Child Health books [5].The KIA book is a tool for the early detection of disorders or maternal and child health problems, communication and counseling tools with important information for mothers, families, and the community regarding services, maternal and child health, including references and concentrations (standards) of MCH services, nutrition, immunization, and toddler growth and development [6].According to reports, two pregnant women in Indonesia pass away during pregnancy or childbirth every hour.In fact, bleeding is the primary clinical cause of death for expectant mothers.The other factors include three reasons for being late.The first is that the choice to seek aid was delayed because the woman was slow to recognize the warning symptoms of pregnancy.Because medical personnel could not have intervened sooner, the patient's bleeding ultimately proved fatal.The second is arriving late for a birthing appointment and offering transportation.The third, however, is failing to seek emergency medical attention as soon This form of research was quantitative, and the research design incorporates analytics.The author of this study attempted to investigate the relationship between variables, specifically attempting to determine a relationship between pregnant women's understanding of pregnancy danger indicators and their use of KIA Books books.A cross-sectional approach methodology was employed.The sample in this study were all pregnant women who had their pregnancies checked in Bandungrejosari Village, Sukun Malang District, from January 19 th -February 9 th , 2023.The accidental sampling technique was applied to the inclusion and exclusion criteria.Inclusion criteria were that all pregnant women attending pregnancy check in Bandungrejosari Public Health Center during the research period could read and write correctly at the first ANC visitation and agreed to be respondents for the research.Subjects will be excluded from the study if they will not be part of the respondent.A questionnaire of knowledge, attitude, and KIA book utilization was used as a measurement tool.Researchers used available measuring instruments to measure knowledge, attitudes, and use of KIA books.The knowledge questionnaire consists of 20 multiple-choice questions with a score of True = 1 and False = 0, while the attitude questionnaire consists of 5 questions with a score of agree = 1 and disagree = 0.Meanwhile, the utilization questionnaire consists of 15 questions with a Likert scale of 1 to 4. The scores are then categorized into good, sufficient, and poor.Validity and reliability had been done by previous study.Validity scores for each instrument were r=0.433, r=0.954, and r=0.491.The reliability test performed by the earlier study showed Cronbach Alpha 0.981, 0.762, and 0.788 (more than 0.6) [9].The researcher provided and explained its contents and how to complete its measurement tools for respondents.In addition, the researcher reviewed the information in the respondent's KIA book and completed the questionnaire with the respondent's assistance to prepare for any questions the respondent might not have understood.The researchers thoroughly examined the completeness of the respondents' questionnaires and processed the acquired data.The data were tabulated and edited using SPSS 24 software (IBM Corp., Armonk, NY, USA ).The independent variable was the knowledge and attitude of the mother, and the dependent variable was the utilization of the KIA book regarding emergency signs and symptoms in pregnancy.Descriptive analysis aimed to describe respondents' characteristics such as education, occupation, gravida, knowledge, attitude, and utilization.Data were presented as frequency and percentage.Spearman Rho Test was used to check the correlation among variables.Multiple logistic regression test analysis was used for multivariate analysis.A significant level was considered as p<0.05.An Ethical clearance Approval letter was accepted with reg number 425/KEPK-POLKESMA/2023 from the POLKESMA Etic committee before data collection was conducted.The study was explained to the participants, including the potential dangers and benefits of taking part in it.Immediately following the completion of the informed consent form, questionnaires were made available to attendees.The participants were given the option to either decline or remove their involvement in the study while the data was being collected.
05) DISCUSSION According to Green, behavior related to health is influenced by two main factors, internal and external factors behavior [10].Then, it is shaped by three factors: 1) factors predisposition includes age, type of gender, education, occupation, knowledge, and attitude.2) factors enablers include quality service, mileage, attitude officers 3) reinforcing factors include officers or cadres, family[11].
that mothers' attitudes and beliefs towards posyandu, posyandu facilities, cadre services, and Geographical factors are thought to be several other factors that contribute to posyandu utilizations[18].The role of cadres is thought to be a very important domain in shaping a person's behavior or actions.The role of posyandu cadres can be increased by providing counseling and information regarding the benefits of posyandu and providing motivation to play an active role[19].Knowledge and attitudes play a role in a person's behavior, including visits to Posyandu[20].Knowledge can have a direct impact on the utilization of posyandu.On the other hand, attitude acts as a supporting variable along with other factors such as geographical conditions, the role of cadres, motivation, and information.Nursing implicationsThe research results highlight the analysis of knowledge, attitude, and utilization of KIA books in recognizing signs and symptoms of emergency in pregnancy, which have significant implications for nursing practice.Understanding the gaps in knowledge and attitude towards utilizing resources such as KIA books can guide nurses in designing targeted interventions to improve maternal health outcomes.By addressing these findings, nurses can enhance education efforts, promote evidence-based practices, and ultimately contribute to better 295 emergency care for pregnant individuals.CONCLUSION Knowledge has a simultaneous influence on the use of KIA books utilization on posyandu regarding emergency signs and symptoms in pregnancy.Attitudes influence the use of KIA books in posyandu.Good knowledge will encourage better health attitudes and behavior.Attitudes contribute to behavior, but it seems that they must be supported by other factors, such as mentoring and motivation.The study limitation was a short period of data collection time and a relatively small number of respondents.It suggested involving a bigger sample and longer data collection time for future research.

Table 2
Multivariate Analysis of Knowledge, Attitude, and Kia Book Utilization Regarding Emergency Signs and Symptoms in Pregnancy