Institutional Repository | Satya Wacana Christian University: Hubungan antara Pola Konsumsi Pangan Lansia dengan Hipertensi di Desa Tajuk Kecamatan Getasan Kabupaten Semarang

Informed Consent

PENJELASAN PENELITIAN UNTUK BERPARTISIPASI

SEBAGAI RESPONDEN

Judul Penelitian

: Hubungan Pola Konsumsi Pangan

dengan Hipertensi Pada Lansia di Desa

Tajuk, Kecamatan Getasan, Kabupaten

Semarang

Nama Peneliti

: Susi Lastri

No Kontak

: 082137152190

Saya adalah mahasiswi Program S-1 Ilmu Keperawatan

Fakultas Ilmu Kesehatan Universitas Kristen Satya Wacana

Salatiga yang sedang melakukan penelitian dengan tujuan untuk

mengetahui

“Hubungan

Antara Pola Konsumsi Pangan Lansia

Dengan Hipertensi Di Desa Tajuk Kecamatan Getasan,

Kabupaten Semarang

”.

Penelitian ini bermanfaat untuk

menambah pengetahuan secara luas dalam dunia nyata dalam

meninjau pola makan pada lansia dengan hipertensi. Saya

mengharapkan kesediaan Bapak/Ibu untuk berpartisipasi dalam

penelitian ini. Jika Bapak/Ibu bersedia maka saya akan memberikan

kuisioner kepada Bapak/Ibu untuk dijawab yang meliputi beberapa

pertanyaan mengenai makanan sehari hari yang dikonsumsi.

Bapak/Ibu bebas memilih tempat dan posisi yang nyaman untuk

mengisi kuisioner tersebut, hasil dari kuisioner akan dikumpulkan

kembali kepada peniliti untuk dipelajari dan dicari maknanya.

Peneliti akan menjamin kerahasiaan identitas dengan tidak

menyebarkan isi kuisioner dan tidak menuliskan nama Bapak/Ibu

dalam kuisioner tersebut.

Partisipasi Bapak/Ibu dalam penelitian ini bersifat sukarela,

sehingga Bapak/Ibu bebas untuk mengundurkan diri tanpa sanksi

apapun. Jika Bapak/Ibumemahami dan bersedia ikut berpartisipasi

dalam penelitian ini, silakan menandatangani lembar persetujuan

untuk menjadi partisipan pada lembar yang telah disediakan.

Salatiga, Juli 2015

Peneliti

Susi Lastri

462011036

LEMBAR PERSETUJUAN MENJADI RESPONDEN

Judul Penelitian

: Hubungan

Antara Pola Konsumsi

Pangan Lansia Dengan Hipertensi Di Desa

Tajuk, Kecamatan Getasan, Kabupaten

Semarang

Nama Peneliti

: Susi Lastri

No Kontak

: 082137152190

Berdasarkan penjelasan yang telah disampaikan oleh

peneliti tentang tujuan penelitian untuk mengetahui makanan

sehari-hari pada lansia yang dikonsumsi di Desa Tajuk, Kecamatan

Getasan, Kabupaten Semarang, saya memutuskan tanpa paksaan

dari pihak manapun juga, bahwa saya bersedia berpartisipasi

menjadi partisipan dalam penelitian ini dan saya juga mengerti

bahwa peneliti akan merahasiakan identitas saya dan tidak

menyebarkan isi kuisioner. Demikian pernyataan ini saya buat

untuk dapat digunakan seperlunya.

Salatiga, Juli 2015

Partisipan

Panduan Wawancara pada Lansia

Nama pasien

: ………

Usia pasien

: ………

Jenis Kelamin pasien

: ………

Alamat

: ……….

Perkerjaan

: ……….

TD

:……….

FORMULIR METODE FOOD FREQUENCY (Makanan Pencegah)

Porsi

Frekuensi makanan

>1 x/

hari

1 x/

hari

3-6 x/

minggu

1-2 x/

minggu

1 x/

bulan

1x/

tahun

Tidak

pernah

1.

Makanan

pokok

a.

Ubi

b.

Nasi

c.

Kentang

2. 2. Sayuran

a. Tomat

b. Wortel

c. Brokoli

d. Bayam

e. Buncis

f. Labu

g. Nangka

h. daun

singkong

3.

3. Buah-buahan

a. Pisang

b. Jeruk

d. Mangga

e. Semangka

f. ketimun

4. ikan, Ayam

a. Ikan air tawar

b. Tongkol

c. Ayam tanpa

kulit

5. 5.

Kacang-kacangan

a. tahu

b. tempe

6. Minuman

a. Teh dengan

gula

b. Air putih

c. Susu murni

FORMULIR METODE FOOD FREQUENCY (Makanan Pemicu)

Jenis makanan

Frekuensi makanan

>1 x/

hari

1 x/

hari

3-6 x/

minggu

1-2 x/

minggu

1 x/

bulan

1x/

tahun

Tidak

pernah

1. Makanan

Tinggi

Kolesterol

a. Daging Sapi

b. Kuning Telur

Ayam

c. Daging

dengan kulit

ayam

d. kerupuk

e. Jeroan

f. Santan

g. ikan laut

h. Mentega

i. Gorengan

2. Makanan

Tinggi Natrium

dan diawetkan

a. Biskuit

b. Craker

c. indomie

d. roti

e. Dendeng

f. Abon

g. Ikan asin

h. Pindang

i. Telur asin

j. Sarden

3. Minuman

a. Susu full

cream

b. Tepung susu

c. kopi

d. teh dengan

garam

4. Minuman

sachet/

kalengan

a. Kopi instan

b. Nutrisari

c. Segar sari

d. Extrajoss

Lampiran Uji Chi Square

1. Ayam tanpa kulit

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 18.254a 4 .001

Likelihood Ratio 23.991 4 .000

Linear-by-Linear Association 13.073 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .20.

2. Bayam

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 24.359a 2 .000

Likelihood Ratio 18.463 2 .000

Linear-by-Linear Association 20.097 1 .000

N of Valid Cases 50

a. 4 cells (66.7%) have expected count less than 5. The minimum expected count is .20.

3. Tomat

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 10.047a 4 .040

Likelihood Ratio 10.198 4 .037

Linear-by-Linear Association 4.795 1 .029

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .56.

4. Brokoli

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 45.754a 4 .000

Likelihood Ratio 54.681 4 .000

Linear-by-Linear Association 34.295 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .44.

5. Pisang

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 55.451a 4 .000

Likelihood Ratio 42.127 4 .000

Linear-by-Linear Association 30.171 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .12.

6. Semangka

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 19.525a 4 .001

Likelihood Ratio 23.246 4 .000

Linear-by-Linear Association 14.853 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .48.

7. Ketimun

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 35.348a 4 .000

Likelihood Ratio 39.760 4 .000

Linear-by-Linear Association 28.841 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .28.

8. Ikan air tawar

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 50.000a 4 .000

Likelihood Ratio 61.086 4 .000

Linear-by-Linear Association 31.014 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .60.

9. Kacang kedelai

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 30.769a 2 .000

Likelihood Ratio 32.717 2 .000

Linear-by-Linear Association 29.764 1 .000

N of Valid Cases 50

a. 3 cells (50.0%) have expected count less than 5. The minimum expected count is .40.

10. Daging dan kulit ayam

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 41.597a 4 .000

Likelihood Ratio 48.771 4 .000

Linear-by-Linear Association 26.863 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .60.

11. Kerupuk

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 65.385a 4 .000

Likelihood Ratio 66.137 4 .000

Linear-by-Linear Association 43.293 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .20

12. Jeroan

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 21.429a 4 .000

Likelihood Ratio 27.436 4 .000

Linear-by-Linear Association 14.948 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .40.

13. Ikan asin

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 33.736a 4 .000

Likelihood Ratio 32.486 4 .000

Linear-by-Linear Association 22.993 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .20.

14. Pindang

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 26.632a 4 .000

Likelihood Ratio 29.239 4 .000

Linear-by-Linear Association 11.881 1 .001

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .40.

15. Telur asin

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 45.626a 4 .000

Likelihood Ratio 54.036 4 .000

Linear-by-Linear Association 31.970 1 .000

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .56.

16.

Kopi

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 31.868a 4 .000

Likelihood Ratio 33.473 4 .000

Linear-by-Linear Association 23.740 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .24.

17. teh dengan garam

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 85.425a 4 .000

Likelihood Ratio 51.876 4 .000

Linear-by-Linear Association 40.082 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .08.

18. Kopi sachet

Chi-Square Tests

Value df Asymp. Sig.

(2-sided)

Pearson Chi-Square 21.429a 4 .000

Likelihood Ratio 27.436 4 .000

Linear-by-Linear Association 15.225 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .20.

10. Daging dan kulit ayam

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 41.597a 4 .000

Likelihood Ratio 48.771 4 .000

Linear-by-Linear Association 26.863 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .60.

11. Kerupuk

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 65.385a 4 .000

Likelihood Ratio 66.137 4 .000

Linear-by-Linear Association 43.293 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .20

12. Jeroan

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 21.429a 4 .000

Likelihood Ratio 27.436 4 .000

Linear-by-Linear Association 14.948 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .40.

13. Ikan asin

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 33.736a 4 .000

Likelihood Ratio 32.486 4 .000

Linear-by-Linear Association 22.993 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .20.

14. Pindang

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 26.632a 4 .000

Likelihood Ratio 29.239 4 .000

Linear-by-Linear Association 11.881 1 .001

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .40.

15. Telur asin

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 45.626a 4 .000

Likelihood Ratio 54.036 4 .000

Linear-by-Linear Association 31.970 1 .000

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .56.

16. Kopi

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 31.868a 4 .000

Likelihood Ratio 33.473 4 .000

Linear-by-Linear Association 23.740 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .24.

17. teh dengan garam

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 85.425a 4 .000

Likelihood Ratio 51.876 4 .000

Linear-by-Linear Association 40.082 1 .000

N of Valid Cases 50

a. 6 cells (66.7%) have expected count less than 5. The minimum expected count is .08.

18. Kopi sachet

Chi-Square Tests

Value df Asymp. Sig. (2-sided)

Pearson Chi-Square 21.429a 4 .000

Likelihood Ratio 27.436 4 .000

Linear-by-Linear Association 15.225 1 .000

N of Valid Cases 50

a. 5 cells (55.6%) have expected count less than 5. The minimum expected count is .20.