Can Health Education Change The Behaviour About Prevention of Infection.
Can Health Education Change The Behaviour About Prevention of Infection?
Luh Mira Puspita1, Eddy Supriyadi2, Fitri Haryanti3
1
2
Nursing Program Faculty of Medicine Universitas Udayana
Pediatric Hemato-Oncology Faculty of Medicine, Universitas Gadjah MadaSardjito Hospital Jogjakarta
3
1
Magister of Nursing Program Faculty of Medicine Universitas Gadjah Mada
mirapuspita990@yahoo.com, 2e.supriyadi@gadjahmada.edu, 1fiths2001@yahoo.com
Background: Infection is the major cause of death in children cancer. Implementation of
infection prevention can be implemented by applying hand-washing, using antiseptic bath,
oral care, visitor restrictions, application isolation, and use of barrier precautions. The problem
faced is the lack of awareness and understanding of families how to prevent infection.
Intervention of health education showed effectiveness to increase awareness and promote
health behavior. This research aimed to analyze the effect of health education on the behavior
of parents in the prevention of infection in children with cancer.
Methods: This research was the Pre Experimental with One Group Pretest-Posttest Design.
The population in this study were all parents who have children with cancer are treated in a
pediatric cancer ward Dr. Sardjito Hospital Yogyakarta. Sampling was performed by
Consecutive Sampling with minimum sample size is 68 respondents. Analysis data using
Paired Sampel t-Test for attitude and using Wilcoxon Test for knowledge and practices. The
predictive value used was α=0,05 and CI= 95%.
Results: The average score on knowledge, attitude, and practices before given health
education was 75.75, 82.21, and 46.26. The average score after given health education was
90.69, 86.23, and 70.09. There was an increase in the average scores before and after health
education. P-value in the variable knowledge, attitude, and practide of each of the 0.000 so
that there are significant differences between before and after health education.
Conclusions: Health education given for parents can change the behavior of parents about
prevention of infection in children with cancer.
Keywords: infection, parents’s behavior, health education, children’s cancer
28
who are received chemotherapy to reduce
BACKGROUND
Cancer is a disease with complex
the side effects of chemotherapy one of
manifestations depending on the type and
which is the occurrence of infection.
location of the cells grow. In children, the
Infection is the most frequent cause of
incidence of cancer is about 1 in 600
death in patients leukemia (4). Prevention
people and be the cause of death is about
of infection is very important because it
14% in children aged between 1-15 years.
can reduce the risk of infection and
In the period of 2000-2009, of 1,124
complications of the disease that can cause
children diagnosed cancer patients in
death and improve quality of life (5).
Hospital Dr. Sardjito, patients diagnosed as
Implementation
of
infection
much as 40.6% ALL, AML 13.9%, 6.7%
prevention
retinoblastoma,
5.5%,
applying the hand washing, using antiseptic
nephroblastoma 4.5%, and non-Hodgkin
bathing, oral care, visitor restrictions,
neuroblastoma
(1).
implemented
by
application isolation, and the use of barrier
prevalence of leukemia that occurs in
precautions (6,7). Prevention of infection
children showed the majority of children
which is can be done either at home or in
diagnosed with ALL is about 68.9% of all
the hospital to wash their hands properly,
cases of leukemia and 23.6% are cases of
the setting of food and drink with caution,
AML of all cases of leukemia. As for CML
as well as the child's environment settings
occurs approximately 4.2% of cases of the
(8).
is
4.4%
be
The
lymphoma
about
can
total of all cases of leukemia in children
(2).
The nurse important role in the
treatment of children with chemotherapy
Chemotherapy
is
one
of
the
ranging from prevention, early detection,
management for patients with cancer.
and
Effects of chemotherapy will damage the
providing information to patients and
cells that has a high proliferation activity
families. Giving proper education will
such as
bone marrow and mucosal
enhance the understanding of caring for
epithelial cells that chemotherapy will
children who require more attention due to
cause bone marrow depression, alopecia,
the child's condition. Increased knowledge
and mucositis (3). Treatment in patients
and behavior of parents can support the
management
of
neutropenia
by
29
monitoring conducted by the parents
The study was conducted in a ward
against her condition provision of health
childhood cancer treatment of Dr. Sardjito
education interventions showed effective
Hospital within the period from August to
results to the increased awareness of
October 2014. Ward childhood cancer
disease control and support the health
treatment consists of two rooms those are
seeking
research
Wards Kartika 1 and Kartika 2 with each of
conducted by Sherman and Koelmeyer
bed capacity of 13 and 23 beds. The type of
(2011) indicates that the provision of
study is the Pre Experimental. The study
information by nurses about lymphedema
design used one group pretest-posttest
can change the behavior of the patient in
design
minimizing the risk of lymphedema (10).
differences in the parental behavior in
behavior
(9).
The
Parents with children who suffer from
that
aims
to
determine
the
preventing infection in children with
of
cancer before and after given treatment.
decisions.
This study was approved by the Medical
Information needs required by parents
and Health Research Ethics Committee
throughout the period of the child's
(MHREC) Faculty of Medicine, Gadjah
treatment and can always be changed so
Mada University and Dr. Sardjito Hospital
that the necessary provision of continuous
the number KE / FK / 849 / EC.
leukemia
information
requires
to
help
the
support
make
information (11). Health education is given
The population in this study were all
regularly will help meet the needs of
parents who has children with cancer are
information needed by parents for caring
treated in a pediatric cancer ward Dr.
for children.
Sardjito Hospital. Sampling was performed
This study aims to analyze the effect
by consecutive sampling technique that is
of health education on the behavior of the
based on the research subjects to hospital
parents that knowledge, attitudes, and
arrival. Hospital Dr Sardjito within a
practices in the prevention of infections in
period of study with a minimum sample
children with cancer.
size is 68 respondents.
Before health education, researchers
METHOD
has determined that the observer who is
The place of research and study design
will help in this study were recruit from a
30
nurse who served in the room. Any parent
while for observation made 1 day before
who has a child aged 1-12 years, diagnosed
given health education. Observations for
with cancer, and is being treated at Kartika
the posttest was performed 1 day after
Space 1 and 2 are invited to participate in
health education and observed for 3 days in
the study. Parents who are work as health
a row. Posttest knowledge and attitudes by
professionals such as doctors, nurses, or
using a questionnaire carried out 7 days
midwives are not included in the study. All
after
parents
Respondents
who
have
been
willing
to
participate in the study will be given an
the
health
education
who
had
given.
given
health
education booklet that can be read back.
explanation of the study and performed the
procedure for awarding a contract for
Statistical analysis
health education.
Univariate analyzes performed on each
Intervention
variable to see the frequency of distribution
The provision of health education in
and the proportion of each variable namely
this study using the media booklets that
the
contain material about how to prevent
variable, and the variable of respondent
infection do parents at home or in hospital.
characteristics namely age, educational
Measurement of the parents's behavior and
level,
attitude
a
numerical data was analyzed use the mean
questionnaire compiled in Indonesian and
value, minimum-maximum values, and
had previously tested the validity and
deviation standard. While the categorical
reliability. The questionnaire contains 21
data be analyzed by using frequency
questions where as knowledge of the
distribution and percentage.
attitude
18
analysis conducted on the independent
of
variables and the dependent variable to test
that
the hypothesis of whether there is the effect
contains 9 items observable actions by
of health education on parenting behaviors
nurses who served in the wards. The health
such as knowledge, attitudes, and practices
education is
given after the pretest
of parents in the prevention of infection
questionnaire for knowledge and attitudes,
before and after health education. Before
that
questionnaire
statements.
parents
knowledge
contains
Measurement
using
using
observation
practices
sheet
independent
and
variable,
previous
dependent
information.
For
Bivariate
31
the bivariate analysis, the data normality
Table 1 Characteristics of respondents (N =
test to determine the distribution of normal
data or not. Normality test data using the
Kolmogorov-Smirnov test because the
sample size of more than 50 respondents.
Normality test was also performed to
qualify the use of parametric statistical test
of Paired Samples T-Test to analyze
changes in behavior before and after health
education. However, the data in this study
only attitude that is normally distributed
variables, while for knowledge and attitude
variables not normally distributed so as to
test the non-parametric Wilcoxon test to
analyze
the
behavioral
changes
that
knowledge and practices before it is given
health education (pretest) and after given
health education (posttest). The predictive
value used was α = 0.05 and CI = 95%. All
analyzes
were
performed
using
the
computer program package.
68)
Characteristics
Age (Year)
17-25
26-35
36-45
46-55
Education level
- Elementary
education
- Secondary
education
- Higher
education
Information
- Ever
get
information
- Never
get
information
Variables
have
Amount
Percentage
(n)
(%)
10
31
18
9
14.7
45.6
26.5
13.2
27
39.7
33
48.5
8
11.8
16
23.5
52
75.5
the
knowledge
and
practices are not normally distributed data
so using the Wilcoxon nonparametric test
that test. While the attitude variable has a
normal distribution of data that uses
parametric test with Paired Samples T-
RESULTS
Test.
Respondents in this study amounted
to 68 people and 3 of them do not follow
the posttest. Distribution characteristics of
the respondents as follows:
32
Table 2 Parents' behavior before and after
of health education have been carried out
intervention
in service at the hospital with a variety of
Variable
Mean
SD
Knowledge
Pre
75.75
Post
90.69
Attitute
Pre
82.21
Post
86.23
Practices
Pre
46.26
Post
70.09
*Wilcoxon Test
p-value
0.000*
0.000**
the
0.000*
and
provision of health education in nursing
health
about
education
demonstrate
the
breastfeeding
early,
giving
colostrum, and sustained breastfeeding.
average
value
respondents
before
and
education.
The
analysis
on
after
health
showed
significance for knowledge, attitudes, and
practices 0.000 each smaller than the value
of α = 0.05 so that there are significant
between
attitudes,
knowledge, attitudes, and practices better
19.43
13.77
knowledge, attitudes, and practices of the
differences
knowledge,
mothers showed that mothers who received
6.64
6.67
From Table 2 it was found that there is an
in
improve
practices of parents. Research on the
13.02
9.42
**Paired Samples T-Test
increase
health conditions. Health education can
the
scores
of
knowledge, attitudes, and practices before
and after given health education.
Health workers have an important role in
enhancing the knowledge and motivate
mothers
to
breastfeed
(12).
Brief
educational intervention on asthma and
healthy home showed positive changes in
older people who feel they have the
opportunity to realize a healthy home
environment. Education is given increasing
parental knowledge specifically and assist
parents in changing behavior to implement
changes in the family environment (13).
Knowledge is the result of obtaining
DISCUSSION
The provision of health education on
the prevention of infection to the parents in
children with cancer showed a significant
difference between knowledge, attitudes,
and actions of the respondents before and
after health education given. The provision
information that will affect the formation
of one's actions, attitudes are enclosed
response to an object that can predispose a
behavior. Attitude is not automatically
realized in the form of action as to be able
to be a real action required supporting
factors such as facilities and support of the
33
environment. The practices is a response to
(16). The provision of health education on
the stimulus in the form of tangible and
how to prevent infection provide additional
observable (14). The results of this study
knowledge to parents so that parents tend
showed
knowledge,
to change behavior because they feel such
attitudes, and practices of parents in
action will bring benefits to themselves.
preventing infection. Changes in behavior
Health workers who showed support
that occurs as a result of the learning
infection prevention measures also affect
process. Learning is a process of change in
the behavior of the parents to behave to
behavior due to the interaction between
prevent infection. Given health education
individuals
increases
no
changes
and
in
individuals
with
the
the
ability
of
parents
to
environment so as to interact and adapt to
implement
its environment (15). Parents who have
Sustainability and compliance measures are
given health education has increased in
closely related to confidence in the
knowledge, attitudes, and practices so that
effectiveness of actions taken. In addition,
there has been a learning process in their
health
parents. This is consistent with the
agreement in action so that the actions
characteristics of a learning activity that
taken by the health workers become
results in a change in the individual, both
uniform. It is important to ensure patients
actual and potential, and the changes are
and families about the benefits of the
not caused by a temporary condition such
actions recommended (17).
as fatigue or the influence of drugs (14).
infection
professionals
Health
prevention.
must
behaviors
that
have
an
appear
Based on Health Promotion Model
influenced by three factors: predisposing
theory raised by Nola J Pender stated that
factors which include knowledge and
someone would do that behavior change is
attitudes about health. In this study shows
expected to bring benefits to themselves.
that the knowledge and attitudes of parents
Health promotion will increase a person's
be increased after a given health education
ability to perform certain actions and
so as to encourage parents to behave to
deeds. The influence of the external
prevent infection. Availability of facilities
environment can also affect the desire to
which
participate in health-promoting behaviors
facilities for hand washing and other
are
Enabling
factors
include
34
infection
prevention
influence
the
also
media used. Media used will greatly assist
in
in the delivery of the information provided
preventing infection. The results show a
and the recipient will receive information
change in behavior after the infection
information more clearly and precisely
prevention education is given. Changes in
(14). This study uses the booklet as a
behavior can also occur because of the
medium for the provision of health
support facilities provided by the hospital.
education. Selection of the use of print
Practices of parents to hand washing is
media in this study because the print media
good because there are adequate facilities
has the advantage can be well designed,
for the realization of the action of washing
easy to read, and can reach out to all people
hands. But to act the use of masks and
because of a relatively low cost (21).
special clothes visitors still lacking due to
Research on the provision of information
insufficient availability of such facilities.
through the booklet can increase the
Reinforcing factors are reflected in the
knowledge of children and parents of
attitudes and actions of a role model, which
children with heart transplant recipients
in this case the nurse, and the action of the
(22). Continuous provision of information
surrounding
and ease of access to information will
actions
application
of
environment
parents
affects
the
behavior of the parents in the prevention of
increase
infection (18).
needs required by parents throughout the
knowledge
(23).
Information
Availability and ease of access to
period of the child's treatment and can
facilities affect a person's behavior to
always be changed so that the necessary
execute an action. Health worker adherence
provision of continuous information (11).
to hand washing higher internsif care unit
Education has a direct impact on
than non-intensive care room is connected
health behavior, a person who is given
with the ease of access using handrubs to
more health education will have better
always perform hand hygiene (19). Ease of
health
access using handrubs contribute to the
ability is not a primary factor influencing
desire to perform hand hygiene (20).
health behaviors. To achieve the desired
The level of acceptance of the
behaviors.
However,
cognitive
behavioral changes required to provide
information provided is influenced by the
35
information that is sustainable so that the
accordance with applicable regulations
behavior shown may be permanent.
relating to the prevention of infection such
as the provision of hand washing facilities
LIMITATIONS
dominated and availability of special
This study uses only one group alone did
clothes visitors. Research using control
not use a control group that did not note the
groups can be done to further research.
difference in behavior between parents
who are given and not given health
LIST OF ABBREVIATIONS
education. In addition, researchers can not
Abbreviations are used in the text : LMH
control the possibility of respondents
(Luh Mira Puspita), ES (Eddy Supriyadi),
interact with prospective respondents who
and FH (Fitri Haryanti)
do not get health education, to the extent
COMPETING INTERESTS
possible candidates respondents had little
The authors declare that they have no
exposure on infection prevention material
competing interests.
of the respondents who had received health
AUTHORS’ CONTRIBUTION
The research was conducted by LM and
supervised by ES and FH. The ethical
approval was obtained by LM. Data
collection done by LM. All authors read
and approved the final manuscript.
education. It would negatively affect the
results of the posttest.
CONCLUSIONS
There is the effect of health education
provision on parenting behaviors such as
knowledge, attitudes, and actions in the
prevention of infections in children with
cancer. Recommendation that can be given
is the health worker in hospital especially
nurses is expected to provide health
education on an ongoing basis by using the
media as a booklet in the delivery of health
education
expected
materials.
to
provide
The
hospital
is
the
facility
in
ACKNOWLEDGEMENTS
The authors would like to thank for the
nurses at the pediatric cancer ward Dr.
Sardjito Hospital for their support in this
study and also the parents who agreed to
participate in this study
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38
Luh Mira Puspita1, Eddy Supriyadi2, Fitri Haryanti3
1
2
Nursing Program Faculty of Medicine Universitas Udayana
Pediatric Hemato-Oncology Faculty of Medicine, Universitas Gadjah MadaSardjito Hospital Jogjakarta
3
1
Magister of Nursing Program Faculty of Medicine Universitas Gadjah Mada
mirapuspita990@yahoo.com, 2e.supriyadi@gadjahmada.edu, 1fiths2001@yahoo.com
Background: Infection is the major cause of death in children cancer. Implementation of
infection prevention can be implemented by applying hand-washing, using antiseptic bath,
oral care, visitor restrictions, application isolation, and use of barrier precautions. The problem
faced is the lack of awareness and understanding of families how to prevent infection.
Intervention of health education showed effectiveness to increase awareness and promote
health behavior. This research aimed to analyze the effect of health education on the behavior
of parents in the prevention of infection in children with cancer.
Methods: This research was the Pre Experimental with One Group Pretest-Posttest Design.
The population in this study were all parents who have children with cancer are treated in a
pediatric cancer ward Dr. Sardjito Hospital Yogyakarta. Sampling was performed by
Consecutive Sampling with minimum sample size is 68 respondents. Analysis data using
Paired Sampel t-Test for attitude and using Wilcoxon Test for knowledge and practices. The
predictive value used was α=0,05 and CI= 95%.
Results: The average score on knowledge, attitude, and practices before given health
education was 75.75, 82.21, and 46.26. The average score after given health education was
90.69, 86.23, and 70.09. There was an increase in the average scores before and after health
education. P-value in the variable knowledge, attitude, and practide of each of the 0.000 so
that there are significant differences between before and after health education.
Conclusions: Health education given for parents can change the behavior of parents about
prevention of infection in children with cancer.
Keywords: infection, parents’s behavior, health education, children’s cancer
28
who are received chemotherapy to reduce
BACKGROUND
Cancer is a disease with complex
the side effects of chemotherapy one of
manifestations depending on the type and
which is the occurrence of infection.
location of the cells grow. In children, the
Infection is the most frequent cause of
incidence of cancer is about 1 in 600
death in patients leukemia (4). Prevention
people and be the cause of death is about
of infection is very important because it
14% in children aged between 1-15 years.
can reduce the risk of infection and
In the period of 2000-2009, of 1,124
complications of the disease that can cause
children diagnosed cancer patients in
death and improve quality of life (5).
Hospital Dr. Sardjito, patients diagnosed as
Implementation
of
infection
much as 40.6% ALL, AML 13.9%, 6.7%
prevention
retinoblastoma,
5.5%,
applying the hand washing, using antiseptic
nephroblastoma 4.5%, and non-Hodgkin
bathing, oral care, visitor restrictions,
neuroblastoma
(1).
implemented
by
application isolation, and the use of barrier
prevalence of leukemia that occurs in
precautions (6,7). Prevention of infection
children showed the majority of children
which is can be done either at home or in
diagnosed with ALL is about 68.9% of all
the hospital to wash their hands properly,
cases of leukemia and 23.6% are cases of
the setting of food and drink with caution,
AML of all cases of leukemia. As for CML
as well as the child's environment settings
occurs approximately 4.2% of cases of the
(8).
is
4.4%
be
The
lymphoma
about
can
total of all cases of leukemia in children
(2).
The nurse important role in the
treatment of children with chemotherapy
Chemotherapy
is
one
of
the
ranging from prevention, early detection,
management for patients with cancer.
and
Effects of chemotherapy will damage the
providing information to patients and
cells that has a high proliferation activity
families. Giving proper education will
such as
bone marrow and mucosal
enhance the understanding of caring for
epithelial cells that chemotherapy will
children who require more attention due to
cause bone marrow depression, alopecia,
the child's condition. Increased knowledge
and mucositis (3). Treatment in patients
and behavior of parents can support the
management
of
neutropenia
by
29
monitoring conducted by the parents
The study was conducted in a ward
against her condition provision of health
childhood cancer treatment of Dr. Sardjito
education interventions showed effective
Hospital within the period from August to
results to the increased awareness of
October 2014. Ward childhood cancer
disease control and support the health
treatment consists of two rooms those are
seeking
research
Wards Kartika 1 and Kartika 2 with each of
conducted by Sherman and Koelmeyer
bed capacity of 13 and 23 beds. The type of
(2011) indicates that the provision of
study is the Pre Experimental. The study
information by nurses about lymphedema
design used one group pretest-posttest
can change the behavior of the patient in
design
minimizing the risk of lymphedema (10).
differences in the parental behavior in
behavior
(9).
The
Parents with children who suffer from
that
aims
to
determine
the
preventing infection in children with
of
cancer before and after given treatment.
decisions.
This study was approved by the Medical
Information needs required by parents
and Health Research Ethics Committee
throughout the period of the child's
(MHREC) Faculty of Medicine, Gadjah
treatment and can always be changed so
Mada University and Dr. Sardjito Hospital
that the necessary provision of continuous
the number KE / FK / 849 / EC.
leukemia
information
requires
to
help
the
support
make
information (11). Health education is given
The population in this study were all
regularly will help meet the needs of
parents who has children with cancer are
information needed by parents for caring
treated in a pediatric cancer ward Dr.
for children.
Sardjito Hospital. Sampling was performed
This study aims to analyze the effect
by consecutive sampling technique that is
of health education on the behavior of the
based on the research subjects to hospital
parents that knowledge, attitudes, and
arrival. Hospital Dr Sardjito within a
practices in the prevention of infections in
period of study with a minimum sample
children with cancer.
size is 68 respondents.
Before health education, researchers
METHOD
has determined that the observer who is
The place of research and study design
will help in this study were recruit from a
30
nurse who served in the room. Any parent
while for observation made 1 day before
who has a child aged 1-12 years, diagnosed
given health education. Observations for
with cancer, and is being treated at Kartika
the posttest was performed 1 day after
Space 1 and 2 are invited to participate in
health education and observed for 3 days in
the study. Parents who are work as health
a row. Posttest knowledge and attitudes by
professionals such as doctors, nurses, or
using a questionnaire carried out 7 days
midwives are not included in the study. All
after
parents
Respondents
who
have
been
willing
to
participate in the study will be given an
the
health
education
who
had
given.
given
health
education booklet that can be read back.
explanation of the study and performed the
procedure for awarding a contract for
Statistical analysis
health education.
Univariate analyzes performed on each
Intervention
variable to see the frequency of distribution
The provision of health education in
and the proportion of each variable namely
this study using the media booklets that
the
contain material about how to prevent
variable, and the variable of respondent
infection do parents at home or in hospital.
characteristics namely age, educational
Measurement of the parents's behavior and
level,
attitude
a
numerical data was analyzed use the mean
questionnaire compiled in Indonesian and
value, minimum-maximum values, and
had previously tested the validity and
deviation standard. While the categorical
reliability. The questionnaire contains 21
data be analyzed by using frequency
questions where as knowledge of the
distribution and percentage.
attitude
18
analysis conducted on the independent
of
variables and the dependent variable to test
that
the hypothesis of whether there is the effect
contains 9 items observable actions by
of health education on parenting behaviors
nurses who served in the wards. The health
such as knowledge, attitudes, and practices
education is
given after the pretest
of parents in the prevention of infection
questionnaire for knowledge and attitudes,
before and after health education. Before
that
questionnaire
statements.
parents
knowledge
contains
Measurement
using
using
observation
practices
sheet
independent
and
variable,
previous
dependent
information.
For
Bivariate
31
the bivariate analysis, the data normality
Table 1 Characteristics of respondents (N =
test to determine the distribution of normal
data or not. Normality test data using the
Kolmogorov-Smirnov test because the
sample size of more than 50 respondents.
Normality test was also performed to
qualify the use of parametric statistical test
of Paired Samples T-Test to analyze
changes in behavior before and after health
education. However, the data in this study
only attitude that is normally distributed
variables, while for knowledge and attitude
variables not normally distributed so as to
test the non-parametric Wilcoxon test to
analyze
the
behavioral
changes
that
knowledge and practices before it is given
health education (pretest) and after given
health education (posttest). The predictive
value used was α = 0.05 and CI = 95%. All
analyzes
were
performed
using
the
computer program package.
68)
Characteristics
Age (Year)
17-25
26-35
36-45
46-55
Education level
- Elementary
education
- Secondary
education
- Higher
education
Information
- Ever
get
information
- Never
get
information
Variables
have
Amount
Percentage
(n)
(%)
10
31
18
9
14.7
45.6
26.5
13.2
27
39.7
33
48.5
8
11.8
16
23.5
52
75.5
the
knowledge
and
practices are not normally distributed data
so using the Wilcoxon nonparametric test
that test. While the attitude variable has a
normal distribution of data that uses
parametric test with Paired Samples T-
RESULTS
Test.
Respondents in this study amounted
to 68 people and 3 of them do not follow
the posttest. Distribution characteristics of
the respondents as follows:
32
Table 2 Parents' behavior before and after
of health education have been carried out
intervention
in service at the hospital with a variety of
Variable
Mean
SD
Knowledge
Pre
75.75
Post
90.69
Attitute
Pre
82.21
Post
86.23
Practices
Pre
46.26
Post
70.09
*Wilcoxon Test
p-value
0.000*
0.000**
the
0.000*
and
provision of health education in nursing
health
about
education
demonstrate
the
breastfeeding
early,
giving
colostrum, and sustained breastfeeding.
average
value
respondents
before
and
education.
The
analysis
on
after
health
showed
significance for knowledge, attitudes, and
practices 0.000 each smaller than the value
of α = 0.05 so that there are significant
between
attitudes,
knowledge, attitudes, and practices better
19.43
13.77
knowledge, attitudes, and practices of the
differences
knowledge,
mothers showed that mothers who received
6.64
6.67
From Table 2 it was found that there is an
in
improve
practices of parents. Research on the
13.02
9.42
**Paired Samples T-Test
increase
health conditions. Health education can
the
scores
of
knowledge, attitudes, and practices before
and after given health education.
Health workers have an important role in
enhancing the knowledge and motivate
mothers
to
breastfeed
(12).
Brief
educational intervention on asthma and
healthy home showed positive changes in
older people who feel they have the
opportunity to realize a healthy home
environment. Education is given increasing
parental knowledge specifically and assist
parents in changing behavior to implement
changes in the family environment (13).
Knowledge is the result of obtaining
DISCUSSION
The provision of health education on
the prevention of infection to the parents in
children with cancer showed a significant
difference between knowledge, attitudes,
and actions of the respondents before and
after health education given. The provision
information that will affect the formation
of one's actions, attitudes are enclosed
response to an object that can predispose a
behavior. Attitude is not automatically
realized in the form of action as to be able
to be a real action required supporting
factors such as facilities and support of the
33
environment. The practices is a response to
(16). The provision of health education on
the stimulus in the form of tangible and
how to prevent infection provide additional
observable (14). The results of this study
knowledge to parents so that parents tend
showed
knowledge,
to change behavior because they feel such
attitudes, and practices of parents in
action will bring benefits to themselves.
preventing infection. Changes in behavior
Health workers who showed support
that occurs as a result of the learning
infection prevention measures also affect
process. Learning is a process of change in
the behavior of the parents to behave to
behavior due to the interaction between
prevent infection. Given health education
individuals
increases
no
changes
and
in
individuals
with
the
the
ability
of
parents
to
environment so as to interact and adapt to
implement
its environment (15). Parents who have
Sustainability and compliance measures are
given health education has increased in
closely related to confidence in the
knowledge, attitudes, and practices so that
effectiveness of actions taken. In addition,
there has been a learning process in their
health
parents. This is consistent with the
agreement in action so that the actions
characteristics of a learning activity that
taken by the health workers become
results in a change in the individual, both
uniform. It is important to ensure patients
actual and potential, and the changes are
and families about the benefits of the
not caused by a temporary condition such
actions recommended (17).
as fatigue or the influence of drugs (14).
infection
professionals
Health
prevention.
must
behaviors
that
have
an
appear
Based on Health Promotion Model
influenced by three factors: predisposing
theory raised by Nola J Pender stated that
factors which include knowledge and
someone would do that behavior change is
attitudes about health. In this study shows
expected to bring benefits to themselves.
that the knowledge and attitudes of parents
Health promotion will increase a person's
be increased after a given health education
ability to perform certain actions and
so as to encourage parents to behave to
deeds. The influence of the external
prevent infection. Availability of facilities
environment can also affect the desire to
which
participate in health-promoting behaviors
facilities for hand washing and other
are
Enabling
factors
include
34
infection
prevention
influence
the
also
media used. Media used will greatly assist
in
in the delivery of the information provided
preventing infection. The results show a
and the recipient will receive information
change in behavior after the infection
information more clearly and precisely
prevention education is given. Changes in
(14). This study uses the booklet as a
behavior can also occur because of the
medium for the provision of health
support facilities provided by the hospital.
education. Selection of the use of print
Practices of parents to hand washing is
media in this study because the print media
good because there are adequate facilities
has the advantage can be well designed,
for the realization of the action of washing
easy to read, and can reach out to all people
hands. But to act the use of masks and
because of a relatively low cost (21).
special clothes visitors still lacking due to
Research on the provision of information
insufficient availability of such facilities.
through the booklet can increase the
Reinforcing factors are reflected in the
knowledge of children and parents of
attitudes and actions of a role model, which
children with heart transplant recipients
in this case the nurse, and the action of the
(22). Continuous provision of information
surrounding
and ease of access to information will
actions
application
of
environment
parents
affects
the
behavior of the parents in the prevention of
increase
infection (18).
needs required by parents throughout the
knowledge
(23).
Information
Availability and ease of access to
period of the child's treatment and can
facilities affect a person's behavior to
always be changed so that the necessary
execute an action. Health worker adherence
provision of continuous information (11).
to hand washing higher internsif care unit
Education has a direct impact on
than non-intensive care room is connected
health behavior, a person who is given
with the ease of access using handrubs to
more health education will have better
always perform hand hygiene (19). Ease of
health
access using handrubs contribute to the
ability is not a primary factor influencing
desire to perform hand hygiene (20).
health behaviors. To achieve the desired
The level of acceptance of the
behaviors.
However,
cognitive
behavioral changes required to provide
information provided is influenced by the
35
information that is sustainable so that the
accordance with applicable regulations
behavior shown may be permanent.
relating to the prevention of infection such
as the provision of hand washing facilities
LIMITATIONS
dominated and availability of special
This study uses only one group alone did
clothes visitors. Research using control
not use a control group that did not note the
groups can be done to further research.
difference in behavior between parents
who are given and not given health
LIST OF ABBREVIATIONS
education. In addition, researchers can not
Abbreviations are used in the text : LMH
control the possibility of respondents
(Luh Mira Puspita), ES (Eddy Supriyadi),
interact with prospective respondents who
and FH (Fitri Haryanti)
do not get health education, to the extent
COMPETING INTERESTS
possible candidates respondents had little
The authors declare that they have no
exposure on infection prevention material
competing interests.
of the respondents who had received health
AUTHORS’ CONTRIBUTION
The research was conducted by LM and
supervised by ES and FH. The ethical
approval was obtained by LM. Data
collection done by LM. All authors read
and approved the final manuscript.
education. It would negatively affect the
results of the posttest.
CONCLUSIONS
There is the effect of health education
provision on parenting behaviors such as
knowledge, attitudes, and actions in the
prevention of infections in children with
cancer. Recommendation that can be given
is the health worker in hospital especially
nurses is expected to provide health
education on an ongoing basis by using the
media as a booklet in the delivery of health
education
expected
materials.
to
provide
The
hospital
is
the
facility
in
ACKNOWLEDGEMENTS
The authors would like to thank for the
nurses at the pediatric cancer ward Dr.
Sardjito Hospital for their support in this
study and also the parents who agreed to
participate in this study
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