International Journal of Innovative Research in Science, Engineering and Technology (IJIRSET)
| e-ISSN: 2319-8753, p-ISSN: 2320-6710| www.ijirset.com | Impact Factor: 7.512|
||Volume 9, Issue 6, June 2020||
EMO-DEMO Influence to Woman of
Childbearing Age in Performing Visual
Inspection with Acetic Acid (VIA)
Gusti Ayu Marhaeni1, I Gusti Ayu Surati2, Ni Nyoman Astika Dewi3, Ni Wayan Armini4
Ni Ketut Nuratni5, Ni Gusti Kompiang Sriasih6
Lecturer, Department of Midwifery, Poltekkes Kemenkes Denpasar, Bali, Indonesia1,2,4,6
Lecturer, Department of Medical Laboratory Technology, Poltekkes Kemenkes Denpasar, Bali, Indonesia3
Instructor, Department of Dental Hygienist, Poltekkes Kemenkes Denpasar, Bali, Indonesia5
ABSTRACT: The high mortality rate due to cervical cancer in Indonesia is caused by 95% of women not undergoing
early examinations, causing delays in diagnosis Data shows that public awareness, especially women of childbearing
age to carry out inspection of acetic acid is still low. This problem occurs because the woman of childbearing age
knowledge about cervical cancer is lacking, feels ashamed, feels no symptoms of cervical cancer, and feels no need to
have a check-up. The aim of the study is to find the EMO-DEMO educational influence on the enhancement of
knowledge, attitudes and participation of women of childbearing age in screening cervical cancer using the method of
Visual Inspection with Acetic Acid (VIA).We used Quasi experimental research with nonequivalent control group
design. In June until August 2019, the sample selection was done by probability sampling with simple random
sampling for60 respondents per group, the data collected using the questionnaire for the knowledge and attitude data
and the interview sheets for the participation data. We found that there is a meaningful difference between pre test and
post test on knowledge, attitude and participation in cervical cancer screening using VIA method with p = 0.000.
Therefore,there are increasing knowledge, attitudes and participation in screening cervical cancer using VIA
method on treatment
KEYWORDS: VIA method, Knowledge, Attitude, Participation, Cervical cancer screening.
I. INTRODUCTION
The incidence rate of cervical cancer in 2012 was estimated at 528,000 new cases and 266,000 deaths from
cervical cancer, as well as 70% of deaths occurred in developing countries. The incidence rate of cervical cancer in
Indonesia continues to increase to 98,692 cases in 2013 and about 235,000 cases including the death[1]. Data on the
early detection of cervical cancer in Indonesia in 2016 showed suspicious numbers of cervical cancer in several
provinces namely Jakarta 269 cases, Bali 254 cases and Bangka Belitung 227 cases[2]. The data shows that Bali is one
of the areas that have a high cervical cancer number.
The Visual Inspection with Acetic Acid(VIA test) is a cervical cancer screening method using a 3-5% acetic
acid solution in the cervix and seeing the discoloration that occurs after the spreads. The objective of VIA to see the
presence of cervical cells in dysplasia[3]. VIA test has been widely used in primary health care because VIA method is
relatively simple, easier and more cost effective so that it can increase the coverage of VIA[4].
In Bali, 2014 VIA examination target of 1.28% of the population of women aged 30-50 and the acquisition of
coverage of 2.69% exceeds the target set[5]. That was in 2015 took place in Karangasem, was done screening against
women aged 30-50 and found 19.8% VIA in positive result and in 2016 found 5.45 with positive VIA. Rendang sub
district, one of the sub-districts in Karangasem Regency, is a sub-district with the highest positive result of 30.4%[5].
The high mortality rate caused by cervical cancer in Indonesia is because 95% of women do not perform early
examination, causing a late diagnosis of cervical cancer and lowering the life expectancy of women[3]. There should be
awareness of women of childbearing age for screening against cervical cancer by VIA check-up. Data shows that
public awareness especially women of childbearing age to perform VIA is still low, whereas the Government has
encouraged healthy lifestyle and early detection. This problem occurs because their knowledge of cervical cancer is
lacking, felt ashamed, felt no symptoms of cervical cancer, and felt no need to be checked[3].
One of the efforts that need to be done to raise the awareness of women of childbearing age is the education
provision on VIA test with emo demo method. The provision of information on women of childbearing age that had
IJIRSET © 2020
DOI:10.15680/IJIRSET.2020.0906007
4057
International Journal of Innovative Research in Science, Engineering and Technology (IJIRSET)
| e-ISSN: 2319-8753, p-ISSN: 2320-6710| www.ijirset.com | Impact Factor: 7.512|
||Volume 9, Issue 6, June 2020||
been done was to provide counseling about the prevention and early detection of cervical cancer. Education with Emo
demo method is an educational activity accompanied by demonstrations that need emotional power. Implementation of
counseling with emo demo technique takes only 15 – 20 minutes and was done simply. The activity was given to
women of childbearing age through fun games and watching movies
Based on empirical studies performed, Karangasem regency, especially the work area of Public Health of
Rendang, experiencing problems of low number of woman of childbearing age performing VIA test as early detection
of cervical cancer due to lack of knowledge and information about its importance.
Paper is organized as follows. Section II describes Visual Inspection with Acetic Acid and its importance on
woman of childbearing age. Afterwards, the quasi experimental research with non-equivalent control group design is
given in Section III. Section IV presents experimental results showing results of test. Finally, Section V presents
conclusion.
II. RELATED WORK
Cervical cancer is one of cancer which leads to hundreds of thousands premature death among women and 8-%
from developing countries[6][7][8][9]. Human papillomavirus (HPV) is the cause of invasive cervical cancer in
which 70% of all cervical cancer are with HPV-16 and 18[10][11][12]. Cervical cancer itself is the second common
cancer in women. Key components to comprehensive approach of cervical cancer prevention are community
education, social mobilization, vaccination, screening, and treatment to palliative care [13]. Summary estimation of
visual inspection with acetic acid (VIA) was done with 29 studies review in which the summary sensitivity and
specificity of VIA for CIN2+ were 73.2% and 86.7%. VIA is proven good in its sensitivity detecting severe
outcome, in spite of slight loss is specificity. VIA could be a good option for cervical cleaning in low -resource
settings[14]. Yet, community based screening programs require sophisticated infrastructure, highly trained
personnel, as well as adequately equipped laboratories and good referral system.The study with cross-sectional
with questionnaires with samples by simple random sampling was done and the majority of reproductive age and
married woman are willing and accept VIA test. Meaning that the doing the test can arise their awareness.
However, that should be simultaneously done with education.
Emotional Demonstration also known as Emo Demo is the method of public education using a new approach which
focus on Behaviour Centred Design (BCD). BCD finds how brains learn with a practical set of steps and tools to create
successful behaviour change programs in which the change can be achieved with response to something new and
challenging. There are five steps regarding behaviour change, i.e. Assess, Build, Create, Deliver and Evaluate.
[15][16][17]. Somehow, the studies about Emo Demo is still few discussed. One thing to understand is that the future
of emotion research can be successful if keep in mind that emotion became respectable, need to focus on experimental
approach that simplified the problem in way to make it tractable[18].
III. METHODOLOGY
This research is an experimental research quasi with nonequivalent control group design. The study was performed in
June to August 2019. The population in this study of all women of childbearing age in Karangasem Regency, Bali,
Indonesia with analysis unit or respondent of this research is women of childbearing age in Rendang District. The
selection of samples was probability sampling by simple random sampling in accordance with the criteria of inclusion
and exclusion criteria with the number of respondents as many as 60 people per group, the data collected using the
questionnaire for the data of knowledge and attitudes. In addition, interview sheets for the participation data. All data is
processed with normality test using Kolmogorov Smirnov with the results of undistributed data and different tests using
non parametric tests: Wilcoxon, Mann Whitney, and Chi-Square
IV. EXPERIMENTAL RESULTS
The distribution characteristics of women of childbearing age is that from 60 respondents in the control
group is found that the average age is 34.12, with median 35, the most age is 35 with a standard deviation of 7.321, and
the youngest age is 21 while the oldest age is 41. Meanwhile, the treatment group derived the average age of 30.90 with
a median of 29 years old, and the most age is 25 with a standard deviation of 6.724, and the youngest is 19 while the
oldest age is 48 years old. The characteristics of respondents based on education, employment, income, number of
children and the source of information shows from the educational characteristics of the 60 respondents in the control
group gained 50% of respondents are High School graduate while in the treatment group is largely 35% elementary
graduate. The characteristics of the respondents based on revenue in the control group gained that the majority of the
IJIRSET © 2020
DOI:10.15680/IJIRSET.2020.0906007
4058
International Journal of Innovative Research in Science, Engineering and Technology (IJIRSET)
| e-ISSN: 2319-8753, p-ISSN: 2320-6710| www.ijirset.com | Impact Factor: 7.512|
||Volume 9, Issue 6, June 2020||
63.3% had no income and in the majority of the treatment group, 71.7% also had no income. When viewed from the
characteristics of the number of children in the control group, it obtained the majority of 43.3% have 2 children while
the treatment group is mostly at 43.3% have 1 child. Characteristics of respondents based on the source of information
in the control group gained that the majority of 58.3% get information from social media while the treatment group of
the majority is 38.3% also get information from social media.
4.1 Observation results on respondents to research variables
The results of observation on knowledge of screening cervical cancer using VIA is shown in Table 1.
Table 1. Distribution of women of childbearing age based on knowledge
No
Group
1
Control
2
Treatment
N
Pre
Post
Pre
Post
Mean
73.37
78.50
68.38
80.36
60
60
60
60
Mode
Median
76
81
67
80
SD
12.117
11.281
10.440
9.476
76
76
66
78
Min-Max
47-95
60-98
52-90
65-98
Of the 60 respondents either in the control or treatment group, it can be seen that there is different number in their pre
and post-tests. From the control group, the post-test mean and median is higher than its pre-test. While the most value
is same, namely in 76. Those condition is also shown in treatment group in which the mean, median and mode of posttest is higher than its pre-test. Between control and treatment group, the one that has better Min-Max value is the
treatment group. Secondly, the results with research variables of attitude shows the data in Table 2.
Table 2. Distribution of women of childbearing age based on attitude
No
1
2
N
Group
Pre
Control
Post
Pre
Treatment
Post
60
60
60
60
Mean
72.07
78.78
73.28
83.15
Mode
Median
70
77.50
73
81.50
Sd
5.772
5.012
4.923
4.967
69
75
69
80
Min-Max
59-93
67-96
64-88
75-97
The results show that both control and treatment group has better mean, median and mode in its each post-test than the
pre-test. Although in general, treatment group has better result that control group. In addition, the Min-Max value of
treatment group is better than control group. It can be seen in its post-test that treatment group gained 75-97, better than
that in control group with only 67-96.
Last variable which is participation, obtained data as shown in Table 3.
Table 3. Distribution of women of childbearing age based on participation
Participation
No
Do
Group
1
Control
2
Treatment
Pre
Post
Pre
Post
Amount
Not
F
%
21
35.0
33
55.0
F
60
39
60
27
%
100
65.0
100
45.0
F
60
60
60
60
%
100
100
100
100
Table 3 shows that from 60 respondents in the control group specifically in pre-test, didn’t do screening cervical cancer
with VIA, while in the post-test most of the 65.0% also did not do cervical cancer screening by VIA. The treatment
group of 60 respondents in pre-test also didn’t perform cervical cancer screening with VIA while posttest data is mostly
55.0% didcervical cancer screening with VIA.
4.2 Analysis of Data
Normality test on knowledge and attitude of women of childbearing age shows that the value of P before and after
condition of knowledge and attitude have a value of P less than α (0.05), meaning that the data is not a normal
distribution. Afterwards, it was then carried out data transformation yet the results remain the same. This means that the
analysis couldn’t use normality test, and it drives to use Wilcoxon and Mann Whitney
IJIRSET © 2020
DOI:10.15680/IJIRSET.2020.0906007
4059
International Journal of Innovative Research in Science, Engineering and Technology (IJIRSET)
| e-ISSN: 2319-8753, p-ISSN: 2320-6710| www.ijirset.com | Impact Factor: 7.512|
||Volume 9, Issue 6, June 2020||
The analysis of knowledge is shown in Table 4.
Table 4. Bivariate analysis of knowledge in performing cervical cancer screening using VIA
No
N
Group
1
Control
2
Treatment
Pre
Post
Pre
Post
60
60
60
60
Mean
73.37
78.50
68.38
80.36
Difference of
Mean
p Value
5.43
0.000
11.98
0.000
Using Man Whitney test, it was found that there is an increase in the average knowledge after given counseling
compared to it wasn’t before, in as much as 5.43, with an average value of 73.37 increased to 78.50 after
given counseling. While in the treatment group also occurs the increase in the average knowledge after given
educational method using the Emo demo method compared with before given education with emo demo as much as
11.98, with an average value of 68.38 at the time before given education with emo demo increased to 80.36 after being
given education with emo demo. Results of bivariate analysis using Wilcoxon test and obtained p = 0.000 value in the
control and treatment group. Due to the value of P < α (0.05), then H0 is rejected. This means that there is a difference
in the knowledge of women of childbearing age in performing cervical cancer screening using VIA method in terms of
before and after treatment.
Level of knowledge of respondents varies greatly, meaning that there is a considerable difference in knowledge
among respondents. Based on the facts above, although health education is rarely held about cervical cancer screening
using VIA, there are respondents who obtained a knowledge score of 85 at the time of the pre-test. This data shows that
respondents have been exposed to information about cervical cancer. Information sources jointly develop and influence
individual decisions related to specific tasks, behaviours, or appearance or achievements[19]. The results of knowledge
post-test obtained a mean value of 80.36 with a standard deviation of 9.47. The value of the respondent's knowledge
range after treatment is 65-98. This shows that the Emo Demo method carried out can arouse the attention of women of
childbearing age to listen. Thus the information submitted can be received well and clearly by respondents. Based on
education, 50% of respondents received secondary education equivalent to formal high school education. The
respondent's education level can influence the respondent's knowledge after the EmoDemo method so that there are
differences in the results of the pre-test and post-test. This result is reinforced by the theory put forward by [20]that the
educational factor influences one's knowledge and it cannot be denied that the higher a person's education the easier
they receive information and the more knowledge they have.
The results of knowledge pre-test obtained a mean value of 73.37 with a standard deviation of 12,117. The value of
the range of respondents' knowledge before treatment is 47-95. This shows that respondents already considered cervical
cancer screening activities important. This is due to the sufficient knowledge of the respondents, so they have the
readiness and motivation to do cervical cancer screening.
The results of knowledge post-testobtained a mean value of 78.50 with a standard deviation of 11.28. The value of
the respondent's knowledge range is 60-98. This increase in knowledge was due to the mother having gained
knowledge of cervical cancer screening using VIA methods in counselling activities so that respondents' knowledge
increased. This gives awareness to innovate and change mindset, and improve health status. This is in line with
research conducted by [21]which states that health education can have a positive impact on women of childbearing age
in order to increase knowledge about cervical cancer so that the incidence rate of cervical cancer will decrease. The
results of research from [22]on the effect of counselling on knowledge about cervical cancer in fertile-aged women in
Bongsari village, West Semarang, also showed that there was an increase in knowledge between before and after health
education about cervical cancer.
The analysis differences in attitude can be seen in Table 5.
Table 5. Bivariate analysis of attitude in performing cervical cancer screening using VIA
Group
No
1
Control
2
Treatment
IJIRSET © 2020
Pre
Post
Pre
Post
N
60
60
60
60
Mean
72.07
78.78
73.28
83.15
Difference
of Mean
p-Value
6.71
0.000
9.87
0.000
DOI:10.15680/IJIRSET.2020.0906007
4060
International Journal of Innovative Research in Science, Engineering and Technology (IJIRSET)
| e-ISSN: 2319-8753, p-ISSN: 2320-6710| www.ijirset.com | Impact Factor: 7.512|
||Volume 9, Issue 6, June 2020||
It was found that there are increase in either control or treatment group in its each pre and post-test. In control group, it
increased from 72.07 to 78.78 while in treatment group from 73.28 to 83.15. The average difference in attitude in the
treatment group who were given education by the emo demo method was higher at 9.87 compared to the control group
which is only 6.71. The results of the bivariate analysis used Wilcoxon and Mann Whitney test that obtained the value
of p = 0,000 in either the control ortreatment group. Because the value of p <α (0.05), H0 is rejected, meaning that there
is difference in attitude of respondents in performing cervical cancer screening using VIA.
An increase in the average attitude of respondents after being given education with the EmoDemo method
compared to before being given education with Emo Demo from an average value of 73.28 to 83.15. In the concept of
health behaviour it is stated that attitude is the second domain after knowledge in the level of behaviour change.
Women of childbearing age in the treatment group significantly increased knowledge of cervical cancer screening using
the VIA method. Changing attitudes is inseparable from increasing one's knowledge. The increase in the average score
of women of childbearing age attitudes in screening for cervical cancer using VIA with Emo Demo is because at the
time of the study, it was added property in the form of cervical phantum that can arouse emotions and feelings of
respondents. This is in line with the theory of BehaviourCentred Design (BCD) that education is intended for feelings,
not thoughts, so that changes in feelings can improve the attitude. BCD theory states that an intervention must change
something in the environment.
Improving the attitude of women of childbearing age to screen for cervical cancer using VIA is a good method
compared to counselling, this can be seen from the difference in the average attitude. This difference is caused because
in promoting cervical cancer screening using the emo demo method, researchers conduct two-way interactions with
research subjects accompanied by props that can arouse the feelings and emotions of respondents, thereby giving rise to
the trust of research subjects towards researchers.
Table 6 shows the analysis results on participation variable. It is obtained that participation in the treatment
group given the education with the Emo demo method is higher in 33 respondents compared with the control group
with 21 respondents. Regarding the analysis on participation as the third variable, this part as bivariate analysis used
Chi Square test and obtained p = 0,000. Since p –value is less than α (0.05), then in conclusion, there is a difference of
participation on respondents in response of VIA application.
Table 6. Bivariate analysis of participation in performing cervical cancer screening using VIA
1
Control
60
Post
participation
21
2
Treatment
60
33
No
Group
N
p-Value
0.044
In the treatment group, of the 60 respondents it was found that all pre-test had not performed cervical cancer screening
by VIA, while after the post-test most of it was 55.0% screened for cervical cancer by VIA. This shows that the greater
the percentage of respondents who participated in cervical cancer screening activities with the emo demo method. Emo
demo is used as a way to carry out education because this method can provide a detailed and clear information and
easily understood by respondents directly and most importantly by involving the emotions of the respondents.The
difference in woman of childbearing age participation in screening for cervical cancer using VIA method is influenced
by many factors, in this case the method of intervention being carried out. Fear is an emotional one that can be raised to
change the behaviour of research subjects. An individual naturally will avoid painful threats[23]. The description of
changes in the cervix from normal to having cancer can arouse the feelings of research subjects. This motivation is
what makes research subjects participate in cervical cancer screening activities using VIA. Unlike Emo-Demo,
promotion of cervical cancer by extension methods only provides information in one direction to 60 respondents, so it
is difficult to measure the things that can be understood and can be learned. Health education in general is one-way
communication with few opportunities to measure the amount that can be learned or understood and only a small
portion that seems to be remembered at the end of the meeting and will be reduced in a few days[24]. Woman of
childbearing age’s knowledge also influences its participation in cervical cancer screening using the IVA method. Lack
of knowledge and awareness of the importance of testing is an inhibiting factor for cervical cancer screening.
Individual knowledge about the disease will shape the individual's perception of the threat of disease and belief in the
vulnerability of the disease and will motivate the individual to perform health behaviours[25]. The Emo-Demo method
which is carried out as an intervention uses the BehaviouralCentred Design (BCD) approach. This approach seeks to
incorporate psychological elements as innovations to change individual behaviour. The combination of knowledge and
creativity in composing messages, making this method can transfer the message of behaviour change that is more easily
accepted by the target.
IJIRSET © 2020
DOI:10.15680/IJIRSET.2020.0906007
4061
International Journal of Innovative Research in Science, Engineering and Technology (IJIRSET)
| e-ISSN: 2319-8753, p-ISSN: 2320-6710| www.ijirset.com | Impact Factor: 7.512|
||Volume 9, Issue 6, June 2020||
V. CONCLUSION
We have implemented Visual Inspection of Acetic Acid (VIA) with Emo-Demo (Emotional Demonstration)
towards women of childbearing age. This method brings results on differences in knowledge, attitude and participation
of the respondents. There are meaningful differences in knowledge, attitude and participation of the respondents
namely women of childbearing age in as much as 60 persons provided with p-value of less than 0.05.
REFERENCES
[1]
[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
[14]
[15]
[16]
[17]
[18]
[19]
[20]
[21]
[22]
[23]
[24]
[25]
R. Bott, “Data and Health Information of Cancer Situation,” Igarss 2014, vol. 1, pp. 1–5, 2014.
Pusdatin Kemenkes RI, Data dan Informasi Profil Kesehatan Indonesia 2016. Kementrian Kesehatan RI, 2017.
S. Mulyati, O. Suwarsa, and I. F. D. Arya, “Pengaruh Media Film Terhadap Sikap Ibu pada Deteksi Dini Kanker
Serviks,” J. Kesehat. Masy., vol. 11, no. 1, pp. 16–24, 2015.
Z. Momenimohayed and H. Salehiniya, “Incidence, mortality and risk factors of cervical cancer in the world,”
Biomed. Res. Ther., vol. 4, no. 12, p. 1795, 2017.
Dinas Kesehatan Kabupaten Karangasem, Profil Kesehatan Kabupaten Karangasem Tahun 2016. 2017.
M. J. V. Germar and M. Merialdi, Visual Inspection with Acetic Acid as A Cervical Cancer Screening Tool for
Developing Countries. 2003.
A. B. Jenson and W. D. Lancaster, “Association of human papillomavirus with benign, premalignant and malignant
anogenital lesions,” Papillomavirus Hum. Cancer.ed.by H. Pfister (CRC Press. Inc), pp. 11–43, 1990.
N. Muñoz, “Human papillomavirus and cancer: the epidemiological evidence,” J Clin Virol, vol. 19, no. 1–2, pp. 1–5,
2000.
S. Ghim, P. S. Basu, and A. B. Jenson, “Cervical Cancer : Etiology , Pathogenesis , Treatment , and Future Vaccines,”
Cerv. Cancer Etiol. Vaccine, vol. 3, no. February, pp. 207–214, 2002.
F. X. Bosch, Y. L. Qiao, and X. Castellsague’, “CHAPTER 2 The epidemiology of human papillomavirus infection
and its association with cervical cancer.,” Int Jf Gynecol Obstet. pp. S8–S21, 2006.
J. S. Smith, L. Lindsay, B. Hoots, J. Keys, S. Franceschi, and R. Winer, “Human papillomavirus type distribution in
invasive cervical cancer and high-grade cervical lesions: a meta-analysis update,” Int J Cancer, vol. 121, no. 621–
632, 2007.
R. B. Hassan, E. Armawan, I. Farisa, and D. Arya, “Visual Inspection Test with Acetic Acid for Cervical Cancer
Screening : Willingness and Acceptability among Reproductive Age and Married Women,” Althea Med. J., vol. 5, no.
31, pp. 98–104, 2018.
World Health Organization (WHO), Comprehensive cervical cancer prevention and control : a healthier future for
girls and women. 2013.
L. Qiao, B. Li, M. Long, X. Wang, A. Wang, and G. Zhang, “Accuracy of visual inspection with acetic acid and with
Lugol ’ s iodine for cervical cancer screening : Meta-analysis,” Obstet. Gynaecol. Res., vol. 41, no. 9, pp. 1313–1325,
2015.
R. Aunger and V. Curtis, A Guide to Behaviour Centred Design, no. April. 2015.
R. Aunger and V. Curtis, “Behaviour Centred Design : towards an applied science of behaviour change,” Health
Psychol. Rev., vol. 10, no. 4, pp. 425–446, 2016.
A. B. Birawida, M. Selomo, A. Mallongi, and D. Adilah, “Effectiveness of Emotional Demonstration Method in
Counseling Handwashing with Soap in Small Islands of Makassar,” in ICER-PH, 2019.
J. E. Ledoux, “Emotion Circuits in The Brain,” in Annu Rev Neurosci, 2000, pp. 155–184.
A. Bandura, Self Efficacy – The Exercise of Control (Fifth Printing, 2002). New York: W.H. Freeman & Company,
1997.
M. Irmayanti, MPKT Modul I. Jakarta: Lembaga Penerbitan FEUI, 2007.
P. Tani, H. Wungouw, and G. Masi, “Pengaruh Penyuluhan Kesehatan tentang Kanker Serviks Terhadap
Pengetahuan Wanita Usia Subur di Desa Sendangan Satu Kecamatan Sonder,” Ejournal keperwatan (e-Kp), vol. 6,
no. 2, 2018.
S. Wahyuni, “Pengaruh Penyuluhan Terhadap Pengetahuan Tentang Kanker Leher Rahim Pada Wanita Usia Subur di
Kelurahan Bogasari Semarang Barat Tahun 2011,” J. Kebidanan dan Keperawatan, vol. 2, no. Desember, pp. 119–
125, 2015.
E. Leontsini and P. J. Winch, “Increasing handwashing with soap: Emotional drivers or social norms?,” Lancet Glob.
Heal., vol. 2, no. 3, pp. e118–e119, 2014.
S. Notoatmodjo, Metodologi Penelitian Kesehatan. Jakarta: Rinek Cipta, 2010.
E. Masturoh, “Faktor-Faktor yang Mempengaruhi Wanita Usia Subur (WUS) dalam Melakkan Deteksi Dini Kanker
Serviks Metode Inspeksi Visual Asam Asetat (IVA),” Universitas Negeri Semarang, 2016.
IJIRSET © 2020
DOI:10.15680/IJIRSET.2020.0906007
4062
Ketut Nuratni