EFIKASI BALANCED COUNSELING PLUS PLUS PADA IBU HAMIL UNTUK MENURUNKAN UNMET NEED KB POSTPARTUM: RANDOMIZED CONTROLLED TRIAL

DINI INDO VIRAWATI, Prof. dr. Siswanto Agus Wilopo, SU., M.Sc., Sc.D.; Prof. Dra. RA. Yayi Suryo Prabandari, M.Si., Ph.D.

2020 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar belakang: Konseling KB merupakan salah satu strategi untuk memenuhi kebutuhan unmet need KB. Konseling KB dapat diintegrasikan dengan upaya mengatasi masalah prioritas kesehatan lainnya. Kanker serviks merupakan salah satu penyebab kematian wanita yang dapat dicegah. Namun, belum ada bukti tentang manfaat konseling KB pada periode ANC terhadap penurunan unmet need KB postpartum dan peningkatan niat mencegah kanker serviks. Tujuan: Mengembangkan model konseling KB untuk ibu hamil dan menganalisis efikasi balanced counseling strategy plus plus (BCS++) terhadap unmet need KB postpartum dan niat mencegah kanker serviks. Metode: Penelitian tahap pertama adalah deskriptif kualitatif dengan delapan responden yang terdiri dari ibu hamil, bidan, kepala puskesmas dan penentu kebijakan dan dianalisis secara tematik. Desain tahap kedua adalah randomized controlled trials (RCT). Sampel penelitian berjumlah 152 orang ibu hamil di Kota Samarinda. Intervensi konseling BCS++ diberikan secara single blinding untuk menurunkan unmet need KB postpartum dan meningkatkan niat mencegah kanker serviks. Analisis statistik ditujukan untuk mengetahui perbedaan proporsi unmet need KB postpartum dan niat mencegah kanker serviks serta penyesuaian faktor- faktor lainnya digunakan regresi poisson. Hasil: Studi kualitatif menemukan masih ada kelemahan konseling KB. Alat bantu konseling KB perlu dimodifikasi agar sesuai untuk ibu hamil. Hasil modifikasi alat bantu konseling diberi nama Balanced Counseling Strategy Plus Plus (BCS++ Studi kuantitatif menemukan BCS++ berpengaruh signifikan menurunkan unmet need KB postpartum. Perbedaan proporsi unmet need KB postpartum pada kedua kelompok sebesar 56% dengan 95% CI= [0.43,0.68]. Konseling BCS++ berpengaruh signifikan meningkatkan niat mencegah kanker serviks pada kelompok intervensi dengan perbedaan proporsi sebesar 57% dan 95% CI = [0.44, 0.69]. Konseling BCS++ juga berpengaruh signifikan terhadap ideation, kualitas informasi, dan niat menggunakan metode. Variabel umur, pendidikan, jumlah anak, ideation pretest dan diskusi tentang KB tidak berpegaruh terhadap unmet need KB postpartum. Kesimpulan: BCS++ efektif untuk menurunkan unmet need KB postpartum, meningkatkan niat mencegah kanker serviks, ideation, kualitas informasi, dan niat menggunakan kontrasepsi pasca salin.

Background: Family planning counseling is one of the strategies to meet the needs of unmet family planning needs. Family planning counseling can be integrated with efforts to address other health priority issues. Cervical cancer is one of the preventable causes of female death. However, there is no evidence yet about the benefits of family planning counseling in the ANC period for decreasing unmet need for postpartum birth control and increasing intention to prevent cervical cancer. Objective: To develop a family planning counseling model for pregnant women and to analyze the efficacy of a balanced counseling strategy plus plus (BCS++) on postpartum unmet need and the intention to prevent cervical cancer. Method: The first stage of the research was a qualitative descriptive study with eight respondents, namely pregnant women, midwives, community health center heads and policy makers. Data analyzed thematically. The second stage design is a randomized controlled trial (RCT). The research sample consisted of 152 pregnant women in Samarinda City. BCS++ intervention is given single blinding to reduce unmet need for postpartum KB and increase intention to prevent cervical cancer. Statistical analysis aimed to determine differences in the proportion of postpartum unmet need for FP and the intention to prevent cervical cancer as well as the adjustment of other factors used logistic regression. Results: A qualitative study found that there were still weaknesses in counseling. The family planning counseling tools needed to be modified so that they are suitable for pregnant women. The results of the modification of the counseling tool are named Balanced Counseling Strategy Plus Plus (BCS++). The quantitative studies found BCS++ was shown to significantly reduce postpartum unmet need FP. The difference in the proportion of postpartum unmet need KB in the two groups was 56% with 95% CI = [0.43,0.68]. BCS++ counseling was shown to significantly increase intention to prevent cervical cancer in the intervention group with a difference in proportions of 57% and 95% CI = [0.44, 0.69]. BCS++ counseling also has a significant effect on ideation, information quality, and intention to use methods. The variables of age, education, number of children, ideation pretest and discussion about family planning do not affect the unmet need for postpartum birth control. Conclusion: BCS++ was incredibly effective in reducing postpartum unmet need and in increasing intention to prevent cervical cancer, quality of counseling, ideation and intention to use postpartum contraception.

Kata Kunci : Unmet need KB postpartum, balanced counseling strategy plus plus, unmet need postpartum, balanced counseling strategy plus plus