Maternal Health Literacy Ibu Hamil Pada Keluarga Berpendapatan Rendah: Studi Kasus Eksploratoris di Kabupaten Purbalingga

Ema Wahyu Ningrum, Dr. dr. Mubasysyir Hasanbasri, MA; Dr. dr. Emy Huriyati, M.Kes; Lely Lusmilasari, S.Kp., M.Kes, P.hD

2024 | Disertasi | S3 Kedokteran Umum

Latar belakang: Skala demografi yang besar, tingkat pendidikan dan sosioekonomi yang rendah, peran bidan dan sistem kesehatan berpengaruh pada ibu hamil berpendapatan rendah dalam mengakses perawatan berkualitas. Keberhasilan pelayanan kesehatan selain ditentukan oleh kualitas program dan petugas kesehatan juga bagaimana pemahaman pasien dalam mengakses dan menggunakan layanan kesehatan. Penelitian dilaksanakan di Kabupaten Purbalingga dimana  prevalensi AKI dan AKB relatif tinggi dibandingkan Kabupaten lain di Provinsi Jawa Tengah. Penelitian bertujuan mengeksplorasi faktor ibu, faktor tenaga kesehatan, faktor sistem pelayanan kesehatan terhadap maternal health literacy ibu hamil berpendapatan rendah.

Metode: Penelitian kualitatif pendekatan studi kasus tunggal terjalin (embedded single case study) dengan pola eksploratoris. Teknik penentuan informan secara purposive sampling yang memenuhi kriteria inklusi eksklusi. Informan wawancara mendalam sejumlah 17 ibu, FGD sejumlah 9 bidan desa dan triangulasi sejumlah 10 narasumber. Pengumpulan data secara wawancara mendalam, FGD, observasi, telaah dokumen. Proses transkripsi dilakukan menggunakan software Otranscribe, pengolahan data menggunakan software NViVo edisi March 2020, analisa data dilakukan dengan metode pattern matching. 

Hasil penelitian: Kemampuan maternal health literacy ibu hamil berpendapatan rendah masih terbatas dalam mengakses, memahami, menilai dan mengaplikasi sumber informasi. Perilaku komunikasi bidan, media edukasi dan sistem pelayanan kesehatan pemerintah masih bersifat top to down approach belum 100% mendukung upaya peningkatan maternal health literacy ibu hamil berpendapatan rendah. 

Kesimpulan: Maternal health literacy dipengaruhi oleh faktor ibu hamil, perilaku komunikasi bidan, support sistem, dan sistem pelayanan kehamilan. Pendekatan aktif partisipatif, literate communication dan organizational health literacy sebagai strategi untuk meningkatkan maternal health literacy. Upaya peningkatan maternal health literacy dimulai dari sistem pelayanan kesehatan yang memenuhi prinsip-prinsip literasi berupa organizational health literacy dipadu dengan peningkatan kepemimpinan bidan dalam pelayanan kehamilan.

Background: The large demographic scale, low levels of education and socioeconomic status, the role of midwives, and the healthcare system influence low-income pregnant women in accessing quality care. The success of healthcare services is not only determined by the quality of programs and healthcare providers but also by patients' understanding of accessing and utilizing healthcare services. The study was conducted in Purbalingga Regency, where the prevalence of maternal mortality and morbidity is relatively high in Central Java Province. The study aims to explore maternal factors, healthcare provider factors, and healthcare system factors influencing maternal health literacy among low-income pregnant women.

Method: The study employed a qualitative research design with an embedded single case study approach and an exploratory pattern. Informants were selected through purposive sampling based on inclusion and exclusion criteria. In-depth interviews were conducted with 17 mothers, FGDs with 9 village midwives, and triangulation with 10 key informants. Data were collected through in-depth interviews, FGDs, observations, and document reviews. Transcription was done using Otranscribe software, data processing utilized NVivo software (March 2020 edition), and data analysis employed Pattern Matching method.

Research Findings: The maternal health literacy abilities of low-income pregnant women are still limited in accessing eHealth, understanding, evaluating, and applying information sources. The communication behavior of midwives, educational media, and the government healthcare system's top-down approach are not fully supporting efforts to enhance maternal health literacy among low-income pregnant women. 

Conclusion: Maternal health literacy is influenced by factors such as pregnant women's characteristics, midwives' communication behaviors, support systems, and the pregnancy care system. Active participatory approaches, literate communication, and organizational health literacy serve as strategies to enhance maternal health literacy. Efforts to improve maternal health literacy begin with healthcare systems that adhere to literacy principles, incorporating organizational health literacy along with enhancing midwives' leadership in pregnancy care.

Kata Kunci : Maternal Health Literacy, Sistem Pelayanan Kesehatan, Perilaku Komunikasi, Bidan, Ibu Hamil, Media Edukasi, Negara Berpendapatan Rendah