Kepatuhan penerapan asuhan persalinan normal di Puskesmas Rawat Inap di Kota Kupang Provinsi Nusa Tenggara Timur dengan pendekatan teori perilaku terencana
RALO, Theresia Sarlyn, Prof. dr. M. Hakimi, SpOG(K), PhD
2010 | Tesis | S2 Ilmu Kesehatan MasyarakatLatar Belakang: Berdasarkan evidence Asuhan Persalinan Normal (APN) mampu mencegah berbagai penyulit yang mengancam keselamatan ibu dan bayi baru lahir, serta efektif menurunkan Angka Kematian Ibu (AKI). Namun terdapat kesenjangan dalam kepatuhan menerapkan evidence based practices. Di Kabupaten Ende Provinsi NTT tingkat kepatuhan menerapkan standar APN pada aspek evaluasi prosedur pasca persalinan hanya 57,14%. Pendekatan teori perilaku terencana dapat digunakan untuk memprediksi perilaku guna mendesain intervensi, bagi peningkatan kepatuhan penerapan standar pelayanan kesehatan. Tujuan: Diketahuinya tingkat kepatuhan penerapan standar APN di puskesmas rawat inap di Kota Kupang dan prediktor terbaik kepatuhan menerapkan standar APN, menggunakan pendekatan teori perilaku terencana serta permasalahan penerapan standar APN. Metode: Penelitian observasional, rancangan cross sectional, dilengkapi data kualitatif. Pengambilan sampel non probabilitas terhadap 32 bidan di puskesmas rawat inap di Kota Kupang. Instrumen: kuesioner, daftar tilik dan pedoman wawancara mendalam. Analisis bivariat: Korelasi Pearson Product Moment, Independent t-test, One Way Anova dan analisis mutivariabel: Path Analysis pada tingkat kepercayaan 95%. Hasil: Tingkat kepatuhan standar APN di Kota Kupang 81%. Analisis jalur model 3 menunjukkan norma subyektif (β=0,387) dan kontrol perilaku (β=0,371) berhubungan secara signifikan dengan intensi. Sementara intensi (β=0,160) tidak berhubungan dengan kepatuhan menerapkan standar APN. Kepatuhan menerapkan standar APN berhubungan secara signifikan dengan kontrol perilaku yang dihayati (β=0,338) setelah mengikutsertakan variabel pendidikan D3 (β=0,661) dan D4 (β=0,496). Masa kerja (β=0,408), sarana (β=0,567) dan pelatihan APN (β=0,398) berhubungan signifikan dengan kepatuhan menerapkan standar APN. Permasalahan penerapan standar APN secara patuh adalah sarana belum sesuai standar, pasien tidak kooperatif, kurangnya motivasi bidan, sistem kerja yang menggabungkan rawat inap persalinan dan non persalinan. Kesimpulan: Tingkat kepatuhan penerapan standar APN di puskesmas rawat inap di Kota Kupang melampaui standar intervensi yang ditetapkan Depkes. Namun intervensi masih perlu dilakukan, mengingat aspek kritis APN penerapannya sangat rendah. Norma subyektif dan kontrol perilaku yang dihayati merupakan prediktor intensi untuk menerapkan standar APN secara patuh. Namun kepatuhan menerapkan standar APN tidak dapat diprediksi oleh intensi, tetapi dapat diprediksi oleh kontrol perilaku yang dihayati pada tingkat pendidikan responden D3 dan D4.
Background: Based on the evidence, the best practice of normal childbirth care (NCC) can prevent many inhibitors that endanger the safety of mothers and the newborn and effectively minimize maternal mortality rate. However, there are gaps between evidence-based practices and routine practices of health providers. At District of Ende, Province of Nusa Tenggara Timur adherence to the implementation of standard NCC in the aspect of postpartum procedure evaluation is only 57.14%. Planned behavioral theory approach can be utilized to predict behavior for the purpose to design intervention to improve compliance to the implementation of standard health service. Objective: To identify compliance to the implementation of standard NCC at inpatient health centers in Kupang Municipality and the best predictor for the compliance to the implementation of standard NCC. Method: The study was observational with cross sectional design and qualitative data. Samples were 32 midwives at inpatient health centers in Kupang Municipality taken using non probability sampling technique. Research instruments consisted of questionnaire, checklist and indepth interview guide. Data analysis used bivariate with Pearson Product Moment correlation, Independent t-test, One way Anova and multivariate with Path Analysis at confidence interval 95%. Result: Compliance to standard NCC at Kupang Municipality was 81%. The result of 3 way model analysis showed subjective norm (ß= 0.387) and behavioral control (ß=0.371) were significantly associated with intention. Meanwhile intention (ß=0.160) was not associated with compliance to the implementation of standard NCC. Compliance to the implementation of standard NCC was significantly associated with comprehended behavioral control(ß=0.338) after including variable of diploma 3 (ß=0.661) and 4(ß=0.496) education. Length of tenure (β=0,408), facility (β=0,567) and childbirth care training (β=0,398) were significantly associated with compliance to the implementation of standard NCC.The problems in the compliance to standard NCC were facilities irrelevant with the standard, non cooperative patients, lack of motivation of midwives, and work system that mixed inpatient for childbirth and non childbirth. Conclusion: Degree of compliance to the implementation of standard NCC at inpatient health centers in Kupang Municipality exceeded the standard intervention specified by the Ministry of Health. However, intervention was needed considering that the critical aspect of NCC implementation was relatively low. Subjective norm and comprehended behavioral control were predictor of intention for the implementation of standard NCC with compliance. Yet compliance to the implementation of standard NCC could not be predicted by intention, but by comprehended behavioral control of respondents with D3 and D4 education.
Kata Kunci : Kepatuhan,Asuhan persalinan normal,Teori perilaku terencana
