THE EFFECT OF HEALTH EDUCATION ON WASHING HANDS WITH SOAP WITH

WHITEBOARD ANIMATION MEDIA ON SDN BALINGBING II STUDENTS'S KNOWLEDGE

AND ATTITUDE

Pipit Mulyasari 1), Mona Megasari 2), Sri Maryati 3)

1) Students of Nursing Education Study Program STIKes Nursing Budi Luhur Cimahi
2) Lecturer of Nursing Education Study Program STIKes Budi Luhur Cimahi
3) Lecturer of Diploma III Study Program at STIKes Budi Luhur Cimahi

Abstract

The current level of children health is not said to be good yet because there are still many health
problems, especially in school children, such as diarrhea and ARI that are closely related to
hand washing with soap. In Subang Regency in 2018 only 6.4% of elementary schools that
have carried out hand washing with soap properly. In Pagaden Barat sub-district in 2017 only
9.09% of elementary schools that had been given health education about hand washing with
soap. The research aims to know the effect of health education on washing hands with soap
with audio visual media (whiteboard animation) on the knowledge and attitude of students in
class 1-3 at SDN (Balingbing II State Elementary School) Subang Regency. The Type of this
research the Pre Experiment method by using the One Group Pre Test Post Test research
design. The way to take samples is using total sampling obtained 77. The data analysis
technique was used univariate and bivariate analysis techniques with paired t-test because the
data were normally distributed. The results showed an increase in lack of knowledge, namely 32
(41.6%), increased after being given health education to 37 (46.1%) and in the positive attitude
category, 43 (55.8%) increased after being given health education to 59 ( 76.6%). Based on the
t-test found p-value 0,000 (p <0.05), it means that there is an effect of health education on
washing hands with soap with audio visual media (whiteboard animation) on the knowledge and
attitude of class 1-3 students at SDN Balingbing II Subang Regency. The results of this
research are used as a reference for the school to continue to develop the learning media to be
more interesting. The school can also further enhance collaboration with health centers to hold
health education for students at least once a month.

Keywords: health education on washing hand with soap (CTPS), audio-visual media,
knowledge, attitude.

Preliminary

Children are the most important asset in a country that must be protected and protected by the
State, children are the next generation of the nation. The number of children in Indonesia is
around 70.49 million people or about 26.6% of the total population of Indonesia (BPS RI, 2018).
The current level of children's health is still not said to be good yet because there are still many
health problems, especially in school children.
School age is the age of a child who is gaining knowledge in the future. The number of
problems of school-age children are caused by the lack of clean and healthy living behaviors
(PHBS) in children.
PHBS is part of efforts to increase health promotion and prevention (prevention) of
disease. PHBS are grouped into 5 orders, namely PHBS in schools, PHBS in households,
PHBS in health institutions, PHBS in public places and PHBS in workplaces. From the five
orders, PHBS in schools is the initial order to form healthy resources (Rastini, 2018). The
coverage of PHBS indicators in the elementary school order is 16 indicators, including washing
hands in running water and using soap (Subang Health Office, 2018)
The government supports the hand washing program with soap and has been
regulated in the Republic of Indonesia Minister of Health Regulation No. 3 of 2014 concerning
Community-Based Total Sanitation. Based on article 4 paragraph 2 the behavior of washing
hands with soap is manifested through activities that at least consist of: a) cultivating hand
washing behavior with clean running water and soap in a sustainable manner; and b) provide
and maintain hand washing facilities with running water, soap and sewerage.
Global Handwashing Day occurs on 15 October of each year, is a global campaign
launched by the United Nations (United Nations) in collaboration with other organizations both
government and private to promote the behavior of washing hands with soap by the community
in an effort to reduce child mortality and prevention of diseases that can have an impact on
decreasing the quality of human life (Wikipedia, 2019).
Washing hands with soap (CTPS) according to WHO is able to reduce the number of
diarrhea by 45%, but the use of soap for washing hands only reaches 3% of the whole
community (Rasini and Marwati, 2018). Not only diarrhea, including other diseases that can be
prevented by washing hands with soap, namely: intestinal worms, respiratory infections, eye
infections and hepatitis (Syartiani, 2018). Washing hands with soap has also been proven to
prevent the spread of helminthiasis and can reduce cases of acute respiratory infections (ARI)
and bird flu by up to 50% (MOH RI, 2017)
Based on the 2007 Basic Health Research (Riskesdas), the behavior of Indonesian
people washing their hands is still low, and only 17% of elementary school-aged children wash
their hands with soap and clean water. Riskesdas 2013 the proportion of those aged ≥10 years
who wash their hands properly is 46.7% (Natsir, 2018).
Based on data from the Directorate General of P2P, Ministry of Health Republic of
Indonesia (2017) the number of school-age population in West Java is 5,869,361 people. The
discovery of infectious disease cases in 2015 in West Java in children aged over 5 years the
percentage of the diarrhea case is 50.44%, and the pneumonia case is 43.69% (West Java
Provincial Health Office, 2015).
Subang Regency is is one of the areas with a very high incidence of infectious
diseases. Data from the Subang District Health Office in 2018, ISPA (Acute Respiratory
Infection) is ranked first, especially in children aged 5-14 years as many as 9,564 cases
followed by diarrhea as many as 3,503 cases (BPS Subang Regency, 2018). Based on data
from the Subang District Health Office (2018), the coverage chart of the PHBS indicator (Clean
and Healthy Behavior) in Subang District is only 6.4% of the 872 elementary schools that have
carried out hand washing with soap properly (Kemendikbud, 2019). From these data it is known
that washing hands with soap is still not effectively carried out in elementary schools.
One of the districts with a high incidence of ARI and diarrhea is in the working area of
the West Pagaden Health Center. The incidence of infectious diseases, especially ARI and
diarrhea in Pagaden Barat Subang district in 2018 is still in the top 10 diseases, where the
number of ARI in children aged 5-14 years is 873 cases, followed by diarrhea as many as 595
cases (Annual Report of West Pagaden Health Center, 2018).
In addition, based on data from the West Pagaden Public Health Center in 2017 in the
West Pagaden sub-district, only 9.09% of the 22 elementary schools (SD) have been given
health education about washing hands with soap, namely SDN (Public Elementary School)
Ciungwanara and SDN Bendungan, while the others are still not. Based on the writer's
observation, at SDN Bendungan. The teacher said that he had been given hand washing
material with soap, but when he tested, 7 from 10 children apparently still did not understand
about how to washing hand properly. From the result of the observations, the writer conclude
that in the elementary schools that have been given about hand washing material, there are
also still children who do not understand, moreover the elementary schools that have not been
given about the material.
One of the elementary schools which has not been given about hand washing material
with soap is SDN Balingbing II. SDN Balingbing II is an elementary school in the area of work in
the West Pagaden Public Health Center.The preliminary survey that conducted by the
researchers found that in the last 2 months of class 1-3 attendance data at SDN Balingbing II
there were 3-4 children who did not go to school due to diarrhea, coughing colds, and
chickenpox. In addition to seeing attendance, researchers also conducted direct interviews with
Balingbing II Elementary School teachers, researchers found that there had never been a health
education about washing hands with soap in SDN Balingbing II.
The results of the observations of researchers of 8 students in washing their hands, all
of them washed their hands not according to 6 steps washing hand properly. From the 8
students, some of them used soap and some did not use soap or only used water and washed
their hands carelessly. So far no one has ever done research about hand washing at SDN
Balingbing II. Data obtained from the results of direct interviews with SDN Balingbing II teachers
for grade 1-3 students amounted to 77 people, namely: Class 1 as many as 30 people, grade 2
as many as 26 people and grade 3 as many as 21 people. Based on the preliminary study , one
of the factors that make children not wash their hands properly is a lack of knowledge and
information about how to wash hand properly.
One way to increase knowledge is through health education. Especially health
education in schools, because school children can be potential agents of change to promote
infectious disease prevention behaviors, which is washing hands with soap. The Good hygiene
of hands is a very important measure of infection control due to contact from one individual to
another. Transmission of germs, including through hand, is a common mode of transmission for
gastrointestinal and respiratory infections. Hand hygiene is very important in elementary
schools to prevent the spread of infectious diseases and it is a measure of infection control
(Chittleborough, et al, 2012)
Based on the results of previous studies by Johan, et al (2018) entitled The Effect of
Counseling Audio Visual Video Media on the Behavior of Handwashing with Soap on Class III
Students at SDN 027 Samarinda. The results of the pre-test and post-test of the experimental
group with the Wilcoxon Signed Ranks Test showed that the value of 0.001 <0.05, which means
there are significant differences, it means the behavior of students who are given audio-visual
video counseling tends to increase the behavior of washing hands with soap well compared with
groups that were not provided with audio-visual video media.
The trend of children today is that technology has been introduced, especially mobile
phones with applications that are preferred by children. One of them is YouTube application that
provides diverse and interesting audio-visual video content. Especially the animated video that
makes kids like it more because it's funny and interesting. The writer is interested in providing
health education with audio-visual video media in the form of whiteboard animation.
Nursing model theory according to Nola J Pender about Health promotion model that
combines 2 theories, namely the expectancy value theory and social cognitive theory, this
theory is consistent in seeing the importance of health promotion and disease prevention. This
is in accordance with the role of nurses according to Hidayat (2012) including as an educator
and disease prevention.
Based on the data, the writer is motivated to examine The Effect of Health Education
on Washing Hands with Soap with Audio Visual Media (Whiteboard Animation) on the
Knowledge and Attitudes of Students in Class 1-3 of SDN Balingbing II, Subang Regency.

Method

The research design used was Pre-Experiment (Pre-Experiment Design) using the One Group
Pre Test Post Test research design, ie research was conducted on the experimental group
without the comparison group (control group). In this study design using a pre-test and then
after treatment is given a measurement (post test) again to determine the effect of the treatment
given, so that the magnitude of the effects of the experiment can be known with certainty
(Notoatmodjo, 2012).
This study aims to identify the effect of health education on washing hand with soap
with audio visual media (whiteboard animation) on the knowledge and attitudes of students at
SDN Balingbing II Subang Regency.

Results

Table 4.1 Frequency distribution of students' grade 1-3 knowledge of hand washing with
soap before and after health education with audio visual media (whiteboard animation) in
SDN Balingbing II, Subang Regency
Pre Post
No Knowledge
F % F %
1 Well 15 19,5 37 46,1
2 Enough 30 39,0 30 39,0
3 Less 32 41,6 10 13,0
Total 77 100,0 77 100,0
Source: Primary Data, 2019

Table 4.2 Frequency distribution of attitudes of students in grades 1-3 towards washing
hands with soap before and after health education with audio visual media (whiteboard
animation) in SDN Balingbing II, Subang Regency
Pre Post
No Attitude
F % F %
1 Positive 43 55,8 59 76,6
2 Negative 34 44,2 18 23,4
Total 77 100.0 77 100.0
Source: Primary Data, 2019

Table 4.3 Effects of health education on washing hands with soap with audio visual
media (whiteboard animation) on the knowledge of students in grades 1-3 SDN
Balingbing II, Subang Regency
Knowledge Mean p-value
Knowledge Before
58,84
0,000
Knowledge after
70,55
Source: Primary Data, 2019

Table 4.4 Effects of health education on washing hands with soap with audio visual
media (whiteboard animation) on the attitudes of students in grades 1-3 SDN Balingbing
II, Subang district.
Attitude Mean p-value
Attitude Before 12,78
0,000
Attitude After 16,00
Source: Primary Data, 2019
Discussion

Based on table 4.1, from 77 respondents there were almost half of respondents in the
knowledge category lacking before health education which was 32 (41.6%), increasing after
being given health education to almost half of respondents in the good knowledge category that
was 37 (46.1%). The results of this observation are in line with the theory which states that
knowledge is the result of knowing, and this happens after people have sensed an object.
Sensing occurs through the five human senses, namely the sense of sight, hearing, smell, taste
and touch. Knowledge or kongnitif is a very important domain for the formation of action
(Notoatmodjo, 2012).
Based on the results of the observation in table 4.2, of the 77 respondents there were
more than half in the positive attitude category that was 43 (55.8%) increased after being given
health education to almost all respondents in the positive attitude category that is 59 (76.6%).
The results of this observation are consistent with the theory that the mechanism of action
changes occurs due to increased knowledge and positive attitudes. After assessing and
weighing the pros and cons of stimulus, someone starts trying new actions. Because attitude is
a form of evaluation or feeling reaction. A person's attitude to an object is supportive or impartial
(favorable) or a feeling of not supporting or impartial (infavorable) (Azwar, 2015).
Based on table 4.3 the results of knowledge analysis are obtained before being given
health education the average value of students is 58.84. The average value of knowledge after
being given health education is 70.55. The results of the analysis test using paired t-test
obtained a p-value of 0,000, it can be concluded that there is an effect of health education on
washing hands with soap with audio visual media (whiteboard animation) on the knowledge of
grade 1-3 students of SDN Balingbing II, Subang Regency. The post test results found that
there was an increase, this is because respondents who previously had the knowledge category
simply showed an increase in scores when the post test became good. This increase in
knowledge occurs due to additional information during health education and the character of
respondents who are quite easy to receive information. Health education has the advantage of
being able to focus on problems, so clients can solve their problems well.
Considering the role of nurses according to Hidayat (2012) including being an
educator and prevention of disease, this is in accordance with Nola J. Pender's theory of the
"Health Promotion Model" which is closely related because it combines 2 theories, namely the
expectancy value theory and social cognitive theory (social cognitive theory) that is consistent in
seeing the importance of health promotion and disease prevention.
This is in accordance with research conducted by Sasmitha (2017) entitled "Increasing
Knowledge About Handwashing Through Health Education with Audiovisual Media". The
statistical test results with the Mann-Whitney test found that there was an influence of health
education with audiovisual on knowledge about washing hands in school-age children (p <0.05).
Based on the results of this observation, this video media can be one of the effective media
used in health education, because video media is able to display things that are in accordance
with reality or also referred to as real examples from real life.
The analysis test results in table 4.4 obtained the attitude analysis results before being
given health education the average attitude value is 12.78. Attitude after being given health
education the average attitude value is 16.00. The results of the analysis test using paired t-test
obtained a p-value of 0,000, it can be concluded that there is an influence of health education
on washing hands with soap with audio visual media (whiteboard animation) on the attitudes of
students in grades 1-3 SDN Balingbing II, Subang Regency. The results of this observation are
consistent with Newcomb's statement (in Notoatmodjo, 2012), revealing that attitude is the
readiness of attitude to react to an object in certain ways if the individual is faced with a stimulus
that requires a response. According to Guy, Edgley (in Azwar, 2015) attitude is a pattern of
behavior, tendencies or anticipatory readiness, precipitations to adapt to social situations, or
simply attitude is a response to conditioned stimuli.
The purpose of health education is a change in the attitudes and behavior of
individuals, families, special groups, and the community in fostering and maintaining healthy
living behavior also plays an active role in realizing optimal health status. In general, the goal of
health education is to change the behavior of individuals / communities in the health sector
(Nursalam et al, 2010).
Seen from the Green approach in Tampubolon (2009) that with an educational
approach can change a person's attitude. This illustrates how a person's attitude will depend on
the stages of cognitive development that is available, one cognitive aspect is knowledge.
Attitudes are formed from the interactions experienced by individuals which contain
more than just contact and relationships between individuals as group members. Interaction
occurs interplay between one individual relationship with another, there is a reciprocal
relationship that also affects the behavior patterns of each individual. Interaction includes the
relationship between individuals with the physical environment and psychosocial environment
(Azwar, 2015).
 According to WHO in Notoatmodjo (2012) stated that attitude changes are basically
influenced by factors of knowledge and beliefs obtained from sensing results, one of which is
obtained through education or learning processes.
Based on the results of Sitorus's research (2014) entitled "The Effect of Health
Education on Knowledge and the Attitude of Handwashing with Soap on Elementary Students
157 Palembang City in 2014". The statistical test results of Wilcoxon test showed that there was
an influence of health education on the attitude of washing hands with soap in elementary
school students of N 157 in Palembang with significance (p = 0.001 <0.05). While the results of
research Kurniawan, et al., In 2019 about "The Effect of Health Promotion on Children's
Knowledge and Attitudes of Children About Clean and Healthy Behavior (PHBS)" obtained the
results that there is an effect of health promotion on the knowledge and attitudes of PHBS grade
IV students and V in SD Negeri 1 Petungsewu, Dau District, Malang Regency.
Providing health education about washing hands with soap increases the attitude of
the respondents to wash their hands maximally. This increase was proven statistically
significant in this observation. This is consistent with what was stated by Notoatmodjo (2012)
that attitude change is basically influenced by factors of knowledge and beliefs obtained from
sensing results, one of which is obtained through education or learning processes.

Conclusions And Suggestions

Based on the data of research results that have been conducted, the conclusions that
researchers can take include almost half of the respondents in the knowledge category lacking
before health education which is 32 (41.6%), increasing after being given health education to
almost half the respondents in the good knowledge category that is 37 (46.1%). There are more
than half of them in the positive attitude category that is 43 (55.8%) increased after being given
health education to be almost all respondents in the positive attitude category that is 59
(76.6%). There is an effect of health education on washing hands with soap with audio visual
media (whiteboard animation) on the knowledge of students in grades 1-3 SDN Balingbing II
Subang Regency with a p-value of 0,000. There is an effect of health education on washing
hands with soap with audio visual media (whiteboard animation) on the attitudes of students in
grades 1-3 SDN Balingbing II Subang Regency with a p-value of 0,000.
The suggestions that researchers can convey based on the research results obtained
include the results of this observation used as a reference for the school to continue to develop
learning media by finding more interesting learning media so that children can faster in
capturing learning. For example, using audio visual media like researchers do. it will attract
more attention of children to learn not only in the health field but also can be applied in other
fields. In addition, the school can further enhance collaboration with health authorities such as
health centers, by asking the health centers to more often hold health education to students at
least once a month.

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