Analysis Factors that Correlated with Intention of Pospartum Women Using Long

Acting Reversible Contraseptive Based on Theory of Planned Behavior

Tantya Edipeni Putri, Retnayu Pradanie, Tiyas Kusumaningrum

Faculty Of Nursing, Airlangga University

Campus C Jl.Mulyorejo Surabaya, Telp. 031-5913754, email: putritantya7@gmail.com

ABSTRACT

Introduction: The use of Long Acting Reversible Contraseptive (LARC) in postpartum

women is still low even though the government recommends as an effective method to

decrease the rate of population growth. Attitude, subjective norm, and perceived behavioral

control are background factors that shape people’s intentions in displaying behavior. This

study aimed to analyze the correlation between attitude, subjective norm, and perceived

behavioral control with postpartum women’s intentions using LARC.

Method: This study used a descriptive correlational design with cross sectional approach.

The populations were postpartum women ≤ 42 days in Puskesmas Gading and Puskesmas

Pacarkeling area. The samples were 84 people that met using a purposive sampling

technique. Data were collected with a questionnaire and analyzed using spearmen’s rho test.

Results: The result showed that attitude (p=0,000), subjective norm (p=0,000), and perceived

behavioral control (p=0,000) had significant correlation with intentions.

Conclusions: The positive attitude, good subjective norm support, and strong perceived

behavioral control give high intentions using LARC in postpartum women.

Keywords: intention, Family Planning program, LARC, postpartum

INTRODUCTION

The increasing of high population in Indonesia from one year to another year with the

percentage of population growth reaches 1.33%. The target of National Family Planning

Population in Strategic Planning of National Family Planning Population (RENSTRA

BKKBN) from 2015 to 2020, the percentage of population growth is 1.1.9 % in a year (BPS,

2016). The government has Family Planning program to keep the rate of population growth.

Government has the policy to increase the using of long-term contraceptive methods in the

National Medium Term Development Planning (RPJMN) and National Family Planning

Population in Strategic Planning of National Family Planning Population (RENSTRA

BKKBN) from 2015 to 2019. The method is more effective. In the effort to succeed in

Family Planning Program and the effort to increase the mother health, the main respondent of

Family Planning Program is unmeed need groun and postmortem mother. Family Program in

postmortem mothers is rated very important to do. Because the reversion in the postmortem

mother cannot be predicted and can happen before coming the next menstrual cycle. Even the

fertility to postmortem mother can reverse in the breastfeeding time (Kemenkes RI, 2013)

. The total of Family Planning acceptors in Indonesia are 64% from the total couple of

childbearing age (SDKI, 2017). The target user of Long Acting Reversible Contraseptive

(LARC) in Indonesia is according to RENSTRA BKKBN from 2020 to 2024 is 23.5%.

Nowadays, Indonesia has reached the target which the percentage of using LARC is 24.6%

(BKKBN, 2019). The percentage of Family Planning acceptors using LARC in postpartum

women is 28.72% from the total of acceptors 28.72% in Indonesia (SDKI, 2017) Surabaya is

the largest city in East Java with the largest popluation such as 2.8 million people in 2017.

The average of population rate growth in Surabaya from 2013 to 2017 is 0.49% every year.

The total of Family Planning acceptors to the couple of childbearing age in Surabaya City is

392,206. Tambaksari Sub-District dominates the total of Family Planning acceptors with the
percentage 11.5% from all of the Family Planning total in Surabaya City. Although, Family

Planning Acceptors in Tambaksari Surabaya are the highest, so is the birth rate in Surabaya

City such as 2,492 birth rates in a year. In 2017, the percentage of Family Planning acceptors

in Tambaksari Sub-District is 25% from the total of childbearing age couples. This

percentage is the total of LARC as 22.9 % (BPS, 2018).

The participation of postpartum women in the Family Planning Program still being

dominated by Non-Long Acting Reversible Contraceptive (Non-LARC). This condition

opens the potency of Family Planning Program to be less effective because the high failure

rate of Non-LARC with the percentage 1.8% (SDKI, 2017). The government especially

BKKBN has given understandable socialization to the communities about Family Planning. It

is not the exception to the important figure in the communities. Although, not all of the

communities do not get the socialization (SDKI, 2017) The decision in using contraception

will determine Family Program in Indonesia. The choosing method of using the contraception

must be based to many objective considerations. It is suitable with the need and believe in the

Family Planning acceptors to appear the intention, decision, and behaviour in doing Family

Program by using LARC.

The participation of postpartum women in doing Family Planning Program and

choosing contraception devices are very important. Public Health Centers in Tambaksari

have endeavoed to increase the using of LARC. Through education and counseling

postpartum Family Program Planning since the pregnancy. The atitutude can be formed

slowly from the knowledge, attitude, and action. According to Theory of Planned Behavior,

people attitude with used LARC influenced by three factors such as: attitude toward the

behavior, subjective norn, perceived behavioral control. All of those factors will appear the

intention to use LARC (Fishbein and Ajzen in (Nursalam, 2017)).

METHOD

Study Design

The design of this research is descriptive correlational uses cross sectional approach to

find out the correlation between independent variable and dependent variable. This research

is done in Tambaksari, Surabaya from March 2020 to April 2020.

Population,Samples, and Sampling

The population in this research is all of the postpartum women < 42 days in Tambaksari

Sub-Regent (Work Area of Puskesmas Gading and Puskesmas Pacarkeling) with the total 139

people. The sample of 84 respondents are based on the purposive sampling technique.

Instruments

The instrument used in this research was a questionnaire consisting of demographic

data, attitude, subjective norm, preceived behavioral control, and intention. The demographic

data questionnaire consisted of ages, education, the salary of the family, the total of children,

and the knowledge about contraceptive method. The attitude questionnaire consisted of 8

questions with three parameters, namely by the security of LARC, benefits, and the effect

using LARC. The subjective norm questionnaire cosists of 10 questions with two parameters,

namely the government, public figure, health worker, husband, and close friend. The

perceived behavioral control questionnaire consisted of 10 questions with five parameters,

namely knowledge, cost, availability of facilities, time, and reward. The intention

questionnaire of 5 questions with five parameters, namely the benefits, security,

effectiveness, comfort, and desire to have children. The instrument of attitude, subjective

norm, preceived behavioral control, and intention is modified according to (Satria, 2015).
Procedure

Researcher gets cover letter from Fakultas Keperawatan Universitas Airlangga to be

adressed to Bangkesbangpol and Linmas of Surabaya City. Researcher also gets the license to

the Dinas Kesehatan Kota Surabaya. Besides, also gets the cover letter to the Puskesmas

Gading and Puskesmas Pacarkeling. The researcher looks for the workers of Maternal and

Child Health in the Community Health Center to get the data about the candidate of

respondents and cadre contact of postpartum women. Reseacher determines total samples

based on the purposive sampling technique. Researcher coordinates with the caders to share

the questionnaires. Then, the caders explain to the candidate of respondents. It will be

participated to the research, the candidate of respondents agree and researcher contacts the

candidate of the respondents to send the informed consent and questionnaires to google form.

Respondents fill google form and the researcher ensures about the right data.

Data Analysis

The collected data is analyzed by using analysis descriptive and bivariate analysis.

Descriptive data analysis is used to find out the percentage and frequency distribution.

Bivariate analysis is used to find out the relationship among the variables. Bivariate analysis

in this research uses statistic test of spearmen rho test with α = 0.05. If the value of p < 0.05,

H1 will be accepted. If the value of p > α =0.05, H1 will be rejected.

Ethical Clearance

The procedure of this reasearch is agreed by the Komisi Etik Penelitian Kesehatan

Fakultas Keperawatan Universitas Airlangga dengan No. 1964-KEPK. The ethic aspects

which are considered to this research such as: informed consent, anonymity, and

confidentiality.
RESULTS

Table 1. Demographic Data Characteristics of Respondents in Work Area of Pusekesmas

Gading and Puskesmas Pacarkeling, Tambaksari Sub-Disctrict, Surabaya, March 2020

(n=84)

Characteristics n %

≤25 years old 32 38

From 26 to 35 years old 47 56

Wife Ages
From 36 to 45 years old 5 6

Total 84 100
Ages
≤25 years old 16 19

Husband From 26 to 35 years old 56 66,7

Ages From 36 to 45 years old 12 14,3

Total 84 100

Education Elementary School/ Islamic 3 3,6

Elementary School/ equality

Junior High School/ Islamic 2 2,4

Junior High School/ equality
Mother
Education Senior High School/ Islamic 36 42,9
Senior High School/ equality

Academy /University 43 51,2

Total 84 100

Husband Elementary School/ Islamic 2 2,4

Education Elementary School/ equality

Junior High School/ Islamic 1 1,2

Junior High School/ equality

Senior High School/ Islamic 31 36,9

Senior High School/ equality

Academy /University 50 59,5

 Characteristics n %

Total 84 100

< Rp4.200.479 22 26,2

Rp4.200.479 4 4,8
The salary of the family
>Rp4.200.479 58 69

Total 84 100

1 50 59,5

2 31 36,9

The total of children 3 2 2,4

>3 1 1,2

Total 84 100

Non-MKJP only 12 14,3

The knowledge about contraceptive MKJP only 6 7,1

method Non-MKJP and MKJP 66 78,6

Total 84 100

Based on the table 1, it is known the the respondents characteristics are based on the

most of mothers ages are from 26 to 35 years old such as: 47 respondents (56%). The most

age of husbands are from 26 to 35 years old such as: 81 respondents (96.4%) with the

marriage less than 10 years old. It can be reviewed from education side that the last education

of mothers are dominated by Academic/University with the total 45 respondents (51.2%), the

last education of husbands are dominated by Academic/University with the total 50

respondendents (59.5%). There are 58 respondents (69%) have the family income more than

IDR 4,200,479. According to the data of the total children from 50 respondents (59.5%) have

a child. It is reviewed from the knowledge of contraseption method that respondents know

from non long term conseptive method and long term conseptive method with the total 66

respondents (78.6%). Most of the respondents do not use contraception method with the total
63 respondents (75%). The most information source about the respondents of Family

Planning comes from the nearest people (family, neighborhood, parents, and husband) with

the total 33 respondents.

Table 2. Distribution of Respondents Based on Variable in Work Area of Pusekesmas Gading

and Puskesmas Pacarkeling, Tambaksari Sub-Disctrict, Surabaya, March 2020 (n=84)

Variabel Kategori n %

Positive 62 73,8

Attitudes Negative 22 26,2

Total 84 100

Very Good 20 23,8

Good 45 53,6

Subjective Norm Enough 16 19

Less 3 3,6

Total 84 100

Very Stong 23 27,4

Stong 40 47,6

Attitude Control Perception Enough 16 19

Weak 5 6

Total 84 100

Very High 39 46,4

High 38 45,2

Intention Medium 3 3,6

Low 4 4,8

Total 84 100
 Table 2 shows that the most of postpartum women have positive attitude are 62

respondents (73.8%), have good support of subjectie norm with the total 45 respondents

(53.6%), have strong perceived behavioral control with the total 40 respondents (47.6%), and

there are 39 respondents (46.4%) have high intention in using LARC.

Table 3. Cross tabulation of the correlation between attitude and intention using LARC

Intention Total

Attitudes Low Medium High Very High

n % n % n % n % n %

Negative 3 3,6 3 3,6 12 14, 4 4,8 22 26,2

3
Positive 1 1,2 0 0 26 31 35 41,7 62 73,8
Total 4 4,8 3 3,6 38 44, 39 46,5 84 100
3

Spearmen Statistic Test of Rho Test p= 0,000 r= 0,604

According to table 3, it is known that there are 62 respondents (73.8%) from the total

84 respondents who have positive attitudes in the intention to use LARC. The analysis result

of Spearmen Rank Test Correlation statistic shows that there are many strong significant and

related to the attitude and similar to use the intention with using LARC (p= 0.000) and

(r=0.604).

Tabel 4. Cross tabulation the correlation between subjective norm and intention using LARC

Intention
Total
Subjective Norm Low Medium High Very High

n % n % n % n % n %

Low 1 1, 1 1, 1 1,2 0 0 3 3,6

 2 2
Medium 2 2, 0 0 11 13, 3 3,6 16 19
4 1
Good 1 1, 2 2, 25 29, 17 20,2 45 53,6
2 4 8
Very Good 0 0 0 0 1 1,2 19 22,6 20 23,8
Total 4 4, 3 3, 38 45, 39 46,4 84 100
8 6 2

Statistic Test of Spearmen Rho Test p= 0.000 r= 0.610

According to the table 4, it is known that 25 respondents (29.8%) from 84 respondents

have the support from good subjective norm with the intention of using LARC. The result of

statistic test of Spearmen Rank Test Correlation shows that there are many strong significant

and similar to the subjective norm to the intention in using LARC (p=0.000) and (r=0.610).

Tabel 5. Cross tabulation the correlation between perceived behavioral control and intention

using LARC

Intention

Persepsi kontrol Sangat Total

Rendah Cukup Tinggi
perilaku tinggi

n % n % n % n % n %

Kecil 2 2,4 2 2,4 0 0 1 1,2 5 6

Sedang 1 1,2 0 0 12 14,3 3 3,6 16 19
Besar 0 0 0 0 25 29,8 15 17,9 40 47,6
Sangat Besar 1 1,2 1 1,2 1 1,2 20 23,8 23 27,4
Total 4 4,8 3 3,6 38 45,2 39 46,4 84 100

Uji Statistik Spearmen Rho Test p= 0,000 r= 0,628

 Based on table 5, there are many 25 respondents (29.8%) from 84 respondets have high

intention and strong perceived behavioral control to use LARC. The result of statistic test of

Spearmen Rank Test Correlation shows that there are many strong significant and similar to

the preceived behavioral control to the intention in using LARC (p= 0,000) and (r= 0,628).

DISCUSSION

The Correlation between Attitude and Intention of Postpartum Women using LARC

Attitude has strong significant relationship and similar to the intention of postpartum

mother in using long term contraceptive method. The majority of respondents have positive

attitude to high intention in using Long-Term Contraceptive Method. The result analysis

states that many respondents who have positive attitude do not always appear high intention.

It happens in the vice versa, respondents with negative attitude does not always appear low

intention to the using of long-term contraceptive method. This research is according to

(Lestari, 2018) that there are many relationship with the intention to use contraception

postmortem. This research proves that the respondents who have negative attitude do not

always appear low intention in using postpartum contraceptive. Other research from (Huda,

Widagdo, & Widjanarko, 2016) that there are many signifact relations between attitude and

behaviour of using contraceptive device. This research is done to 37 respondents and the

result of postitive effect will appear the significance between attitude support to use

contraceptive device. (Joeliatin, 2016) that there are many significant direct relationships

between attitude and the intention of women of childbearing age to become the participants

of long term conseptive method. Beside that, according to (Anggraeni, 2015) that women on

the childbearing age with positive attitude have the chance 3 times higher to become the

participants of long tern conseptive method than woman of childbearing have negative
attitude. Other research from (Nasrulloh, 2015) that there are many relationship between

attitude and participation of couole of chealbearing age in doing Family Planning program.

Attitude is the important basic in the availability of participating Family Planning program.

The positive atitude of respondents with high intention happens from 26 to 35 years

olf, the last education dominates to Academy/University. More of them have salary more

than 4 million rupiah, and most of them have a child. Most of them have the knowledge about

non long term conseptive method and long term conseptive method. Most of them get the

informations from the nearest perople (family, neighborhood, parents, and husband).

According to result analysis in the questions of attitude questioner, on the question nomor 1

can be seen that respondents trust with using long term conseptive method. They can prevent

the pregnancy effectively and safely. Although, repondents with negative attitude but have

high intensity in using long term conseptive method is influenced by the prerspective of the

respondents to the long term conseptive method. Because of the afraid feeling, it willl

influence sexual function. Although, respondents have understood about the benefits of long

term conseptive method is more effective to prevent the pregnancy than non long term

conceptive method. Most of the respondents do not want to use long term conseptive method

because they will assume to cause infertility.

According to the result, researcher gets opinion that health workers should be able to

encourage the Postpartum Family Planning Program (P4K) since 2007. It is important to do

because there are many respondents get the informations about the contraceptive method

from the nearest people (family, neighbourhood, parents, and husband). This condition shows

that the role of health workers in giving the related education about the contraseptive method

especially long term conseptive method is less. Besides encouraging of Postpartum Family

Planning Program (P4K), it can be expected that health workers also provide the education to

press the using of long term conseptive method does not disturb sexual function and long
term conseptive method except the sterilization doe not influence the infertility. The

increasing of awareness about the importance in doing long term conseptive program to the

postmortem needs doing. Because it remembers the return of women fertility approximatey

45 days afterbirth as the effort to increase the degree of mothers and children.

The Correlation between Subjective Norm and Intention of Postpartum Women using

LARC

Subjective norm has strong significant relation and similar to the intention of

postmortem mothers uses long term contraceptive method. Most respondents of postmortem

mothers get good subjective form and have high intention by using long term contraceptive

method. More better support from good subjective form and have high intention uses long

term contraceptive method. It is also gotten high intention. This research is similar to the

research from (Joeliatin, 2016) said that there are indirect relationship and the significance

between subjective norm and the intention of women of childbearing age (WUS) to become

the participants of long term conceptive method through the attitude. It means that more

better subjective norm, women of childbearing age attitude becomes subjective norm. Thus,

women of childbearing age attitute becomes positive. Thus, women of childbearing age

attitude is more prosititve that can be strong intention to the women of childbearing age to be

parcipants of long term conceptive method. According to (Lestari, 2018) that subjective norm

has signicant relationship between subjective norm to the intention of using contraseptive

device. The other research from (Putri, 2018) that subjective norm has the strongest effect in

generating the intention to particpate in Family Planning program. In this research, the

support from the couple can give influence to the awareness in participating Family Program.

It is the awareness of the role of health workers in suggesting the couple of childbearing age

to join in the Family Planning Program.

 The influence of the highest subjective norm is gotten from the respondents to the

health workers. This fact is proven to the most of respondents agree in the questioner item of

subjective norm number 3 such as there are many suggestions from health workers in using

long term conseptive method. It is similar to (Ruwayda, 2014) that there are significant

relationship netween the role of health workers with using contraseptive devices in the

postmortem. The suggestion from health worker is rated to connect the attitude of using

contrasptive device. It is according to the researcch from Huda et al. (2016) that there are

many signifact relationship between the role of health workers with the action of using

contraceptive method. The other research from Setiasih et al. (2016) that there are many

support relationship between the Health Worker Service of Family Planning with the

choosing of non hormonal long time contraceptive method.

The suggestion from husband in this research also determine the respondents subjective

norm to the health worker. It is proven that most of the respondents answer agree in the items

of quesionnaire question about subjective norm number 4 to the support from husband in

using long term conseptive method. According to that there are many significants relationship

between the support from huusband and the action of using contraseptive device to the wife.

The research from Susanto (2015) that the support from husband also havs the relationship in

making decision to use contraceptive devices. The support from husband can use long term

conceptive method is very important because without supporting from the husband, the

comfortable feeling does not get in using. It is proven to the research from (Mahmudah &

Fitri Indarwati, 2016)said that there are many relationship between husband and the choosing

of LARC.

According to the analysis result, the lowest indicator is on the subjective norm variable

from the public figure. It is showed by the most of respondents answer disagree in the item of

questionnaire question on the number 2 to the suggestion from public figure to use ling tern
conseptive methode. According to this research, researcher has the opnion that it is important

to health workers for provide the information and education about long term conseptive

method with the participation of the public figure. Beside that, it is important to extend the

education target in determining the intention. Thus, husband also provides the information

and full education from the health worker about the importance of using the LARC to the

postpartum women.

The Correlation between Preceived Behavioral Control and Intention of Postpartum

Women using LARC

Perception for Control Action has signifact relationship and similar to the intention of

postmortem mothers use log term conceptive method. The high perception for action control,

thus the result of the intention is high. The previous reseach is supported by (Joeliatin, 2016)

that there are many indirect relationships and significances between control action and the

participation from women of childbearing age in the intention of long term conceptive

method. It means that high perception in control action from women of childbearing age in

long term conceptive method. The research of (Lestari, 2018) said that there are many

perception for control actions and the intention of using contraceptive method.

Respondents have high intention to use long term conceptive method because they have

many knowledges about long term conceptive method such as benefit, the using effect, and

know the using. It is proven to the most of respondents answer agree in the item of perception

for control action perception in the number 1. It is according to the research of (Ruwayda,

2014) that many respondents have good knowledge will be the acceptors of postpartum

Family Planning . The knowledge is one of the factor influences to the action control

perception to the person.it is according to the research of (Nasrulloh, 2015) that there is the

relationship between knowledge and the participation from the couple of childbearing age in
doing Family Planning. It is reviewed from the knowledge, the research from (Megawati,

Febi, & Adisty, 2015). This research is gotten the data that the using of contraceptive method

is dominated by the respondents with good knowledge.

The supporting facilities also determine the respondents of action control perception. It

is proven that more respondents answer agree to the questionnaire question about action

control perrception nomber 3 such as the facilities to probe in using long term contraceptive

method. It is similar to the research from (Putri, 2018) that easy access reachers the

supporting afacilities in the implementation of Family Planning Program. It becomes the

important thing in participating of Family Program. According to the research of (Bailey,

2014), describes that there are many variations in the participation of couple on the

childbearing age in the Family Planning program. The affordability and information exposure

will support Family Program about the participation from the couple of childbearin age in the

Family Planning Program. The availability of the facilities also becomes determining factor

according to (Setiasih et al., 2016) said that the service of availailabity such as infrasucture,

distance, and advice influence the interest in women of childbearing age in using Non

Hormonal long term conceptive program. It is similar to the research of (Haloho & Tety,

2011) that there is significant relationship between the completeness of the infrastructure to

choose Innauterine Device contraception.

The cost factor is one of the factor to make person intention. This fact is proven with

the most respondents answer agree in the question number 2 of action control perception

questionnaire about the cheaperst cost. It will make the respondents to use long term

conceptive method. This research is similar to the research of (Septalia & Puspitasari,

2016)about the cost of fixing the contraceptive device with the using. The percentage of the

non long term conceptive method with cheap price is higher than long term conceptive

method. Because non leng conceptive method is cheap. It shows that the community
intentions use something with cheap price higher than the desire uses thing with expensive

price.

According to the analysis data, the lowest indicator is on the variable of action control

perception in the parameters of gift/reward. It can be showed from the most of the

respondents anwers disagree to the items of questionnaire quesion of the action control

number 5 about the reward atu gift to motivate the using of long term conseptive method.

According to this research, researches gets opinion that health workers can provide the

information and high education to reach all of the communities to increase the knowledge of

the community. Beside that, it can be expected that the government provides health facilities

in may regions especially far away from the health facilities. The government also expected

to give the subsidy about the contraceptive especially long term contraceptive method. In

order to all of the communities can reach that method from the cost.

CONCLUSION

The positive attitude to postpartum mother generates high intention in using Long-Term

Contraceptive Method. However, negatif attitude does not always appear the low intention.

More support from subjective form of postpartum mothers generates high intention in using

Long-Term Contraceptive Method, supports from health workers and husband are the support

to get high effect to postpartum mother. More good perception in controlling the attitude

(knowledge, the availability of facility, and high cost) of postpartum women generates high

intention in using LARC.

ACKNOWLEDGMENT
 We want to say thank you for the respondents and all of the participants who help in the

implementation of this research.

CONFLICT OF INTEREST

The Authors declares that there is no conflict of interest.

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