TERM PAPERTHE DIFFERENCES BETWEEN VIDEO TOOLS AND CARTOON FLIPCHART FOR HEALTH EDUCATION TOWARDS KNOWLEDGE AND ATTITUDE ABOUT HAND WASHING WITH SOAP OF SCHOOL-AGED CHILDREN

In partial fulfillment of the requirement of the course:

NURSING THEORY Submitted by:

APOLONIA ANTONILDA INAARELLANO UNIVERSITY

GRADUATE SCHOOL OF NURSINGMay 19, 2014Introduction

Since the majority of the nations children are enrolled in elementary school, school-based health promotion programs can be implemented to increase the health-promoting behaviors among children before certain behavior patterns solidify. Schools should be health-enhancing environment that build resilience and assist children to develop healthy behaviors, such as hand hygiene. Health promotion programs attempt to induce changes in health-related behavior to prevent diseases. Health promotion behavior is acquired more readily in childhood, when routine and habits are being formed. Habits or a behavior developed in childhood is more likely to persist as an integral part of ones lifestyle than changes made in health behaviors later in adult years. Development of healthy behaviors in children is critical to increasing the prevalence of healthy lifestyles in the total population (Pender, Murdaugh and Parsons, 2006). Health education is any combination of learning experiences designed to help individuals and communities improve their health, by increasing their knowledge or influencing their attitudes (WHO, 2014).One of health promotion is hand hygiene. Hand hygiene is the primary measure to reduce infections (WHO,2009). Hand washing with soap is one way to keep the body healthy because this action scientifically proven can prevent infectious diseases, such as diarrhea and upper respiratory tract infection and avian influenza (Indonesia Department of Health, 2010). Medical evidence suggests that the hands are the main transmitters of diarrhea and respiratory infections. As such, they constitute disease vectors carrying respiratory microorganisms and fecal material into the domestic environment of the susceptible child.8 Health experts recommend hand washing with soap as a critical action in protecting public health because it is a mainstay in infection control. Yet, rates of hand washing with soap at critical times remain low throughout the world, even when both soap and water are available.

Hand washing with soap is among the most effective and inexpensive ways to prevent diarrheal diseases and pneumonia, which together are responsible for the majority of child deaths. Yet, despite its lifesaving potential, hand washing with soap is seldom practiced. Around the world, the observed rates of hand washing with soap at critical moments range from zero percent to 34 percent. Although people wash their hands with water, very few wash their hands with soap at critical moments. Washing hands with soap after using the toilet and before handling food can reduce rates of diarrheal disease, includingsome of its more severe manifestations, such as cholera and dysentery, by 48-59 per centand rates of respiratory infection by about one-quarter. Washing hands with water alone is significantly less effective than washing hands with soap in terms of removing germs. (UNICEF, 2008).

According to UNICEF, 600.000 children dying in each year and over 1.7 billion cases because of diarrhea diseases and also associated with a higher risk of stunting (low weight for age and developmental delay) and take a huge toll on society. However, one of the simplest and most inexpensive barriers to infection is hand washing with soap. Health promotion about hand washing with soap is needed to solve this problem.

In order to give health education about hand washing with soap, needed media visual or audio-visual to support that activity. The reason why video (audio-visual media) and cartoon flipchart (visual media) used as media in health promotion about hand washing with soap because as visuals are used effectively to strengthen communication, visuals help people remember what they see and help memory, for a majority of people it is easier to remember pictures than to remember just words.

Based on WHO, to facilitate the process of starting the project and its following implementation activities. it is very important to ensure that training sessions are accompanied and supported by educational material such as a guideline summary, leaflets, brochures, information sheets and flipcharts (WHO, 2009). The WHO Implementation toolkit includes an extensive range of tools for education, including a slide presentation, a brochure summarizing why, when, and how to perform hand hygiene, a leaflet containing the core recommendations of the guidelines, a practical pocket leaflet and a training film (WHO, 2009).

In general, media for health promotion can be categorized into four different types, they are audio-visual broadcast media such as television, radio; audio-visual non-broadcast media such as video, CD, DVD, self-help packages; print media such as newspaper, magazine, leaflets, flipchart, mail shots, billboards; digital media such as internet, mobile phones (Dixey, 2013). Health learning materials are those teaching aids that give information and instruction about health specifically directed to a clearly defined group or audience. Flip charts are useful to present several steps or aspects that are relevant to a central topic, such as health education about hand washing with soap.

Audio-visual materials combine both seeing and listening, as the name implies. These materials include TV, films or videos which provide a wide range of interest and can convey messages with high motivational appeal. They are good when they are accompanied with interactive methods. Audio-visual health learning materials can arouse interest if they are of high quality and provide a clear mental picture of the message. They may also speed up and enhance understanding or stimulate active thinking and learning and help develop memory.

Based on the previous research by Elfian Zulkarnain, Leersia Yusi, Nikmatul Farida in 2009 about effectiveness difference between speech method with flipchart and video compact disc in increasing pregnant mothers knowledge and attitude toward early breastfeeding initiation. The result from this research is there is significant difference using video and flipchart in increasing knowledge and attitude of pregnant mothers

The researcher believes that through this study, the aforementioned concerns in nursing care can possibly be addressed. The result of this study will guide the researcher in giving the best way of health education for children. Further, it may improve the knowledge and attitude of school-aged children in hand washing with soap, increase awareness of children in hand washing and prevent infectious diseases.

This study will utilize the theory of Nola J. Pender about health promotion behavior. A health promoting behavior is an end point or action outcome that is directed toward attaining positive health outcomes such as optimal well-being, personal fulfillment and productive living and the theory from Dorothea Orem about self care deficit (Alligood and Tomey, 2010). With heath education can increase awareness and ability in self care to prevent illness.

Background of Study

One of the factors that influence the health of society is behavioral factor. With doing healthy behavior can reduce morbidity rate. One of behavior factors is hand washing. In Indonesia, the number of people that doing hand washing rightly in 2013 is 47%, it is higher than in 2007 is 23,2%. In East Nusa Tenggara in 2013 the number of people doing hand washing rightly is 38,1% (Riskesdas, 2013). Hand washing with soap alone averts 0.5-1.4 million death per year, yet hand washing levels seems to be low among school-aged children (Peltzer & Pengpid, 2014).Hand washing rightly is hand washing with soap before prepare foods, when their hand is dirty (e.g. hold money, pets or farming), after bowel movement, after using pesticide/insecticide and before breastfeeding. Hand washing with soap is the activity of cleaning the palms and fingers to clean and kill germs that cause disease (Health Promotion,2011).

According to Indonesia Health Profile 2011, diarrhea is an endemic disease in Indonesia. Diarrhea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual. Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-water or from person to a person as a result of poor hygiene (WHO,2013). Interventions to prevent diarrhea, including safe drinking-water, use of improved sanitation and hand washing with soap can reduce disease risk. In Basic Health Research 2013, the incidence and prevalence diarrhea in Indonesia is 4,3% and 10.9%.

Based on Ngada Regency Health Profile 2009, the scope of health service for preschool-aged, school-aged and teenagers is 76,42% whereas the target is 90%. The scope of health service in elementary school in 2009 is 64,07% whereas the target is 100%. In 2009, diarrhea is included in ten diseases in Ngada Regency. The number of patient with diagnose diarrhea as many as 2.488 cases. In 2009 the morbidity of diarrhea is 18 per 1000 people and in 2008 the morbidity of diarrhea is 19,4 per 1000 people. Compared to 2008, the number of diarrhea in 2009 is decrease. Diarrhea becomes outbreak usually in area where the risk-factor control is still low. A significant proportion of diarrhea disease can be prevented through safe drinking-water and adequate sanitation and hygiene. These findings have encouraged and behooved the researcher to conduct an experimental study on differences between video tools and cartoon flipchart for health education towards knowledge and attitude about hand washing with soap of school-aged children In Lebijaga Elementary School, Ngada Regency, East Nusa Tenggara, Indonesia. It is hope that the result on the study will help gain the upper hand in prevent illness.

Theoretical FrameworkThis study will utilize the theory of Jean Piaget about cognitive development. Jean Piaget explored how intelligence and cognitive functioning develop in children. He believed that human intelligence progresses through a series of stages based on age, with the child at each successive stage demonstrating a higher level of functioning than at previous stages. The four stages, include: sensorimotor (birth to 2 years); preoperational (2 to 6 years); concrete operations (6 to 12 years), in this stage the child begins to apply logic to thinking, understand spatiality and able to apply rules; and formal operations (12 to 15 years and beyond). The nurse may better understand what the child means if the nurse is aware of his or her level of cognitive development. Also, teaching for children is often structured with their cognitive development in mind (Videbeck, 2011).

This study will also utilize the theory of Nola J. Pender about health promotion behavior. A health promoting behavior is an end point or action outcome that is directed toward attaining positive health outcomes such as optimal well-being, personal fulfillment and productive living (Alligood and Tomey, 2010).

The study is anchored on Orems Theory of Self Care and Self Care Deficit Theory of Nursing. According to Orem, self care is the performance of practice of activities that individuals initiate and perform on their own behalf to maintain life, health, and well-being. When self care is effectively performed, it helps to maintain structural integrity and human functioning, and it contributes to human development (Tommey, 2008).

The researcher will combine the theories above. Knowing the cognitive development of child is important for researcher to select the material in health education and use the simple word in share information, so that the children will easy to understand. Orem said that nursing has a special concern for mans needs on such factors as self care action and the provision and management of it is on a continuous basis in order to sustain life and health, recover from disease on injury and cope with their respective effects. When self care is not maintained, illness, disease or death will occur. Nurses sometimes manage and maintain required self care continually for persons who are totally incapacitated. In other instances, nurses help persons to maintain required self care by performing some but not all activities, by supervising others who assist patients and by instructing and guiding individuals as they gradually move towards self care.

Thus, the goal of Penders theory is about preventing illness, persons can modify cognitions, affect, and the interpersonal and physical environments to create incentives for health actions while the goal of Orems theory is helping the client perform self care and the goal of Piagets theory is knowing cognitive developmental of children based on the age. For the reason, modify these theories can increase awareness of school-aged children because after they get information about hand washing with soap, school aged children decide to do hand washing with soap, Orem is said to be moving towards self care because it is performing actions which would prevent illness of children.