THE EFFECT OF INTERACTIVE EDUCATION WITH 3 DIMENSIONAL PUZZLE ON INJURY

PREVENTION BEHAVIOR IN SCHOOL-AGED CHILDREN

Indah Puspitasari1
Sigit Mulyono2

1.Master Program of Faculty of Nursing Universitas Indonesia, Depok 164242, Indonesia.

2. Community Nursing Department of Faculty of Nursing Universitas Indonesia, Depok 16424,
Indonesia.

E-mail: indahpuspitasari.ners@gmail.com

ABSTRACT:
Awareness of prevention of injury to school-age children is still very low, so the problem of
injury to school-age children still tends to be high. Need a method of health education in
accordance with the stage of development of school-age childrenn operational concrete. The
purpose of this study was to identify the effect of interactive education with 3-dimensional
puzzles on injury prevention behavior in school-age children. The research method used is
quantitative with a quasy experiment design and uses a pre-post group design with control
group. The sample in this study were 120 elementary school students with 60 students as the
intervention group and 60 students as the control group. The study used multistage random
sampling to determine the place and school, while to determine the research subjects using
simple random sampling. The results showed interactive education with 3-dimensional puzzle
significant to knowledge (p value = 0,000), attitude (p value = 0,000) and injury prevention
skills (p value = 0,000). The recommendation of this research is that interactive education with
3-dimensional puzzle can be used as a health education to prevent injury in school-age
children. In addition, 3-dimensional puzzle media can be used by school nurses for health
education.

Keywords: school-age children, injury prevention, 3-dimensional puzzle

INTRODUCTION
School-age children are classified in the age group at risk of injury due to their growth and
development period (1). Basic Health Research (Riskesdas) of West Java Province in 2013
recorded data on the incidence of injuries at schools in Bekasi District reaching 5.4% and
occurring in the mean age of 5-14 years. The prevalence of injuries and causes according to
their characteristics, injury due to falls in the age of 5-14 years reached 57.3%. Nationally the
most injuries occurred on the highway (42.8%), home (36.5%), agricultural area (6.9%) and
school (5.4%) with the age group 5-14 years for the incident fall injury (2).

Injuries are physical damage due to the transfer of mechanical, thermal, electrical, chemical,
radiation energy or even the sudden absence of heat and oxygen (3). Whereas, injury at school
is defined as intentional or unintentional injury that can endanger the child physically (1). Other
studies in Finland show that the school environment contributes 39% as a risk factor for injury.
Physical environmental factors also contribute to 11.6% of injuries, including doors, chairs,
windows, floors, staircases and school grounds (4). Schools and playgrounds are the locations
that most often cause falling injuries. Playing, walking, cycling, sports activities are the most
frequent causes of injury at school resulting in injuries to the hands, feet and head ( 5).

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Health education needs to be carried out by community nurses as an effort to prevent injury
to school-age children. Nursing interventions using innovation media can be done to improve
injury prevention behavior in groups of primary school age children. 3-dimensional puzzle is a
medium that can be used as a tool in improving injury prevention behavior in groups of primary
school-age children. Previous research has used puzzles as a medium to improve nutrition
knowledge in school-age children. The researcher uses 3-dimensional puzzle as a medium
that brings concrete thinking to school-age children to the material presented. The purpose of
this study was to identify the effect of education with 3-dimensional puzzles on behavior
(knowledge, attitudes and skills) in groups of children of primary school age.

METHODS
Design
This research is a type of quantitative research with a quasy experiment design and uses a
pre-post group design approach with control group. Research sites and schools were selected
using multistage random sampling, while the research subjects were selected using simple
random sampling. Karang Baru Elementary School 01-06 as the intervention group and
Simpangan 01-07 Public Elementary School as the control group.

Sample
The total number of samples from the intervention group and the control group totaled 120
children, namely 40 students for the intervention group and 40 students for the control group.

Research instrument
The instrument used in this study is a questionnaire consisting of children's demographics,
knowledge, attitudes and skills modified from previous research. The reliability test using
Cronbach alpha is 0.646.

Procedure
Interactive education with 3-dimensional puzzles is given in groups of 10 groups per school.
The study was conducted six times in three weeks with 40 minutes each meeting. Post test is
done after the intervention is completed with a two-day pause. Researchers also provided
education about the prevention of injury in the control group.

RESULTS
The results of the study showed that the age of the most respondents was 10 years and 11
years with the highest number of women (51.7%) in the intervention group and men (55%) in
the control group. Walking is the highest choice of transportation to schools, namely 43.3% in
the intervention group and 46.7% in the control group. The most common environmental
conditions found by students are crossings and there are police or security guards who help
cross.

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Table 1. Results of paired t-test of knowledge, attitudes, and skills of school-age children in
Bekasi in 2017 (n = 120)
variabel Intervention Group
Mean before SD Mean after SD Differentiate P value
mean
Knowledge 10,45 0,832 11,57 0,500 1,12 0,000
Attitude 34,70 2,982 35,80 2,767 1,1 0,009
Skills 40,60 2,764 44,12 3,474 3,52 0,000
variabel Control Group
Mean before SD Mean after SD Differentiate P value
mean
Knowledge 10,42 0,850 9,42 2,028 -1 0,001
Attitude 32,85 3,739 31,23 3,739 -1,62 0,003
Skills 40,53 3,847 39,25 3,847 -1,28 0,034

The results of the analysis showed that in the intervention group there was a significant change
in knowledge, attitudes and skills after interactive education with 3-dimensional puzzle.
However, in the control group there was a decrease in the mean of knowledge, attitude and
skills.

Table 2. Results of independent t-test t-test of knowledge, attitudes, and skills of school-age
children in Bekasi in 2017 (n = 120)
variabel Groups
Intervention Control Differentiate P value
Mean SD Mean SD mean
Knowledge 11,57 0,500 9,42 2,028 2,15 0,000
Attitude 35,80 2,767 31,23 3,739 4,57 0,000
Skills 44,12 3,474 39,25 3,847 4,87 0,000

The results of the analysis showed that there were differences in knowledge, attitudes and
skills between the intervention group and the control group after intervention.

DISCUSSION
The results showed that interactive education with 3-dimensional puzzles effectively increased
knowledge, attitudes and skills in preventing injury to school-age children. The use of 3-
dimensional puzzle as a medium of education is the right thing to increase the knowledge,
attitudes and skills of school-age children. The form of a puzzle that describes and presents
the game in real objects resembles the original object. School-age children experience phases
of children's cognitive development are still limited to real events ( 6). School-age children are
at operational concrete stages. Children experience the learning process through a real action
or event (7).

The results of the analysis found that there were significant differences in the level of
knowledge before and after interactive education with a 3-dimensional puzzle. Knowledge is
the result of observation through the senses of objects, knowledge can be formed continuously
because of new understandings that can be obtained by intervening both directly and indirectly
( 8; 9)
. Knowledge is generated from sensing that can affect someone in taking action. Receiving
information from people who have an understanding of the information needed is one way to

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foster understanding in the learning process. Cognitive ability namely knowledge can form a
strong perception of security (10).

Analysis of attitudes and skills of school-age children shows that there are differences before
and after intervention. Attitudes are strongly influenced by activities that are often done,
attached and will be repeated in the future while the skills are the final form of commitment to
conduct healthy behavior. Skills are influenced by the knowledge and attitudes of students (11).

Interactive education with 3-dimensional puzzles is one of the right media to achieve the goals
of health education in the school environment, namely increasing the knowledge of school-
age children, instilling a positive attitude towards the principles of healthy living and applying
healthy living behavior. Health education carried out through interactive education with 3-
dimensional puzzles emphasizes increasing the knowledge, attitudes and skills of school-age
children about the prevention of injuries from injury due to falls, drowning, burning, traffic
accidents and poisoning.

Education using puzzle media is proven to be more effective in increasing knowledge and can
explore an individual's ability to solve problems in students in electrocardiogram learning
compared to traditional methods (12). The use of puzzles as an educational tool makes children
enthusiastic about understanding a problem. Puzzles provide images that attract attention and
become a learning that is not boring. In fact, Puzzles generally describe real problems that
must be solved. In addition, the use of puzzles as an educational medium is an entertainment
factor in its implementation (13). Explains that 3-dimensional media is a props with a display
that can be observed from various directions, so that the appearance presented is in the form
of an imitation that represents the original object (14).

Education is one of the roles of nurses in community settings that can be done based on
population or aggregate with the aim of minimizing the inability to achieve actualization and
as an effort to improve health welfare (1; 15). 16 describe efforts to prevent accidental injury at
school as a primary, secondary and tertiary effort. Interactive education with 3-dimensional
puzzles is one of the efforts made by nurses in conducting primary prevention in the risk of
injury to school-age children. This education can be included in the role of UKS (School Health
Business) in shaping the healthy behavior of school-age children based on the
Comprehensive School Health Model (CSH) with three programs namely health education,
health services and healthy environment development. The implementation of this program
involves the support of families and school communities so that healthy behaviors are realized
(17)
.

CONCLUSION
Interactive education with 3-dimensional puzzles is one of the right media to achieve the goals
of health education in the school environment. this media is in accordance with the stage of
development of the child or operational concrete concrete. Interactive education with 3-
dimensional puzzles can be one of the choices of nursing interventions for injury prevention
health education in the School Health Unit (UKS).

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 ACKNOWLEDGEMENTS
Acknowledgments were given to Directorate of Research and Community Service (DRPM) UI
and students of SD Negeri Karang Baru and SD Negeri Simpangan in Bekasi as research
respondents.

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