"Factors Affecting Adolescents Health Care Services"

Written by :
GROUP 2

1. Ainun Salsa Bella P17120018041

2. Aulia Nurul Annisa P17120018045
3. Euis Siti Saadah P17120018051
4. Firda Lailati P17120018052
5. Khairunnisa Asshofat P17120018058
6. Luthfiana Fadhlika P17120018059
7. Rizka Julianti Sabilla P17120018069
8. Rosa Afriza P17120018070
9. Salsabila `Aulal Azmi P17120018072
10.Sinta Samhana P17120018076

HEALTH POLYTECHNIC OF HEALTH MINISTRY JAKARTA I

DIPLOMA NURSING PROGRAM
ACADEMIC YEAR 2018/2019
 Factors Affecting Adolescents Health Care Services

Health Polytechnic of Health Ministry Jakarta 1, South Jakarta 12430

Aulia Nurul Annisa, et al.
*E-mail : keperawatan1be@gmail.com

ABSTRACT
Adolescence is a period of transition between childhood and adulthood, where growth
occurs, secondary sex characteristics arise, fertility is achieved and psychological and
cognitive changes occur (Widyastuti, et al., 2009: h.11). Adolescents Care Health
Services (ACHS) is a Health Service for Adolescents who accesses all adolescents,
and can be accepted in accordance with comprehensive, effective and efficient.
Sampling data is taken purposively, namely a method of selecting sample members by
visiting respondents who are sampled and then getting other sample information from
samples that have been visited to identify factors related to the use of ACHS in Depok
SMAN 10. Respondents who used high ACHS were 11th grade at 53.70% (29
people), sexes that mostly used ACHS were women at 53.85% and respondents'
knowledge about ACHS utilization was 53.26% (49 people). Chi square test results
obtained p value = 0.144 (> 0.05) for class variables, gender p value = 0.66 (> 0.05)
and knowledge p = 0.996 (> 0.05). Based on the objectives, methods, results of the
analysis that have been carried out, as well as the discussion, the conclusion can be
drawn that the majority of the female (60.9%) respondents have been exposed to
information (87.3%), but the availability of information facilities is still lacking
(71.8%) the dominant one related to ACHS utilization was information exposure (p-
value = 0.010), peer social support (p-value = 0.010), and health worker social
support (p-value = 0.013).

INTRODUCTION character from childhood to adulthood.

Adolescence is a period of growth and
development that occurs dynamically and
rapidly both physically, psychologically,
intellectually, socially, sexual behavior
that is associated with the onset of puberty
(Marcell, et. Al., 2011). This characteristic
of rapid growth and development causes
adolescents to have a great curiosity, love
adventure and challenges and tend to dare
to take risks without careful consideration
(Soetjiningsih, 2004). Physical
development is marked by the maturation
of reproductive organs. Sexual maturity
that is too fast or slow can also affect
psychological development. Adolescent
psychological development is a change in
The 2013 Basic Health Research (BHR)
data showed that the prevalence of marital
age that occurred at less than 15 years was
2.6% and the age of 15 to 19 years was
23.9%. The National Family Planning
Health Agency (NFPHA) in 2013 stated
that 4.38% of adolescents aged 10 to 14
years had carried out free sex activities,
while adolescents aged 14 to 19 years were
41.8%. Abortion events increased, from 86
cases in 2011 to 121 cases in 2012. The
case resulted in eight deaths. Cases of
adolescent delinquency also occur more
and more, the influence of globalization
has the effect of criminal acts such as theft,
drugs, and brawls. Data from the 2009

2
ACHS program report in Tanah Laut
District showed that out of 1055
teenagers, adolescents who used ACHS
services were only 124 (11.75%). ACHS
in Kendal District since September 2010
adolescent visits based on data in Patebon
01 Public health service as many as 44
adolescents, teenage service coverage is
still 20%, so it is still far from the
government's target to reach 80%. The
results of interviews with high school
students, they said did not know about
ACHS because they had never been
socialized and had not received
counseling.
Based on the background above, the
research problem can be formulated as
follows "What are the Factors Associated
with the Utilization of Health Care for
Adolescents in DEPOK SMAN 10".
1. General Purpose
The general purpose is to identify factors
that are related to the utilization of health
care services for adolescents in Depok
SMAN 10.
2. Specific Purpose
The specific purpose in this study is to
identify the utilization of health care
services for adolescents in Depok SMAN
10 as described below:
a. To identify the relationship of
Predisposing Factors:
Characteristics of Respondents
(Gender) and respondents'
knowledge about the utilization of
caring health services for
adolescents in Depok SMAN 10.
b. To identify the relationship of
Enabling Factors (exposure to
information and availability of
information facilities) to the
utilization of caring health services
for adolescents in Depok SMAN
10.
c. To identify the relationship
between Strengthening Factors
(peer support, teacher support and
support from health workers) with
the utilization of health care
services for adolescents in Depok
SMAN 10.
METHOD
The analytic descriptive research design
uses the cross sectional method with the
aim of obtaining a clear picture of
"Analysis of Factors Associated with the
Use of Adolescents Care Health Services
(ACHS) in Depok SMAN 10". This
research was conducted with respondents
of students in Depok SMAN 10 On May
2015.Beginning with the preparation of
proposals, data collection then continued
with processing results and writing
research reports.
Sampling data is taken Purposively, which
is a method of selecting sample members
by going to the sample respondents and
then getting other sample information from
the samples that have been visited.
Samples obtained from respondents
according to the size of the sample desired.
In this study consists of two independent
variables (free) and dependent variable
(bound). Independent variable is a variable
whose value determines other variables.
While the dependent variable is the
Utilization of Adolescents Care Health
Services (ACHS). Based on the results of
the preliminary study the number of
students in Depok SMAN 10 amounted to
234 students. While the sample will take as
many as 70 students.
3
RESULTS
Table 5.1
Relationship of Predisposing Factors: Characteristics of respondents
(class, gender, age) and respondents' knowledge with utilization of adolescent
caring health services (ACHS)

Test results Chi Square

Utilization of ACHS (Kai Squared)

No Variabel P OR
High Low Total
Value (95% CI)
n % N % N %
Class
a. 10 21 39,6 32 60,38 53 100 0,144 1,768
1 b. 11 29 2 25 46,30 54 100 0,820 – 3,808
53,7
0
Gender:
a. Female 35 53,8 30 46,15 65 100 0,66 0,476
2 b. Male 15 5 27 64,29 42 100 0,214 – 1.057
35,7
1
Knowledge
a. High 43 46,7 49 53,26 92 100 0,996 1,003
3 b. Low 7 4 8 53,33 15 100 0,336 – 2,995
46,6
7

In the table above shows that respondents
who use high ACHS are class 11
amounting to 53.70% (29 people), sexes
that mostly use ACHS are women at
53.85% and respondent knowledge about
ACHS utilization is 53.26% (49 people)
Chi square test results obtained p value =
0.144 (> 0.05) for class variables, gender p
value = 0.66 (> 0.05) and knowledge p =
0.996 (> 0.05), it can be concluded that the
factor predisposition, namely class, gender
and knowledge has nothing to do with
ACHS utilization in Depok SMAN 10.

Table 5.2
Relationship of Enabling Factors: Exposure of Information and Availability of
Information Facilities By Utilizing ACHS

Test results Chi Square

Utilization of ACHS (Kai Squared)

4
 No Variabel P OR
High Low Total
Value (95% CI)
n % N % n %
Information
Exposure
1
a.Well 41 44,09 52 55,91 93 100 0,158 0,438
b. Less 9 64,29 5 35,71 14 100 0,136 – 1,408
Availability of
Information
2 Facilities
a. Wel 19 63,33 11 36,67 30 100 0,032 2,563
b. Less 31 40,26 46 59,74 77 100 1,073 – 6,125

The table above shows that respondents
who have information exposure with less
ACHS utilization is equal to 64.29% and
the availability of good information
facilities with ACHS utilization in Depok
SMAN 10 is 63.33%. The results of Chi
square test for the exposure of information
obtained a value of p = 0.158 (> 0.05), it
can be concluded that there is no
relationship with the utilization of ACHS
(Adolescents Care Health Services) in
Depok SMAN 10 and the results of Chi
square test analysis of the availability of
information facilities obtained the value of
p = 0.032 (> 0.05), it can be concluded that
there is a relationship between the
availability of information facilities and
the utilization of ACHS in Depok SMAN
10 and the OR value of 2.563 means that
students who have information facilities
utilize PK63 as much as 2.563 times
compared to female students who have
availability of information facilities.

Table 5.3
Relationship between Strengthening Factors (peer support, teacher support, and
support from health workers) with the use of ACHS

Test results Chi Square

Utilization of ACHS
(Kai Squared)
P OR
High Low Total
No Variabel Value (95% CI)
N % N % n %
1 Social Support
a.Teacher
- Support
- Not support 34 56,67 26 43,33 60 100 0,020 2,534
16 34,04 31 65,96 47 100 1,129 – 5,585
b. Health
Workers
- Support
- Not support 37 56,92 28 43,08 65 100 0,009 2,948
13 30,95 29 69,05 42 100 1,301 – 6,679
c.Peers
- Support
- Not support
43 55,13 35 44,87 78 100 0,004 3,861

5
 7 24,14 22
Respondents (students) who have social
support for school teachers support with
high ACHS utilization of 56.67% (34
students), social support for health workers
supports with high ACHS utilization of
56.92% (37 students), having peer social
support with high ACHS utilization of
55.13% (43 students). Chi square test
results of school teacher social support
related to ACHS utilization obtained a
value of p = 0.020 (<0.05), it can be
concluded that there is a relationship
between the social support of school
teachers and the use of ACHS in Depok
SMAN 10 and the results of the analysis
obtained an OR value of 2.534 it means
that students who have social support from
low school teachers use ACHS as much as
2.563 times compared to students. Chi
square test results obtained p value = 0.009
(<0.05), it can be concluded that there is a
DISCUSSION
A. Concept of Adolescents
Adolescents are a transition period
between childhood and adulthood, where
growth spurts occur, secondary sex traits
arise, achievement of fertility and
psychological and cognitive changes occur
(Widyastuti, et al., 2009: h.11). Stages of
Adolescents According to Yusuf (2003)
adolescence can be divided into: Pre-
adolescence 11 to 12 years, early
adolescence 13 to 15 years, late
adolescence 16 to 18 years, and early
adulthood 18 to 25. Adolescent
development is differentiated into sexual,
psychological, and social development.
75,86 29 100 1,478 – 10,089
relationship between social support of
health workers with ACHS utilization in
Depok SMAN 10 and the results of the
analysis obtained an OR value of 2.948,
meaning that students who have social
support Health workers use ACHS as
much as 2,948 times compared to students
who have high health support staff. Chi
square test results obtained a value of p =
0.004 (<0.05), it can be concluded that
there is a relationship of peer social
support with the use of ACHS in Depok
SMAN 10 and the results of the analysis
obtained an OR value of 3.861, meaning
students who have support low social peer
group, at risk of not utilizing ACHS as
much as 3,861 times. So, reinforcing
factors such as social support from school
teachers, social support from health
workers and peer social support are related
to the use of ACHS in Depok SMAN 10.
B. Concept of adolescent Care Health
Services (ACHS)
1. Definition of ACHS
ACHS is a health service for adolescents
who access all adolescents groups, which
can be
accepted in accordance with
comprehensive, effective and efficient.
2. Objectives of ACHS
The purpose of ACHS is to improve the
provision of adolescent health services,
increase the knowledge and skills of
adolescents in the prevention of adolescent
6
specific health problems, increase
adolescent involvement in planning,
implementation, evaluation of adolescent
health services, counseling on health
problems and various other adolescent
problems
3. Target of ACHS
ACHS targets are all adolescent who are
everywhere either at school or outside
school such as adolescents clubs,
adolescents mosques / churches / temples /
temples, boarding schools, dormitories,
and other adolescents groups.
4. Benefits of ACHS
The benefits of ACHS according to Muladi
(2010) are to add insight and friends
through counseling activities, interactive
dialogue, Focus Group Discussion (FGD),
seminars, jamboree, counseling / vent
about health problems and various other
teenage problems.
5. Types of ACHS Activities
According to Anonim (2005: 14-18) that
activities in ACHS are in accordance with
the conditions and needs, carried out in
buildings or outside buildings, for
individual or group targets, carried out by
health center officers or other officers in
institutions or communities, based on
partnerships. The types of ACHS activities
include:
- Providing Information and Education
Conducted inside the building or outside
the building, using the question and
answer lecture method, Focus Group
Discussion (FGD), interactive discussions
equipped with print media or electronic
media tools (radio, e-mail, telephone /
hotline, and SMS)
- Medical Clinical Services including
Supporting Examinations and Referrals
- Counseling
Counseling is a mutually beneficial
relationship between counselors and
clients until good communication is
achieved, and in time the counselor can
offer support, expertise and knowledge on
an ongoing basis so that the client can
understand and recognize himself and the
problems he faces better and then help
himself with help with several aspects of
his life.
6. Referral Services
Social referrals are also needed in ACHS,
for example, channeling to work skills
institutions for adolescents after drug
abuse or channeling to certain institutions
in order to obtain mentoring programs in
the efforts of mental rehabilitation of rape
victims.
C. Factors Associated with Utilization of
Adolescents Care Health Services
1. Student Class
In the classroom all aspects of learning
meet and process. The teaching-learning
process in the classroom will essentially
involve all elements in the school
concerned but will directly be involved in
the following: The teacher as an educator,
the student as educated, the tools used, the
situation in and the classroom
environment, the class itself. In
Permendiknas No. 41 of 2007 that
classroom management must include:
a. The teacher organizes seating
according to the characteristics of
students and subjects, and the
learning activities that will be
carried out.
b. The volume and intonation of the
teacher's voice in the learning
process must be well heard by
students.
7
 c. Speech words polite teacher and
can be understood by students.
d. The teacher adjusts the subject
matter with the speed and learning
abilities of students.
e. The teacher creates order,
discipline, comfort, safety, and
decisions on regulations in carrying
out the learning process.
f. The teacher provides reinforcement
and feedback on the response and
learning outcomes.
g. Students learn during the learning
process takes place in the
classroom.
h. The teacher respects students
regardless of their religious
background, ethnicity, gender and
socio-economic status.
i. The teacher respects the opinions
of students in the learning process.
j. The teacher wears clothes that are
polite, clean and neat.
k. The teacher delivers the syllabus at
the beginning of the semester.
l. Management is a translation of the
word management.
Classroom management is the skill of the
teacher to create optimal learning
conditions, and control them if there is
interference in the teaching and learning
process.
2. Gender
Gender is the difference in shape, nature,
and function. That means reproductive
organs cannot work alone properly.
a. Women have reproductive organs,
namely: the vagina, egg, uterus,
and hormone functions, which,
among others, help remove breast
milk.
b. Men have reproductive organs,
namely: penis, penis, sperm, and
the functions of male hormones
that complement human organs.
Gender is biological and carried from birth
so that it cannot change. For example: only
women can give birth, and only men can
make a pregnant woman.
3. Adolescents Knowledge about
ACHS
Various studies state that behavior based
on knowledge is more consistent than
without knowledge. Knowledge in this
study aims to increase knowledge about
ACHS in activities outside the Public
health service , namely at school.
4. Information exposure
Teenagers get information about many
things from their peers, from print and
electronic media. They give attention to
things that are considered to increase their
self-esteem, then accept it without first
assessing whether it is in accordance with
the norms, religious or cultural values that
apply in their environment. Adolescents
often consider everything from developed
countries to be exemplified because it
affects more than 65% of respondents by
sex-related matters, dating topics 89.5%
and topics on relationships are better, the
information they get comes from
magazines, stencils , pornographic films,
and pornographic VCD tapes that he
sought clandestinely (Saifudin).
Information is all things that can be used
by someone so that they know about
something new, and have characteristics,
namely,
1) Can be seen, read and learned
2) Researched, reviewed and analyzed
3) Utilized and developed in educational,
research, laboratory activities
8
 5. Transformed to others.
Sources of information in this study are all
things that can be used by students to get
information about ACHS, in the form of
leaflets, electronic media, counseling by
public health service officers, teachers,
parents and so on
6. Availability of Information
Facilities
The family is the first and foremost vehicle
and system that is closest to children and
can be classified as an informal
educational institution. Likewise, sex
education in the family is a continuous
educational institution for children. The
role of parents is to guide the child
between them as an educator.
7. Adolescent Social Environment
Adolescent social environmental factors
include family environment, namely
parents and siblings, peers and teachers
which are sources of information related to
ACHS activities and programs. As quoted
by Notoatmodjo, that social environment
consists of the role of parents, peers, and
schools / teachers and health workers. The
policies and support referred to in this
study are policies and support from
schools and health centers related to the
implementation of ACHS programs.
A. School Teacher Support
The path of education in schools is
education held in schools through tiered
and continuous teaching and learning
activities. The level of education included
in school education consists of elementary
schools, high schools and high schools.
Secondary education is held to continue
and expand basic education and prepare
students to become members of the
community who have the ability to
establish reciprocal relations with the
surrounding social, cultural and natural
environment and can develop further
abilities in the world of work or higher
education (Ministry of Education Republic
of Indonesia, 1989).
B. Peer Friend Support
Teenagers have a strong tendency to be
among their peers, outside the home, they
will be in groups and will feel safe in the
group. In speaking or speaking, interests,
skills, attitude and behavior are more
influenced by peer groups. They will feel
accepted by the group if they have the
same attitude and behavior, both those
who follow the norm and those who
deviate without thinking of the
consequences that will occur to him or the
impact on his family (Hurlock).
For the process of socialization with the
environment, children need peers or peer
groups, but attention from parents is still
needed to monitor who the child is getting
along with, especially for adolescents. The
environmental aspects of peers are very
important with increasing cases of drug
abuse, narcotics and promiscuity
(Soetjiningsih)
C. Support of Health Officers
Officers who serve ACHS in Public health
service or outside ACHS health centers
can be a doctor, midwife or trained nurse.
They will serve with patience, friendliness,
ready to accommodate all adolescent
problems and ready to discuss (provide
counseling). Special officers who care
about teenagers must meet the criteria:
Having attention and caring, kind,
understanding, friendly, having technical
competence in providing special services
to adolescents, having interpersonal
communication skills and counseling,
having motivation to help and cooperate
with adolescents, not judging, not
behaving and commenting unpleasant or
9
degrading , can be trusted and can
maintain confidentiality, able and willing
to sacrifice time as needed, can / easily be
found on repeat visits.
D. Laurence's theory
Predesposing factors that are manifested in
the knowledge of enabling factors, related
to physical conditions, such as facilities
and infrastructure, health center facilities,
the existence of latrines. The reinforcing
factors, which are related to policies,
health workers, or other officers related to
public health. Based on the theory above it
can be concluded that the health behavior
of individuals or communities is
influenced by factors of knowledge,
beliefs, attitudes and values in society,
besides the available facilities, equipment,
comfort of place, attitudes of health
workers and government policies can
strengthen behavior in health
( Notoatmodjo, 2012).
CONCLUSION
Based on the research objectives and the
results of the analysis that have been
carried out in this study and the discussion,
then conclusions can be taken as follows:
1. The characteristics of the
respondents were mostly female
(60.9%), the majority had been
exposed to information (87.3%),
but the availability of information
facilities was still lacking (71.8%).
2. There is a relationship between the
availability of information facilities
and the utilization of ACHS (p-
value = 0.032).
3. There is a relationship between
peer social support and the use of
ACHS (p-value = 0.004).
4. There is a relationship between the
social support of school teachers
and the use of ACHS (p-value =
0.020).
5. There is a relationship between
social support of health workers
with the use of ACHS (p-value =
0.009).
6. The dominant factors related to
ACHS utilization were information
exposure (p-value = 0.010), peer
social support (p-value = 0.010),
and health worker social support
(p-value = 0.013).
7. Based on the research objectives
and the results of the analysis that
have been carried out in this study
and the discussion, it can be
concluded that the majority of
female respondents (60.9%)
characteristics have been exposed
to information (87.3%), but the
availability of information facilities
is still lacking (71.8% ) the
dominant factors related to ACHS
utilization were information
exposure (p-value = 0.010), peer
social support (p-value = 0.010),
and health worker social support
(p-value = 0.013).
REFERENCES
Anthony Yeo, konseling suatu pendekatan
pemecahan masalah, 1995
BKKBN. 2007.Remaja dan SPN(Seks
Pranikah).www.bkkbn.go.id
BPS, BKKBN, DepartemenKesehatan RI
dan MacroInterna 2008, Survei Demografi
dan KesehatanReproduksi
RemajaIndonesia2007,Jakarta
Ditjen PP & PL Kemenkes RI,
2012Fadhlina, D. (2012). Pelaksanaan
ACHS 2012.
http://ACHS.datainformasi.netberita-
ACHS.htmldi akses 18September
2012Kapan Lagi,
2008.http://m.merdeka.com/pernik/63
Depkes RI, Direktorat Kesga, Materi
Pelatihan Pelayanan Kesehatan Peduli
Remaja, 2003
10
Depkes RI dan Kesejahteraan Sosial, Muadz,M.M, dkk. (2008).Kurikulum dan
Direktorat Promosi Kesehatan, Konseling ModulPelatihan PengelolaanPusat
kesehatan dalam pemberdayaan keluarga Informasi danKonseling
Panduaan pelatihan konseling bagi KesehatanReproduksi Remaja (PIK-).
petugas kota / kabupaten, 2001
Notoadmodjo,S.2007.PromosiKesehatan
Direktorat Bina Kesehatan Keluarga, dan IlmuPerilaku. Rineka Cipta:Jakarta
Depkes RI, 2005, Pedoman Pelayanan
Kesehatan Peduli Remaja di Public Riau Pos, 2011. Hindari
health service . PerilakuBeresiko.http://www.riaupos.co.id
/spesial.php?act=fu
Direktorat Bina Kesehatan Anak, Depkes
RI, 2009, Leaflet tentang Pelayanan Sarwono, S.W. 2006.PsikologiRemaja PT.
Kesehatan Peduli Remaja RajaGrafindoPersada: Jakarta

Depkes RI, (2003). Pelayanan Kesehatan Sugiyono, 2008.Metode

Peduli Remaja (ACHS), Jakarta: Dirjen PenelitianPendidikan.CV.
Pembinaan Kesehatan Masyarakat. Alfabeta:Jakarta.

Depkes RI. (2005). Pedoman Suryoputro, A, dkk. (2006).Faktor-Faktor

Perencanaan Program Kesehatan yang MempengaruhiPerilaku Seksual
RemajaJakarta: Dirjen Bina Kesehatan Remaja diJawa Tengah:
Masyarakat. Implikasinyaterhadap Kebijakan
danLayanan Kesehatan Seksual dan
Depkes RI. (2005). Strategi Nasional Reproduksi. Makara,Kesehatan. 10 (1), 2-
Kesehatan RemajaJakarta: Dirjen Bina 40.
Kesehatan Masyarakat.
Suhartin. 2007.Perbedaan sikap tentang
Depkes RI. (2005). Pedoman Pelayanan perilaku sekspranikah antara remaja laki-
Kesehatan Peduli Remaja di Public laki dan perempuan diSMAN 1
health service .Jakarta: Dirjen Bina Tenggarang,Bondowoso.
Kesehatan Masyarakat. DIVKebidananUNS. KTI.

Depkes RI. (2008). Program Kesehatan Tim pembina UKS Propinsi Jawa Barat,
Reproduksi dan Pelayanan Integratif di 2007, Pedoman pelaksanaan UKS untuk
Tingkat Pelayanan Dasar. Jakarta: Dirjen guru di jawa barat.
Bina Kesehatan Masyarakat, Direktorat
Bina Kesehatan Ibu. Wijaya, SW. (2012). PIK
Remaja.http://jonsudiyono.blogspot.com/2
Direktorat Remaja dan perlindungan Hak- 012/03/pusat-informasi--konseling-
Hak Reproduksi BKKBN. (2008). remaja.html?m=1akses 11September 2012
Ketrampilan Hidup (Life Skills) Dalam
Program Kesehatan ReproduksiRemaja. PENGARUH KEGIATAN
BKKBN Pusat PENYULUHAN DALAM PELAYANAN
KESEHATAN PEDULI REMAJA
Humris W. Edith, Sp Kj, RSCM, (ACHS) TERHADAP PENGETAHUAN
Konseling Kesehatan remaja, 2004 DAN SIKAP REMAJA TENTANG SEKS
Diposkan oleh Kapevi Hatake di 9:58 PM PRANIKAH DI SMAN1 LUBUK
DALAM KABUPATEN SIAK SRII
NDRAPURA TAHUN 2013

11
Nuzulia Rahayu1,Yusniwarti Yusad2,Ria
Masniari Lubis21AlumniFakultas
Kesehatan Masyarakat USU2Staf Pengajar
Fakultas Kesehatan Masyarakat USU

12