ANALYSIS OF PREDISPOSING FACTORS RELATED TO MOTHERS WITH TODDLER’S VISIT TO INTEGRATED COMMUNITY HEALTH SERVICE

Mothers’ behavior has an important role in the growth and development of toddlers and affects the mothers’ visit frequency to integrated community health service. It is also affected by some aspects and various factors, one of which is predisposing factors. The purpose of this research was to identify predisposing factors related to mothers with toddlers’ visit to integrated community health service in Mojoroto sub-district, Kediri city. The research used survey analytic method with a cross sectional design. The sample of this study was the whole population consisted of 40 mothers who had toddlers aged 0-59 months. Data collection was using a questionnaire. Data analysis was using univariate, bivariate with chi-square and Odds Ratio. The results of this research showed that the mothers’ visit to integrated community health service had correlation with employment status factor (p value 0.024; OR 4.5), and the factors which did not have any correlation with the mothers’ visit were the knowledge (p value 0,385), attitude (p value 0,622), education (p value 0,057), motivation (p value 1,000), and the age (p value 0,251). It is recommended that those mothers must always be advised and encouraged to join integrated community health service activities to keep monitoring the growth and development of their toddlers by taking them to available health service centers.


INTRODUCTION
Toddlers are a group of age that is vulnerable to health problems.Health problems occur in toddlers affect growth and development both in infancy and their future development periods.Disturbances in growth and development can cause stunting, which can hinder children's cognitive development, and children will be more susceptible to infections and non-communicable diseases (Aviva et al., 2020).Some efforts can be made to monitor the growth and development of toddlers so that they will not face too many health problems in the future, one of them is to bring toddlers to community health service centers such as integrated community health service ( Ind: Posyandu).
Posyandu is a form of community-based activity aimed at accelerating the reduction of the Maternal Mortality Rate, Infant Mortality Rate, and Under-five Child Mortality Rate in Indonesia.
Posyandu services cover at least 5 activities namely Mother and Child Health (KIA), Family Planning (KB), immunization, nutrition and diarrhea management (Ministry of Health RI, 2011).Posyandu activities are carried out once a month where they have midwives, cadres, and are usually assisted by local health workers, targeting infants/toddlers aged 0-5 years to monitor the development and growth status of toddlers using Health Monitor Card included in Maternal and Child Health handbook.These activities are useful for early detection of some diseases.If a disease is found, immediate recovery or prevention efforts can be conducted so that children do not become undernourished or malnourished, thereby it can reduce the risk of death due to malnutrition (Ministry of Health RI, 2019).Mother's active involvement in Posyandu activities is needed to ensure the fulfillment of toddlers' basic health needs, to reduce maternal and infant mortality rate.
According to data from East Java Provincial Health Office in 2017, the infant mortality rate was still high, with 4,059 babies died per year and as many as 4,464 toddlers died per year.In addition to this high mortality rate, according to Riskesdas, 2018, the prevalence of stunting in Indonesia is still high, with the score of 30.8%, which is still far from the recommended level by WHO, which is 20% (Aviva et al., 2020).So, it is necessary for mothers to be active in taking their toddlers to Posyandu regularly to be weighed, so that they can monitor the growth and development of their toddlers intensively (Ministry of Health RI, 2019).A person's behavior is influenced by various aspects and factors.According to Purnomo et al (2018) predisposing factors or predisposing factors are factors that can influence a person's 87 behavior such as knowledge, attitudes, beliefs, beliefs, values, traditions, and so on.Knowledge and attitudes of mothers can increase mothers visit to health facilities.
To support the growth and development of toddlers, facilities and infrastructure or health facilities for the community are needed.Based on the 2017 East Java health profile, there are 37 public health centers in the Kediri district, and 9 public health centers in Kediri city area.For community based health service, there are 1,503 active ones in Kediri district with 86.93% of them are posyandu, and in Kediri city there are 310 active ones with 91.45% of them are posyandu.
In 2015 Kediri health profile, D/S coverage was obtained from 9 working areas of public health center which had reached the national target of 85%, only at Mrican Health Center it was 86.9%.Other public health center work areas still have not reached the national target of 85%.The level of community participation in Posyandu activities results in a minimum number of 85%.If it is below 85%, then the level of community participation or the activity of visiting mothers under five is considered to be low (Faradibah, et al, 2018).
The data at Posyandu Menur, Mojoroto Village, stated that there are 40 mothers with toddlers aged 0-59 months.All toddlers already have Health Monitor Book.There were 13 children who did not attend Posyandu, 27 of them came and were weighed, 6 children had increased weight and 30 children had the same weight as previous visit.
From the results of observations made at the Menur Posyandu, Mojoroto Village, the visit of toddlers was decreased due to several possibilities that affect mothers compliance to visit Posyandu including their knowledge, attitudes, education, employment status, motivation, and age.To attract mothers to make active visits to posyandu every month, activities such as nutrition counseling and cooking demonstrations on how to make Complementary Foods for Breastfeeding can be carried out by nutritionists and cadres.
Based on the explanation above, to find out the factors causing the lack of visits to Posyandu, the researchers are interested in conducting research that aims to identify predisposing factors associated with mothers' visit to Posyandu in Menur village, Mojoroto, Kediri City.

MATERIALS AND METHODS
The type of this research was an analytic survey research with a cross-sectional design that was used to identify predisposing factors (knowledge, attitudes, education, employment status, motivation, age) associated with the visit of mothers to posyandu observed at one time in each respondent using a questionnaire that had been tested its validity and reliability.The population used was all mothers who have toddlers aged 0-59 months as many as 40 respondents.The sample used involved the entire existing population.The analysis in this study used univariate analysis to get an overview of the frequency distribution of each variable and bivariate analysis to determine the correlation between the two variables.Bivariate analysis in this study used analytical tests with Chi-Square and Odds Ratio (OR) calculations.

RESULTS
The results of univariate analysis of this study can be seen from this following table: Table 2 shows that 25 respondents have negative attitude (62.5%) and 15 respondents have positive attitude (37.5%).5 shows that 20 respondents have positive motivation (50%), and 20 respondents have negative motivation (50%).Table 8 shows that from 23 mothers (57.5%) who have good knowledge, there are 9 respondents (22.5%) who have good visit and 14 respondents (35.0%) are lacking in visit.For those who have lack of knowledge there are 9 respondents (22.5%) with enough visit and 8 respondents (20.0%) lack of visit.Chi-square score with p value of 0.385< (α) 0.05, shows that there is no correlation between knowledge factor and mother's visit to Posyandu.Table 9 shows that there are 15 respondents (37.5%) have positive attitude toward the visit with 6 respondents (15.0%) have good visit and 9 respondents (22.5%) lack of visit.Those who have negative attitude are 25 respondents (62.5%) with good visit of 12 respondents (30.0%) and 13 respondents (32.5%) are lack of visit.Chi-square score with p value of 0.22 > α 0.05, means that there is no correlation between attitude factor and mother's visit to posyandu.Table 10 shows that there are 8 respondents (20.0%) who have low education level, with good visit of 6 respondents (15.0%) and 2 respondents (5.0%) with lack of visit.There are also 32 respondents (80.0%) who have high level of education, with 12 respondents (30.0%) have good visit and 20 respondents (50.0%) lack of visit.Chi-square result shows p value of 0.057 > α 0.05, meaning that there is no correlation between education factor and mother's visit to posyandu.Table 11 shows that there are 21 respondents (52.5%) who are unemployed with 13 respondents with good visit (32.5%) and respondents (20.0%) lack of visit.There are also 19 (47.5) working respondents, with 5 respondents (12.5%) who have good visit and 14 respondents (35.0%) have lacked of visit.Chi-square result shows a p value of 0,024 < (α) 0.05, which shows that there is a correlation between job factor and mother's visit to posyandu.The result of analysis shows OR score = 4.550 (1.181-17.524)which means that respondents who are working have 4.55 chance of not visiting posyandu.Table 12 shows there are 20 respondents (50.0%) who have positive motivation toward the visit, with 9 respondents (22.5%) with visit and 11 respondents (27.5%) lack of visit.Those who have negative motivation shows the same result as the positive ones.Chi-square shows p value of 1.000 > α 0.05 meaning that there is no correlation between motivation factor and mother's visit to posyandu.

A Multidisciplinary Journal for Health Professionals
Table 13 shows that there are 15 respondents (37.5%) are at their early adult age.There are 5 respondents (12.5%) who have good visit and 10 respondents (25.0%) with lack of visit.There are also 25 respondents (62.5%) at their late adult age, with 13 of them (32.5%) have good visit and 12 respondents (30.0%) lack of visit.Chi-square test shows p value result of 0.251 > α 0.05 which means that there is no correlation between age factor and mother's visit to posyandu.Based on the results of research using chi-square test, it shows that the correlation between knowledge and mothers visits to posyandu has no meaningful correlation, the result of p-value was 0.385> α (0.05).The results of this study are in line with research conducted by Ningsih (2019) which stated that there was no significant relationship between mother's knowledge and mother's visits to posyandu, with a p-value of 0.729.In contrast to the results of research conducted by Fitriyah et al (2019), the knowledge factor has a meaningful correlation with p-value of 0.0001 and an OR result of 13.886, which means that respondents who have good knowledge have the opportunity 14 times more to visit to posyandu compared to those with less knowledge.
Mother's knowledge can be obtained from anywhere, both formal and non-formal education, but everyone has different abilities so that the mothers also have different level of abilities.According to (Wawan, 2011) knowledge is very closely related to the level of education where those who have higher education will have a wider knowledge base.However, it is necessary to emphasize that knowledge is not only from formal education but from nonformal education can also increase knowledge.
According to the writers' analysis, most of the mothers with higher knowledge at Posyandu Menur prefer to go to midwives and doctors to carry out weighing and immunization because they have sufficient income.This is also caused by Posyandu Menur schedule which is held during working hours.so that they do not have time to make visits.Another factor that might have occurred in this study was caused by changes in behavior of the mothers who have good knowledge but do not have awareness or a positive attitude to make active visits to posyandu.

The correlation between attitude factor and the visit of mothers to Posyandu
The results of chi-square test showed that p value was 0.622 indicating that p > α (0.05), which means that there is no meaningful correlation between attitudes and visits by mothers to posyandu.It is different from the results of research conducted by (Cholifah et al., 2017) where the it showed that there was a correlation between attitudes and visits to posyandu with a p value of 0.014 <0.05.However, the result of a research conducted by (Ketaren, 2009) was in line with that carried out by researchers where the attitude factor has no significant correlation with the visit of mothers to posyandu, with a p-value of 0.906 > 0.05.

Health Frontiers
Attitude is an opinion or judgment of a person accompanied by a tendency to act according to attitude.Attitudes are formed from experience and individual development and it is very important the formation of each individual's attitude.According to the writers' analysis, the negative attitude of toddler mothers at the Posyandu was due to a lack of persuasive approach to respondents such as counseling on services available at the Posyandu and the benefits that will be obtained when visiting the Posyandu, for example in the form of immunization, giving vitamin A twice a year, etc.If this can be implemented, it can lead to a positive attitude and make good use of posyandu.However, according to Lawrence Green's theory (Notoatmodjo, 2014), apart from the attitude factor, there are other factors that influence visits to posyandu, including work factors.Occupational status greatly affects mothers' visits to the posyandu because the time for caring for children and giving attention to children is automatically reduced because mothers are busy with their work, including visits by mothers to bring their toddlers to the posyandu once every 1 month.

The correlation between educational factors and mother's visits to Posyandu
Education affects a person's behavior.Education is the most important factor for thinking, analyzing, and understanding information obtained with more rational considerations and good education will provide the ability to make decisions about family's health (Hastono, 2009).
In this study, the results showed that the correlation between education and mother's visits had no meaningful correlation with chi-square statistical test showing a p-value of 0.057 > α (0.05).
The results of this study are in accordance with research conducted by (Sativa, 2017) which states that there is no significant relationship between education and the active participation of mothers in posyandu activities with a p-value of 0.099 > 0.05.Then the results of the related research were also found in research conducted by (Cholifah et al., 2017) which showed a pvalue of 0.255 > 0.05 so there was no correlation between education and visits to posyandu.
The result of the research shows that most of the respondents are highly educated (80%).People who have higher education have a good mindset in receiving and absorbing various information both through print and mass media.According to the researcher's analysis, mothers who have higher education at the Menur Posyandu do not always visit the Posyandu because active visit to Posyandu is also influenced by provision of information by health workers, for example from midwives or cadres.Reminding about Posyandu schedule through social media or bulletin boards in the neighborhood area or conduct counseling about the importance of the posyandu in order to form a positive attitude is essential so that mothers' visits to posyandu can be improved.Health Frontiers

Correlation between Occupational Factors and Mother's Visit to Posyandu
The results of the chi-square statistical test analysis obtained a p value of 0.024 (p <0.05), which means that there is a significant relationship between work and visits by mothers to posyandu.
The OR value was 4.550 which means that respondents who did not work had the opportunity to visit the posyandu 5 times.
The results of this study are in accordance with previous research conducted by (BD, 2018), regarding factors related to toddler visits to posyandu in the working area of public health center Air kota Padang which states that visiting behavior of mothers of toddlers at posyandu can be influenced by several factors including mother's type of work (0.000).
The respondents in this study were mostly unemployed, so they had free time to visit posyandu, after completing their household chores.These housewives get more information about health from posyandu cadres, so they make better use of posyandu compared to working mothers.On the other hand, some working mothers check the growth and development of their toddlers at higher level of health facilities due to the mother's work schedule does not match posyandu schedules on working days so they may not be able to attend posyandu activities.

Correlation between motivational factors and mother's visit to Posyandu
Motivation can be interpreted as a strength and encouragement to act or do something to carry out a certain goal.Likewise, there are actions without any motivation drive, where the action takes place automatically or spontaneously (Ahmadi, 2009).
In the research results, it was found that the proportion of respondents who had positive and negative motivation with good visits was the same, which is (22.5%).The results obtained from chi-square test p-value 1.000> 0.05, which means that there is no correlation between motivational factors and mother's visits to posyandu.
In contrast to research conducted by (Nurdin et al., 2019) regarding factors related to the participation of mothers in Jorong Tarantang, it was discovered that the proportion of respondents with high motivation who did not visit posyandu was 36.2% lower than respondents with low motivation who did not visit posyandu (63.8%)where the p-value was 0.003 (p <0.05) with OR 4.332 which means Health Frontiers that respondents with low motivation were more at risk of not visiting posyandu at 4 times.
The analysis in this study of motivation at Posyandu Menur shows the results of the same number of positive and negative visits with good or poor visits.This can happen due to a lack of.Mothers who visit Menur Posyandu are mostly only with their toddlers, it is very rare for the husband to accompany them so there is a possibility of a lack of support from the husband to his wife which results in the mother of being less active.It is better if Posyandu staff and community leaders provide counseling/encouragement to mothers who have negative motivation to be more active in posyandu activities.For mothers who already have positive motivation, it is expected that they can invite or influence other mothers who still have negative motivation to be more active in visiting posyandu.It is recommended that mothers at Posyandu are more active in making visits to Posyandu.Meanwhile, Posyandu cadres can conduct counseling in the form of counseling about health and the benefits of visiting the Posyandu, making complementary foods for breastfeeding, or parenting counseling so that it attracts the mothers to be more active in joining posyandu activities.However, in this study, the motivation of the mother and their visit to posyandu did not have any correlation, which could be caused by several factors, such as the dishonest answers from the respondents or the respondents who made the results insignificant were not at significant numbers.

The correlation between the age factor and the visit of mothers to posyandu
In this study, the results obtained were a p-value of 0.251 (p>0.05), which means that there was no significant correlation between age and visits by mothers to posyandu.The result is similar compared to a research conducted by (Cholifah et al., 2017) where it showed that the age factor of the mother's was not significant with a p-value of 0.757.

Health Frontiers
According to (Hastono, 2009) young and new mothers will tend to pay greater attention to their children, but as they get older, busier and increase in the number of children, this will affect their motivation to provide good health services for the children. .The researcher's analysis in this study was that age did not have any meaning due to increased awareness and understanding of mothers about the importance of visiting posyandu in groups of young and old mothers.Awareness of the importance of visiting the posyandu is very lacking for both age groups.For mothers in the older age group, they have more children so they have to take care of their other children so they don't have time to visit the posyandu.For mothers in the young adult age group at Posyandu, this is because they have many activities out of their home, so bringing their children to Posyandu on weekdays is not possible.Then from the results of data analysis in this study, the age factor has no correlation with mother's visit to posyandu, it could be because the age of the mother is an individual characteristic, only demographic factors and predisposing factors, while a visit to posyandu is a form of health behavior, especially related with the utilization of health services, so that these factors do not affect the behavior of mothers to be active in posyandu visit.

CONCLUSION
Our study highlights the correlation between work factors and visits by mothers to Posyandu Menur, Kelurahan Mojoroto, Kediri City.From this study, it is recommended that: 1) Mothers of toddlers who have a busy job keep monitoring the growth of their toddlers by regularly taking them to posyandu and other health centers; 2) It is expected that the cadres will collaborate with various parties, such as community leaders and recommend mothers to participate in Posyandu activities so that the mothers are more motivated; 3) It is expected that midwives and cadres can provide health education about the importance of participating in posyandu activities every month.
Health Frontiers: A Multidisciplinary Journal for Health Professionals, Vol 1 Issue 2 2023 E-ISSN : 3024-9740 This is an open access article under Creative Commons Attribution-ShareAlike 4.0 International License 90The results of bivariate analysis can be seen in the following table:

Table 1
Respondents' distribution based on the correlation between knowledge and mother's visit to Posyandu

Table 3
Respondents' distribution based on the correlation between education and mother's visit to Posyandu

Table 4
Respondents' distribution based on the correlation between types of job and mother's visit to Posyandu

Table 5
Respondents' distribution based on the correlation between motivation and mother's visit to Posyandu