Contextual Effect of Community Health Center on Visual Inspection Acetic Acid Uptake in Magelang, Central Java: A Multilevel Analysis

Herlina Ika Martaningrum, Uki Retno Budihastuti, Bhisma Murti


Background: Cervical cancer is a major prob­lem in women's. Cervical cancer can be prevented by early examinations i.e. visual inspection acetic acid (VIA). This study aimed to analyze the contex­tual effect of community health center on VIA up­take in Magelang, Central Java.

Subjects and Method: This was analytic obser­­­­vational study with cross-sectional design. The stu­dy was conducted at 25 community health cen­­­­­ters in Magelang, Central Java, from Sep­tem­ber to October 2019. A to­tal sample of 200 women aged 30 to 50 years was selected ran­domly. The dependent variable was VIA uptake. The independent variables were knowledge, ob­ser­­­vational lear­ning, behavioral reinforcement, cues for action, access to information, family sup­port, attitude, self-efficacy, outcome expec­tation, and contextual factor of community health cen­ter. The data were collected by ques­tion­naire and analyzed by a multilevel multiple logistic reg­res­sion run on Stata 13.

Results: VIA uptake increased with good know­ledge (b= 4.02; 95% CI= 0.61 to 7.42; p= 0.021), obser­­vational learning (b= 2.28; 95% CI= -0.35 to 4.93; p= 0.090), strong behavioral rein­force­ment (b= 4.11; 95% CI= 0.82 to 7.40; p= 0.014), strong cues to action (b= 5.36; 95% CI= 0.65 to 10.07; p= 0.026), good access to information (b= 3.71; 95% CI= 0.42 to 7.01; p= 0.027), strong family support (b= 4.23; 95% CI= 0.21 to 8.25; p= 0.039), positive attitude (b= 3.29; 95% CI= -0.23 to 6.81; p= 0.067), strong self-efficacy (b= 2.94; 95% CI= 0.10 to 5.78; p= 0.042), and strong outcome expectation (b= 3.39; 95% CI= 0.35 to 6.44; p= 0.029). Community health cen­ter had strong contextual effect on VIA uptake with intra-class correlation (ICC)= 23%.

Conclusion: VIA uptake increases with good know­ledge, observational learning, strong beha­vi­o­ral rein­forcement, strong cues to action, good access to information, strong family support, posi­tive attitude, strong self-efficacy, and strong out­come expectation. The community health center has a strong contextual effect on VIA uptake.

Keywords: visual inspection acetic acid, social cognitive theory, multilevel analysis

Correspondence: Herlina Ika Martaningrum, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Su­tami 36A, Surakarta 57126, Central Java, Indo­nesia. Email: Mobile: 085643528156

Journal of Maternal and Child Health (2020), 5(2): 129-140



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