PERNIKAHAN DINI BERBASIS TRANSKULTURAL NURSING DI DESA KARA KECAMATAN TORJUN SAMPANG MADURA ( Early Marriage Based on Transcultural Nursing Theory in Kara Village Sampang )

Introduction: The early-age marriage is still happened in the world with many reasons. Early marriage has many negative impacts on education, social, economic, psychological, and reproductive health. The purpose of this study is to analyze the factors of early marriage based on Transcultural Nursing theory. Methods: Design used in this research was cross-sectional approach. The sampel was women who got married between January 2015 and February 2016. The 39 sample respondents were chosen by purposive sampling technique. The independent variables in this study were knowledge, culture, family suport, economic, technology and the dependent variable was early marriage. The data were collected by using questionnaire and analyzed by using chi square test. Results: The results showed significant correlation between cultural factor (p=0.013), family support factor (=0,001), economic factor (p=0,040), and technology factor (p=0,002) with early marriage, while knowledge factor have not significant correlation with early marriage. Discussion: By the result of this study, it was expected there will be some actions together with relevant parties to give health education for adolescent who has married yet to prevent early marriage.


INTRODUCTION
The age of married for women is one of the factors that affect the health status of mothers and children.According to the national family planning agency (BKKBN) determine the ideal age for girls to get marry considering the medical and psychological condition is after the age of 20 years while for male is 25 years old above, because at this age the reproductive system can function properly.Initial data collection from the religious affairs office in the village of Torjun in January to February 2016 showed data that there were 41% of women married before the age of 21 years.Sixty nine of 218 women in Kara, 69 were married and 34 of them were married before the age of 20 years.It means that the early marriages presentation in Kara is still very high.Thus, it is important to investigate the factors associated with early marriage based on Transcultural Nursing theory in Torjun village Sub district Kara, Sampang Madura.
Data from BPS (2013) showed that the number of women aged 10 years and under 17 years in East Java on 2011-2013 was 26.33%.The number of early marriage is still high in Bondowoso (53.26%),Situbondo (51.54%),Probolinggo (48.09%),Sumenep (45.08%), and Sampang (43.33%).Those caused by various factors such as cultural factors, economics, technology and knowledge.Desiyanti (2015) said that other factors that influenced early marriage is parents support.Parents have authority to delay the marriage of their children.Reproductive health problems began with sexual activity.Early marriage could be a matter of reproductive health because the earlier age, the longer time span for reproduction (Riskesdas 2013).
Early marriage has many consequences on education, health, economic, and family harmony.Girls who married before 20 have increased risk of school drop out.Early marriage of young females have a risk in reproductive health and also counts for the consequences of early pregnancy and increasing maternal mortality (Noviyanti, W. & Trihandini 2013).This is in line with research conducted by Sarwono in Lestari 2013 said that of women who married before the ideal age tend to have health problems: the reproductive organs are immature causes uterine contractions, the reproductive period is longer trigger the risk of cervical cancer, anemia in pregnancy causes low birth weight, and complication during pregnancy.
According to BKKBN (2012) cultural factors are still the main reason that caused early marriage among girls in East Java.The cultural dimension in Madura is still very strong makes analysis of the problem with the transcultural approach is needed.Effort to identify factors associated with early marriage in the Madurese community can use the transcultural theory because of early marriage in the Madurese community is a culture or habit that carried on from generation to generation.

MATERIAL & METHODS
Design used in this research was crosssectional approach.The samples were 39 women who got married from January 2015 until February 2016.The samples were chosen by purposive sampling technique.The independent variables in this study were knowledge, culture, family suport, economic, technology and the dependent variable was early marriage.The data were collected by using questionnaire and analyzed by using chi square test.This research was conducted for 4 days, on 25-26 June 2016 and 2-3 July 2016.
Instruments used in the form of a questionnaire drawn from research instruments by Priyanti (2013), Kharimaswatii (2014) and Arika (2013).The questionnaire consist of 10 questions about knowledge (the definition of early marriage, the ideal age to get married, the impact of early marriage), culture (values and norms of early marriage, social interaction communities, tradition early marriage in the community), family support (emotional, cognitive, and material), economic (family income), technology (access to information technology, acces media massa and the press, and access to electronic tools and environment).The data were then analyzed using statistical test Chi Square α≤0,05 level of significance.

RESULT
Socio-demographic characteristics of the samples shown that almost (51.3%) of respondents were 20-35 years, and majority they were married on aged under 20 years old (66.7%).Early marriage has the risk of complications during pregnancy because of the immature reproductive organs.Most respondents had junior high school education bacground (64.1%),only 1 respondents finished higher education and 33.3% respondents classified as having a low education level.Background of education is one of the internal factors that can affect a person's decision making.Education is one of the main factors that determine the quality of life, the higher education level, the smaller intention to get married at an early age.On job categories, majority of respondents were housewifes (69.2%) and and the others were farmers and private sector worker.Assosiations of technology and early marriage based on transcultural nursing showed that 16 respondents (41%) in the less categories of use of technology and 15 respondents (38,5%) were married at early age.

DISCUSSION
The number of women who married at early age is greater than women who married in ideal age.That is because there are several factors that support women to choosed to married earlier.These factors include knowledge, culture, family support, economic, and technology.Knowledge influenced by education, mass media or information, sociocultural, family support, environment, experience, and age (Rahmawati, 2010) .
Basd on the results of this study, knowledge is not related to early marriage because there were other factors that more influence early marriage decision.According to Leininger (2002) educational background have an impact on the absorption of information.Someone who has a higher education will also have a good knowledge.Knowledge without a good education would enable women choose the wrong decision.
Different educational levels will affect different behavior in the decision to marry or not.Some people who do not continue their education to higher levels tend to be productive so that a woman will decide to get married early (Qibtiyah, 2014).But women who have a good knowledge will not necessarily be married at the ideal age, because there are several other factors such as social support and support for families who have a strong influence on the decision of a woman to get married early.This is also reinforced by the theory of Leininger (1991) say that family support is very influential on a person's knowledge.High family support will affect a person's knowledge to be good because there is family support elements in the cognitive support which many families on these elements provide guidance, advice, and counsel.A good knowledge alone is not enough if the family support to get early marriage.
Cultural aspect in the community has a strong influence on early marriage.The result showed the relationship between culture with early marriage.Individuals as social beings can not be separated from the environment in which they live by the norms and customs that are always binding, for example is weddings (Syairwan, 2015).Cultural factors that influence most in this study lies in the values and norms of early marriage developed in the community.This is evident from the respondents' answers when completing the questionnaire almost respondent agree with the prevailing belief is better to early get married than dating.There isi Paradigm miss understanding the religion that is speeding up the wedding to avoid promiscuity and adultery reinforces early marriage.The results also supported by research conducted by Rusiani 2013 obtained the fact that people do because it follows the tradition of early marriage, it is because the tradition is still strong.Community interest did early marriage is influenced by the environment around the dwelling and desires of the individuals themselves.
According to the theory of Leininger's Transcultural Nursing stated that the behavior, values, beliefs and groups based on their individual needs must be taken to ensure that the nursing care provided effective and satisfactory.Culture early marriage in Kara Village community if it continues will be harm in health status, so that health providers as nurses as care giver should seek common cultural restructuring their culture.
Family support have an important role in early marriage.According Desiyanti (2015) mentions the factors that influenced early marriage is the role of parents in this regard have contributed greatly to the decision of child marriage.Parents have the authority to delay the age of marriage.Family support related to early marriage because of family support will influence a child's decision to get married at an early age.According Daryanto (1998) in Firanika (2010) prevailing belief in the family as well as the role of parents in decision-making in the family contributed to the women's age at first marriage.In Undang Undang Pernikahan Chapter II Article 6 confirms that to enter into marriage of a child who has not attained the age of 21 years must obtain permission from both parents.Although it has been allowed to get married, the role of parents are needed to guide, help, and gave permission to all its responsibilities.
Results of research conducted by Rahmawati (2010) showed that the decision to marry can not be separated from the influence of parents or family, within tribe Osing decision making girls to marry much share the parents in it even still exist that all the decisions on the parents so that the child must follow their parents in terms of marriage.
In this study economics associated with early marriage.A person with poor economic conditions were more likely to marry at an early age due to marry soon expected to raise the degree of economic family (Faaulina, 2014).Economic motive behind parents decided to marry off their children in the hope of reducing the financial burden of families because, when his son married the life of the child borne by the husband.The level of the poor economy will encourage early marriage.The results of the study by the Center for Research on population BKKBN in 2011 which stated that the economic factor is the most dominant factor for age at first marriage, especially in rural areas with married then there is help parents to work in the fields in order to harvest more abundant Existing technology in society also influence early marriage.Technology is one of the cultural dimension that can affect a person's health in this case relates to one's perception of the use and utilization of technology to manage health problems (Leininger, 1978).Utilization HP with various features to provide ease in finding information but besides that it also had a negative impact and positive impact.Technological factors associated with early marriage, namely access to the mass media and the press.Data analysis can show that of the respondents at the time of filling the questionnaire majority of respondents answered never get counseling about early marriage and most respondents answered that widespread exposure to sex in the media led to increasingly attract attention to prefer to get married.The mass media is also a factor that affects a person to behave.Access to information obtained indirectly can make them behave over the information acquired .
According Qibtiyah (2014) received information capable of affecting the public mindset.Almost every day the public was treated to the spectacle television that tells the story of early marriage, dating, violence etc.Many spectacle educate but also there needs to be filtered.According Astuty (2013) phenomenon of young age marriages are a phenomenon today is not only influenced by the lack of awareness and knowledge but indirectly influenced by a "role model" from the world of entertainment to watch.

Conclusion
From the result we conclude that factors associated with early marriage is a cultural, family support, economic level, and technology.Knowledge was not significantly assosiated with early marriage.

Recommendation
In relation to the factors related to the early marriage, it is recommended to involve religious leaders and community leaders in an effort to socialize maturation age of marriage.Enhancing the role of health workers in health information and education about early marriage and its impact on the health of unmarried young people in order to prevent early marriage.

Table 1
The correlation between knowledge and early marriage evidence in Kara, Madura