The Correlation of the Perception of Early Detection Cervical Cancer with Attitude to do Visual Inspection with Acetic Acid

Cervical cancer is a malignant tumor that grows in the uterus/ cervix which is the lowest part of the uterine core and is attached to the top of the vagina. The high incidence of cervical cancer in Indonesia is due to a lack of knowledge and perception of women to prevent the development of cervical cancer. The incomprehensive information about IVA test exposure is as the cause of the women didn’t want to do the test. Lack of knowledge about the process of IVA test, feel fear and shame including feeling against to religion principles as the inhibitor factors to do test. The research design used correlational design with a cross-sectional approach. The study population is 30 respondents and the sample consisted of 27 respondents using purposive sampling technique. Data were analyzed using Spearman rank. The research data showed that there was a relationship between the level of perception of mothers about cervical cancer and the attitude of mothers to carry out the IVA test (Visual Inspection with Acetic Acid) p value = 0,000, so the p value = 0,000 <0.05 while r = 0.678. The relationship of perception with attitude shows that more than half of the respondents 66% have a positive perception in early detection of cervical cancer and they are positive about IVA (Visual Inspection with Acetic Acid).


INTRODUCTION
Cervical cancer is the number two cause of death in the world in women. For that reason, early detection of cervical cancer is important for women as a form of anticipation. The IVA method is an alternative for early detection that has been proclaimed by the government for free for WUS. However, the IVA examination participation rate is still very low, around 8.1% (Suwiyoga 2014).
The results of research from Susi (2015) showed all five informants perceived cervical cancer as a malignant disease. They found themselves at risk for cervical cancer as well. Four of 5 informants said they would seek immediate preventive measures, but only two of them had made prevention efforts. One informant who, despite believing cervical cancer as a malignant disease and aware of the risks of this disease, and knowing there were efforts that could be done to avoid cervical cancer stated she would not make any prevention efforts.The high incidence of cervical cancer in Indonesia is due to a lack of perception and awareness of women to prevent the development of cervical cancer. The low level of public perception about the importance of early detection of cervical cancer in Indonesia is largely due to the lack of maturity levels of the community towards cervical cancer and information toward prevention and detection methods. In an effort to fight cervical cancer in the community, many obstacles are encountered. The problem in attempting to examine cervical cancer with the IVA (Visual Inspection with Acetic Acid) test is the reluctance of women to be examined is because they feel shame. Other causes such as uncertainty about the importance of theIVAtest, the negative perceptions about the importance of the IVA test, ignorance at the test, and fear of feeling sick during test. Perception can be obtained from experience that comes from various sources of information so that it can form a belief for someone. This belief will affect one's attitude and this is one of the good factors to get new perception and hopefully can be applied in life.
According the research from Nonik, 2018, that a positive attitude towards early detection of cervical cancer was 96.3%. 80.3% believed that cervical cancer would heal if it was found early.
Taking an IVA test is part of women's reproductive health awareness. Mothers' attitude play important role in the formation of mothers' behavior in IVA examination. It is important to determine attitude aspect of perception, aspects of thinking, beliefs and emotions. From various aspects that mentioned above, the perception factor is one of the factor that plays a role in determining attitudes. In forming an action in this case an IVA examination, a positive attitude is needed because negative perceptions of cervical cancer can affect maternal attitudes toward IVA examination in an effort to prevent cervical cancer (Marmi, 2013) Prevention of cervical cancer is crucial, because of that understanding will arise awareness of the importance of maintaining quality of life and avoiding the dangers of cervical cancer. Early prevention is better because it will spendlower cost. Prevention should not only be done by menopause women who clearly have a greater risk, but young adulthood also necessary.
Based on preliminary studies conducted by researchers at the KIA Polyclinic at the Kepanjen kidul Community Health Center in Blitar City, it was found that there were no clear data regarding cervical cancer, however, the data showed that the number of EFA in 2018 was 22,319 people. Of these, only 70 people took the IVA test. From the results of the examination 1 person tested positive for cervical cancer symptoms and 70% tested positive for STIs. In addition, based on interviews with 7 KIA visitors, all said they did not know about the IVA test and its benefits and did not feel the need for the examination.
In order to find out the relationship between the levelperception of mothers about cervical cancer and the attitude of the mother to do an IVA test (Visual Inspection with Acetic Acid). The specific objectives of this study include: 1) Identifying the level of perception of mothers about cervical cancer. 2) Identifying the attitude of the mother to do the IVA test (Visual Inspection with Acetic Acid). 3) Analyzing the relationship between the level perception of mothers about cervical cancer and the attitude toward IVA tests (Visual Inspection with Acetic Acid).

METHOD
The research method used is a correlational design with cross-sectional approach. The population in this study were all mothers who doing gynecological examinations at the KIA Poly of the Kepanjenkidul Health Center in Blitar City with a total of 30 respondents. Determined by sampling purposive sampling technique, inclusion criteria for the study sample were mothers under the age of 20 consist of 27 respondent. The data was collected at KIA Polyclinic at the Kepanjenkidul Community Health center in Blitar City on January 2019. The instrument used in this research is questionnaire with 30 item. Data analysis technique with spearman rank rho. Analysis of attitude score data shows p value 0,000 where p <0.678 then Ho is rejected. The conclusion of this research is that there is a correlation between the perception of early detection of cervical cancer and the attitude of the mother to do an IVA test.    Table 4 Distribution of characteristics of the number of children

RESULT
The data above shows that majority of respondents have age 25-34 years.
The data above shows that less than half of respondents have high school education.
The data above shows that more than half of respondents are housewives.
The data above shows that more than half of respondents have 1 child.  Table 5 Information distribution The data above shows that more than half of respondents had received about cervical cancer and IVA test.

No
Perceptions f %   The data above shows that majority of respondents have positive attitudes about conducting IVA test

Perception of early detection of cervical cancer and how to prevent it
Based the result on research from Rio and Eunike (2017), mentioned that there are correlation between attitudes, beliefs and early detection of cervical cancer. Knowledge of cervical cancer was mostly in the low category (97.4%). A positive attitude towards early detection of cervical cancer was 96.3%. 80.3% believed that cervical cancer would heal if it was found early. 92.3% respondents didn't do VIA test in the last 3 years. Factors related to early detection of cervical cancer are knowledge (p-value = 0.005). This is line with this research that based on the results of the study, it was found that more than half of respondents around 66% have positive perceptions of early detection of cervical cancer and how to prevent it. The variation in the mothers' level of perception about cervical cancer and how to prevent is caused by the differences in the characteristics of respondents, namely the age difference, which in this study most of the 55.6% of respondents are 25-34 years old, which allows the perception of respondents in sufficient category.
In addition to age factors, there are variations in the level of perception of mothers about cervical cancer and how to prevent it, also due to factors in education level. In this study most of the respondents' education was high school, which was 44.4%. So as to allow most of the perceptions of respondents in sufficient categories. Education also determines the ease with which someone absorbs and understands the perceptions they get. The higher the education of a person, the better the perception. In addition to these two factors, the variation in perception is also caused by the information obtained. In this study almost half of the respondents had received information about cervical cancer and IVA test (Visual Inspection with Acetic Acid) which was 48.1%. They obtained information about cervical cancer and IVA (Visual Inspection with Acetic Acid) tests through mass media such as television, radio, internet or magazines. Perception is strongly influenced by internal factors, namely age and intelligence, and external factors, namely education, experience and environment (mass media and electronic media) are greatly influence the level of one's perception. A good perception about prevention of cervical cancer as a redisposing factor for a woman's attitude and action in preventing cervical cancer, especially in IVA (Visual Inspection with Acetic Acid) are required.
The perception factor that most underlies WUS is not willing to do an IVA test based on the Health Belief Model theory is the perception of obstacles (Perceived Barrier). The greater the inhibiting factor that is felt, the more difficult it is to carry out the test. The perceived obstacle is a potential negative consequence to reduce the desires that arise when taking certain actions in accordance with the HBM theory developed by Glanz, Rimer and Viswanath (Wahyu, 2016) WUS's obstacle perception in conducting IVA tests occurred because of the lack of information obtained by WUS both about the benefits, disadvantages, IVA test process and the impact if not the test. More negative perceptions in WUS's mind in conducting IVA tests, such as pain, if detected pain will become a burden of thought, shame because it is done in a sensitive area and fear will be contrary to religious principles. In addition, the busyness of WUS in working or taking care of children and their households has made the barriers to testing become even greater.

Mother's attitude to conduct IVA examination (Visual Inspection with Acetic Acid)
Based on the results of the study it was found that the attitude of mothers to conduct IVA (Visual Inspection with Acetic Acid) examination showed that almost all (77.8%) had a positive attitude towards IVA examination (Visual Inspection with Acetic Acid). While 22.2% had a negative attitude Attitude is a constellation of cognitive, affective, and conative components that interact in understanding, feeling, and behaving towards an object. Attitude as a certain order in terms of feeling (affection), thought (cognition) and predisposing action someone to an aspect in the surrounding environment. The tendency of the mother's attitude towards the examination of IVA (Visual Inspection with Acetic Acid) varies due to several factors (Azwar, 2011).
The first factor is perception, in determining the attitude aspects of perception, aspects of thinking, beliefs and emotions play an important role. From the various aspects above, perception factors are one of the factors that play a role in determining attitudes. This opinion is not excessive, because perception is one of the main components of an attitude. Once trust is formed, it will become the basis of one's perception of what can be expected from the object of attitude. So the mother 's perception of cervical cancer is very influential in the formation of the mother's attitude towards IVA test (Visual Inspection with Acetic Acid).
In addition to the perception factor, the variation in the attitude of the mother towards the examination of IVA (Visual Inspection with Acetic Acid) was also caused by several sources of attitudes. The first source of attitude is personal experience, namely the experience of information obtained. In this study almost half of all respondents 44.4% had received information about IVA (Visual Inspection with Acetic Acid) so that this become the reason why the attitude of almost half of the respondents is positive.
The results of this study are in line with Wulandari's research (2018), which showed a significant relationship between attitudes and behaviors of IVA examination. The results of this study are not in line with Situmorang et al. (2016), namely the results of statistical tests with Yates Correction (p-value = 0.061) indicate that there is no significant relationship between attitude and behavior of early detection in patients with cervical cancer in RSUP dr. Kariadi Semarang in 2015. The results of this study are also in line with the research of Sri et al (2013) which stated that the tendency of WUS to have a good attitude tended to conduct IVA examinations rather than WUS whose attitude was lacking.
Attitudes can be the result of pleasant or painful experiences with objects of attitude. So the correct information factor about cervical cancer has an impact on the formation of the mother's attitude towards the IVA examination. If the information obtained is accurate, it indirectly affects the cognition element of themothers' attitude of the in the IVA examination.
While other factors that cause variations in attitudes are social influences, namely parents or other people who are considered important, peers and mass media. In this study the source of information (social influence) obtained by respondents varied, thus causing variations in respondents' attitudes. Mothers' attitude towards IVA (Visual Inspection with Acetic Acid) examination is very important for the formation of maternal behavior in IVA examination (Visual Inspection with Acetic Acid). A positive mother's attitude strongly supports future maternal behavior in realizing a good form of behavior in IVA examination (Visual Inspection with Acetic Acid). Attitudes will always influence the behavior of mothers in IVA examination (Visual Inspection with Acetic Acid) this is because attitude is a predisposing factor for a fairly strong behavior. Good perception without being followed by a positive attitude in IVA examination (Visual Inspection with Acetic Acid) then the behavior of IVA (Visual Inspection with Acetic Acid) examination will not be formed.

Relationship between Mother Perception Levels of Cervical Cancer and the Attitude of Mothers to Conduct IVA Tests (Visual Inspection with Acetic Acid)
The relationship of perception with attitude shows that more than half of the respondents 66% have a perception of early detection of cervical cancer and are positive about IVA (Visual Inspection with Acetic Acid). The results of the Spearman Rho test showed a p value = 0,000, so that the p value = 0,000 <0,05 or significant, which means there is a relationship between the level of perception of mothers about cervical cancer and the attitude of mothers to perform IVA tests (Visual Inspection with Acetic Acid). In addition, there is a strong positive relationship between perceptions and attitudes of respondents characterized by a correlation value r = 0.678.
Based on the description, this study shows that the majority of respondents 66% have positive perceptions and positive attitude. This negative attitude towards the examination of IVA (Visual Inspection with Acetic Acid) arises because the respondents stated that they felt it was not important to carry out the examination, in addition, they only conducted an examination if there were complaints. While the positive attitude of respondents will arise if the respondent gets a stimulus or stimulus that is in the form of perception. Respondents who have good perceptions will tend to have a positive attitude. Conversely, respondents who have minimal perceptions tend to be negative. The negative attitude of respondents can result in not wanting to do IVA examination (Visual Inspection with Acetic Acid). This situation will cause respondents to have a greater risk of cervical cancer.
This shows that the attitude of mothers about IVA examination (Visual Inspection with Acetic Acid) has a relationship with the perception of cervical cancer. The existence of the above correlation in accordance with the statement in determining the attitude of an aspect of perception because perception is one of the main components of an attitude. A perception will generate a belief which is the basis for the formation of an idea about the general nature or characteristics of an object of attitude. Once trust is formed, it will become the basis of one's perception of what can be expected from the object of attitude.

CONCLUSION
Most of the respondent have positive level of perception of early detection of cervical cancer.
Most of the mother 's attitude to test IVA (Visual Inspection with Acetic Acid) is positive There is a relationship between the level of perception of mothers about cervical cancer with the attitude of mothers to do IVA (Visual Inspection with Acetic Acid) p value = 0,000, so the p value = 0,000 <0.05 while r = 0.678.

SUGGESTION
It is expected that health workers should be more focus to provide information about cervical cancer and how to prevent it to the community, especially to mothers (married women), which can be done through simple print media (leaflets) or increase counseling in Posyandu, PKK, training, and meetings-routine village meetings involving community leaders, local religious leaders.