Factors Affecting the Use of Visual Inspection Acetic Acid Test: Multilevel Analysis on the Contextual Effect of Health Center

Siti Kholifah, Uki Retno Budihastuti, Bhisma Murti

Abstract

Background: Cervical cancer is one of the deadliest diseases that are a major cause of female mor­bidity and mortality in developing countries. This study aimed to determine the effect of health cen­ters on the use of visual inspection acetic acid (VIA) tests using social cognitive theory.

Subjects and Method: This was an analytic observational study with a cross sectional design, conducted at 25 community health centers (Puskesmas) in Surakarta and Karanganyar, Central Ja­va, Indonesia. A sample of 225 married women at reproductive age was selected by random sam­pling. The dependent variable was the use of VIA test. The independent variables at level 1 were intention, self-efficacy, attitude, outcome expectation, imitation, type of contraceptive method, dis­tan­ce to health service, belief, and time to attend health services. Puskesmas was independent va­ri­able at level 2. The data were collected by questionnaire and analyzed by a multilevel logistic regre­s­sion.

Results: The use of VIA tests was positively affected by intention (b= 1.25; 95% CI= 0.30 to -2.13; p= 0.010), attitude (b= 1.25; 95% CI = 0.30 to -2.13; p= 0.010), outcome expectation (b= 0.86; 95% CI= -0.89 to -0.19; p= 0.076), imitation (b= 1.58; 95% CI= 0.62 to 2.54; p= 0.001), intra ute­ri­ne device (b= 1.55; 95% CI= 0.65 to 2.45; p= 0.001), distance (b= 1.39; 95% CI= 0.44 to 2.34; p = 0.004), self-efficacy (b= 1.11; 95% CI= 0.26 to 1.97; p= 0.011), trust in health service (b= 1.84; 95% CI= 0.87 to 2.81; p <0.001), and spare time to attend health center (b = 0.76; 95% CI = -0.11 to 1.64; p= 0.090). Puskesmas accreditation status had contextual effect on the use of VIA tests with ICC= 30.68%.

Conclusion: The use of VIA tests was positively affected by intention, attitude, outcome expec­ta­tion, imitation, intrauterine device, distance, self-efficacy, trust in health service, and spare time to attend health center. Puskesmas accreditation status had contextual effect on the use of VIA tests.

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

Correspondence: Siti Kholifah. Masters Program in Public Heath, Universitas Sebelas Maret, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: olifkholifah53@gmail.com. Mobile: 081575644051.

Journal of Health Promotion and Behavior (2019), 4(1): 1-11
https://doi.org/10.26911/thejhpb.2019.04.01.01

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