Improving knowledge and attitude towards child marriage prevention among senior high school students

ABSTRACT


RESULT
The adolescents' age was [15][16][17][18][19] years. There was an increasing prevalence of good knowledge levels and positive attitudes towards maturing age of marriage after treatment in both groups. There was a significant difference in knowledge level scores and attitudes after being given educational video media. In the pocketbooks group, there was a significant difference in knowledge level.
This research respondents were senior high school students in XI class. The total number of students was 120 students. Respondents' characteristic based on age, gender, family income, parental education, access to social media, and source of information about reproductive health were described in Table 1. The age range in each group was 15-19 years. The age of students in the study was in the adolescent age range. The age range in the experiment group was 15-19 years. The age of students in the control group was 15-18 years. It was in the adolescent age range.
The educational level of the student's fathers in the experiment group and the control group showed that most of them graduated from secondary education (50%). The percentage occupies the highest level of father education in both groups. This can also be seen in the education percentage of students' mothers where secondary education is the highest level of education in both groups (68.3%).
The social media access, almost all of the students access more than four types of social media. Students in this research got information about reproductive health from various sources. Based on the source of information, the majority of the student's received information from more than four sources. The internet was the biggest source of information about reproductive health for adolescents in both groups. A source of information is anything that can be used to convey information from sender to receiver.  The results showed that gender was associated with knowledge level with a p-value of 0.016. The percentage of female students who have good knowledge reaches 80.6%. Male students who have good knowledge were 60.4%. Female students have a higher percentage of having a good level of knowledge. Students who got information about reproductive health from mothers have a higher percentage of having a good level of knowledge. The students who received information from their mothers had a good level of knowledge with a percentage of 78.7%. The provision of reproductive health information by mothers is related to the knowledge level of adolescents about the maturation of marriage age with a p-value of 0.011. Table 2 shows that students' attitudes towards the maturation of age marriage were related to gender and sources of reproductive health information. Student attitudes related to gender (p=0.006). A total of 61.6% of female students have a positive attitude. Meanwhile, only 35.4% of male students have a positive attitude toward the maturation of age marriage. The students who received information about reproductive health from the mass media had a positive attitude with a percentage of 61.1%. The provision of reproductive health information through mass media was also associated with positive attitudes of adolescents. Statistical test results showed p-value=0.042.

Adolescents' knowledge level and attitude towards the maturation of age marriage before and after treatment
The knowledge level and attitudes about the maturation of age marriage in the pretest and post-test of both groups were divided into two categories. The first category for knowledge level was good knowledge level for >76% of rights answers. The second category was poor knowledge level for less than 76% of rights answers. The first category for attitude was the positive attitude for > mean score. The second category was negative attitudes for less than the mean score. Table 3 shows the statistical data about knowledge levels and attitudes before and after being given the treatment of each group. Our finding in Table 3, it can be seen that adolescents in the control group before being treated as much as 78.3% had a level of knowledge in the good category while after being treated with education through pocketbooks, the knowledge level of adolescents in the good category increased by 90%. Based on the attitude assessment, 50% of adolescents before being given treatment had a positive attitude toward the maturation of age marriage. After being given treatment, adolescents who had a positive attitude showed an increase of 58.3%.

The effect of video on adolescents' knowledge level and attitudes about the maturation of age marriage
Differences in the knowledge level and attitudes of adolescents toward the maturation of age marriage before and after treatment were known in this study. The homogenity test was described in Table 4. It was also carried out first for both research groups. Differences in the level of knowledge on the maturation of marriage age were tested with the Wilcoxon test. The distribution of the data was not normal. In the attitude category with normal data distribution, it was tested with a paired sample t-test. The statistical test results can be seen in Table 5. The average score of adolescents' knowledge level at the pretest or before treatment in the experiment group was 79.83 while the average post-test score or after treatment was 87.93. The difference in the average value of the pretest and post-test knowledge levels for the experiment group was 8.10. The results of the statistical test obtained a p-value of 0.000 which indicates that there was a significant difference in the value of the adolescents' knowledge level about the maturation of age marriage between before and after treatment with video media education.
Based on Table 5, the mean score of adolescents' attitudes during the pretest in the experiment group was 79.15 while the mean score increased by 82.56 during the post-test. The difference in the mean pretest and post-test attitude scores for the experiment group was 3.41. Statistical test results obtained a pvalue of 0.006 which indicates that there was a significant difference in attitude values before and after treatment with video media education. The provision of education through videos has an effect on increasing the knowledge and attitudes of adolescents about the maturation of age marriage.
The mean score of the adolescents' knowledge level at the pretest in the control group was 83.12 while the mean post-test score increased to 89.20. The difference in the mean score of the pretest and posttest knowledge levels for the control group was 6.08. The results of the statistical test obtained a p-value of 0.003 which indicates that there was a significant difference in the value of the level of knowledge about the maturation of marriageable age before and after treatment with pocketbooks education. Providing education through pocketbooks has an effect on increasing knowledge about the maturation of age marriage.
Our findings also suggest that the average value of adolescents' attitudes during the pretest in the control group was 81.53 while the average post-test score actually increased by an average of 82.48. The difference in the mean pretest and post-test attitudes for the control group was 0.95. Statistical test results obtained a p-value of 0.314 which indicates that there was no significant difference in the mean score of attitudes toward the maturation of age marriage before and after treatment with pocketbooks.

Factors influencing the adolescents' knowledge level and attitudes about the maturation of age marriage
The variables with p-value<0.25 were analyzed for multivariate analysis. Logistic regression was used for multivariate analysis. The final results of the multivariate analysis were presented in table 6. The final results of the analysis in Table 6 shows that the provision of educational media through videos and the existence of information about reproductive health from mothers affect the knowledge level of adolescents regarding the maturation of age marriage. The source of information from the mother about reproductive health was the dominant factor that affects the knowledge level of adolescents about the maturation of age marriage p=0.006 (OR 3.68; 95% CI 1.435-8.912). Adolescents who were given information by mothers about reproductive health were 3.7 times more likely to have a good knowledge level toward maturing age of marriage. Adolescent gender and the existence of information about reproductive health from the mass media influence adolescents' attitudes regarding the maturation of age marriage.

Respondents' characteristics
The age range in each group was 15-19 years. It was in the adolescent age range. According to the World Health Organization (WHO), adolescence is a phase of change from childhood to adulthood from the 10-19 years. This phase is uniquely related to human development and an essential period for laying the foundation for healthy behavior [12]. The majority of students were females.
The educational level of the student's fathers and mothers in the experiment group and the control group showed that most of them graduated from secondary education. The social media access, almost all of the student access more than four types of social media. Adolescents are active users of social media [13]. Social media is one of the effective media to provide health information but it can also have a negative impact if not controlled [14]. All of the adolescents in experiment group were accessed Instagram. The other media social that was most accessed by adolescents in the experiment group were WhatsApp and YouTube. In the control group, WhatsApp and Instagram were also the most accessed social media.
Students in this research got information about reproductive health from various sources. Based on the source of information, the majority of the students received information from more than four sources. The internet was the biggest source of information about reproductive health for adolescents in both groups. A source of information is anything that can be used to convey information from sender to receiver. Internet and social media are like a double-edged sword, they can be used as access to information but also become an issue of pornography, provocation, unsafe sex, bullying, and other risky behavior if it's done without parental supervision. Social media has a particular effect on sexual behavior in adolescents [14].

Relationship of respondents' characteristics with knowledge level and attitude towards the maturation of age marriage
Gender was associated with knowledge level with a p-value of 0.016. Female students have a higher percentage of having a good level of knowledge (80.6%). This is in line with a study in 2020 that adolescent girls have a good level of knowledge about the maturation of marriage age [15]. Students got information about reproductive health from various sources. Students who got information about reproductive health from mothers have a higher proportion of having a good level of knowledge (78.7%). The provision of reproductive health information by mothers was related to the knowledge level of adolescents about the maturation of marriage age with a p-value of 0.011. Previous research supports the results of this study where the highest communication between parents and children about reproductive health occurs between mothers and children [16]. Mothers with daughters and sons communicate better than fathers with their children.
Mothers who provide information about reproductive health to their child were related to the adolescents' knowledge level about reproductive health, p-value 0.001 [17].
The results showed that students' attitudes towards the maturation of age marriage were related to gender and sources of reproductive health information (p=0.006). Similar research also mentions that there are contrasting attitudes between male and female adolescents about the age of marriage. Females have ambivalence and reluctance to marry young. Females are more concerned that young marriage will thwart their aspirations and ambitions about education and work. Males, with their fantasies want to marry young. Nevertheless, males also have concerns if they are unable to support their families economically [18]. The provision of reproductive health information through mass media was also associated with positive attitudes of adolescents. Statistical test results showed p-value=0.042. Mass media is one of the sources of information that is useful for increasing the knowledge and attitudes of adolescents.

Adolescents' knowledge level and attitude towards the maturation of age marriage before and after treatment
There was increasing coverage of good level knowledge and positive attitudes in the experiment group after being treated with education through video. It also can be seen in the increasing coverage of good level knowledge and positive attitudes in the control group after being treated with pocketbooks. There was an increasing prevalence of good level knowledge and positive attitudes of adolescents about the maturation of age marriage in both groups. Our findings were in line with another study about the effectiveness videos  [19], [20]. Video and pocketbooks can be health promotion media to increase good level of knowledge and positive attitudes on health reproductive education.
In the knowledge questionnaire, almost some respondents still answered incorrectly during the posttest on numbers 2 and 10. A total of 20% of respondents answered incorrectly on number 2. Respondents who answered incorrectly on number 10 reached 30%. Question number 2 relates to regulations and rules for early marriage in Indonesia. Question number 13 regarding the risks of early marriage. Previous research related to the determinants of the maturation of age marriage states that adolescents with knowledge of age should be women giving birth to their first child (AOR=4.930; CI: 4.610-5.272) and adolescents who have knowledge of age should marry males (AOR=3.145; CI: 2.962-3.338) have a better propensity for the planning of marriage age. This proves that the strengthening of regulations and the dangers of early marriage must still be done [21].

The effect of video on adolescents' knowledge level and attitudes about the maturation of age marriage
Knowledge level scores before treatment and after treatment increased. There was a significant difference in the mean score of the adolescents' knowledge level about the maturation of age marriage before and after treatment with video media education (p=0.000). Research by Bond and Ramos on the treatment of educational videos about the health behavior of people living with HIV/AIDS states that 89% of respondents' knowledge increases after being given the video. Respondents rated videos as better for providing health information [22]. Audiovisual media as health promotion media increases adolescents' knowledge level about HIV [23].
Our findings suggest that there was a significant difference in attitude values before and after treatment with video media education with a p-value of 0.006. The provision of education through videos has an effect on increasing the knowledge and attitudes of adolescents about the maturation of age marriage. Video is an audiovisual educational medium that can display image and sound elements simultaneously when communicating with messages or information so that they can reveal an event and object with the actual situation. Audiovisual health education is considered more interesting and understandable. A previous study stated that the video-giving treatment group showed a result of 0.001 meaning that there was a difference in the value of adolescent knowledge and attitudes about the maturation of age marriage during the pretest and post-test [24].
The use of video media facilitates the delivery of information, facilitates understanding of concepts and absorption of material. Video can speed up the process of receiving information in life and influencing one's emotions through the senses. This media also allows individuals to remember 50% of the information seen and heard, so that they can increase knowledge and change attitudes in a positive direction. The other study also found that audio-visual media have a significant role in increasing sexual-reproduction health knowledge among adolescents [25].
The results of the statistical test in the control group's knowledge level obtained a p-value of 0.003 which indicates that there was a significant difference in the value of the level of knowledge about the maturation of marriageable age before and after treatment with pocketbooks education. The results of our study were in line with research by Murtiyarini et al. [26] that there was a significant difference in the mean scores before and after treatment with pocketbooks. Pocketbooks are light and concise information media.
Pocketbooks are able to disseminate information with attractive packaging and appearance so as to make readers pay close attention to their readings. This can increase the reader's knowledge.
The other study about the implementation of the medical research module to the medical student's knowledge stated that there were significant changes in students' knowledge about medical research from before to after the research module implementation [27]. Use of textbook (p=0.12, p<0.001) has a significant effect on academic achievement in the school [28]. From the study above, it can conclude that providing education through pocketbook at school has an effect on increasing knowledge.
Statistical test results obtained a p-value of 0.314 which indicates that there was no significant difference in the mean score of attitudes toward the maturation of age marriage before and after treatment with pocketbooks. The provision of education through pocketbooks has no effect on adolescents' attitudes about the maturation of age marriage. Our finding was in line with a previous study in 2020 that discusses the influence of the media on changes in knowledge and attitudes about free sex in adolescents. The researcher's assumption that there was no effect on providing education through the media because of the ability to absorb different information from each respondent and the lack of intention and willingness of respondents to pay close attention to information from the media [29].

Factors influencing the adolescents' knowledge level and attitudes about the maturation of age marriage
The provision of educational media through videos and the existence of information about reproductive health from mothers affect the knowledge level of adolescents regarding the maturation of age marriage. The source of information from the mother about reproductive health was the dominant factor that affects the knowledge level of adolescents about the maturation of age marriage. Adolescents who were given information by mothers about reproductive health were 3.7 times more likely to have a good knowledge level toward maturing age of marriage. Parents' self-confidence was the most influential factor in reproductive health education for adolescents (OR=3.052, CI=1.534-6.071). Lack of skills to explain the topic of sexuality, lack of knowledge of the material that will be given, and the shame when conveying sexuality material is something that affects parents' self-confidence [30].
During the period of adolescent development, the intensity of communicating with friends increases. Although adolescents can increase their time to spend with friends, the bounding relationship between father and mother with adolescents will help adolescents to increase their self-confidence and self-esteem. There was a positive correlation between parent adolescent communication and self-esteem. Self-esteem is related to self-acceptance which affects the tendency to behave positively [17], [31] Adolescent gender and the existence of information about reproductive health from the mass media influence adolescents' attitudes regarding the maturation of age marriage. Health promotion for adolescents has a significant impact on knowledge, attitudes, and health behavior. Health promotion can use various media to make it easier [32]. Interventions in adolescents regarding the maturation of marriage age prevent child marriage and increase adolescent maturity in deciding to marry [33]. Exposure to reproductive health information through the media, gender, and the functioning of reproductive functions in the family can help adolescents to plan for maturing age at marriage. The method of giving videos is effective to increase the knowledge level and attitudes of adolescents about the maturation of age marriage.

CONCLUSION
There was a significant difference in mean and an increase in the knowledge level and attitudes of adolescents after being given educational video media p<0.05. The method of giving videos is effective to increase the knowledge level and attitudes of adolescents about the maturation of age marriage. Video can be used as an educational medium to improve adolescent reproductive health as the maturing of marriage-age education programs at school. However, the role of the mother and information media also support in increasing adolecents' knowledge and attitudes about the maturation of age marriage. Therefore, the integration of the marriage-age maturation programs is needed to improve it. Our findings can become reference material for the development and improvement of future research.