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Choosing intrauterine device of mothers in rural area, Indonesia: Based on Health Belief Model Theory
Aria Aulia Nastiti
Corresponding author
aria.aulia.n@fkp.unair.ac.id

Corresponding author.
, Retnayu Pradanie, Desy Ratna Sari
Maternity and Pediatric Nursing Department, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The IUD is a long-term contraceptive method with a high success rate in the first year of use&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">1</span></a> Data from Nganjuk Health Department shows that contraceptive acceptors have less interest in using a long-term contraceptive method&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a> Women of childbearing age in Nganjuk had low confidence in using the IUD&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The active family planning participants in Indonesia in 2016 was 74&#46;80&#37; of the total of fertile age couples&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">3</span></a> The number of IUD users dropped from 12&#46;65&#37; in 2015 to 10&#46;61&#37; in 2016&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> The number of new family planning participants in 2016 was only 7&#46;23&#37; of the total of fertile age couples&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> In 2017&#44; 14 of the 20 sub-districts in Nganjuk had new IUD users below the target&#46; Wilangan Sub-district has the lowest achievement of new IUD users&#44; which is 20&#46;24&#37; of the target&#46; Ngudikan Village has the lowest new IUD users &#40;0&#46;8&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The family planning program aims to realize a healthy and prosperous Indonesia&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> Current government efforts are to increase the use of long-term contraception&#46; Long-term contraception is felt to be more effective and efficient in preventing pregnancy&#46; The Indonesian government has made various efforts to increase the number of users of long-term contraception&#46; Adequate information about the effectiveness of contraceptive methods can be a consideration to determine the right method for contraceptive users&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">4</span></a> The Health Belief Model Theory can facilitate contraceptive users regarding contraceptive behavior&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The study aimed to analyze factors related to IUD selection in women of childbearing age&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">This descriptive cross-sectional study was conducted between June and July 2018&#46; The sample was 109 mothers&#46; The population in this study was mothers of childbearing age who live with their husbands at Ngudikan Village&#44; Nganjuk&#44; Indonesia&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The sample of this study was 109 mothers that met the inclusion criteria&#46; The inclusion criteria involved the mothers who live with their husbands&#46; The exclusion criteria included the mothers who had early menopause&#46; They had a hysterectomy and a tubectomy&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The data collection tool was a questionnaire regarding sociodemographic characteristics&#46; The sociodemographic characteristics questions were concerning the age&#44; education&#44; duration of the marriage&#44; occupation&#44; and income&#46; The questionnaires were developed by the researchers using items based on the Health Belief Model Theory&#46; While preparing the questionnaire contents&#44; the researchers were assisted by two experienced nurses in the field of maternity nursing&#46; A qualified translator from Indonesia accomplished the translation&#46; Before analyzing the data&#44; the questionnaires were tested for validity and reliability to the 17 mothers who have attended the Integrated Health Service Post &#40;Posyandu&#41; at the Community Health Center in Ngudikan&#44; Nganjuk&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Spearman&#39;s rho values were used to determine the correlation between perceived susceptibility&#44; perceived seriousness&#44; perceived benefits&#44; self-efficacy&#44; cues to action&#44; and mother&#39;s decision in choosing an intrauterine device&#46; Descriptive statistics&#44; including frequencies and percentages&#44; were used to describe sociodemographic characteristics&#44; perceived susceptibility&#44; perceived seriousness&#44; perceived benefits&#44; self-efficacy&#44; and cues to action&#46; In all statistical analysis&#44; <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#44; so it meant that it was considered significant&#46; All of the data were analyzed using the SPSS software&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">6</span></a> This study has passed the review and certification of the Ethical Agreement with no&#46; 944 &#8211; KEPK issued by the Faculty of Nursing University of Airlangga&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Result</span><p id="par0045" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; respectively&#44; shows the results of the descriptive analysis of the variables in which participants&#8217; sociodemographic characteristics were included in this study&#46; Most women &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>79&#44; 72&#37;&#41; were 20&#8211;35 years old&#44; and more than three-quarters of the women &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>86&#44; 79&#37;&#41; were housewives&#46; Half of the women &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>58&#44; 53&#37;&#41; possessed an income below 2 million IDR per month&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the result of the descriptive analysis of the variables regarding the history of the participants&#8217; family planning&#46; Half of women had 2 children &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>55&#44; 51&#37;&#41;&#44; and used the injection &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#44; 55&#37;&#41;&#46; More than three-quarters of women &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>85&#44; 78&#37;&#41; wanted to have 2 children&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> describes the result of descriptive analysis of the variables and the correlation between perceived susceptibility&#44; perceived seriousness&#44; perceived benefits&#44; perceived barriers&#44; self-efficacy&#44; and cues to action and mothers&#8217; decisions in choosing an intrauterine device&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">The results of the analysis show a fairly strong relationship between perceived-susceptibility factors and IUD selection&#46; The results showed that some respondents believed that non-IUDs needed to be routinely used to prevent pregnancy&#46; However&#44; some respondents were not afraid of non-IUD side effects&#46; This can be caused by the mothers&#8217; knowledge and the side effects of a contraceptive method that have been felt&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">There were respondents with high <span class="elsevierStyleItalic">perceived-susceptibility</span> factors&#44; but they did not use an IUD&#46; The number of children and the socioeconomic status level of couples of childbearing age can influence the choice of contraceptive methods&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">8</span></a> Some respondents who had a child are still willing to have more children&#46; According to Gomez&#39;s research&#44; women who wish to get pregnant will tend to choose short-term contraceptive methods&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The results showed that some respondents believed that non-IUDs could cause side effects&#44; such as affecting body weight and milk production&#46; However&#44; respondents are not sure that non-IUD can cause illness and regrets&#46; <span class="elsevierStyleItalic">Perceived-seriousness</span> is formed from health information and individual knowledge about an illness&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> The results showed that some respondents were housewives who spent most of their time at home&#46; This can cause a lack of information about contraceptive methods&#46; According to Khalil&#44; knowledge influences a person&#39;s decision to choose contraceptive methods&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a> Someone chooses contraceptive methods based on their purposes&#44; including regulating fertility&#44; sparing&#44; or ending fertility&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The results showed that some respondents believed that the IUD did not affect breast milk and did not interact with drugs&#46; Some of them also believed that IUD was effective after the insertion&#46; However&#44; some respondents believed that IUD affects comfort when dealing with husbands and affects fertility&#46; The wrong concept of contraceptive side effects influences the decision on contraceptive use&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">11</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">There were respondents with high <span class="elsevierStyleItalic">perceived benefits</span>&#44; but they did not use an IUD&#46; This can be caused by fear of side effects of IUD&#44; fear of infertility after using IUD&#44; and support&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">12</span></a> A comparison of the benefits and constraints of contraceptive methods determines contraceptive use&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> Advice from someone who is more knowledgeable can also influence the choice of contraceptive methods&#46; The motivation from health workers can also influence a person&#39;s decision to choose a contraceptive method that is suitable for her&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">perceived barrier</span> from contraceptive use is a negative impact that may be obtained from the use of contraception&#46;<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">5</span></a> The results showed that respondents felt embarrassed and afraid of the IUD insertion procedure&#44; worried about the side effects of the IUD&#44; and felt that the IUD insertion cost was expensive&#46; This is in line with the previous research that psychology can influence someone in the selection of an IUD&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">14</span></a> Socioeconomic factors and self-perception of health can influence a person&#39;s behavior&#46; Women of childbearing age who have a family income are less likely not to use the IUD&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">15</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Women of childbearing age who have used non-IUD for a long time will have a good perception of non-IUD&#46; The fear and mistrust of women of childbearing age to health workers in the insertion of the IUD can also influence the choice of contraception&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">16</span></a> Women who do not want to get pregnant will tend to choose long-term contraceptive methods&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> Despite encountering several obstacles in the selection of the IUD&#44; the high goals to be achieved can make a person behaves positively to prevent disease&#46; The perception regarding IUD side effects is a natural thing that can also affect the use of IUD&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Perceived self-efficacy</span> is a person&#39;s belief in which the person is able to behave healthily so that he can get the expected results from the actions he has taken&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> The results showed that some respondents felt confident about the information obtained regarding the effectiveness of the IUD&#46; However&#44; some respondents were worried that the IUD would hurt them&#46; Perceived self-efficacy is influenced by information&#44; consideration&#44; and perceived comfort&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> Women of childbearing age who get information and feel confident about using the IUD will be more likely to use an IUD&#46; The motivation of the family to use the IUD can also affect a person&#39;s confidence&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">18</span></a> The experience of people who used the IUD can increase a person&#39;s confidence&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">19</span></a> Respondents who have used non-IUD for years will have higher perceived self-efficacy toward non-IUD&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cues to action</span> are a person&#39;s consideration in using contraception&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">10</span></a> The results of the study showed that some respondents received support from health workers to use the IUD&#46; However&#44; some respondents lacked support from their husbands and families&#46; Pair&#39;s support influences decisions on contraceptive use&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">20</span></a> Support from friends&#44; family&#44; the internet&#44; and health workers can also influence a person&#39;s decision to use contraception&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">13</span></a> Some respondents with high cues to action chose not to use the IUD&#46; The purpose of contraceptive use that could cause this&#46; A person who is not willing to have children will tend to choose a contraceptive method with high effectiveness and long-lasting method&#46;<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">9</span></a> There were respondents with low cues to action&#44; but they used an IUD&#46; The level of education and knowledge can influence a person&#39;s decision to use IUD&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">7</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Perceived susceptibility&#44; perceived seriousness&#44; perceived benefits&#44; perceived barriers&#44; self-efficacy&#44; and cues to action were correlated with mothers&#8217; decisions in use intrauterine devices&#46; Health education should be developed to improve the perceptions of the benefits&#44; to reduce perceptions of the barriers&#44; and to improve the husband&#39;s support to use the intrauterine device for family planning&#46; Educational materials on the intrauterine device should also emphasize the importance of pregnancy spacing and the use of the intrauterine device if people plan long-term planning for pregnancy&#44; but it is not harmful&#46; The authors declare the absence of conflict of interest as regards their present work&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1358807"
          "palabras" => array:4 [
            0 => "Intrauterine device"
            1 => "Health belief model"
            2 => "Contraception"
            3 => "Women"
          ]
        ]
      ]
    ]
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    "resumen" => array:1 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aimed to identify the correlation between perceived susceptibility&#44; perceived seriousness&#44; perceived benefit&#44; self-efficacy&#44; perceived barrier&#44; cues to action&#44; and the choice of using the intrauterine device&#46; A cross-sectional study was carried out to 109 mothers in Ngudikan Village&#46; Data were collected using questionnaires&#46; The data was analyzed using the Spearman Rank correlation with a level of significance <span class="elsevierStyleItalic">&#945;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#46; The result show that there is a correlation between perceived susceptibility &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;436&#41;&#44; perceived seriousness &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;000&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;402&#41;&#44; perceived benefits &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;033&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;204&#41;&#44; perceived barriers &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;00&#44; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#8722;0&#46;614&#41;&#44; perceived self-efficacy &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;008&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;253&#41; and cues to action &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#59; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;261&#41; had a correlation with the choice of intrauterine device in Nganjuk&#44; Indonesia&#46; Perceived susceptibility&#44; perceived seriousness&#44; perceived benefits&#44; self -efficacy&#44; and cues to action will affect the decision of mothers in choosing an intrauterine device&#46; This study recommended further research on a transcultural nursing approach to follow up on the result of this study&#46;</p></span>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Peer-review under responsibility of the scientific committee of the 4th International Conference for Global Health &#40;ICGH&#41; in conjunction with the 7th Asian International Conference in Humanized Health Care &#40;AIC-HHC&#41;&#46; Full-text and the content of it is under responsibility of authors of the article&#46;</p>"
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          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Note</span>&#58; 14&#44;000 IDR equal to 1 US &#36;&#46;</p>"
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;20 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>20&#8211;35 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">27&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;25&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1&#8211;5 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;30&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>6&#8211;10 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;33&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>11&#8211;20 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;29&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;20 years&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;15&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Elementary school&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">&#40;38&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;39&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Factory worker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  """
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        "tipo" => "MULTIMEDIATABLA"
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            "rol" => "short"
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        "titulo" => "Acknowledgements"
        "texto" => "<p id="par0110" class="elsevierStylePara elsevierViewall">The Universitas Airlangga Surabaya supported this study&#46; We thank Puskesmas Wilangan Nganjuk&#44; Indonesia&#44; for permitting us to conduct our research&#46; We appreciate and thank the mothers who participated in this study&#46;</p>"
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Article information
ISSN: 11308621
Original language: English
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es en pt

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