THE EFFECTIVENESS OF HEALTH EDUCATION TO THE WOMEN’S ATTITUDE IN FACING PRE-MENOPAUSE

Pre-menopause period is a natural thing for women and cannot be ignored or avoid but some women still haven’t learned about it, including changes in Physiology as well as psychic will happen after menopause. This research aimed to know the influence of health education on woman’s attitude towards time of pre-menopause. The research method used preexperiments with design pre-test and post-test one group design. The sample in this research was 31 mothers aged 40-50 years in Polindes desa Pasirharjo kecamatan Talun kabupaten Blitar, which was determined by sampling total sampling technique. Treatment in the form of the granting of health education by lecturing methods lectures. The measurement of the attitude was done before and after the treatment. The instrument used a questionnaire. The data analysis technique used paired sample t-test. The mean value of the results of the study showed the average pre-test of the attitude of average value and 22,8 and flat post-test attitude 24,1. The data analysis showed the value of attitude p score value where p was 0.000 where p 0.046 so Ho was declined. The conclusion of the research was there was an effect of health and education towards women’s attitudes about the pre-menopause in Polindes Desa Pasirharjo Kecamatan Talun Kabupaten Blitar. Based on the results of such research, it is suggested to women who experienced a period of pre menopause, can accept changes to physical and sexual abuse that happened to him at that time with the thought that menopause is a reasonable and positive holds events.


INTRODUCTION
Reproductive health is a state of complete physical, mental, social, physical well-being in all matters relating to women's functions, roles and reproductive systems.Knowledge about reproductive health should be done since adolescence because one will be able to recognize abnormalities in her own reproductive health, especially about menstruation.(Purwoastuti, 2015).The pre-menopausal phase is a phase that begins at age 40 and begins to enter in the climacterium phase.This phase is characterized by irregular menstrual cycles, with prolonged menstrual bleeding and moderate amounts of menstrual blood, and sometimes accompanied by menstrual pain (disminorhea) (Purwoastuti, 2015).
A person's knowledge will affect attitudes toward healthy living behaviors and in tackling the less-understood issues of attitudes in facing menopause.Also in everyday life many women do not understand how to behave to face menopause (Notoatmodjo, 2005).
Based on a preliminary survey conducted by researchers, interviewing 10 mothers in Posyandu Lansia Desa Pasirharjo Kecamatan Talun Kabupaten Blitar, 7 out of 10 interviewees said they already know what pre-menopause is but they still do not know about any changes that will happen during pre-menopause, and some of them said that they were confused in responding to the changes that occur in theirs.Based on the description above, the researchers are interested in taking the title "The Effect Of Health Education Counseling Counseling To The Women's Attitude In Facing Pre Menopause At Polindes Pasirharjo Kecamatan Talun Kabupaten Blitar ".
Based on the background above, the writer can take a formulation of the problem: Is there any effect of health education counseling counseling to the women's attitude in facing pre-menopause at Polindes Pasirharjo Kecamatan Talun Kabupaten Blitar?" The general purpose is to know how the effect of health education counseling counseling to the women's attitude about pre menopause responding to the changes that occur in theirs.Specific objectives are (1) Identify mother's attitude before health education counseling counseling about premenopausal period.(2) Identify mother's attitude after health education counseling counseling about pre-menopausal period.(3) Analyze the effect of health education counseling counseling on women's attitude about pre-menopausal period.
Benefits of this research is a.Theoretically, as an input in midwifery care about the effect of health education counseling counseling for women's attitudes toward pre-menopausal period.b.Practically (a) For Researchers, this research is expected to add insight into the effect of health education counseling counseling to women's attitude about pre-menopause.(b) For the Midwife who stay in village (remote area), this research is expected as an input material in an effort to improve the quality of service, especially about the effect of health education counseling counseling to women's attitude in facing pre-menopausal period.c.For Educational Institution, this research is expected as an additional references, additional insight also information for student to be developed in subsequent research about the effect of health education counseling counseling to women's attitude in facing premenopuse period.d.For Health Service Institution, this research is expected as an input material in giving counseling at elderly posyandu about the effect of health education counseling counseling to women's attitude in facing pre-menopause period.e.For Other Researchers, this research is expected as a source of inspiration to conduct any other research on the effect of health education counseling counseling to the women's attitude in facing pre menopause.

METHOD
The research method used is pre experiment with pre test and post test one group design.The sample in this study were 31 mothers aged 40-50 years in Polindes Desa Pasirharjo Kecamatan Talun Kabupaten Blitar, determined by sampling total sampling technique.Treatment in the form of health education counseling counseling using lecture method.Measurement of attitude is done before and after treatment.Instrument used in this research is questionnaire.Data analysis technique with paired sample t-test.The results showed the average value of pre-test attitudes of 22.8 and the average posttest attitudes 24.1.Analysis of attitude score data shows p value 0,000 where p <0.046 then Ho is rejected.So the conclusion of this research is, there is effect between health education counseling to woman attitude in facing pre-menopause at Polindes Pasirharjo Kecamatan Talun Kabupaten Blitar.The result of attitude analysis from paired t test after giving health education counseling with significant test 0,05 and result of Asymp.Sig = 0.000 this value show result less than 0,05 and before given health education counseling result Asymp.Sig = 0,046.So when viewed from the different value there are differences in attitude before being given health education counseling and after being given health education counseling this means there is an effect of health education counseling on women's attitude in facing pre menopause at Polindes Pasirharjo Talun District Blitar regency.

DISCUSSION
Women's attitude in facing pre-menopause before joining health education counseling.
Result shows that prior to the pre-menopausal health education counseling, respondents who had positive attitudes were 20 people (64.5%) and had negative attitudes of 11 people (35.5%).
From the results of the research, the attitude of respondents before being given health education counseling about the pre menopause shows that some respondent have positive attitude bigger than negative attitude.Negative attitude of respondents shows that respondents support the negative attitude questions with indicator of the number of answers agree and strongly agree, whereas having a positive attitude indicates that respondents reject the negative questions and choose agree and strongly agree with the positive questions.Attitudes that stand out about pre-menopausal before being given a health education counseling include menarch age, it is when a woman get first experience menstruation in a young age, then the menopause will come longer.Health education counseling provided by health workers will increase the knowledge of the mother's insight, especially about the symptoms of pre menopause and attitude in facing the premenopause itself.

Women's attitude after health education counseling about the pre menopause
Research result shows that after giving about pre menopause period, respondents who have positive attitude 24 people (77,6%) and have negative attitude 7 people (22,6%).Based on the above data, shows an increase in attitude where the original percentage of positive attitude before given health education counseling 20 people (65.5%) to 24 people (77.4%).Changes in attitude can occur slowly along with the increasing knowledge, information and experience gained.This is in accordance with Azwar (2011) that the formation of attitudes can be effectd by several factors namely education, experience, effect of others who are considered important, emotional factors and mass media.
Respondents argue that after being given health education counseling they were be more aware of what the pre menopausal period is and how to handle it.In this case health education counseling has a function as a new knowledge or knowledge enhancement, although the intensity of people's acceptance is different.The success of a health education counseling can be effected by extension factors, goals and processes in counseling.Therefore, the most effective lecturing method is used in the delivery so that the respondent can understand the content of the counseling.Extension methods used by researchers is to provide material about the pre menopause with lectures, giving leaflets and also provide souvenirs to respondents to have the spirit in following the counseling.Attitudes of respondents in this study after being given counseling is still negative.
Attitudes of respondents in this study after being given a health education counseling is still negative.One characteristic of attitude is spontaneity, which concerns the extent to which individual readiness to express his/her attitude spontaneously (Azwar, 2011).Provision of health education counseling that only held a few minutes can not grow a positive attitude to the respondents who previously had a negative attitude when the measurement of attitude conducted in this study.To change a person's attitude takes a time.Provision of health education counseling will increase one's understanding about the pre menopause.

The effect of health education counseling on women's attitude about pre-menopausal period
Based on the result shows that before given health education counseling, the percentage of positive attitude is (64,5%) after given health education counseling increased to (77.4%).Prior to health education counseling, the percentage of negative attitudes is (35.5% and after health education counseling decreased to (22.6%).From result of data analysis using Wilcoxon statistic test, got significance value with level 0,046.Thus, between counseling with respondents' attitude have significant effect, but there are (22,6%) of respondents who still have negative attitude after doing this who differ in age, intelligence, and the way how the researchers give the counseling (whether it is understandable or not).
The intelligence of the respondent determines whether or not a person is easy to absorb and understand the knowledge they gain and have a good understanding which can makes he/she can think critically in facing pre-menopause.While the counseling conducted by researchers, it greatly affect the course of research, if counseling given easy to read and understood then respondents want to pay attention to the stimulus given about the pre menopause and research can run as planned.
Based on the above description, it can be concluded that in general, health education counseling to face the pre menopause can improve the attitude of mothers, one way that can be done is health education counseling can be held intensively twice or more.Health education counseling is an attempt to motivate or coordinate goals so that they behave in accordance with the guidance of health values (Notoatmodjo, 2011).The success of a health education counseling can be effected by extension factors, goals and processes in counseling.Good health education counseling will certainly be able to change a person's behavior to do the best for his/her health.
The expected result of this health education counseling is the positive mother's attitude in facing pre menopausal period, so they are not afraid when facing it.In this study most of the mothers' positive attitude in facing pre-menopausal period shows an improvement, there was a small part of the attitude remained no change, but the positive attitude not decreasing in number from before and after being given counseling

Conclusion
Based on research result of health education counseling effect to woman attitude of pre menopause at Polindes Pasirharjo Kecamatan Talun Kabupaten Blitar, hence can be drawn conclusion as follows:Pre-menopausal attitude before giving health education counseling about premenopause period as many as 20 people (64,5%) besikap positive and 11 people (35,5%) to be negative.Mother attitude after health education counseling about pre-period menopause as many as 24 people (77.5%) were positive and 7 people (22.5%) were negative.Health education counseling has an effect on mother attitude evidenced with level of significance 0,046.

Suggestion
Based on the results of research on the effect of health education counseling on women's attitude about the pre menopause in Polindes Pasirharjo Talun District Blitar District, the suggestions that can be conveyed as follows: For researchers is expected to study more in-depth about the differences in health education counseling effect on women's attitude about the pre menopause through a review of literature and research methods better.
For the place of research, it is expected to be able to establish good cooperation between client and health service that can be realized in routine counseling every month about pre-menopause period.For the respondent, it is expected that the public (pre menopausal women) try to increase their knowledge and information through various mass media and newspapers (magazines, newspapers, TV etc) so when pre-menopausal comes, the discomfort and painful inconvenience can be reduced and even eliminated.