THE PERFORMANCE OF HIGH RESOLUTION NEUTRON POWDER DIFFRACTOMETE

Chronic non-communicable diseases are increasingly affecting people around the world. Based on research conducted by the World Health Organization (WHO) from 2000-2016, there are 4 diseases that cause the highest death in the world, namely cancer, cardiovascular disorders, chronic respiratory disorders, and diabetes. (Rini et al., 2017)

As many or 7 out of 10 deaths in the world are caused by these four diseases. In 2018, cancer was the leading cause of death for around 9.6 million people. Based on data from the Global Burden of Cancer Study (GLOBOCAN), International Agency for Research on Cancer (IARC), it is known that in 2018 there were 18,167,894 new cases of cancer and 9,601,575 cancer deaths worldwide, one of which was caused by cervical cancer. Cervical cancer is the second deadly disease after breast cancer in women. This disease as many as 529,800 in the world in 2008 and 85% occurred in developing countries. The highest incidence rates were in Central and South America, the Caribbean, Africa and South Asia. The lowest incidence rates were in Middle Eastern countries. North America, Australia, China and parts of Western Europe. Cervical cancer became the fourth leading cause of death in women worldwide in 2008, with an estimated 275,100 deaths. Nearly 90% of cervical cancer deaths occurred in various countries, including 53,300 deaths in Africa, 31,700 deaths in Latin America, 159.00 deaths in Asia (Smith et al., 2011). In Indonesia, which has a population of around 220 million, there are around 52 million women who are threatened with cervical cancer. According to pathology-based cancer data in 13 pathology laboratory centers, cervical cancer is a cancer that has the highest number of sufferers in Indonesia, which is approximately 36%. From data from 17 hospitals in Jakarta 1977, cervical cancer ranks first, namely 432 cases among 918 cancers in women.

According to the World Health Organization (WHO), cervical cancer is caused by infection with the HPV (Human Pappiloma Virus) virus that does not heal for a long time. If the immune system is reduced, this infection can become pathogenic and cause cervical cancer. Prior to 1930, cervical cancer was still the main cause of death for women and the cases had dropped dramatically since the introduction of Pap smear screening techniques by Papanicolauo in 1934, there had been much progress so that in the United States and Western Europe, the incidence rate of cervical cancer had decreased.

In 2018 the number of cancer patients visiting hospitals in Indonesia reached 6,511 with the proportion of cervical cancer patients who were outpatients of 16.47% and hospitalizations was 10.9%, besides that more than 80% of cervical cancer cases came to the hospital. in an advanced stage (Antarsih & Kusumastuti, 2019). In the Tangerang

Regency area, data was obtained from the Tangerang Regency Health Office, the number of cervical cancer sufferers in 2017 was 121 and in 2018 there were 148 cases, from 2019 to September there were 153 cases.

Based on the above phenomena and research on the analysis of the influence of competence, knowledge and attitudes of midwives towards the implementation of cervical cancer prevention programs which are currently still limited, the authors are interested in researching this.

Research Methods

This type of research is a quantitative study, with a non-experimental research design. This study used a regressive analytic method with a cross sectional survey research design to determine the effect of Competence, knowledge and attitudes of work midwives with cervical cancer prevention program at Tangerang Hospital. Which was carried out on 44 respondents.

Results and Discussion

A. Characteristics of Respondents

From 44 respondents, it was found that the most respondents had a working period of 1-10 years, namely 26 people (59%) and the most education was a. Diploma III, as many as 30 people (68%). Furthermore, at most 20-35 years old, as many as 29 people (66%)

B. Hypothesis Test Analysis

Hypothesis test is conducted to determine whether the independent variable affects the dependent variable or not. The hypothesis is accepted if the P value <0.005. Hypothesis testing is significant if the P value <0.005.

Based on table 1, the results of the analysis of the hypothesis test show that there is a parisal influence on the characteristics of the knowledge profession and attitudes towards cervical cancer prevention programs, where the significant value is P = 0.000, which is smaller than P = 0.005. Meanwhile, attitude does not have a significant effect on cervical cancer prevention programs where the P value = 0.354.

Discussion

1. The Influence of Midwife Competence on the Implementation of Cervical Cancer Prevention Program.

The results of the calculation of the hypothesis found that the competency variable seen from the aspect of having attended training and had not attended training had a significant influence on the cervical cancer implementation program at the hospital. Based on calculations made by a number of midwives who attended and had not attended the training had a significant impact on the implementation of the cervical cancer prevention program, the number of midwives who had attended the training was 24 out of 44 people who were respondents in this study. The results of the three boxes show that the average value of the implementation of cervical cancer prevention programs at RSU Tangerang is in the good category, besides the age factor of midwives who are on average at a healthy age (20-35 years) can also influence the planning program for cervical cancer prevention, In addition, the average tenure is between 1-10 years. This also affects the implementation of the cervical cancer planning program, where from the results that only 24 people participated in the training, which means that not many midwives have attended the training, because the average age and working period are still very young.

According to Webstre's Ninth New Collegiate Dictionary Competence is the skill of an expert, where an expert is defined as someone who has a certain level of skill or high knowledge in a particular subject gained from training and experience, Cervical cancer is a malignant disease, in this study explains that Competence A good program can help increase knowledge about the importance of cervical cancer prevention. This research has significant results, which means the need for special training in order to run the program in accordance with the SOP that has been set, so that in running the program the midwife is able to run it properly too.

This research is in line with research conducted by (Nurasiah, 2019) which states that there is a significant difference between those who fhave not and have carried out training in carrying out Cervical Cancer Prevention Counseling Services in Kuningan Regency in 2018. Therefore, it is necessary to increase training on cervical cancer for all midwives and other health workers so that the targets to be achieved are in accordance with the standard implementation of cervical cancer prevention programs. The effect of knowledge on the implementation of cervical cancer prevention programs.

2. The Effect of Knowledge on The Implementation of Cervical Cancer Prevention Programs.

The results of hypothesis testing of the knowledge variable on cervical cancer prevention programs have a significant influence. Based on the results of the three boxes, it is known that the average value of the implementation of cervical cancer prevention programs at RSU Tangerang is in the good category. According to (Reber & Reber, 2010) in its collective meaning, knowledge is a collection of information possessed by a particular person or group, or culture. Whereas in general knowledge is the mental components that result from any process, whether born from innate or achieved through experience.

In this study, midwives had good knowledge of cervical cancer prevention programs, which based on the results of hypothesis testing, knowledge was closely related to running cervical cancer prevention programs.

This study is in line with research conducted by (Sidabukke et al., 2017), that knowledge greatly influences behavior in early detection of cervical cancer. Another study conducted by (Susanti et al., 2018) a person's knowledge of certain objects plays a very important role in how that person acts and makes decisions related to reproductive health. In the case of the midwife profession, good knowledge about cervical cancer will make midwives more active in providing this knowledge to patients and the community. In line with this research, (Mirayashi, 2014; Sepa & Rusminingsih, 2015; Septadina, 2015) stated that good knowledge about cervical cancer will be able to increase participation in the prevention of cancer services, namely IVA and Pap smear. (Rochwati et al., 2018) stated that good knowledge of midwives affects the practice of midwives in counseling VIA examinations for women of childbearing age so that the better the knowledge, the more WUS will want to carry out cervical cancer prevention.

Based on the results of the research above, the importance of knowledge for midwives in the implementation of cervical cancer prevention programs, therefore it is necessary to be supported by facilities and infrastructure as well as business information about cervical cancer with television shows that present events about health, especially cervical cancer. The existence of television advertising is also a positive support from the government for women to be aware of reproductive health and facilitate health workers in providing information and counseling.

3. The Influence of Attitudes on the Implementation of Cervical Cancer Prevention Programs

The results of hypothesis testing the attitude variable do not have a significant effect on cervical cancer prevention programs. Based on the results of the three boxes, it is known that the average value of the midwife's attitude about cancer prevention is in the Good Enough category.

In this study, attitude is an important variable in carrying out cervical cancer prevention programs. if the attitude of the midwife is responsive and caring, the cervical cancer prevention program will be implemented so that the implementation of cervical cancer prevention can be educated to patients and to women who are ranged. The influence of midwives' attitudes towards cervical cancer prevention programs at Tangerang General Hospital. The relationship between the level of knowledge about cervical cancer and attitudes towards the Pap smear examination. In this case the attitude has no influence on the cervical cancer prevention program. (Davis & Howden-Chapman, 1996)

It is seen that a positive attitude is needed in providing such important information about cervical cancer prevention. This study also shows that the average working age is 20-35 years old, which means that midwives are still very young and have a working period of 1-10 years. This could be another factor that causes the midwife's attitude is not optimal in providing information to each patient. (Davis & Howden-Chapman, 1996)

4. The Joint Effect of Competence on Midwives Knowledge and Attitude towards Cervical Cancer Prevention Programs

The results of partial hypothesis testing show that there is an influence between professional characteristics, knowledge, and attitudes towards cervical cancer prevention programs. According to Webstre's Ninth New Collegiate Dictionary Competence is the skill of an expert, where an expert is defined as someone who has a certain level of skill or high knowledge in a particular subject gained from training and experience or uterine cervical carcinoma is the growth of abnormal cells in the tissue of the cervix (cervix), where the surface cells (epithelium) are multiplying and changing properties unlike normal cells. The competence of midwives can influence midwives in carrying out cervical cancer prevention programs. This research is in line with research conducted by (Nurasiah, 2019) which states that there is a significant difference between those who have not and have conducted training in running Cervical Cancer Prevention Counseling Services in Kuningan Regency. In a collective sense, knowledge is a collection of information that is owned by a person or group, or a particular culture. This is in accordance with (Susanti et al., 2018) statement that a person's knowledge of certain objects plays a very important role in how that person acts and makes decisions related to reproductive health. In the case of the midwife profession, good knowledge about cervical cancer will make midwives more active in providing this information to patients and the public. Which means that the characteristics of the profession, knowledge and attitudes have a strong influence on cervical cancer planning programs. In this study, attitude is an important variable in carrying out cervical cancer prevention programs. The attitude of the midwife is very important in addressing the problem of cervical cancer, if the attitude of the midwife is responsive and caring, the cervical cancer prevention program will be implemented so that the implementation of cervical cancer prevention can be educated to patients and to women who are ranged. The influence of midwives' attitudes towards cervical cancer prevention programs at Tangerang General Hospital. There is a relationship between the level of knowledge about cervical cancer and attitudes towards the Pap smear examination. In this case, attitudes have an influence on cervical cancer prevention programs. (Davis & Howden-Chapman, 1996)

5. Research Findings

In this section, the researcher will describe and explain all the research findings at the Tangerang General Hospital, which are as follows:

a. A total of 24 midwives have attended training on cervical cancer, out of 44 midwives, and in hypothesis testing, the training conducted has a significant effect on cervical cancer prevention programs.

b. Knowledge has a significant influence in the implementation of cervical cancer programs, but there is still information that is not well known by midwives. From the threebox results, the less known aspects are prevention methods and IVA.

c. Attitude does not have a significant effect on cervical cancer prevention programs.

d. Cervical cancer planning programs have been carried out well by midwives but there are still some that have not been implemented properly.

Conclusion

From the results of hypothesis testing and discussion in this study, several conclusions can be drawn, including the following: There is an influence of competence on cervical cancer planning programs. This means that the competence in question is that there are still many midwives who have not carried out specific training on cervical cancer prevention. So that it has a significant influence when carrying out cervical cancer prevention programs. There is an influence of knowledge on cervical cancer prevention programs. This means that if the midwife has good enough knowledge, the midwife is able to carry out a cervical cancer planning program properly. There is no influence of attitude towards cervical cancer planning program. There is a significant effect simultaneously between the variables of professional characteristics, knowledge and attitudes towards cervical cancer planning programs. This means that if the midwife has sufficient training, sufficient knowledge and good attitude, the midwife is able to carry out a cervical cancer planning program.

Bibliografi

Antarsih, N. R., &Antarsih, N. R., & Kusumastuti, A. (2019). Faktor Determinan Perilaku Pencegahan Primer Kanker Serviks Pada Remaja Putri. Sel Jurnal Penelitian Kesehatan, 6(1), 10–24. Google Scholar

Davis, P., & Howden-Chapman, P. (1996). Translating research findings into health policy. Social Science & Medicine, 43(5), 865–872. Google Scholar

Mirayashi, D. (2014). hubungan antara tingkat pengetahuan tentang kanker serviks dan keikutsertaan melakukan pemeriksaan Inspeksi Visual Asetat di puskesmas Alianyang Pontianak. Jurnal Mahasiswa PSPD FK Universitas Tanjungpura, 1(1). Google Scholar

Nurasiah, A. I. (2018). Pengaruh Pelatihan Keterampilan Konseling Terhadap Sikap Kader Posyandu Dalam Pelayanan Konseling Pencegahan Kanker Serviks Di Kabupaten Kuningan Tahun 2018. Jurnal Ilmiah Bidan, 4(5). Google Scholar

Reber, S. A., & Reber, E. S. (2010). Kamus Psikologi Yogyakarta: Pustaka Pelajar. Google Scholar

Rini, K., Effendy, N., & Masrul, M. (2017). Antenatal Care Satisfaction According To Perspective of Patient and Midwives In Kronjo Public Health Center, Tangerang, Banten 2017. Google Scholar

Rochwati, S., Jati, S. P., & Suryoputro, A. (2018). Pengetahuan Bidan Mempengaruhi Praktik Bidan dalam Konseling Pemeriksaan IVA pada Wanita Usia Subur. Jurnal Promosi Kesehatan Indonesia, 11(2), 84–99. Google Scholar

Sepa, F., & Rusminingsih, R. (2015). Pengaruh Penyuluhan Kanker Serviks terhadap Minat Pemeriksaan PAP Smear Pada Ibu Usia 20-60 Tahun di Dusun Ngangkrik Triharjo Sleman. STIKES’Aisyiyah Yogyakarta. Google Scholar

Septadina, I. S. (2015). Upaya pencegahan kanker serviks melalui peningkatan pengetahuan kesehatan reproduksi wanita dan pemeriksaan metode iva (inspeksi visual asam asetat) di wilayah kerja Puskesmas Kenten Palembang. Jurnal Pengabdian Sriwijaya, 3(1), 222–228. Google Scholar

Sidabukke, I., Sembiring, R., Malan, J. R., USMI, D. P. D.-I. K., & USMI, I. I. I. K. (2017). Faktor-Faktor Yang Berhubungan Dengan Minat Wus Melakukan Deteksi Dini Kanker Leher Rahim Di Puskesmas Tanjung Marulak Kota Tebing Tinggi Tahun 2017. Reproductive Health, 2(2). Google Scholar

Smith, R. A., Cokkinides, V., Brooks, D., Saslow, D., Shah, M., & Brawley, O. W. (2011). Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening. CA: A Cancer Journal for Clinicians, 61(1), 8–30. Google Scholar

Susanti, T. R. I. I., Hikayati, H., & Ningsih, N. (2018). Hubungan Dukungan Keluarga Dengan Kualitas Hidup Pada Pasien Kanker Serviks. Sriwijaya University. Google Scholar

Kusumastuti, A. (2019). Faktor Determinan Perilaku Pencegahan Primer Kanker Serviks Pada Remaja Putri. Sel Jurnal Penelitian Kesehatan, 6(1), 10–24. Google Scholar

Davis, P., & Howden-Chapman, P. (1996). Translating research findings into health policy. Social Science & Medicine, 43(5), 865–872. Google Scholar

Nurasiah, A. I. (2019). Pengaruh Pelatihan Keterampilan Konseling Terhadap Sikap Kader Posyandu Dalam Pelayanan Konseling Pencegahan Kanker Serviks Di Kabupaten Kuningan Tahun 2018. Jurnal Ilmiah Bidan, 4(1). Google Scholar

Reber, S. A., & Reber, E. S. (2010). Kamus Psikologi Yogyakarta: Pustaka Pelajar. Google Scholar

Rini, K., Effendy, N., & Masrul, M. (2017). Antenatal Care Satisfaction According To Perspective of Patient and Midwives In Kronjo Public Health Center, Tangerang, Banten 2017. Google Scholar

Smith, R. A., Cokkinides, V., Brooks, D., Saslow, D., Shah, M., & Brawley, O. W. (2018). Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening. CA: A Cancer Journal for Clinicians, 61(1), 8–30. Google Scholar

No	Variable	B	Coefisein Standard B	P	Information
1	The Influence of Competence on The Cervical Cancer Prevention Program at RSU Tangerang.	0,557	0,092	0,016	H1 Received
2	The Effect of Knowledge of Midwives on Cervical Cancer Prevention Programs at RSU Tangerang	0,215	0,086	0,000	H2 Received
3	Attitude of Midwives Towards Cervical Cancer Prevention Program at Tangerang General Hospital	0.114	0,122	0,354	H3 Rejected
4	The Characteristics of The Knowledge Profession and The Attitude of The Midwives Together on The Cervical Cancer Program at Tangerang General Hospital.	-	-	0,000	H4 Received