Knowledge And Anxiety About The Immunization Effect On Motivation Of Mother Giving Full Basic Immunization

Background : Understanding of mothers about immunization is very necessary because with high knowledge about immunization, it is expected that mothers want to fully immunize their children and not be afraid or anxious. Objective To find out the level of knowledge and anxiety about the effects of immunization on the motivation of mothers to provide complete basic immunization in the UPTD area of Paleleh Health Center, Buol Regency. The design used in the study was cross sectional. Population is all mothers who have babies / toddlers. The sample size was 188 respondents using Purposive Sampling techniques. Independent variables of research are Knowledge and anxiety. The dependent variable is motivation. Data was collected using a questionnaire, then data were analyzed using the Spearman Rho test, with a significance level of α ≤ 0.05. The results showed that more than half of respondents had enough knowledge as many as 99 respondents (52.7%), had mild anxiety as many as 86 respondents (45.7%), had sufficient motivation as much as 82 respondents (43.6%). The results of the study with a <0.05 found that knowledge (p = 0,000) and anxiety (p = 0,000) on motivation with p <a, so it can be concluded that H1 is accepted and H0 is rejected which means that there is a relationship between Knowledge and Anxiety About Immunization Effects Against the Motivation of Mothers Giving Complete Basic Immunization


Introduction
Health services are democratic demands, openness, social and economic status will encourage the community to demand more fair and quality health services. (Azwar, 2012).
The World Health Organization (WHO) takes policy by developing a model that is improving clinical performance for health workers. This model is known as the Clinical Performance Management Development System (SPMKK), applied by Puskesmas and hospitals (Ministry of Health, 2010: 4).
The UNICEF report states that 27 million children under five and 40 million pregnant women throughout the world still have not received routine immunization services, causing more than two million deaths each year. This figure includes 1.4 million children under five who are taken away by their souls (Kadir et al., 2014). Based on the data obtained, Indonesia is one of the 10 countries that are among the highest in the case of nonimmunized children, which is around 1.3 million children (Ismet, 2013).
Health development goals towards a healthy Indonesia in 2025 are to increase awareness, willingness and ability to live healthy for everyone in order to realize the highest degree of public health through the creation of a society, nation and state of Indonesia characterized by people who live with behavior and in a healthy environment. the ability to reach quality services in a fair and equitable manner, and to have the highest degree of health throughout the Republic of Indonesia (Health Sector RPJP 2005-2025. It is estimated that throughout the world, in 2013, 1 in 5 children or about 21.8 million children did not get immunizations that could save their lives. This is due to the lack of supplies of vaccines, access to health services, lack of knowledge of the community and small political and financial support (Ministry of Health, 2015).
In Indonesia, the target of 93% complete basic immunization and village UCI 92% in 2019. In achieving these targets with various types of Indonesian Geographical conditions the Ministry of Health has made efforts to ensure access to immunization services, especially in hard-to-reach areas, guarantee the availability of vaccines, training for Health officials besides the Government have also intensified health promotion programs in order to disseminate information about the importance of immunization (Ministry of Health, 2016 Buol, 2016) Especially in the working area of the UPTD Puskesmas Kec. The number of villages in the UCI village in 2017 was 92%, with a total of 12 villages where 9 villages were UCI and 3 villages were not UCI. Health workers have carried out promotive and preventive efforts, especially in immunization programs. Health services have been carried out regularly / regularly every month according to the schedule of the posyandu that has been established, one of the health services carried out at the Posyandu, namely immunization services, both vaccine and counseling. The outreach schedule is in accordance with the posyandu schedule, before the Vaccine delivery service is carried out, immunization officers provide prior counseling related to immunization. Immunization services are carried out in 12 (twelve) villages in the work area of the Paleleh Health Center UPTD. Apart from that immunization officers also carried out immunization sweeps in this case home visit activities carried out every 3 months, this was done to meet the target immunization coverage that had been set (Immunization Data from Paleleh Health Center, 2016-2017). Based on a preliminary study conducted in January 2018 by interviewing 10 mothers of children under five, it was found that they did not understand and did not understand the functions of HB0, BCG, DPTHB, Polio and Measles Immunization, prospective researchers also looked at recapitulation / immunization lists (books baby cohort) In January 2017 until December 2017, there were 25 infants / toddlers getting immunizations not according to the time of administration, there were 10 babies / toddlers who received incomplete immunizations and there were 6 babies who did not get BCG and Polio I. (Immunization Data Paleleh Health Center, 2016-2017.
The failure to achieve immunization targets to cover all infants in Indonesia, among others, is caused by people's understanding which is still limited in number to immunization, in addition to the lack of infrastructure and the low level of healthy living.
Mother's understanding of immunization is very necessary because with high knowledge about immunization, it is expected that mothers want to fully immunize their children and not be afraid or anxious (Kompas, 2013) Anxiety is a certain condition that is facing uncertain and uncertain situations in terms of their ability to deal with the object is in the form of unpleasant emotions experienced by the individual and not anxiety as inherent in personality (Ghufron et al., 2012). Mother's health beliefs and behavior are also important, because the use of health facilities by babies is closely related to the behavior and beliefs of mothers about health and influences immunization status. (Muhammad Ali, 2012).
In improving the achievement of the UCI coverage of the village health personnel, especially managers of immunization at the UPTD Puskesmas Kec. Paleleh, has carried out routine and continuous health services both preventively and promotively. In particular, immunization services to mothers of babies have been carried out effectively. However the level of maternal visits at the posyandu has not been as expected. So that this affects the achievement of the village UCI Coverage not in accordance with the target. On the basis of the above, the researcher is interested in conducting the study: "Knowledge and Anxiety About the Effects of Immunization on Mother's Motivation Providing Complete Basic Immunization in Workplace UPTD in Puskesmas Paleleh, Buol Regency" Method design used in the study was cross sectional. Population is all mothers who have babies / toddlers. The sample size was 188 respondents usingtechniques Purposive Sampling. Independent variables of research are Knowledge and anxiety. The dependent variable is motivation. Data was collected using a questionnaire, then the data were analyzed using thetest Spearman Rho, with a significance level of α ≤ 0.05.

Results
The results of the study found the characteristics of respondents and displayed in the frequency distribution table below: The results showed that more than half of respondents aged 21-30 years as many as 102 respondents (54.3%). The results showed that more than half of the respondents had high school education as many as 107 respondents (56.9%). The results of the study showed that at most 135 respondents did not work (71.8%). The results of the study showed that more than half of the respondents had sufficient knowledge as many as 99 respondents (52.7%). The results of the study showed that most respondents had mild anxiety as many as 86 respondents (45.7%). The results of the study showed that most respondents had sufficient motivation as many as 82 respondents (43.6%). The results of the study found that most respondents had sufficient knowledge with sufficient motivation as many as 73 respondents (38.8%). The results of the study showed that most respondents had mild anxiety with sufficient motivation as many as 61 respondents (32.4%). The results of the study with a <0.05 found that knowledge (p = 0,000) and anxiety (p = 0,000) on motivation with p <a, so it can be concluded that H1 is accepted and H0 is rejected which means that there is a relationship between Knowledge and Anxiety About Immunization Effects Against the Motivation of Mothers Giving Complete Basic Immunization in the UPTD Working Area of Paleleh Health Center, Kab.

Discussion
The results of the study found that most respondents had sufficient motivation as many as 82 respondents (43.6%). The results showed that most respondents had mild anxiety with sufficient motivation as many as 61 respondents (32.4%). The results of the study showed that at most respondents had sufficient knowledge with sufficient motivation as many as 73 respondents (38.8%).
Motivation is as internal and external resistance in a person indicated by; desires and interests; encouragement and needs; hope and ideals; appreciation and respect (Uno, 2011). Motivation is a will that causes someone to do janh.candle.or.id ~ 65 ~ an action to achieve a certain goal. Motivation comes from the word motive which means "dororngan" or stimulation or "driving force" that is in someone (Weiner, 2011). Immunization as a prevention of preventive efforts that have a positive impact on public health must be carried out continuously, thoroughly, and according to standards so as to be able to break the chain of transmission of disease and cause / increase one's immunity actively against a disease (MOH, 2011). The importance of immunization is based on the idea that disease prevention is the most important effort in maintaining children's health (Supartini, 2012).
Based on the results of the study it was found that most respondents had sufficient motivation as many as 82 respondents (43.6%). The results showed that most respondents had mild anxiety with sufficient motivation as many as 61 respondents (32.4%). The results of the study showed that at most respondents had sufficient knowledge with sufficient motivation as many as 73 respondents (38.8%). In accordance with Puspitaningrum's research (2014) that motivation is important to influence knowledge. Supported by Yustinus RBG (2014) that an important motivation for someone to decide something is to carry out immunization. Factors that influence motivation are Environment, Demands and encouragement development.
Most respondents with motivation have enough age of 21-30 years, have high school education, work in the private sector. This shows that the productive and healthy age for pregnancy increases the motivation for immunization, and the higher the respondent's education, the better the motivation of someone to immunize their child.
The results of the study with a <0.05 found that knowledge (p = 0,000) and anxiety (p = 0,000) on motivation with p <a, so it can be concluded that H1 is accepted and H0 is rejected which means that there is a relationship between Knowledge and Anxiety About Immunization Effects Against the Motivation of Mothers Giving Complete Basic Immunization in the UPTD Working Area of Paleleh Health Center, Kab. Immunization as a prevention of preventive efforts that have a positive impact on public health must be carried out continuously, thoroughly, and according to standards so as to be able to break the chain of transmission of disease and cause / increase one's immunity actively against a disease (MOH, 2011). Good knowledge and lack of anxiety about immunization will support the motivation of respondents to be better.
The importance of immunization is based on the idea that disease prevention is the most important effort in maintaining children's health (Supartini, 2012). immunization is an attempt to actively raise / enhance one's immunity against an illness, so that if one day is exposed to the disease it will not get sick or only experience mild illness (Ministry of Health, 2013). Generally nothing. In some children, it can cause fever and diarrhea, but the case is very small. Usually fever lasts a week. Sometimes there is also a reddish effect like measles for 3 days.
The results showed that there was a relationship between Knowledge and Anxiety About the Effects of Immunization on the Motivation of Mother Giving Complete Basic Immunization in the Work Area of the UPTD of the Paleleh Health Center, Kab. In accordance with the theory that Knowledge makes the formation of associative thinking that connects or intertwines a thought with reality or other thoughts based on experience that is immunization about understanding (Astinah, et al, 2013). Anxiety can affect motivation because Anxiety can change a mood, a change in itself that arises from within without any stimulation fromthe other, namely the information provided or perception. Knowledge and good and lack of anxiety can make an motivationmotivation increasingly good as internal and externalin the respondent.

Conclusion
1. The results of the study found that more than half of the respondents had sufficient knowledge as many as 99 respondents (52.7%). The results of the study found that most respondents had mild anxiety as many as 86 respondents (45.7%). 3. The results of the study found that most respondents had sufficient motivation as many as 82 respondents (43.6%). 4. The results of the study with a <0.05 found that knowledge (p = 0,000) and anxiety (p = 0,000) on motivation with p <a, so it can be concluded that H1 is accepted and H0 is rejected which means that there is a relationship between Knowledge and Anxiety About Immunization Effects Against the Motivation of Mothers Giving Complete Basic Immunization in the UPTD Working Area of Paleleh Health Center, Kab.