Pocket Book as a Media of Health Education to Improve Healthy Behavior in Street Teenagers

Background: Street teenagers generally spend the day on the road, so they are vulnerable to health and psychological disorders. In fact, it is often identified as a community that pays less attention to healthy living behavior. One of the interventions carried out is by carrying out health promotions for street youth. The use of pocket book media can improve practice in the prevention of health problems. Objective: This study aims to analyze the effectiveness of pocket books as a medium of health education to improve healthy behavior in an effort to prevent health problems of street teenagers. Methods: This research is a quasi-experimental research with pre-test and post-test with one group design. The sampling technique was purposive sampling as many as 60 street teenagers. The research was conducted from July-October 2021 on street teenagers who are under the guidance of the Tabayun halfway house (Bogor Regency), the Bina Insan Mandiri halfway house (Depok City) and the Cinta Anak Negri halfway house (Bekasi City). The influence variable in the intervention group is pocket book media, while the affected variable is the behavior of street teenagers towards the prevention of adolescent health problems which includes the knowledge, attitudes, and skills or actions of street teenagers towards the prevention of health problems. The data collection instrument in this study used a questionnaire to measure the behavior of street teenagers. Data analysis was carried out using the paired sample test. Result: Health education with pocket book media can increase knowledge (p=0.000), attitude (p=0.000) and skills (p=0.000) of street teenagers in health prevention. Conclusion: pocket books are effective as an educational media in improving the health behavior of street teenagers.


INTRODUCTION
The phenomenon of street teenagers has been considered as one of the biggest problems in the 21st century. Street teenagers are divided into two groups, firstly those who spend the day on the road but return home at night and those who are completely homeless due to lack of family support and thus spend their lives on the road all day. This results in less supervision and communication as well as protection with families, making them vulnerable to health and psychological disorders. Street teenagers are prone to health problems because the activities they carry out such as being buskers, hawkers or porters in the market cause them to be exposed to a lot of pollution and contamination due to unsanitary environmental conditions [1,2]. Street teenagers are children who are excluded, marginal and alienated from affection, because most of them at a relatively early age have to deal with a harsh and unfriendly city environment. Street teenagers always experience an increase every year. Based on data from the Central Statistics Agency in 2009 the number of street children throughout Indonesia amounted to 230,000 children. In 2010 there were 5.4 million neglected children, 232,000 of whom were street children. Data on street children in Indonesia according to the data and information center of the Ministry of Social Affairs in 2011 amounted to 135,983 children and in 2012 increased again to 230,000 children. Of course, with the increasing number of street teenagers, problems around street teenagers will occur, including in terms of health. Street teenagers are often identified as a community that pays less attention to healthy living behaviors, including those related to personal hygiene [3][4][5][6]. Healthy behavior is important to prevent disease, food contamination and environmental health. Diseases that can be caused due to lack of clean and healthy living behavior include: diarrhea, dengue fever, cholera and others. The results showed that there was a relationship between healthy behavior and diarrhea. Other studies have shown that street teenagers have a relationship with tuberculosis [7][8][9].
Street teenagers face daunting challenges related to their need for food, shelter, and health care. Living in a dangerous environment often causes a lot of harm to the physical health of street children. They are very susceptible to bacterial infections, parasites, respiratory disorders, skin and digestive conditions. In addition, due to early sex initiation and unprotected sex, the prevalence of infectious infections is high [10][11][12]. One of the interventions carried out on this incident was by carrying out health promotions for street teenagers. The delivery of educational materials requires certain educational media. One of the media that can be chosen to educate street teenagers is pocket books [13,14]. Pocket book media are generally widely used in the health promotion process so that the delivery of information is more acceptable to the target because it can foster interest or interest in the target with the content of the message conveyed. Pocket books can be designed simply by using attractive images to improve understanding and strengthen memory of the important information provided. Through pictures accompanied by descriptions, the target can easily understand information that is difficult to explain only in writing because they can see the actual form of information. The positive impact of the use of illustrated pocket books can be seen in the research of Jha et al which shows a change in the knowledge, attitudes and skills of the target after being given an intervention using print media [15][16][17]. The use of pocket book media can improve practice in the prevention of health problems. The pocket book has a small size so that it is practical to carry anywhere and also makes it easier to study at any time and the information contained in it is more detailed [18].

METHODOLOGY
This research is a quasi-experimental research with pretest and posttest with one group design. The sampling technique was purposive sampling as many as 60 street teenagers. The research was conducted from July-October 2021 on street teenagers who were under the guidance of a halfway house including: Tabayun (Bogor Regency), Bina Insan Mandiri (Depok City) and Cinta Anak Negri (Bekasi City). Street youth who were in a halfway house were selected as the intervention group. The selection of the shelter was based on consideration of the potential involvement of the halfway house during and after the study, making it easier to monitor and nurture street youth respondents who still live with their families (children on the street). The Jabodetabek area was chosen because it has high population mobility and is prone to drug abuse, this is the main reason for choosing the research site. The influence variable in the intervention group is pocket book media, while the affected variable is the behavior of street teenagers towards the prevention of adolescent health problems, which includes knowledge, attitudes, and skills or actions of street teenagers towards health prevention. The data collection instrument in this study used a questionnaire to measure the behavior of street teenagers. Data analysis was carried out using the SPSS statistical program, paired sample test to determine the difference before and after the intervention.

RESULT AND DISCUSSION
The proportion of respondents who are male is more than female, namely 40 people (70.0%), most of the respondents are aged 14-16 years, respondents are still in school 46 people (76.7), 47 people work (78.3) and all of them still living with parents 60 people (100%). (Table 1)  Health promotion is any combination of health education and interventions related to economics, politics and organizations, which are designed to facilitate behavioral change and a conducive environment for health. Health promotion is an effort to increase the ability of the community through a learning process from, by for and with the community, so that they can help themselves, as well as develop community-based activities, in accordance with local socio-cultural conditions and supported by health-oriented public policies. Helping yourself means that people are able to behave to prevent health problems and disorders, maintain and improve their health status, and are able to behave to overcome health problems [19][20][21]. The results showed that there were differences in knowledge scores (p=0.000), attitude scores (p=0.000) and skill scores (p=0.006) which were very significant in the before and after measurements with a significance level of 5%, meaning that pocket books are effective as a health education medium. on increasing healthy behavior in an effort to prevent street youth health problems. This research is also relevant to Munawaroh et al's research proving that pocket books are effective in increasing knowledge, attitudes and practices of pregnant women in preventing iron deficiency anemia. The research of Taamu et al. also proves that giving pocket books is effective in increasing knowledge and skills in washing hands [22,23]. Knowledge is one of the factors that influence behavior regarding health prevention. One's knowledge can be obtained through education, experience, social relations (socio-cultural environment), exposure to mass media (access to information) and economics (income). Referring to this aspect, the increased knowledge of street teenagers about the prevention of health problems is obtained from pocket books as a medium that can be used by students to learn independently [24][25][26]. Pocket books as learning media are very good for shaping knowledge and attitudes for street teenagers and print media is the closest medium to them [26]. Printed materials also occupy an important position in health research because they provide clear messages that can be brought home. The material is effective in strengthening the information conveyed orally or if it is used as a medium to convey the information it self.
Skills are the ability to carry out tasks or work using available limbs and work equipment. Skills are a continuation of cognitive (understanding) and affective (actions or behavior) learning outcomes [21]. Maintenance of health behavior that can lead to the formation of skills, namely health prevention skills. The results showed that there was a fairly high skill improvement in the treatment group after being given a pocket book as a stimulus to improve their skills. The use and procurement of media in learning can help provide meaningful experiences for children, the use of media can make children motivated to learn so that they can implement their knowledge through physical activity in the form of skills. Pocket books are one of the alternative media that can improve children's hand washing skills. This is allegedly the effect of the attractive illustrations in the pocket book so that they are interested in trying it or practicing it themselves. If this is done repeatedly it will encourage their ability to wash their hands. Not only being able to do it during the research process but in fact will form consistent behavior in the prevention of health problems.

CONCLUSION
Based on the research results, it can be concluded that pocket books are effective as an educational media in improving the health behavior of street teenagers.