INFLUENCE OF HEALTH EDUCATION THROUGH BOOKLET MEDIA ON PUBTER WOMAN KNOWLEDGE ABOUT EXCLUSIVE BREASTFEEDING AT PMB MURNIYATI

As reported by the World Health Organization (WHO), less than half of infants under the age of six months worldwide are exclusively breastfed. The Indonesian Nutrition Status Survey (SSGI) indicates that the prevalence of early breastfeeding initiation was 47.4 percent in 2021 and 58.1 percent in 2022. Additionally, the data for exclusive breastfeeding among infants aged 0-5 months was 52.1 percent in 2021 and 52.2 percent in 2022 (Saragih and Istianah, 2022). The objective of this study is to ascertain the impact of health education on postpartum mothers' knowledge regarding exclusive breastfeeding at PMB Murniyati. This study utilizes a quantitative research design with a quasi-experimental approach and a one-group pretest-posttest model. The sampling technique employed was total sampling, with a sample size of 30 individuals. The instrument utilized was a questionnaire designed to assess knowledge about exclusive breastfeeding. The data were analyzed using the Wilcoxon signed-rank test. The results of the study demonstrated that health education had a significant impact on postpartum mothers' knowledge and skills regarding the correct breastfeeding technique at PMB Murniyati. This was evidenced by a statistically significant difference in the pretest and posttest p-value (p < 0.05). The findings of this study indicate that health education has a significant impact on postpartum mothers' knowledge about exclusive breastfeeding at PMB Murniyati.


INTRODUCTION :
As reported by UNICEF (2018), global data indicates that 95% of infants are breastfed.
Nevertheless, in low-and middle-income countries, the prevalence of never breastfeeding is 4%, or 1 in 25 babies.In 2010, the journal Pediatrics published scientific evidence indicating that approximately 17.2 million breastfeeding mothers worldwide experienced breastfeeding problems, comprising 56.4% nipple blisters, 36.12%breast dams, and 7.5% mastitis (Nuryanti, 2019).These figures suggest that globally, breastfeeding rates remain considerably below the recommended levels.The World Health Assembly (WHA) has established a goal of increasing the global prevalence of exclusive breastfeeding to a minimum of 50% by 2025.(Primapara et al., 2023) From the Indonesian Nutrition Status Survey (SSGI) data, early breastfeeding initiation was 47.4 percent in 2021 and 58.1 percent in 2022.Meanwhile, exclusive breastfeeding data for 0-5 months of age in 2021 was 52.1 percent and in 2022 was 52.2 percent (Saragih & Istianah, 2022).
According to Imaz Iglesia, (2019) problems faced such as placing the baby on the breast when breastfeeding and baby attachment errors often result in breast problems and not optimal milk production.Therefore, the success of breastfeeding can be achieved by providing knowledge to mothers about how to breastfeed babies properly and correctly (Yevita, 2022).
Counseling on exclusive breastfeeding is expected so that postpartum women have a good attitude in providing exclusive breastfeeding because there are various factors that are the reason for the low level of exclusive breastfeeding including knowledge, education, work, culture, socioeconomics, and factors from the mother herself, namely the production of breast milk which is small so that according to the mother it is insufficient to give to her baby (Putri, 2019) One of the efforts that can be made to improve the knowledge of postpartum women about exclusive breastfeeding is to provide health education (Supliyani et al., 2021). .In this study, researchers conducted health education using booklet media, booklets are uniquely and attractively designed, contain a digest of material that is in accordance with the results of research or other sources, and booklets are more dominant in images, and the booklet size is smaller so that it can be carried everywhere (Fitranti, 2018).
Based on the results of a preliminary study at the Independent Midwife Practice (PMB) Murniyati, Amd.Keb, which was conducted on October 14-15, 2023, the results of interviews with 8 postpartum women aged 0-40 days included 5 questions.From the interviews that have been conducted, it is found that 5 out of 8 postpartum women aged 0-40 days have never received health education about exclusive breastfeeding.
The lack of knowledge of mothers about exclusive breastfeeding must be addressed immediately in order to provide adequate breast milk for babies aged 0-6 months.It is therefore of great interest to researchers to investigate the impact of health education on exclusive breastfeeding practices.One such

METHOD :
This study employs a quantitative research approach.In employing a quasi-experimental methodology, the study utilized a one-group pretest-posttest design.Its objective was twofold: to investigate the existence of any cause-and-effect relationship and, if a relationship did exist, to quantify the strength of that relationship.This will be achieved by administering specific treatments to several experimental groups and then determining the impact of health education on knowledge levels.This study was conducted in the work area of PMB Murniyati, Jaten, Karanganyar.The sample in this study was postpartum mothers at PMB Murniyati, the sample in this study was 30 people.This study was conducted in January 2024-March 2024.The research Ethical Clearance was carried out at the Health Ethics Committee of Dr. Moewardi Hospital.With number 542/II/HREC/2024.

Respondent Characteristics
The characteristics of the research participants are outlined in accordance with the following criteria: the participants age, level of education, occupational status, and parity.Tabel 4.1 Frequency distribution based on respondent characteristics at PMB Murniyati Table 4.1 illustrates the demographic frequency distribution of respondents based on age.
The majority of respondents (80%) were mothers aged 21-35 years.In the education category, it is dominated by mothers with high school education as many as 20 respondents (66.7%).In the employment category, it is dominated by mothers with jobs as housewives, namely 16 respondents (53.3%).And in the parity category dominated by multiparous mothers as many as 22 (73.3%).

Category
Frequensy The level of knowledge of postpartum women about exclusive breastfeeding before and after being given health education through booklet media can be seen in the following table Table 4 Based on the results of the Wilcoxon calculation, the z value is obtained at -4.804 with a pvalue of 0.00 which is less than 0.05 so that Ha is accepted, it can be concluded that there is a difference in the level of knowledge of postpartum women before and after being given exclusive breastfeeding health education.

DISCUSSION
Based on the age characteristics of postpartum women, the results showed that the age characteristics of the respondents were mostly in the 21-35 years age category as many as 24 respondents (80%).Ages 21-35 years are included in women of reproductive age (women of childbearing age) in accordance with BKKBN that fertile women are women aged 15-49 years, at this age women have a great opportunity to become pregnant (Prasetyo, 2022).
An individual's level of knowledge is subject to influence from factors such as age, where increasing age affects the increase in knowledge gained.Similar to the statement said by other researchers that the level of knowledge of postpartum women can be influenced by age, the more mature a person's age the wiser in thinking and the more experiences he encounters to gain knowledge (Pasiak et al., 2019) The results demonstrated that the majority of postpartum women had received their education at the high school level, with 20 respondents (66.7%) falling into this category.An individual's educational background has a profound impact on their abilities and knowledge base (Pasiak et al., 2019).
The results demonstrated that the majority of respondents (53.3%) were housewives.The respondents' employment status indicates that the majority of respondents are employed as housewives.
This research is in accordance with the findings of Amin et al., (2016) The results of this study indicate that postpartum women have different levels of knowledge and skill levels to the characteristics of postpartum women.This is influenced by several factors such as postpartum women's age, education, occupation and previous breastfeeding experience.
As evidenced in Table 4.2, the findings of this study indicate that prior to receiving health education on exclusive breastfeeding, the respondents exhibited a range of knowledge levels.Prior to the intervention, the majority of respondents with adequate knowledge were 18 individuals (60%), while the minority of respondents with sufficient knowledge were 12 individuals (40%).
This research is aligned with the findings of Sinta (2017), which revealed that prior to receiving exclusive breastfeeding education through booklets, respondents primarily obtained information about exclusive breastfeeding from health workers.However, the recall of information conveyed by health workers is often limited, particularly given the transient nature of these interactions.Consequently, when completing questionnaires, many breastfeeding mothers may not fully comprehend the significance of exclusive breastfeeding.However, in some cases, mothers who are breastfeeding may also receive motivation, family support, and information about their previous breastfeeding history, which can influence the rate of exclusive breastfeeding in the control group.
Based on table 4.3, the results of this study after being given health education about exclusive breastfeeding, the majority of respondents experienced an increase in knowledgeThe results demonstrated that 100% of respondents exhibited a satisfactory level of knowledge.No respondents demonstrated a sufficient level of knowledge, while no respondents demonstrated a deficient level of knowledge.Following the intervention, 30 individuals (100%) demonstrated a satisfactory level of knowledge, while no respondents exhibited a sufficient or inadequate level of knowledge.
These findings align with those of Rinata, (2017), which demonstrated that the provision of educational booklets on exclusive breastfeeding to the treatment group can enhance maternal knowledge.So that it can affect the mother's behavior in exclusive breastfeeding.Where mothers who have babies aged 0-4 months in the treatment group can still provide exclusive breastfeeding to their babies.
The results of the Wilcoxon test with an error rate of 5%, the p-value significance value is 0.000, so Ha is accepted and Ho is rejected, so it can be concluded that there is an effect of health education with booklet media on postpartum mothers' knowledge about exclusive breastfeeding.The results of (2019), it was found that there was an increase in knowledge and a fairly good attitude of mothers about exclusive breastfeeding after counseling using the Booklet method and simulation method compared to counseling without being given any method (Martín Moreno, 2020).
The acquisition of knowledge is contingent upon the source of the information obtained, with the credibility of the source influencing the depth and breadth of the knowledge gained.The counseling provided in the form of a booklet has been shown to positively impact the knowledge base of pregnant women.According to Fitranti (2018), health counseling is an activity carried out by disseminating messages or information about health and instilling confidence so that the community is aware, understands and wants to carry out a recommendation related to their health program.
This study is consistent with the findings of Sinta (2017), which indicated that prior to receiving exclusive breastfeeding education with booklets, respondents primarily obtained information about exclusive breastfeeding from health workers.However, the recall of information conveyed by health workers was often limited, which may have contributed to the observed lack of understanding about the importance of exclusive breastfeeding among many breastfeeding mothers when they completed the questionnaire.However, sometimes breastfeeding mothers also get motivation, family support and previous breastfeeding history so that it can affect exclusive breastfeeding in the control group.
Information about exclusive breastfeeding is considered necessary to be given counseling using booklet media so that breastfeeding mothers' understanding of exclusive breastfeeding increases and are able to breastfeed or provide breast milk exclusively to their babies after giving birth.A person's knowledge can affect a person's behavior.Breastfeeding mothers with good knowledge can influence exclusive breastfeeding for the baby from the age of 0 to 6 months.

CONCLUSION
The study demonstrated that health education had a significant impact on postpartum mothers' knowledge and skills regarding the correct breastfeeding technique at PMB Murniyati.This was evidenced by a statistically significant difference in the pretest and posttest p-value (p < 0.05).

Table 4
.2 Frequency Distribution of Knowledge Level of Postpartum Mothers Before Being Given Health Education about Exclusive Breastfeeding Using Booklet Media.
Table4.3, the distribution of postpartum mothers' knowledge levels in relation to the topic of exclusive breastfeeding, as conveyed through the medium of a booklet, is represented in a frequency table..4 indicates that the data normality test using the Shapiro-Wilk test yielded results with a pvalue less than 0.05, which supports the conclusion that the data employed in the present study are not normally distributed.Accordingly, the researchers proceeded with the Wilcoxon test.
, which indicate that employment Total status can influence an individual's capacity for knowledge acquisition.Those who are not employed are afforded the same opportunity as those who are to gain knowledge.The results of this study demonstrated that the majority of respondents were multiparous, comprising 22 respondents (73.3%).