The Influence of Sources of Information and the Role of Parents on Vaginal Discharge Prevention Behavior in Adolescent Girls

ABSTRACT


INTRODUCTION
Vaginal discharge is fluid that comes out of the vaginal canal, smells bad or not and itches in the local area.Vaginal discharge can occur pathologically and physiologically.Flour albus or white fluid is a form of vaginal and/or cervical fluid in women.Flour albus is said to be vaginal fluid if it changes color and smells in amounts that are not abnormal.Complaints are accompanied by itching, genital edema, and lower abdominal pain or lower back pain.[1] [2] According to WHO, adolescence is a transition period from childhood to adulthood, in where at that time there was rapid growth, including reproductive function, which influenced developmental changes, both physical, mental and social roles.Adolescent Reproductive Health (KRR) is generally defined as the healthy condition of the reproductive systems, functions and processes of adolescents, namely men and women aged 10-24 years.Adolescents' knowledge of reproductive health is still very low.Only 17.1% of women and 10.4% of men know correctly about the fertile period and the risk of pregnancy, teenage women and men aged 15-24 years who know the possibility of getting pregnant with just one sex each amount to 55 .2% and 52%.Access to correct information about reproductive health is very limited, both from parents, schools and the mass media.[3] One of the diseases experienced by young women due to lack of personal hygiene is vaginal discharge.According to the World Health Organization (WHO), 75% of women in the world have experienced vaginal discharge, while woman Europe experience up to 25% vaginal discharge.The prevalence of leukorrhea (vaginal discharge) in teenagers in South Asia is 70%, in Indonesia, around 90% of women have the potential to experience leukorrhea .[4] Indonesia is in a region with a tropical climate.As a result, fungus can easily grow, often resulting in many cases of vaginal discharge.[5] The problem of vaginal discharge is a problem that has long been a problem for women, not many women know about vaginal discharge and sometimes women take the issue of vaginal discharge lightly.However, vaginal discharge cannot be taken lightly because the consequences are very fatal if not treated quickly.Not only can it cause infertil but vaginal discharge can also be an early symptom of cervical cancer, which can lead to death, vaginal discharge can also stress a person's psyche because vaginal discharge tends to recur and reappear so that Int Jou of PHE  313 it can affect a person both physiologically and psychologically.Conditions like this can be prevented by practicing good vulva hygiene habits, while this habit itself is a behavior that every individual must get used to and accompanied by knowledge, for this reason health workers have an important role in educating the public about the importance of good hygiene to prevent vaginal discharge through counseling.[6] Prevention of vaginal discharge is the same as prevention of other diseases, the most important thing to prevent vaginal discharge is maintaining personal hygiene and vaginal moisture.Wash your hands when cleaning the vaginal area, when bathing, don't clean the vaginal area too much with cleanser or soap, change underwear as often as possible because if it is too damp it can be a source of infection and cause symptoms of vaginal discharge.Get used to knowing your own genitals so that if there is any negligence, it can be handled immediately.[7] Reproductive health problems often occur at various stages of life, especially during adolescence.Adolescence is a period of puberty with an age range of 10-21 years who are still single (not married), during adolescence there is a transition period between childhood and adulthood.It is during this time that physical, psychological and social changes often occur which can cause reproductive health problems.Reproductive health problems often occur in teenagers, especially in young women who often experience vaginal discharge.This is the second most common problem after menstrual disorders.Based on statistical data, in Indonesia there are 23 million people aged 15-24 years.Of this number, 84% have had sexual relations, which means that teenagers who have had sexual relations are likely to experience Premenstrual Syndrome (PMS), a symptom that occurs before menstruation.One of the causes of PMS symptoms is vaginal discharge.Meanwhile, the percentage of teenagers aged 10-24 years who received health education regarding reproductive health was only 29.0%, while those who did not receive counseling was 71.0% .[8] To prevent recurrent vaginal discharge, women must always maintain the cleanliness of their external genital organs.This effort is very important in preventing vaginal discharge and also preventing sexually transmitted diseases (STDs).As is known, you should try to keep the skin in the genital area and surrounding areas clean and dry, because damp/wet skin can cause irritation and make it easier for fungi and disease germs to grow.This condition can be achieved by drying the skin with a towel or tissue when sweating or after defecating, in addition to using clean and dry underwear, avoiding wearing tight clothing and frequently changing sanitary napkins during menstruation.To prevent infection from microorganisms originating from the anus/rectum, it is recommended to clean from the front to the back .[9] [10] Information is data that has been processed and processed so that it can increase a person's knowledge.Information can be obtained directly or indirectly, for example direct information from parents, health workers, teachers at school, the environment and others, while indirect information is obtained from books, advertisements, the internet, mass media and others.The information received by teenagers will influence teenagers' knowledge.This is because knowledge is something that a person believes about an object, so it can be concluded that belief is the basis of a person's knowledge.[11] Information sources are all news or information that a person obtains to get what he is looking for and obtains from all directions.[12] Parents are a family component consisting of father, mother and are the result of a legal marriage bond that can form a family.The task of parents is to educate their children in such a way that the children can behave well, and they are willing to discuss reproductive issues.Negative attitudes from parents towards reproductive organ problems affect children's health status.The role of parents is very important for teenagers so that their health can be maintained, especially the health of reproductive organs.The role and support of parents is a motivation for their children to live healthily.The role and support given by parents to their children greatly influences the child's health status.It is hoped that with the role of parents, teenagers can control themselves so that they live healthy and avoid various diseases of the reproductive organs, especially abnormal vaginal discharge .[13] Based on initial observations, researchers found that 8 out of 10 teenage girls had experienced vaginal discharge and as a result of interviews with 8 teenage girls, information was obtained that they had experienced vaginal discharge that was clear to greenish yellow, smelly, itchy, red and hot around the external genital area.Because of the itching experienced, some even experience irritation in the groin area.Teenager daughter the not enough get information Good from mass media and print media about method cleaning genitalia, using pantyliners and softex, vaginal deodorizer and changing clothes in If wet as well as use pants that are tight and juvenile neither does that get support from parents his in matter take care of women's genitalia.

METHOD
The research design was carried out cross-sectionally using a quantitative approach.The instrument used was a closed questionnaire.This research uses saturated sampling.Saturated sampling is a sample determination technique when all members of the population are used as samples.The sample in this research were all female students at SMA 38 Jakarta.According to the opinion of Hair (1999), Ferdinan (2006), Ghozali (2007): the minimum sample size is 5 times the independent variables/indicators and the maximum sample number is 10 times the independent variables/indicators. [14][15] So, the number of indicators in this research is 9 indicators, so the minimum sample size is 45 female students.and the maximum sample size is 90 female students.Range for the number of samples is 45-90 female students, in this case the researchers took 90 female students as samples.
Data analysis used Univariate Analysis and Structural Equation Model (SEM) with Partial Least Square (PLS).Univariate analysis was carried out with the aim of looking at the characteristics of each exogenous and endogenous variable.Data is presented in the form of a frequency distribution table.Structural Equation Model (SEM) analysis with Partial Least Square (PLS) with the Ouput criteria from PLS which is needed to interpret the Outer Model and Inner Model.Parameter coefficients and T-Statistics with estimated values for path relationships in the construct model must be significant, these values can be refined using the boostraping procedure in SmartPLS processing.Resampling boostrapping if: T-Statistics < T Table with a significant level of 0.05 then is rejected and Ha is accepted (there is a significant relationship) and if: T-Statistics > T Table with a significant level of 0.05 then is rejected and Ha is accepted (there is no relationship meaningful).

Univariate Analysis
Descriptive analysis of respondents is to describe the characteristics of the respondents in this study, namely age.Of the 90 respondents studied, they were seen according to the age grouping of the respondents.The grouping of respondents based on age 15 years was the largest with 44 respondents or 48.9%, the 16year age category was 25 respondents or 27.8% and only 21 respondents or 23.3% in the 14year age category.1 it is known Descriptive analysis of descriptive statistical variables in this research is presented to provide information on the characteristics of research variables, especially regarding range, mean and standard deviation.The range value is the range value between the processed values, namely 6, which can be used using the Struges Formula.The information source variable has a range of respondents' answers between 50-70, close to the theoretical range of 15-75 with a mean value of 61.92 and a standard deviation of 5.900.This indicates that respondents' perceptions tend to consider information sources important at SMA 38 Jakarta.In the parental role variable, the range of respondents' answers was between 48-68, close to the theoretical range of 15-75 with a mean value of 60.92 and a standard deviation of 6.814.This indicates that respondents' perceptions tend to consider information sources important at SMA 38 Jakarta.The behavioral variable range of respondents' answers was between 46-73 with a mean value of 62.01 and a standard deviation of 6.961.This indicates that respondents' perceptions tend to consider the role of parents in SMA 38 Jakarta.

Bivariate Analysis Outer Model Evaluation
The measurement model (Outer Model) describes the relationship between the latent variable and its indicators, also called the outer relationship or measurement model, which describes the characteristics of the latent variable and indicators.[16] The collected data was then processed using the SmartPLS 2.0 program.Following are the output results of the Loading run.

Figure 1. PLS Output (Loading Factors)
From Figure 1 it can be seen that the loading factor value has meet the requirements, namely the loading factor value is greater than 0.5.The results of the outer model evaluation consist of loading factors (convergent validity), discriminant validity, from cross loading and AVE roots, as well as composite reliability values.The results of the data processing analysis above show that each indicator or dimension forming the latent variable shows good results, namely a high loading factor value where each indicator is more than 0.5.

Inner Model Evaluation
Inner Model (Hypothesis Test) to assess R 2 for endogenous latent variables and Parameter Coefficients and T-Statistics.

Figure 2. PLS T-Statistics Test Output
From Figure 2, the value of Q-Square relevance functions to assess the amount of diversity or Chi Square of research data on the phenomenon being studied.The R Square value of Parental Role is 0.230031, meaning that 23% of the midwife's performance variable can be explained by changes in the variable of parental role and information sources.Meanwhile, the R Square value of behavior is 0.586582, which means that 58.7% of the variance in behavior can be explained by changes in the information source variable.Thus, only around 41.3% of the variance in behavior is influenced by changes outside the source of information and the role of parents.Meanwhile, most (77%) changes in parental roles are influenced by factors outside the source of information.Int Jou of PHE  316 From Table 2, evaluation of parameter coefficient values and t-statistics states that information sources have a positive effect on behavior.The test results on the parameter coefficient between information sources on behavior show that there is a positive influence of 0.386, while the T-Statistic value is 3.754 and is significant at α-5%.The T-Statistic value is far above the critical value (1.96).Parental role variables have a positive influence on behavior.The test results on the parameter coefficient between the role of parents on behavior show that there is a positive influence of 0.501, while the T-Statistic value is 2.715 and is significant at α -5%.The T-Statistic value is far above the critical value (1.96).From table 3, it states that information sources have a direct and indirect influence on behavior.The test results of the parameter coefficients between information sources on behavior show a direct influence of 26.5%.Likewise, the parental role variable shows a direct influence of 31.4% on behavior.Meanwhile, for the indirect influence of information sources on behavior through the role of parents, you can transfer the path coefficient (source of information to the role of parents) to the path (role of parents to behavior) to get a value of 31.6%.The T-Statistics values reflected on the variables are mostly > 1.96, thus showing a block of indicators that have a positive and significant influence on reflecting the variables.
Predictive Relevance Value which functions to assess the amount of diversity or variation in research data regarding the phenomenon being studied with an R Square value for behavior of 0.586582 and an R Square for the role of parents of 0.230031.Based on Q value Square above, the common thread can be drawn that the analytical model can explain 70 % diversity of data and being able to study the phenomena used in the research, while 30% is another component that is not in this research.

The Influence of Information Source Variables on the Behavior of Young Women
The results of testing information sources on vaginal discharge prevention behavior in young women showed a statistical T number of 3.754 > 1.96.Thus, the results of this study show the influence of information sources on vaginal discharge prevention behavior in young women.The information source parameters for vaginal discharge prevention behavior in young women are said to be significant.This shows that the source of information is important in preventing vaginal discharge behavior among young women at SMA 38 Jakarta in 2023.
Information can be interpreted as anything that can provide additional knowledge and insight to a person or many people.Information sources are all news or information that a person obtains to get what he is looking for and obtains from all directions.Health promotion media is a channel for conveying health information and because these tools are used to facilitate the reception of health messages for the public or clients.[17] The results of this research are supported by research by Chusnul Tri Rahmawati, Yuli Kusumawati, Zaenal Abidin which states that there is a positive influence between sources of information and behavior with the results of statistical test analysis of 0.753 with a significance value of 0.000 (p < 0.05), a person's exposure to information can change a person's knowledge, attitudes and behavior.[18] Also in line with study Emilia and Leli Nur Fadilah with the results of the study showed that there were significant differences in the variables studied, namely sources of information, maternal support, health services on teenagers' knowledge in dealing with vaginal discharge.[13] This research is also supported by research by Winna Kurnia Sari (2018) which states that, the results of analysis tests there is a significant relationship between partial exposure to information and vaginal discharge in young women at SMAS Pertiwi, Jambi City in 2018.The research results show that many respondents are lacking exposed to information and experiencing discharge.This matter shows that young women have less desire to seek information about the health of their reproductive organs.They don't carry out vulva hygiene in the right way and can cause vaginal discharge.If the more young women are exposed to information about vaginal discharge and vulva hygiene, the greater the chance for young women to avoid abnormal vaginal discharge.[19] The results of this research are in line with research (Handayani, Cahyo, & Indraswari, 2017) that respondents who have good exposure to information, respondents get information from their parents, this shows that there is a tendency for women to think that reproductive health issues regarding vaginal discharge are not taboo.The ability of Int Jou of PHE  317 young women to get information correctly is greater, because parents are a source that can be accounted for.Meanwhile, respondents who had less good information exposure.[20] The availability of information with the development of technology and information has become something that can be accessed by the entire community, including teenagers.A variety of information regarding health and prevention of vaginal discharge can be found in various sources including parents, teachers, health workers, print media and electronic media.By still paying attention to the validity of the information provided .[21] The author believes that the more sources of information that young women get about vaginal discharge, the better the behavior of young women towards preventing vaginal discharge.To improve behavior and better ways of caring for the feminine area, this can be done through outreach, counseling, through print media, other media such as leaflets given to each class to gain useful knowledge for young women so that they can carry out care for the feminine area in the correct way.reduce the incidence of vaginal discharge.

The Influence of Parental Role Variables on the Behavior of Young Women
The results of testing the role of parents in preventing vaginal discharge behavior in young women showed a statistical T number of 2.715 > 1.96.Thus, the results of this study show the influence of the role of parents on vaginal discharge prevention behavior in adolescent girls.The parameters of the role of parents in preventing vaginal discharge behavior in young women are said to be significant.This shows that the role of parents is important in preventing vaginal discharge behavior among young women at SMA 38 Jakarta in 2023.
The family environment, especially the mother, is the source of information that plays the most role in knowledge about personal genital hygiene because a child will learn and adopt pre-existing habits from the family, especially from the mother first.Siblings, peers and teachers are also sources of information for someone to know things about reproductive organs, including genital hygiene.Health services are also a good source of information for teenagers regarding reproductive health.Sometimes teenagers visit health services when they feel sick or have complaints, even though health services can help teenagers and their families obtain information about reproductive health, develop skills in preventing problems and dealing with various problems.[22] This research is in line with research by Winna Kurnia Sari (2018) which states that there is a significant relationship between the role of parents in partial terms and vaginal discharge among young women at SMAS Pertiwi Jambi City in 2018.Parents are a family component consisting of father, mother and are the result of A legal marriage bond can form a family.The task of parents is to educate their children in such a way that the children can behave well, and they are willing to discuss reproductive issues.Negative attitudes from parents towards reproductive organ problems affect children's health status.The role of parents is very important for teenagers so that their health can be maintained, especially the health of reproductive organs.The role and support of parents is a motivation for their children to live healthily.The role and support given by parents to their children greatly influences the child's health status.It is hoped that with the role of parents, teenagers can control themselves so that they live healthy and avoid various diseases of the reproductive organs, especially abnormal vaginal discharge.
The research results were obtained from 88 female students at SMKN 3 Bengkulu city, there were 50 people (56.8%) who were unfavorable, 45 people (51.1%) whose parents did not play a role in preventing vaginal discharge in teenagers, 42 people (47.7%), who have poor behavior in preventing vaginal discharge.There is a significant relationship between the source of information and vaginal discharge prevention behavior among young women at SMKN 3 Bengkulu city with a medium relationship category; (4) There is a significant relationship between the role of parents and vaginal discharge prevention behavior among young women at SMKN 3 Bengkulu city with a moderate relationship category.[23] A role is a task that must be carried out by a person which is related to rights and obligations in accordance with his position in a certain neighborhood or community.The role of parents as the starting point for the self-identification process for adolescents can have an influence on the development of the adolescent's soul.17 Parents are the biological father and biological mother of the child who form a nuclear family.Biologically parents and mothers give birth to children and raise them, while socio-economically parents are directly responsible for nurturing, raising and fulfilling the various physiological and psychological needs of their children which must be protected so that they are safe and prosperous.The responsibility of parents towards their children is to care for (raise and mature) their children from birth, childhood to adolescence, or as long as they are still dependent on their parents, until they begin to be independent when a child is already working and has a family then means that they are absolutely independent and can be separated from parental responsibility.Parents have a big role in providing information about development in teenagers, therefore, parents, especially mothers, are expected to be able to provide emotional support so that teenagers feel comfortable and are not afraid to experience development, especially for teenage girls, namely experiencing their first menstruation (menarche).Knowledge that can be given to teenagers about first menstruation includes knowledge about the biological process of menstruation, emotional support and psychological support.[24] Int Jou of PHE  318 Parental supervision of adolescents and having active interaction with their parents tends to delay or even avoid sexual behavior in adolescents.Meanwhile, teenagers who do not receive parental supervision can have their first sexual intercourse at an earlier age.Parents of teenagers who have unhealthy behavior, such as smoking, these parents tend to have very active and high-risk sexual behavior from a very young age.The role of parents as controllers of children's behavior is needed when teenagers are facing the transition from children to adults, because at this time teenagers are in a condition where their feelings and psychology change easily.[25] The first key in directing education and shaping a child's mentality or behavior lies in the role of the parents, so that whether the behavior is good or bad depends on the character of the parents.Apart from that, parents also provide information to their teenage daughters regarding personal hygiene.Mothers are the most important source of information about menstrual problems and personal hygiene.Mothers can provide simple specific information, for example how often menstruation occurs, how long it lasts or how much blood comes out and how to use sanitary napkins.The role of parents is very necessary to provide information to their daughters about menstruation, so that children can go through menarchea at an early age and maintain their reproductive health.Apart from that, parents are the closest people for children to communicate, especially providing information regarding personal hygiene and parents are also the main educators, the first and last educators for their children.So that children do not receive wrong information regarding reproductive health, the role of parents is highly expected.[24] Adolescent behavior is very vulnerable to environmental influences.On the one hand, teenagers have a strong desire to have social interactions in an effort to gain trust from the environment, while on the other hand they begin to think about life independently and apart from the supervision of parents and school.[26] Parental guidance is a reinforcing factor that plays a role in maintaining behavior.Reinforcing factors include social roles, the role of friends, parents, as well as advice and feedback from health workers regarding the process of development in adolescents.[27] The communication patterns that are built will influence parents' parenting patterns.Children care activities will be successful if the communication patterns created are accompanied by love and affection by positioning children as subjects who must be coached, guided and educated and not as mere objects.Effective communication between parents and teenagers, especially discussing reproductive health, and there is effective interaction between parents and children, especially about vaginal discharge prevention behavior.Parents are the closest people for children to communicate, especially providing information in terms of personal hygiene and parents. is also the main educator, the first and last educator for his children.So that children do not receive wrong information regarding reproductive health, the role of parents is highly expected.[24] The author believes that the better and more active the communication between parents and teenagers is, the better the vaginal discharge prevention behavior in teenage girls will be.The role of parents is very important in the behavior of preventing vaginal discharge in adolescent girls, especially mothers who provide information with effective communication that is acceptable to their adolescent daughters.

CONCLUSION
After analysis in this research, the proposed conceptual model was confirmed with existing theory with a CL of 95%.Thus, the results were obtained in the form of direct and indirect influences between the source of information and the role of parents on vaginal discharge prevention behavior in adolescent girls.The following findings were obtained: there was a direct influence of information sources on vaginal discharge prevention behavior in adolescent girls at SMA 38 Jakarta in 20 23 is 26.5%, there is a direct influence of the role of parents on vaginal discharge prevention behavior among young women at SMA 38 Jakarta in 2023, which is 31.4%.And there is an indirect influence of information sources on vaginal discharge prevention behavior among young women at SMA 38 Jakarta in 2023, which was 31.6%.Based on these findings, this research can conclude that vaginal discharge prevention behavior in adolescent girls will be achieved well if there is a source of information and the role of parents.This shows that the analysis model can explain 70% of the diversity of data and is able to study the phenomena that occur in this research, while 30% is explained by other components that are not in this research.