RESEARCH ARTICLE

Copyright © 2017 American Scientific Publishers Advanced Science Letters

All rights reserved
Printed in the United States of America
Vol. 23, 3477–3479, 2017

Effectiveness of Movie to Improve Knowledge,

Attitude and Behavior in Preventing HIV
Transmission from Mother to Child
Sri Widatiningsih∗ , Tuti Sukini, and Siti Rofi’ah
Midwifery School of Magelang, Semarang Health Polytechnic—Central Java, 56102, Indonesia

Background: One of the breakthrough programs for dissemination of HIV/AIDS awareness is a prevention of
Mother To Child Transmission (PMTCT). The promotion program has to be supported by the development of
effective health education media such as a movie. The study was aimed to determine the effectiveness of health
education using movie media upon knowledge, attitude and behavior on PMTCT of HIV/AIDS. Methods: This
study was a pre-experimental study with one group pretest–posttest design. Subjects were 88 pregnant women
registered in the Public Health Center of Parakan, Temanggung Regency, Central Java that were recruited using
purposive-quota sampling. Questionnaire on knowledge and attitude had been proven valid and reliable on
Product Moment Correlation test and Cronbach Alpha test respectively. Wilcoxon Signed Ranks test was applied
with p value of 0.01. Results: There was significant influence of health education using movie media towards
knowledge and attitude regarding PMTCT of HIV/AIDS (p = 0001). However, there was no impact on behavior
IP: 182.255.1.14 On: Wed, 02 May 2018 04:51:49
(p = 0083). Conclusion: Health education through movie media was likely effective to improve knowledge and
Copyright: American Scientific Publishers
attitude towards HIV/AIDS-PMTCT but not for behavioral change.
Delivered by Ingenta
Keywords: PMTCT, HIV/AIDS, Education Using Movie Media.

1. INTRODUCTION
HIV/AIDS has been a global pandemic with harmful effects on
health, and socio-economic. Mother to child transmission is con-
sidered as the majority cause of HIV/AIDS in children. From
2010 to 2014, there were 2.480 people suffered from HIV/AIDS
in Central Java Province. While in Temanggung District there
were 175 HIV/AIDS sufferers. Based on gender, 63 (36%) of
the sufferers were women.1 This condition was very dangerous
due to the risk of mother to child transmission during pregnancy
and birth is high. HIV voluntary counseling and testing (VCT) as
part of Prevention of HIV transmission from mother to child was
clearly shown to be a key entry point for HIV/AIDS prevention,
care and support.
There was no information center for HIV/AIDS in Temang-
gung Regency. The condition led into ignorance about the danger
and prevention of HIV/AIDS among pregnant women.
In order to gain pregnant women’ awareness and combating
the existing problems, a community-based health education is
needed to promote the Prevention of HIV transmission from
mother to child Program. This program needs to be supported
by developed and effective media of health education. Movie is
one of the media which is interesting and entertaining. It had
∗
Author to whom correspondence should be addressed.
been proven that movie was very helpful to increase knowl-
edge and behavior in formal education.2–5 While for pregnant
women, movie was also effective in increasing pregnant women’
knowledge.6
This study was intended to explore the effectiveness of
health education using movie media towards knowledge, atti-
tude, and behavior regarding PMTCT of HIV/AIDS among preg-
nant women in Subdistrict of Parakan-Temanggung-Central Java
Province.
2. METHOD
Pre-experimental design with one group pretest–posttest design
was applied. The study population was 218 pregnant women
within the area of Parakan Public Health Center-Temanggung
Regency during the period of August to September 2015. Sample
size was calculated by Slovin formula, resulted in 141 respon-
dents. After data editing, there were 88 eligible respondents to
be included. Purposive-quota sampling technique was used with
inclusion criteria: pregnant woman, literacy, and no previous
experience of HIV/AIDS-PMTCT health education.
The data collectors were 12 midwives within the area of
Parakan Subdistrict, Temanggung. They all had been exposed to
the movie, and had been trained about inclusion criteria of the
respondents, informed consent, and how to obtain the data.

Adv. Sci. Lett. Vol. 23, No. 4, 2017 1936-6612/2017/23/3477/003 doi:10.1166/asl.2017.9138 3477
RESEARCH ARTICLE Adv. Sci. Lett. 23, 3477–3479, 2017

The movie entitled ‘HIV/AIDS’ with duration of 27 minutes Table II. Pre test and post test knowledge of HIV/AIDS-PMTCT.
was developed by Cilacap Regency Commission of HIV/AIDS Pretest Posttest
Elimination. It was delivered in Bahasa Indonesia, and elaborate
Description n = 88 % n = 88 %
on HIV/AIDS including definition, signs and symptoms, mode
of transmission, prevention/PMTCT, and treatment. Knowledge level:
—Poor 58 65.9 51 58
Questionnaire on knowledge (20 items) and attitude (15 items) —Good 30 34.1 37 42
had been proven valid and reliable on Product Moment Correla- Knowledge score:
tion test and Cronbach Alpha test respectively. Knowledge and —Mean 16.75 17.85
attitude data regarding PMTCT was collected before health edu- —Median 17 18
—Deviation std. 1.690 1.490
cation using movie, and subsequently after the health education.
—Minimum 10 13
Data on behavior was obtained based on respondents report about —Maximum 20 20
their participation in HIV-VCT (Voluntary Counseling and Test- —Variance 2.856 2.219
ing) supported by the evidence of VCT status from local public
health service institutions.
Table III. Knowledge’s change towards HIV/AIDS-PMTCT.
Informed consent was given beforehand as approval evidence
of voluntary participation. Ethical clearance was obtained from Knowledge’s change n % Mean rank
the Ethical Commission of Health Research of Semarang Health Increase (positive ranks) 57 65 39.69
Polytechnic. Decrease (negative ranks) 16 18 27.41
Wilcoxon Signed Ranks test was applied due to the data types Steady (ties) 15 17
Total 88 100
of knowledge and attitude were ratio and both were distributed p value 0.001
abnormally on Kolmogorov-Smirnov test. Behavior data was ordi- z −5.080
nal. The p value of 0.01 was set, with  = 005.
and it was unsupportive if the obtained score was more than and
3. RESULTS equal the median score (Table IV).
The Characteristic of Respondents. Majority respondents were Mostly the respondents’ attitude were supportive towards
25 to 35 year old, their educational level were secondary school PMTCT = 65 out of 88 (73.9%) and at posttest it become 76
(52.3%), and were housewives (73.9%) as shown on Table I. (86.4%). Statistically, there were significant changes on attitude
Pregnant women’ knowledge before and after health education (Table V).
using movie can be referred to Table IP:
II. Level of knowledge As many as 51 (= 58%) respondents experienced an increase
182.255.1.14 On:wasWed, 02 May 2018 04:51:49
categorized as poor if the obtained score <Copyright: in attitude. There was a significant difference of attitude regard-
American
the median score, and Scientific Publishers
good if the obtained score ≥ the median. It can be inferred from bying
Delivered PMTCT (p value = 0.0001, z = −4688).
Ingenta
Respondents’ behavior showed a reverse result as seen on
Table II that there were 58 (65,9%) respondents had poor knowl-
Table VI. There were only 3 out of 88 respondents (3.4%) who
edge on pretest and slightly decrease to 51 (58%) on posttest.
had conducted Voluntary Counseling and Testing (VCT) for HIV
The data was supported by the mild change on Mean, Deviation
after health education by using movie was given. Statistically,
Standard, and Variance of score.
Knowledge’s change category was based on the Wilcoxon
Table IV. Pretest and posttest attitude of HIV/AIDS-PMTCT.
test result where ‘increase’ meant positive ranks, and ‘decrease’
meant negative ranks. As shown on Table III, there was an Pretest Posttest
increase of knowledge for 57 (65%) respondents. There was a Description n = 88 % n = 88 %
significant difference of knowledge before and after health edu- Attitude:
cation using movie (p = 00001 z = −5080), which can be —Supportive 65 73.9 76 86.4
assumed that movie media was effective to improve knowledge. —Unsupportive 23 26.1 12 13.6
Respondents’ attitude towards PMTCT was considered sup- Score:
—Mean 12.74 13.64
portive if the obtained score was less than the median score, —Median 13 14
—Std. Deviation 1.608 1.147
—Minimum 2 7
Table I. Characteristics of the respondents. —Maximum 15 15
—Variance 2.586 1.315
Characteristics n %
Age
—<20 year old or >35 year old 20 22.7 Table V. Attitude’s change towards HIV/AIDS-PMTCT.
—25 to 35 year old 68 77.3
Attitude’s change Freq. % Mean rank
Educational Level
—Secondary school 46 52.3 Increase 51 58 33.87
—High school 35 39.8 (positive ranks)
—Higher education 7 7.9 Decrease 13 15 27.12
Occupation (negative ranks)
—Housewife/unemployed 65 73.9 Steady (ties) 24 27
—Official employee 17 19.3 Total 88 100
—Government employee 4 4.5 p value 0.001
—Farmer 2 2.3 z −4.688

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Adv. Sci. Lett. 23, 3477–3479, 2017
Table VI. Behavior of PMTCT (VCT for HIV).
Description Freq. % Mean rank
Behavior
—Not VCT 85 96.6 2.00
—VCT 3 3.4 0 ing must be taken into consideration. Husband, mother, relatives,
Total 88 100
Reason for not VCT:
—Long distance 5 5.9
—Needles’ fear 9 10.6
—Result’s fear 46 54.1
—No husband’s permission 25 29.4
Total 85 100
there was no significant difference in behavioral of PMTCT as
proven by p value = 0.083. The main reason for not conducting
the HIV-VCT was fear of the result (54.1%).
4. DISCUSSION
Respondents’ knowledge of HIV/AIDS-PMTCT had been proven
increase after health education using movie. Also did in Suher-
tusi’s study among pregnant women, and Taher’s study among
high school students which both had proven that movie was
the best media to gain knowledge compare to leaflet media.6 7
Movie stimulates human auditory and visual to let the message
to be memorized easily. Although as much as 27.41% respon-
dents had a decreased knowledge, however in general it can be
assumed there was a positive impact of health education using
movie media upon knowledge. To improve the movie effective-
ness toward knowledge, it was suggested to combine the movie
with a module exposure.8 A combination of movie and aOn:
IP: 182.255.1.14
brief
module will be very helpful to enhance learning whichAmerican
Copyright:
in turn Scientific
will strengthen the memory. Furthermore, learning byDelivered
a movie bywivesIngenta
needs a set of goals which have to be shared beforehand, so that
the learners will be well prepared to watch the movie in details,
and subsequently followed by a discussion to ensure the audi-
ence’s understanding.9 In this study, the objectives of the health
education was explained, but the huge number of respondents in
the class (88 respondents) might distract the attention, besides
there was no discussion session afterwards.
Generally, there was a significant change in attitude. How-
ever, there were 15% respondents who changed their attitude
from supportive attitude become unsupportive attitude. Addition-
ally, the common practice in the community might change one’s
10 11
attitude. In this case, the respondents became unsupportive
towards HIV/AIDS-PMTCT due to the fact in their community
that it was uncommon and only few pregnant women have VCT
for HIV/AIDS. Moreover, attitude itself is inconsistent in nature,
and influenced by the strength, stability, relevance of attitude,
11
and also influenced by the environmental pressure.
There was a need to integrate the use of several media simulta-
neously to be more effective in attitude modification,12 13 because
every media has different role. Moreover, the importance of
peer teaching has been suggested to be effective in modifying
attitude.13
There was no significant change in behavior as an impact of
health education using movie media. Only 3 out of 88 respon-
dents conducted the Voluntary Counseling and Testing for HIV.
RESEARCH ARTICLE
The main reasons for not doing the VCT were ‘Result’s Fear,’
p-value
and ‘No Husband’s Permission.’ The first reason was related to
fear of stigmatization and isolation as indicated also in a study by
Iliyasu.14 Husband’s and others’ significant role in decision mak-
0.083
and friends were all influence pregnant woman’s behavior.11
There was a need to intensify the HIV/AIDS-PMTCT health
education to the community to be well understood in order to
eliminate stigmatization. Health education for families or hus-
bands about the benefits of VCT for pregnant women will be very
helpful to raise their awareness. There is a need of the high risk
community to have any policy regarding VCT obligation, so that
all pregnant women in the community will obey the obligation
of having VCT without any hesitation.
5. CONCLUSION
Movie media can be implemented to improve knowledge and atti-
tude of HIV/AIDS-PMTCT, but not for behavioral change. It is
suggested to the stakeholders in coordination with all parties to
develop more effective health promotion media that have impact
on behavior. Moreover, the development of a policy regarding
the HIV-VCT for pregnant women in high risk community will
be valuable to change the behavior. It is needed to have further
research with larger sample divided into small classes, using inte-
grated media, and focused on factors interfere with behavior of
HIV/AIDS-PMTCT.
Acknowledgments: We thank to the pregnant women
Wed,in02Parakan
May 2018 for their
04:51:49voluntary participation, the Director of
Semarang Publishers
Health Polytechnic for funding the research, the mid-
and the head of Parakan Public Health Center of Temang-
gung Regency for the extraordinary support.
References and Notes
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2015.
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Teacher Journal 31, e327 (2009).
3. S. Ventura and A. Onsman, Medical Teacher Journal 31, 662 (2009).
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Education 13, 90 (2013).
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(2015).
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Material for Educational Purposes, The Videoaktiv Project (2006).
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Received: 8 October 2016. Revised/Accepted: 1 December 2016.
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