IJNMS

Updated: October 3th, 2020

THE INFLUENCE OF CERVICAL CANCER HEALTH EDUCATION ON MOTIVATION

FOR IVA EXAMINATION: A LITERATURE REVIEW

Raina Resty Ramadhani 1), Noer Saudah 2) , Catur Prasastia Lukita Dewi3)
1)
Undergraduate Student of Nursing of Bina Sehat PPNI Mojokerto Health Sciences College
2)
Lecturer of Nursing of Bina Sehat PPNI Mojokerto Health Sciences College
3)
Lecturer of Nursing of Bina Sehat PPNI Mojokerto Health Sciences College

ABSTRACT Keywords
Cervical cancer was the second highest cause of death in women in the world health
after breast cancer and was a leading cause of death in women in developing countries. education,
Motivation for screening was very important so that women were woulding to detect it motivation, IVA
early, but there were still many Women of Childbearing Age who were not motivated to
take IVA tests, so that efforts were needed to increase motivation to do IVA through
health education. This study aims to determine the effect of cervical cancer health
education on the motivation of conducting an IVA examination. The study design uses a
literature review. Data collection procedures using organize, synthesize, identify, and
formulate. The journals studied were 10 journals taken from the Garuda Portal, Google
Scholar and NCBI using the keyword counseling motivational visual inspection of acetic
acid. The time span used was the 2016-2020 issue of the journal. Journal review results
suggested that before being given health education, Women of Childbearing Age
motivation in conducting IVA examination tends to be classified as moderate or sufficient,
and after being given health education to be high or good, so there was an effect of health
education on Women of Childbearing Age motivation for IVA examination as evidenced
by an increase in motivation scores. The conclusion that could be drawn was that health
education about cervical cancer could increase motivation to do an IVA examination.
Health workers were expected to carry out IVA examinations by picking up the ball or
approaching the target, so as to increase Women of Childbearing Age participation in
conducting IVA examinations.

BACKGROUND
Cervical cancer that attacks the cervical area was the second leading cause of death in women in the
world after breast cancer and was the leading cause of death for women in developing countries. Cervical
cancer was one of the main reproductive health problems in women in Indonesia (Pakkan, 2017). Cancer
control programs were carried out through early detection and management carried out at the Puskesmas and
referrals to hospitals. Early detection of cervical cancer using the Visual Inspection method with Acetic Acid
(IVA) and cryotherapy for positive IVA (pre-cervical cancer lesions) (Kemenkes RI, 2013). Motivation to do
screening was very important so that women were woulding to do early detection (Safa'ah, 2010). There
were still many women women who were not motivated to take the IVA test, this was because they were
embarrassed, do not feel symptoms, were afraid if they find out that they had cervical cancer, and the
examination was sick (Suarniti, 2012). This causes many cases of cervical cancer to be found in an advanced
stage, which in the end cannot be saved (Hesty, Rahmah, & Nurfitriani, 2019).
WHO data suggested that in 2018, cervical cancer was the fourth most frequent cancer in women
with an estimated 570,000 new cases in 2018 representing 6.6% of all female cancers, and in 2019 it had
caused 212.960 female deaths (WHO, 2019) . Indonesian health data and information in 2018 recorded that
the target number of IVA examinations was 37.415.483 people, but only 2.747.662 people did the
examination so that the coverage of IVA examinations was only 7.34%, while in East Java Province the
target number of IVA examinations was 6,012. 729 people and those who followed the IVA examination
were 511.128 people (8.5%). This suggested that the IVA examination was still very low. The results of
early detection of cervical and breast cancer in Indonesia, where in 2018 77.969 positive IVAs were found,
while in East Java there were 18.515 positive IVAs (Kemenkes RI, 2019). The Health Profile of Mojokerto
Regency states that in 2017, the target number was 178.946. The coverage of cervical examinations at the
Mojokerto District Health Center in 2017 was 4.419 (2.47%), the number of positive IVAs was 145 people,
and the most was in Jatirejo with 20 positive IVA people (Mojokerto Regency Health Office, 2018).
The results of Pakkan's research (2017) in Lepo-Lepo Urban Village, Kendari City in 2014
suggested that 52% of Women of Childbearing Ages had less motivation to perform IVA examinations, and
45.8% of Women of Childbearing Ages had sufficient motivation to carry out IVA examinations. The results
of a preliminary study at the Dharma Wanita Association of the Ministry of Religion of the Republic of
Indonesia, Mojokerto Regency on November 18, 2019 suggested that an IVA examination was carried out in
2017 at the Tawangsari Trowulan Puskesmas, participants who participated were 108 members of Dharma
Wanita, the results suggested 2 positive IVA and a follow-up plan had been carried out in the form of
cryotherapy. There had not been any further IVA examinations to date. The results of interviews with 5
mothers suggested that 3 people (60%) had no internal motivation to do an IVA examination, and 2 people
(40%) had a strong urge to take an IVA examination.
The implementation of IVA examinations was influenced by various factors, namely attitudes,
education levels, knowledge levels, the role of cadres, health education and family member support. Factors
of knowledge, attitudes, affordability of distance, exposure to information / mass media, support from
husbands, support from health workers and support from cadres, beliefs, habits, wouldingness, and
motivation (Wulandari et al., 2016). The low motivation to do IVA was the lack of knowledge in efforts to
prevent cervical cancer. The better the mother's knowledge, the better the mother's motivation to participate
in preventive action (early detection with the Acetic Acid Viasul Inspection (IVA) test method. Women of
Childbearing Age was not motivated to carry out the inspection of Acetic Acid Viasul Inspection (IVA)
because of fear / embarrassment of the diagnosis. which the doctor said (Use 2017).
Primary prevention of cervical cancer was carried out through controlling risk factors and improving
communication, information and education. Secondary prevention was carried out through early detection
and management carried out at the Puskesmas and referral to the hospital. Early detection of cervical cancer
using the IVA method and cryotherapy for positive IVA (pre-cervical cancer lesions). Tertiary prevention
could be done by rehalibitative ways, palliative treatment, and the formation of cancer survivors (Ministry of
Health, 2013). Motivation plays an important role in survivors' survival because it would raise optimism and
life expectancy against the threat of death (Dumontier et al., 2017).
Based on this background, researchers were interested in researching the effect of cervical cancer
health education on motivation to perform IVA examinations

RESEARCH METHODS
The research design used a literature review. Data collection procedures used organize, synthesize, identify,
and formulate. As many as 10 journals were reviewed, taken from Google Scholar and Garuda Portal using
the keywords "" health education "and" motivation to do IVA ". The time span used was the 2016-2020
published journals.
Table 1. Inclusion and Exclusion Criteria with PICOS Format
Criteria Inclusion Exclusion
Population National and national journals related to National and national journals that
research topics, namely motivation to examine attitudes, knowledge, interests,
perform visual inspection of acetic acid or behaviors to perform visual
information on acetic acid
Intervention Health education on motivation to Knowledge, attitude, participation IVA
perform visual inspection of acetic acid,
and other factors that influence motivation
to perform visual inspection of acetic acid
Comparation No comparation No comparation
Outcomes There was an effect of health education on There was no effect of health education
motivation to perform visual inspection of on motivation to perform visual
acetic acid inspection of acetic acid
Study design Descriptive, correlation analytic, Literature review, qualitative study
experimental
Years old 2016 and above Before 2016
terbit
Bahasa Indonesian and English Apart from Indonesia and England
RESULTS
1. Characteristics of women of childbearing age
a. Age of women of childbearing age
The results of the study (Hartati et al., 2015) and (Agustin & Fauziyah, 2017) regarding the age of
women who were pregnant women in the motivation to perform IVA examinations were as follows:
Table 1 Distribution of Women of Childbearing Age Age Frequency
Researcher (Hartati et al., 2015) (Agustin & Fauziyah, 2017)
Age f % % %
< 20 years old 1 1.8 0 0
20-35 years old 34 61.8 19 52.8
>35 years old 20 36.4 17 47.2
Total 55 100 36 100

The table above suggested that according to the results of the study (Hartati et al., 2015) that most
(61.8%) of the Women of Childbearing Age studied were 20-35 years old. This was reinforced by
research (Agustin & Fauziyah, 2017) where most (52.8%) of the Women of Childbearing Age
studied were 20-35 years old.
b. Education Women of Childbearing Age
The results of research (Chrystianty et al., 2018) and (Jumaida et al., 2020) regarding the Education
Women of Childbearing Age in the motivation to carry out IVA examinations were as follows:
Table 2 Frequency Distribution of Education Women of Childbearing Age
Researcher (Chrystianty et al., 2018) (Jumaida et al., 2020)
Education f % f %
Elementary 11 11.8 5 12.9
Junior High School 33 35.1 19 48.6
High School 43 45.7 14 35.9
Bachelor 7 7.4 1 2.6
Total 94 100 39 100

The table above suggested the results of the study (Chrystianty et al., 2018) that almost half (45.7%)
of the Women of Childbearing Age studied were high school education, while the results of the
study (Jumaida et al., 2020) suggested that almost half (48.6%) of Women of Childbearing Age
studied junior high school education.
c. Occupation Women of Childbearing Age
The results of research conducted by (Hartati et al., 2015) and (Pakkan, 2017), the characteristics of
the occupation of Women of Childbearing Age that affect the motivation to perform IVA were as
follows:
Table 3 Characteristic Women of Childbearing Age Based on Occupation
Researcher (Hartati et al., 2015) (Pakkan, 2017)
Occupation f % f %
Working 43 78.2 32 38.6
Not working 12 21.8 51 61.4
Total 55 100 83 100

Research results (Hartati et al., 2015) that most (78.2%) Women of Childbearing Age work, while
Research (Pakkan, 2017) suggested that most (61.4%) Women of Childbearing Age do not work.
d. Knowledge of Women of Childbearing Age
The results of research conducted by (Pakkan, 2017) and (Agustin & Fauziyah, 2017), the
characteristic knowledge of Women of Childbearing Age that affects the motivation to do IVA were
as follows:
 Table 4 Characteristic Women of Childbearing Age Based on Knowledge
Researcher (Pakkan, 2017) (Agustin & Fauziyah, 2017)
Knowledge f % f %
Good 0 0 3 8.3
Sufficient 38 45.8 7 19.5
Less 53 54.2 25 72.2
Total 83 100 35 100

The table above suggested that based on research (Pakkan, 2017) almost half (45.8%) had sufficient
knowledge, while the results of research (Agustin & Fauziyah, 2017) most (72.2%) had less
knowledge.
2. Motivation For Women Of Childbearing Age In Conducting IVA Examinations Before Being
Given Health Education
The results of the research (Hamranani et al., 2019) and (Sikumbang, 2019) regarding the motivation to
carry out IVA examinations before health education were as follows:
Table 5 Motivation of Women of Childbearing Age Before Health Education
(Hamranani et al., 2019) (Sikumbang, 2019)
Motivation
F % F %
Low 4 21,0 17 32.1
Moderate 14 73.7 34 64.1
High 1 5.3 2 3.8
Total 19 100 53 100

The table above suggested that according to the results of the study (Hamranani et al., 2019), before
health education the motivation for IVA examination was mostly (73.7%) in the moderate category,
while the results of the study (Sikumbang, 2019) the motivation of women with EFA before being given
health education was categorized as moderate as many as 34 people (64.1%).
3. Motivation For Women Of Childbearing Age In Conducting IVA Examinations After Being Given
Health Education
The results of the research (Hamranani et al., 2019) and (Sikumbang, 2019) regarding the motivation to
carry out IVA examinations before health education were as follows:
Table 6 Motivation of Women of Childbearing Age After Health Education
(Hamranani et al., 2019) (Sikumbang, 2019)
Motivation
F % F %
Low 0 0 4 7.5
Moderate 8 42.1 10 18.9
High 11 57.9 39 73.6
Total 19 100 53 100

The table above suggested that the results of the study (Hamranani et al., 2019), after health education
the motivation for IVA examination was mostly (57.9%) in the high category, while the results of the
study (Sikumbang, 2019) after being given counseling (73.6%) had high motivation.

DISCUSSION
1. Motivation For Women Of Childbearing Age In Conducting IVA Examinations Before Being
Given Health Education
Research conducted by (Hamranani et al., 2019) entitled Health Education of Visual Inspection of
Acetic Acid using Audiovisual Toward Motivation of Childbearing Age Women To Do the Test: A Case
Study in Jemawan Klaten, obtained results that before health education motivation Most of the IVA
examinations (73.7%) were in the moderate category. This was supported by research conducted by
(Hartati et al., 2015) entitled Motivation of Women of Fertile Age to Conduct Visual Inspection of
Acetic Acid which suggested that the motivation of Women of Childbearing Age to perform IVA
examinations was mostly (52.7%) classified as moderate. In line with the research conducted by
(Sikumbang, 2019) entitled The Effect of Health Education on Knowledge, Attitudes and Motivation
about IVA, it suggested that the motivation of EFA mothers after being given health education was in the
moderate category as many as 34 people (64.15%).
Motivation was said to be low if a person had positive desires, but had low expectations and
beliefs that he would succeed in achieving goals and desires (Nursalam, 2016). Motivation was
influenced by internal factors which include education, age, occupation, experience, and external factors
including environment and information (Purwanto, 2011). The low motivation to do IVA was caused by
several things, feeling embarrassed, afraid, and not feeling the need so that they do not do the IVA
examination. Health workers as community protectors, including factors that could influence women's
behavior to undergo IVA examinations. Women who were reminded by health workers to carry out
health checks tend to had a strong desire to carry out these examinations (Chigbu, et al., 2013).
The low motivation for Women of Childbearing Age before being given health education was
because the Women of Childbearing Age do not know about IVA examinations, both the aims, goals,
targets, and benefits for health. This causes the Women of Childbearing Age not motivated to do IVA
examinations, how could someone do something if he does not know what to do. Women of
Childbearing Age who had moderate motivation may be because the Women of Childbearing Age
already know about IVA, but do not understand in detail about IVA, so that Women of Childbearing Age
actually had the desire to do IVA examinations, but Women of Childbearing Age were afraid of accept
the results, so that the Women of Childbearing Age tend to decide not to do IVA examinations. The low
motivation for Women of Childbearing Age in doing IVA examinations could be caused by various
factors.
The first factor affecting motivation was Age. Data from various research journals on the
motivation to carry out IVA examinations, it was found that the Age Women of Childbearing Age
studied were on average 20-35 years old. The results of the study (Hartati et al., 2015) show that most
(61.8%) of the Women of Childbearing Age studied were 20-35 years old. This was reinforced by
research (Agustin & Fauziyah, 2017) where most (52.8%) of the Women of Childbearing Age studied
were aged 20-35 years old. The more enough Age, the level of maturity and strength of a person would
be more mature in thinking and working. This was a result of his experience and mental maturity
(Nursalam & Pariani, 2013). According to the Researcher, this was not in accordance with the above
theory where the age of the Women of Childbearing Age was classified as a mature age, where the
Women of Childbearing Age should had been able to think about what was good for their health, but the
Women of Childbearing Age do not do it because IVA was a term. which may be foreign to the ears of
the Women of Childbearing Age, so they would not be compelled to do so.
The second factor that affects the motivation to perform IVA examinations was education. The
results of the study (Chrystianty et al., 2018) that almost half (45.7%) of the Women of Childbearing
Age studied had high school education, while the results of the study (Jumaida et al., 2020) suggested
that almost half (48.6%) of the Women of Childbearing Age who were researched SMP education.
Someone with a middle and high level of education would find it easier to understand about health
problems, their knowledge, especially those obtained from formal education, also tends to be higher than
those with low education, so that it would affect their motivation in activities or mobilization. This
suggested that education would influence a person's behavior, including one's behavior, aka lifestyle,
especially in motivating to participate in health development. The higher a person's education level, the
easier it was for that person to receive information, so the more knowledge they would have. On the
other hand, a lack of education would hinder the development of one's attitudes towards newly
introduced values (Nursalam & Pariani, 2014).
The higher the education of the person, the higher the motivation to carry out the IVA
examination, whereas the lower the education would affect the motivation to do the IVA examination,
this was because high education would affect the decision or wouldingness to carry out the examination.
Women of Childbearing Age who had an intermediate level of education, Women of Childbearing Age
should had no difficulty understanding health problems, especially IVA. However, not all health
information was obtained from the formal education pathway, if you do not feel any complaints, for
Women of Childbearing Age there was no benefit in doing an IVA examination. In some highly
motivated Women of Childbearing Age because the Women of Childbearing Age had a high desire to do
IVA examinations, Women of Childbearing Age want to know with certainty the condition of the
reproductive organs of Women of Childbearing Age so that Women of Childbearing Age could take
immediate action if indeed the results were positive, and Women of Childbearing Age could maintain the
health of Women of Childbearing Age if the results were negative.
 Research results (Hartati et al., 2015) that most (78.2%) Women of Childbearing Age work, while
Research (Pakkan, 2017) suggested that most (61.4%) Women of Childbearing Age do not work.
Humans need a occupation to could develop and change, someone works aiming to achieve a state that
was better than the previous state. Someone who works in the formal sector had better access to various
forms of information, including health (Nursalam & Pariani, 2013).
Working mothers had the opportunity to get information about early detection of cervical cancer
using the visual acetic acid (IVA) method of inspection, and seeing posters at Posyandu health service
facilities, Puskesmas and from electronic media (TV) the dangers of cervical cancer if not as early as
possible. detected. some from the Women of Childbearing Age said earlier action was better to act
immediately if there were changes in cervical condition whether there were cell changes. For Women of
Childbearing Age who work were not motivated to carry out inspection of Acetic Acid Viasul Inspection
(IVA), they were afraid / ashamed of the doctor's diagnosis and some of the Women of Childbearing
Age do not prioritize health, but pay more attention to carrying out household occupation activities after
returning from the office. Whereas Women of Childbearing Age who work outside the home had an
easier income to reach the facilities and infrastructure as desired by the Women of Childbearing Age,
they would even had more knowledge about how to detect cervical cancer through experiences /
interactions in occupations and reading magazines, brochures, leaflets. , and health education, in health
service places, namely puskesmas, posyandu, private midwives practicing private doctors and local
governments in collaboration with the health office. Women of Childbearing Age who do not work lack
access to seek information about health, in this case IVA which may be obtained from colleagues
because mothers who do not work do not had colleagues who could share health information so that the
knowledge of Women of Childbearing Age about health becomes less. This was what makes Women of
Childbearing Age not motivated to do IVA examinations.
The motivation for IVA examination was also influenced by knowledge. Based on Research
(Pakkan, 2017) almost half (45.8%) had sufficient knowledge, while the results of research (Agustin &
Fauziyah, 2017) mostly (72.2%) had insufficient knowledge. The low motivation for Women of
Childbearing Age could also be caused by a lack of knowledge about IVA examinations, both the aims,
objectives, targets, and benefits for health. This causes the Women of Childbearing Age not motivated to
do IVA examinations, how could someone do something if he does not know what to do. Women of
Childbearing Age who had moderate motivation may be because the Women of Childbearing Age
already know about IVA, but do not understand in detail about IVA, so that Women of Childbearing Age
actually had the desire to do IVA examinations, but Women of Childbearing Age were afraid of accept
the results, so that the Women of Childbearing Age tend to decide not to do IVA examinations. Women
of Childbearing Age who get information also comes from non-health workers whose competence in the
health sector was not clear, misinformation would actually dampen the motivation of the Women of
Childbearing Age to carry out IVA examinations.
2. Motivation For Women Of Childbearing Age In Conducting IVA Examinations After Being Given
Health Education
Research conducted by (Hamranani et al., 2019) found that after health education using
audiovisual media, the motivation for IVA examination was mostly (57.9%) in the high category so that
there was an effect of health education using audiovisual media on the motivation of Women of
Childbearing Age to do IVA examination as evidenced by the Wilcoxon Test results with pvalue =
0,000. This was supported by research (Sikumbang, 2019) showing that the motivation of EFA mothers
after being given health education using the lecture method was in the high category of 39 people
(73.58%) high so that there was an effect of health education on the motivation of Women of
Childbearing Age to carry out IVA examinations as evidenced by Wilcoxon test results with pvalue =
0,000. This research was also strengthened by research conducted by (Karyus et al., 2020) where before
counseling on cervical cancer, the average mother's motivation before counseling was 33.57 with a
standard deviation of 4,261 and after counseling with the lecture method on cancer, based on The results
of data processing, obtained an average of 69.82 with a standard deviation of 4.288 so that there was an
effect of health education on the motivation of the Women of Childbearing Age to carry out IVA
examinations as evidenced by the results of the t-test sample paired with p-value = 0,000.
The exposure to health information was very minimal regarding cervical cancer so that it was
still difficult to change beliefs and customs that had been carried out so far, it could also be seen by the
presence of Women of Childbearing Age who were still reluctant to undergo IVA examinations.
Therefore, in terms of prevention of cervical cancer, it was recommended that health workers be able to
carry out general and comprehensive health education about cervical cancer, not just an appeal to carry
 out IVA examinations. Providing information could use better media, information was more focused on
understanding cervical cancer, symptoms, causes, prevention, treatment and general description of
cervical cancer sufferers so that people would increasingly realize that IVA was very important to do
(Sawitri & Sunarsih, 2018).
Health education on early detection of cervical cancer aims to provide information to women
about the meaning of cervical cancer, signs and symptoms of cervical cancer, how to detect cervical
cancer early, and others. By providing this information, it was hoped that women's knowledge about
cervical cancer would increase so that women's motivation to do prevention or early detection of cervical
cancer would also increase. After being given health education, the motivation of the Women of
Childbearing Age in carrying out IVA examinations had increased, this indicates that the Women of
Childbearing Age had a desire to undergo an IVA examination, Women of Childbearing Age also had
high hopes that Women of Childbearing Age would find out about reproductive health Women of
Childbearing Age by doing an IVA examination, but Women of Childbearing Age still had their own
fears about the results of the IVA examination. Women of Childbearing Age were not sure that the
results would be in accordance with the wishes of Women of Childbearing Age, Women of Childbearing
Age were afraid that if the test results were positive it would make the Women of Childbearing Age
worse and the psyche of the Women of Childbearing Age was threatened, or if the results were negative
then Women of Childbearing Age finds it futile to do IVA examinations.
The results of the study (Mbachu et al., 2017) indicate that Wouldingness to screen for cervical
cancer was very high among study participants. Peer health education was an effective strategy to
increase women's perceptions of the benefits of early detection of cervical cancer and their screening
practices. It had also been shown to be effective in addressing the cultural and social factors that
influence behavior change. Peer health education should be included in the health promotion component
of a cervical cancer control plan, as it could be useful in ensuring the improvement of cervical cancer
screening behavior.
The Women of Childbearing Age did not initially know about IVA examinations, so that the
Women of Childbearing Age had no encouragement to do so. Health education on early detection of
cervical cancer would provide information about the importance of early detection of cervical cancer
using the IVA method to establish healthy behavior for Women of Childbearing Age by providing
encouragement or motivation to perform IVA.
Health education that provides changes in motivation to participate in IVA examinations in
women of childbearing age to perform a Visual Inspection of Acetic Acid (IVA) in order to detect
cervical cancer early, which functions widely to improve the health status of women of childbearing age
themselves. A person who was motivated to perform a Visual Acetic Acid (IVA) Visual Inspection
Inspection was aware of the importance of maintaining the reproductive health of women who would
then feel interested and would weigh the pros and cons who would then carry out a Visual Inspection
Inspection of Acetic Acid (IVA) and support the Visual Inspection of Acetic Acid ( IVA). Motivation
occurs because of someone's need that must be met immediately to immediately achieve the goal.
Motivation arises because of a need to fulfill a goal. Some of these motivations were extrinsic and some
were intrinsic. Motivation for a middle adult female acetic acid (IVA) visual inspection may arise after
she had information about the benefits of acetic acid (IVA) visual inspection and health. If the middle-
aged woman views that health was a factor that plays an important role in her adjustment to her physical
changes for the better, there would be a desire to perform a Visual Inspection of Acetic Acid (IVA).
Health education using audiovisual media would be more effective and interesting so that it could further
increase the motivation of the audience to do what was satisfied in health education. According to
Arsyad (2011), he argues that learning using multiple senses (audio and visual), namely the senses of
hearing and sight, would provide benefits because students would learn more than if the subject matter
was presented with visual stimulation only or just hearing. Kemp and Dayton (in Arsyad, 2011)
suggested several advantages of audiovisual media in the learning process, namely conveying learning to
be more standardized, learning to be more interesting, learning becoming more interactive with the
application of learning theory and psychological principles accepted in participation.

CONCLUSSION
1. Motivation for Women of Childbearing Age to perform IVA examinations before being given heat
education according to journal review results tends to be classified as moderate or sufficient
2. The motivation for Women of Childbearing Age to perform IVA examinations after being given heat
education according to the results of journal reviews tends to be classified as high or good
3. There was an increase in the motivation of Women of Childbearing Age in carrying out IVA
examinations after being given health education. This was because the exposure to health information
was very minimal about cervical cancer so that it was still difficult to change beliefs and customs that
had been done so far, it could also be seen that there were respondents who were still reluctant to do IVA
examinations. Therefore, in terms of prevention of cervical cancer, it was recommended that health
workers be able to provide general and comprehensive counseling about cervical cancer, not just an
appeal to carry out IVA examinations.

SUGGESTION
1. For Women of Childbearing Age
Looking for as much information as possible about cervical cancer from health professionals and reliable
sources.
2. For Health Workers
Planning and developing women's reproductive health services, so as to improve the quality of life for
women through cervical cancer screening, doing IVA examinations by means of pick-up balls or visiting
targets, so as to increase the participation of Women of Childbearing Age to perform IVA examinations
3. For the Community
Provide support for Women of Childbearing Age to carry out IVA examinations, so that it can help early
detection of cervical cancer which can later reduce morbidity and mortality for women due to cervical
cancer by providing information about IVA examinations, collaborating or collaborating across sectors
with health workers to promote IVA examinations to reduce the incidence of cervical cancer.

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