FORM ASSESSMENT OF PROGRESS TEST PROPOSAL / THESIS / THESIS

(Q 2)

Name: Alvi Dwi Fitria Ningrum Signature

NIM: 2041A0259
Study Program: D4 Midwifery
Force: 2020
Specialization: Clinical
Factors - factors that affect re-visit interest acceptor injections future
Plan Theme Research:
pandemics of the 19thcovid

Planrequested Supervisor:

Supervisor that set: 1. Candra Wahyuni, S.Keb., Bd, Kes 1.

the

2. 2.

Testers in Set: 1. 1.

2. 2.
N ASPEC Examiner
COMPONE DESC
o NT T OF RIPTI Recom
. ASSESSM ON mendati
ENT ons
B: True
CHAPTE
RI S: False
R:
Revision
1. Backgr Problem There is a gap between targets The covid - 19 pandemic in Indonesia has caused
ound Statement and outcomes, use the words various kinds of problems in various sectors, including
to "high, low, lack" from the health, economy and population sectors. One
of the impacts is the decrease in the number of family
planning acceptor visits during the pandemic period.
Where this will cause other problems in the long term,
such as the explosion of baby births in the coming
year. This cannot be separated from various factors
that influence acceptors not to re-service family
planning. According to the BKKBN annual data for
the city of Batu, the number of active family planning
participants in January 2020 amounted to 340
participants to 273 participants in December 2020.
From this data, it was recorded that 133 active
injection family planning participants in January
became only 70 participants in December. (BKKBN
City of Stone, 2020)
While the data in get in PMB Griya Babaran midwife
Widiyani Tulungrejo were 48 participants in January
2020 KB to 22 KB participants in december 2020.
(PMB Widiyani annual Data Book, 2020)
From the data in It can be concluded that there was a
significant decrease in the re-visit of injection family
planning participants at PMB Griya Babaran Midwife
Widiyani.
Why the Choose 1 It is necessary to identify the factors that influence
Problem Needs with 2 the interest in revisiting injection family planning
to be 3 with 4 acceptors during the Covid-19 pandemic at PMB
Researched: Widiyani.
1. Target: number of family planning visits 40-50
acceptors / month
Achievements: 20-30 people per month

2. Expectations: the number of family planning

acceptors visits has increased
Reality: there has been a decrease in the number
of family planning acceptors.

Origin of the Choose one According to the BKKBN Kota Batu annual data, the
Problem number of active family planning participants in
January 2020 was 340 participants to 273 participants
in December 2020. Of these data, there were 133
participants. active injection family planning in
January to only 70 participants in December. (BKKBN
City of Stone, 2020)
While the data in get in PMB Griya Babaran midwife
Widiyani Tulungrejo were 48 participants in January
2020 KB to 22 KB participants in december 2020.
(PMB Widiyani annual Data Book, 2020)
 Suspec Mention the things that are 1. Lack of knowledge of the acceptors regarding the
ted suspected of causing the
Covid-19 pandemic.
cause
of the problem. 2. Economicinstability during the Covid-19 pandemic.
proble
3. Acceptor awareness for disciplinary revisits.
m
Solution Plans or interventions 1. Increase understanding of pandemics and prevention
Concept (reduce / decrease / increase) of transmission through the implementation of
health protocols in the new normal era.
2. There is a family planning safari program provided
by the government to impart
3. knowledge to acceptors about the importance of
family planning during the Covid-19 pandemic.

Title Plan 1. Avoid the words "relationship, Factors that influence the interest in re-visits of
influence or difference even injection family planning acceptors during the pandemic
though the analysis contains covid-19
elements of relationship,
influence, difference".
If there are variables
≥ 3 then use the word
"factors"

2. proble in the 1. How formulation of the problem in this research is

m 2. How Any factors - factors that influence re-visit interest
formul Form 3. Did relationship / injecting future pandemic planning acceptors covid-19?
ation Questions influence / difference
3. Objectives General Purpose begins with Analyzing the factors - factors that influence re-visit
Research thephrase interest acceptors injecting covid future pandemics of
"analyze" the 19th
 Special Purpose Similarthe to 1. Identify the factors that influence the interest in re-
formulation of the visit of injection family planning acceptors during the
problem: Covid-19 pandemic
Words Q:
- How  replaced
identify /
- Are  replaced
analyze
4 Benefit Practical 1. Provide an overview for the local government
s of Benefits regarding the factors that influence the interest in
Researc re-visits of injection family planning acceptors
h during the Covid-19 pandemic, so that they can be
given solutions to minimize the possible impact.

Acade 1. Providing and adding new studies in science,

mic especially midwifery, to determine the factors that
Benefit affect the interest in re-visit of injection family
s planning acceptors during the Covid-19 pandemic
5 Authen See, previous research: 1. 1. Research title: The impact of decreasing the
ticity of 1. International number of family planning visits on the baby boom in
Researc read, include, journal (Journal the Covid-19 era. (Sugi Purwanti, 2020)
h write : name) "Only The difference with my research is that the problem
similar / same / abstract" to be investigated in this study is the impact of the
close research decrease in the number of family planning visits to
The same 2. National journal the baby boom in the Covid-19 era, while in my
which comes research what I want to examine are the factors that
from cause a decrease in the number re-visit of the
3. Thesis / Thesis injection family planning acceptor itself during the
(Name of previous pandemic.
researcher) 2. Research title: Family education and community
participation in family planning programs during the
Covid-19 pandemic, Kerandin village, Lingga Timur
district, Lingga district. (Romy Aqmal, 2020)
The difference with my research is that the research
was conducted to determine the level of community
participation in the program during the Covid-19
pandemic through a sociological perspective, whereas
in my research the factors that led to a decrease in the
number of acceptors' return visits Injectable family
planning itself during the pandemic, where this will
also affect the results of the family planning program
during the pandemic.
3. Thesis title: Factors that influence family planning
acceptors in choosing a contraceptive method at the
Jumpandang Baru Public Health Center in Makassar
(Sitti Afsari, 2017)
The difference with research is that this research
focuses on factors that affect the interest of family
planning acceptors in choosing the method of
contraception you want to use regardless of time or
time. the time of installation or use, whereas in my
research I wanted to know the factors that influenced
the interest of family planning acceptors, but the
difference was that the family planning method that I
studied was only for injection contraceptive acceptors
and in my research there was a pandemic period that
 also affected the research
4. Title of study: Factors - factors affecting the use and
not being used by women of reproductive age in
Nigeria (Bola Lukman Solanke, 2017)
The difference with my research is that this study
aims to examine the factors that influence women of
childbearing age to use or not use contraceptives in
Nigeria. In my research, what I want to examine are
the factors that influence the interest in revisiting
injection family planning acceptors during the
pandemic.
5. Research title: Factors affecting the use of modern
contraceptives among married women in the Ho-west
district, Ghana (Alfriye and Elvis, 2019)
The difference with my research is that this study
aims to examine the factors that influence the use of
modern contraceptive methods to help. couples of
childbearing age determine their family planning
program, whereas in my research what I want to
examine are the factors that influence the interest in
revisiting injection family planning acceptors during
the pandemic.
 CHAPT
ER II
1 Literat 1. Adjust to the title
. ure 2. Inverted pyramid
Revie 3. It should be derived from
w the theory of the last 5- 10
years
4. Writing the author's name of
the reference source in
accordance with the existing
guidelines (Vancouver Style)
5. Add link
6. Measuring dimensions
A. Definition of Family Planning Program
According to Law No.10 of 1992 (regarding
population development and development of a
prosperous family) the family planning program is an
effort to increase awareness and participation of the
community through maturity of marriage age (PUP),
birth control, fostering family resilience, improving the
welfare of small, happy and prosperous families. The
family planning program is an integral part of the
national development program which aims to create
the economic, spiritual and socio-cultural welfare of
the Indonesian population in order to balance well with
the national production capacity. (Erma
Setiyaningrum, 2015)
B. Purpose of Family Planning
To improve the welfare of mothers and children in
order to improve NNKBS (Happy and Prosperous
Small Family Norms), which is the basis for
creating a prosperous society by controlling births
and ensuring controlled population growth (Koes
Irianto, 2014).
C. Causes of Population Change in Population
Dynamics Population
change does not just happen, many causes play a role
in it. The causes that affect population change are
births, deaths, population movements as well as
socio-economic and cultural practices adopted by the
community. (Jitowiyono, 2019)
D. The Covid-19 pandemic in Indonesia
According to Moch Halim Sukur, et al (2020), in
December 2019, an outbreak of pneumonia caused
by the corona virus occurred in Wuhan, Hubei
province, and has spread rapidly throughout China.
This plague spread so rapidly throughout the world.
This outbreak was named Corona Virus Disease
2019 (COVID-19) which was caused by Severe
Acute Respiratory Syndrome Coronavirus-2
(SARS-CoV-2). On January 30, 2020, WHO
declared the SARS-CoV-2 outbreak a Public Health
Emergency of International Concern.
WHO declared COVID-19 on March 12, 2020 as a
pandemic. The number of cases in Indonesia
continues to increase rapidly, until June 2020 as
many as 31,186 confirmed cases and 1851 cases died
(Kemenkes RI, 2020).

E. Concepts of KnowledgeThe
Levelslevel of knowledge included in the cognitive
domain according to Notoatmodjo (2012) has 6
levels, namely:
a. Know (know) Tofu is defined as remembering
(recall) a material that has been studied and received
from before. Tofu is the lowest level.
b. Understanding (comprehension) Understanding is
an ability to explain and interpret material that is
known correctly.
c. Application Application is the ability of a person
who has understood a material or object to use or
apply the known principles to actual situations or
conditions
. D. Analysis (analysis) Analysis is a person's ability to
 describe a particular material or object into the
components contained in a problem and are related
to one another.
e. Synthesis (synthesis) Synthesis is a person's ability
to put or connect parts of a particular object into a
new whole.
f. Evaluation Evaluation is a person's ability to make
an assessment of a particular material or object.

F. Concept of Economic Level The

following is an indicator of a family that can be
categorized as a prosperous family according to the level
of welfare according to the BKKBN (2017), namely
1. pre-prosperous family (income IDR 1,000,000 /
month)
2. Prosperous family I (income IDR 1,000,000 -/ month)
3. IDR 2,000,000Prosperous family II (income IDR
2,000,000-IDR 3,000,000 / month)
4. Prosperous family III (income IDR 3,000,000 - IDR
5,000,000 / month)

G. Compliance Concept
Factors that affect compliance according to Kamidah
(2015) include:sense
● Knowledge
Knowledge is the result of knowing and this occurs
after peoplea certain object.
● Motivation Motivation is the desire in a person
that encourages him to behave.
● Family Support

H. Concept of Interest
According to Mutiasari (2017), the
process of forming interest is a sequential process
starting from the category of acceptance or individual
attention as stimuli generated by certain phenomena,
then choosing it according to the benefits that can be
used by it.
2. Concep ● In DraftFigure
t accordance
Frame with Faktor – faktor yang mempengaruhi minat kunjungan ulang
work theresearch akseptor KB suntik dimasa pandemi covid - 19
title is lifted
● in chart
form (there
is input, Tingkat Kesadaran akseptor
process and pengetahuan
Tingkat ekonomi untuk disiplin
output) akseptor mengenai
● the pandemi covid – 19. kunjungan ulang.
distinguishi
ng sign of
the area
being
studied and
● that is
not
Minat kunjungan ulang akseptor KB suntik di PMB
rigorou
Griya Babaran
s
● in the
annexDi
msukkan
Hypothesis ● Resear There are factors - factors that influence re-visit interest acceptor Injectable family planning
3. ch during the Covid pandemic - 19
Hypoth
esis
 CHAPTER III

1. Research research was

Methods The conducted
using
quantitative
descriptive
methods.
Quantitative
descriptive
research is a
method
carried out
with the sole
purpose of
making an
objective
description or
description of
a situation in
the form of
numbers
starting from
data collection
and the
appearance of
the results
(Arikunto,
2010). This
research was
conducted
with a cross
sectional
approach,
namely
research to
study the
dynamics of
the correlation
between
effect factors
and effects, by
approaching,
observing or
collecting data
at once (point
time
approach).
That is, each
research
subject is
observed only
once and
measurement
s are made of
the character
status or
subject
variables at
the time of
examination.
This does not
mean that all
research
subjects were
observed at
 the same time
(Notoatmojo,
2012)

2. Research ● Observati ● Observati 1. Observatio

Design onal on nal:
 ● Interview 2. research
● Document design
Review Cross
observing sectional
3 PopulationP ● Deter ● Population
opulation & mina (N ) ✔ Populati
Sample tion ✔ All on: All
● sam …… old
plin (whic acceptor
g s
h
tech Injectabl
amou
niq e family
nts if
ue planning
the
● Sample at PMB
numb
● data er is Griya
collectio know Babaran
n n) Tulungr
process ✔ All ejo
…….
(if
the Sample: all
numb old injection
er is family
not planning
know acceptors at
n) PMB Griya
Babaran
● S Tulungrejo.
(because the
a population is
m less than
p 100, the
l sample is
e used).
According
to Arikunto
( (2016: 104)
n if the
) population is
F less than
100 people,
o
the total
r sample is
m taken as a
u whole, but if
l the
a population is
✔ C. greater than
Sampl 100 people,
e 10-15% or
(Mater 20-25% of
ial) the
✔ Sampl population
e size can be
table taken.

● Sampling
The
technique sampling
✔ Proba technique
bility used was
saturated
(Cho sampling.
ose Saturated
one sampling is
and a sample
under that
stand represents
the the total
 techn population.
ique Usually
of the done if the
collect population is
ion) small or less
✔ Non than 100.
Proba (Suryani.
bility Hendryani.
Samp 2012)
ling
(Cho
ose
one
and
under
stand
the

techn
ique
of
taking
it)
4 VariableRese Independent 1. The level 1. Ordinal
arch and Data (Free / of
Scale knowledge 2. Ordinal
affecting) about the 3. Nomin
pandemic al
covid
acceptor-
19
2. economic
level
3. Kepatatuha
n to re-
visit
 Dependen Interest in revisiting Ordinal Confounding
t acceptors of family
( Bound / planning injections
affected)

variables …………………………
………
5 Operation DefinitionOper
al ational Parameters / Indicators Mea Dat
Variable Definition surin a Category
g Sca
Instr le
ume
nt
Free Acceptor knowledge 1. Know (know) Question Ordin 1. Good =
level about the covid- 2. Understand (comprehension) naire al answers
19 pandemic 3. Application (application) 10questio correctly 7-
4. Analysis (analysis).
ns 10 questions
5. Synthesis (synthesis).
6. Evaluation. 2. Enough =
answers
correctly 4-6
questions
3. Less =
answers
correctly 0-3
questions
Economic level of ● pre-prosperous families (income IDR Question Ordin Good => Rp.
1,000,000 / month ) naire al 2,000,000, -
● Prosperous family I (income IDR 1,000,000 1 Enough = Rp.
-/ month) question 1,000,000 -
● IDR 2,000,000Prosperous family II Rp. 2,000,000
(income IDR 2,000,000-IDR 3,000,000 / Less = Rp.
month) 1.000.000, -
 ● Prosperous family III (income IDR
3,000,000 - IDR 5,000,000 / month)

Compliance with the ● Knowledge Question Ordinal Good: score 5-

return visit Knowledge is the result of knowing and naire 6
this occurs after people sensing a certain 6 Sufficient:
object. score 3-4
● Motivation Motivation is the desire in a
question
Less: score 1-2
person that encourages him to behave. s
● Family support

Bound Interest of injection ● process of forming interest is a sequential Question Nomina Nominal
family planning process starting from the category of naire l
acceptors revisiting the acceptance or individual attention as a 1
stimulus that is generated by certain
phenomena, then choose them according question
to the benefits that can be used by them.

Confoundi
ng
6 Time Time of Month APRIL -
Research MAY 2021
andLocati
on
Research
Research PMB Griya Babaran,
Sites Tulungrejo District,
Bumiaji District, Batu
City
7 Measuring
Instruments N Variable Parameters / Dimensions No Questions and Properties (Favorable /
o / Grid Unfavorable)
- Favorable: if answered Yes, score 1. If
answered No, score 0.
- Unfavorable: if answered Yes, score 0. If
answered No, Score 1.
1 Free 1. Level of mother's 1. Knowledge level:
knowledge about the Favorable: question number 1,2,4,8,9
Covid pandemic - 19 Unfavorable: question number 3,5,6,7,10
2. Economy
3. Compliance with the 2. Economy
schedule revisit 3. Compliance with the schedule of return visits
Favorable: question no 1,4,6
Unfavorable: question no 2,3,5

2 Bound interest in revisiting

injection family planning
acceptors
 3 Perancu

8 Data ● process 1. Data

collectiondata Descriptio collection. Data collection techniques
collection n are carried out by distributing research
ofprocess questionnaires to respondents.
● There is Researchers conducted research by
an SOP distributing questionnaires to each
for acceptor of injection family planning
experimen who came to PMB Griya Babaran in
tal April - May 2021
research. 2. Editing
● Descriptio The editing process was carried out
n of the after the data obtained from the
process of distribution of questionnaires were
distributin collected, by looking at the
g completeness of the data, if anything
questionn was missing, ask the respondent to
aires. complement.
● Descriptio 3. Coding
n of the Coding is done to make it easier for
observatio researchers to process data, all
n sheet answers or data that need to be
assessmen simplified, namely with certain
t process. symbols, for each answer (coding).

2. Data tabulation Data

tabulation is done to obtain the
frequency of each variable.

Validity Validity ● ofInstruments Validity Test:

 Test of To find out whether this research is feasible or
Minimum not, the researchers tested the validity of the
20 ● Research/ Measuring knowledge level questionnaire at different
question places with almost the same characteristics as
naires. Reliability the research site, namely in PMB Titik
Nugrahati as much as 30 respondents.

test
ReliabilityReability shows in one sense that an
instrument can be trusted enough to be used as
a data collection tool because it is good
(Arikunto, 2016). The reliability test step,
namely by selecting the tool items that are
already valid, so that the invalid ones are not
analyzed in the reliability test

9 Statistical Normality Test Understand, master, In this study the researcher used chi square test.
how to read and the Thechi-squaretest is one of the no-parametic
test "T test prioritizes conditions statistical tests (distribution where the quantity
parametric test" of the population is unknown) which is quite
often used in research using two variables,
where the data scale of the two variables is
nominal or to test for differences in two or more
sample proportions.

Linearity Test Understand, master, Linearity test is a test used to state whether
how to read and the linear equations are suitable for use in existing
requirements data. The linearity test is determined if it meets
the provisions of nR2 <X2 (chi-square).
 Non- Requirements: the variable used is a Data scale Independent
parametric variable with a categorical scale variable: categorical
(nominal and ordinal) Dependent variable: nominal
Test name: chi square

Advisory note:

Approved for the

test proposal by
attaching
measuring
instruments,
journal address,
power point,
English, English
speaking skills,
Supervisor a
maximum of 3
times to complete
the frame of mind /
Framework

In order to
complete the
intended format or
revision first and it
is not
recommended to
go directly totutor

the selected Exam

Online (choose one)

Offline (choose
one)
 Note :
Journal The literature used is as follows:
- D3 program 🡪 1-3 international journals, 3-5 national journals
- S1 program 🡪 3-5 international journals, 5-10 national journals
- S-2 program 🡪 5-10 international journals, 10-15 journals national

Catatan Penguji :
 REFERENCES

1. Afriyie, P. Enowbeyang, E .. Factors influencing use of modern contraception among married women in Ho West district, Ghana: descriptive cross- sectional
study.pan African Journal. 2019.33: 15. https://www.panafrican-med-journal.com/content/article/33/15/full, access April 2020

2. Afsari, Sitti. 2017. Factors Affecting Family Planning Acceptors in Choosing Contraceptive Methods at Jumpandang Baru Public Health Center, Makassar.
http://repositori.uin-alauddin.ac.id/5287/, access March 2021

3. Arikunto, Suharsimi. 2016. Research Procedure: A Practical Approach. Jakarta: Rineka Cipta

4. Aqmal, Romi. 2020. Family Planning Education and Community Participation in the Family Planning Program during the Covid-19 Pandemic in Kerandin
Village, Lingga Timur District, Lingga Regency. Jounal of Education and Teaching, Vol. 1, No. 2, 2020,
http://ejournal.stainkepri.ac.id/index.php/tanjak/article/view/159/106, access March 2020

5. BKKBN, 2020. Number of Active Family Planning Participants and Number of PUS Period January-December 2020, https: // www.bkkbn.go.id/#, Access
March 2021

6. Bestari Kumala Dewi. 2020. 5 Misinformation about Covid-19 and the Facts According to
Science.,:Https://www.kompas.com/sains/read/2020/09/28/100500223/5-informasi-salah-tentang-covid-19- and-fact-based-science? page = all, access March 2021

7. Irianto, Koes. 2014. Family Planning Services. Bandung: Alfabeta

8. Jitowiyono, Sugeng. Abdul, Masniah. 2019. Family Planning (KB) in the Perspective of a Midwife. Yogyakarta: New Library of the

9. Indonesian Ministry of Health. 2020. Status of the Corona Outbreak as a National Disaster. https://www.kemkes.go.id/article/view/20031500003/status-
wabah-corona-di-indonesia-ditentuk-sebagai-bencana-nasional.html, accessed March 2021

10. Mutiasari, asa. Et al. 2017. The Effect of Midwife Counseling on the Level of Knowledge and Interest in Becoming a Post Placenta IUD Family Planning
Acceptor in West Ungaran District in 2016. Diponegoro Medical Journal, Volume 6, Number 2, April 2017. https://media.neliti.com/media/publications/ 107065-
ID-influence-counseling-midwife-to-level.pdf, access April 2021

11. Santjaka, Aris. 2011. Statistics For Health Research. Yogyakarta: Nuha Medika

12. Setiyaningrum, Erma. 2015. Family Planning and Reproductive Health Services. Jakarta: TIM
13. Solanke, Football. 2017. Factors influencing contraceptive use and non-use among women of advanced reproductive age in Nigeria. Journal of Health
Population and Nutrition36 (1). https://www.researchgate.net/publication/312144276_Factors_influencing_contraceptive_use_and_non-
use_among_women_of_advanced_reproductive_age_in_Nigeria. Access April 2021

14. Sugiyono. 2018. Quantitative, Qualitative and R & D Research Methods. Bandung: Alfabeta

15. Suryani. Hendryadi. 2010. Population and Sample. https://teorionline.wordpress.com/2010/01/24/populasi-dan-sampel/ , access April 2021

16. Purwanti, Sugi. 2020. The Impact of the Decrease in the Number of Family Planning Acceptors on the Threat of the Baby Boom in the Covid-19 Pandemic
Era. Bina Cipta Husada Journal.Vol. XVI No. July 2, 2020: https://stikesbinaciptahusada.ac.id/filejurnalbch/index.php/filejurnalbch/article/view/37 , access
March 2021
APPENDIX

APPLICATION TO BE A RESPONDENT

Dear
Mothers, prospective respondents
On-site

With respect,

I am the undersigned below are students of the D4 Midwifery Study Program, Strada Indonesia Institute of Health Sciences

Name : Alvi Dwi Fitria Ningrum

Nim : 2041A0259
Address : Dusun Kekep Rt 03 Rw 04 Tulungrejo Village Bumiaji District, Batu City

Will conduct research with the title "Factors that influence interest in repeat visits injecting family planning acceptors during the Covid pandemic - 19 "
For this purpose, I ask for the willingness of you to be the subject of this research. The confidentiality of the data will be guaranteed.
As proof of willingness to be a respondent in this research, I ask you to sign the consent form that I have provided. Thank you for your
participation and policies.

Researcher
 (Alvi Dwi Fitria Ningrum)
CONSENT SHEET

After reading the explanation of this study and getting answers to the questions I asked, I know the benefits and objectives of this research, I
understand that researchers respect and uphold my rights as a respondent.

I realized that this research would not have a negative impact on me. I understand that my participation in this research is very beneficial for
improving the quality of mental health services in the community.

My signed consent states that I participated in this study.

Batu, 2021
Respondents
 ()

CUSIONARY
FACTORS INFLUENCING INTEREST OF REVISIT OF THE ACCEPTANCE OF KB SYRING IN PANDEMIC PMB GRIYA BABARAN DESA TULUNGREJO
KOTA BATU

1. General data
Date :
Number of Respondents : (filled in by researchers)
a. Name :
b. Age :
c. Last education:

2. Knowledge

Instructions:
1. Answer all the questions below by putting a checklist (√) in the available column on one of the
most suitable alternative answers according to the mother

2. Alternative answers consist of 2 options including:

a. Correct
b. False

3. This question is for research purposes only.

No Questions True False

1. pandemic isan epidemic a diseasethat spreads over a large
A area, for example severalcontinents, or around the world
 2. diseaseendemicWidespreadwith a stable number of
infected people is not a pandemic.
3. The covid-19 virus is a virus that is transmitted only through
the touch of hands and does not spread through the air
4. The covid-19 virus is a virus that attacks the respiratory
tract
5. The covid-19 virus is not transmitted through hand touch
6. Using a mask can prevent transmission of the virus if used
over the mouth
7. Washing hands with water alone is sufficient to prevent
transmission of the covid-19
8. virusvirusspreadsmainlythrough the airwhen people are
Th near one another.
e
9. It is true that Covid-19 and flu are caused by respiratory
viruses and may have some of the same symptoms
including fever, fatigue and cough.
10 The covid-19 virus is only vulnerable to the elderly
.

3. . Economic status
Circle it In one of the appropriate types of work, according to the woman

(1) Laborer
(2) Private
(3) employee Civil servant
(4) teacher
(5) Merchant
 (6) Not working (IRT)
(7) Breeder
(8) Other ________________

Respondent (family) income / month: (1) IDR 500,000 - IDR 1,000,000

(2) IDR 1,000. 000 - Rp. 1,500,000
(3)> Rp. 1,500.00

4. Compliance with the visit schedule

Instructions:

1. Please answer all the questions below by putting a checklist (√) in the available column in one of the
most suitable alternative answers according to the mother

2. Alternative answers consists of 2 options including:

a. Yes
b. No

3. This question is only for research purposes.

No Question Yes No
1. Do you always come for repeat family planning visits
according to the date printed on the card?
2. Have you been more than 3 days late from the scheduled
visit?
3. Do you think it is okay to come late for a repeat visit?
4. Do you know the consequences of being late for family
planning?
5. Have you delayed your scheduled family planning visit for
some reason?
6. Are you one of those people who are disciplined when going
 on repeat family planning visits?

5. Interest

in Revisits Does the covid-19 pandemic affect mothers' interest in re-injection of contraceptives?
a. Yes
b. no