The Influence Of Counseling With Audiovisual Media On The Level Of Knowledge And AttitudeAdolescent Women In Consumption Iron Supplement

Giving iron supplement tablets to young women as a program to prevent and treat anemia has so far not worked as expected. To support this program, appropriate health education is needed. The aim of this research was to determine the effect of counseling using audiovisual media on the level of knowledge and attitudes of young women regarding the consumption of iron supplement tablets at Bahrul Ulum Singingi Junior High School.The research method used was quasi-experimental, and the design used was a non-equivalent control group pretest-posttest design. The research was carried out from November 2022 to July 2023 at Bahrul Ulum Singingi Junior High School with a sample size of 88 people using total sampling techniques. Data analysis was done with the Mann-Whitney test using SPSS with confidence index 95%.The results of the research show that counseling using audiovisual media has an effect on the level of knowledge of young women, with the results of the pretest difference between the experimental and control groups p-value>0.05 (p = 0.531), the posttest difference test p-value<0.05 (p = 0.001), and the difference test increasing the p-value <0.05 (p = 0.000). And counseling using audiovisual media also has an effect on the attitudes of young women, with the results of the pretest difference between the experimental and control groups p-value>0.05 (p = 0.338), the posttest difference test p-value<0.05 (p = 0.000), and the difference test increase in p-value <0.05 (p = 0.000).In conclusion, counseling using audiovisual media influences the level of knowledge and attitudes of young women regarding the consumption of iron supplement tablets.


INTRODUCTION
Adolescence is the phase of life between childhood and adulthood, from 10 to 19 years of age.This stage is an important time to lay the foundations of good health (WHO, 2023) Teenagers who have good knowledge will be able to apply their knowledge, but vice versa, if teenagers have poor knowledge, they cannot apply this knowledge properly, (Kamau et al., 2019), because health in adolescence greatly influences the quality of life of adolescents not only in the present but also in the future, and in a broader sense, adolescent health affects the quality of human resources and the development of a country because the future of a country is in the hands of children and youth.(Octarra et al., 2022) The lack of adolescent knowledge about health is due to limited access to information and the lack of interest of adolescents in the information they receive (Azis & Pratiwi, 2019).Increased knowledge can be gained by Giving iron supplement tablets to young women as a program to prevent and treat anemia has so far not worked as expected.To support this program, appropriate health education is needed.The aim of this research was to determine the effect of counseling using audiovisual media on the level of knowledge and attitudes of young women regarding the consumption of iron supplement tablets at Bahrul Ulum Singingi Junior High School.The research method used was quasi-experimental, and the design used was a non-equivalent control group pretest-posttest design.The research was carried out from November 2022 to July 2023 at Bahrul Ulum Singingi Junior High School with a sample size of 88 people using total sampling techniques.Data analysis was done with the Mann-Whitney test using SPSS with confidence index 95%.The results of the research show that counseling using audiovisual media has an effect on the level of knowledge of young women, with the results of the pretest difference between the experimental and control groups p-value>0.05(p = 0.531), the posttest difference test p-value<0.05(p = 0.001), and the difference test increasing the pvalue <0.05 (p = 0.000).And counseling using audiovisual media also has an effect on the attitudes of young women, with the results of the pretest difference between the experimental and control groups p-value>0.05(p = 0.338), the posttest difference test p-value<0.05(p = 0.000), and the difference test increase in p-value <0.05 (p = 0.000).In conclusion, counseling using audiovisual media influences the level of knowledge and attitudes of young women regarding the consumption of iron supplement tablets.
Vol 5 providing health education.From a study in West Rajasthan, it is known that health education interventions are the best way to increase knowledge, attitudes, and practices about preventing anemia in young women (Kamala Verma, 2017).Research conducted by Agustina, (2019) on young women at State 24 Junior High School, Tangerang City, stated that young women who had good knowledge were 82.2% obedient in consuming iron supplement tablets, while among young women who had sufficient knowledge, only 26.3% were compliant in taking iron supplement tablets.
The provision of education is influenced by one factor that can influence an increase in a person's knowledge, namely educational media.The word media comes from the Latin "medium" which means "intermediary or introduction".Media is thus defined as a tool or goal that can be used as a medium to convey information from the source to the intended recipient (Saddam Husein, 2018).Health education media are all methods or efforts to display messages or information that the communicator wants to convey, whether through print, electronic, or outdoor media, so that targets can increase their knowledge, which in the end is expected to change their behavior in a positive direction regarding their health.Counseling carried out using audiovisual media can create a pleasant atmosphere and increase students' interest in participating in the services provided (Novitasari, 2019).Audiovisual media has the following advantages: a) Messages are communicated more clearly and are less verbal (in written or oral form).b) Handling limitations of space, time, and models, c) Audiovisual media can play a role in tutorial learning (Rindawati et al., 2022).Research by (Madestria et al., 2021) regarding the influence of education via video stated that there was an influence on increasing the knowledge of young women about consuming iron supplements.And research by Dwiningrum & Fauzia, (2022) states that nutrition education using audiovisual media in the form of videos is effective in increasing teenagers' knowledge about anemia in middle and high schools in Bantul Regency.
One of the health programs that targets adolescents is the program for administering iron supplements as a measure to prevent and treat anemia in young women.The program is stated in the Ministry of Health circular letter number Hk. 03.03/V/0595/2016 regarding the provision of iron supplements to young women at school and women of childbearing age (Kemenkes RI, 2016).To support the proper implementation of this program, proper health education is needed, but so far, the program for giving iron supplements to young women has not run as expected.The problem of low levels of iron consumption in young women can be prevented if young women have good knowledge about anemia and its prevention (Nur et al., 2019).
Vol 5 From the results of the 2018 Riskesdas, it was stated that the proportion of iron supplement tablets obtained and drunk by Indonesian young women at school was less than 52 items in one year by 98.6%, while those who consumed 52 items or more were only 1.4%.Kuantan Singingi Regency, out of 12 regencies and cities in Riau Province, is in the 4th lowest place for achieving the percentage of young girls who get iron supplements in 2019 (Dinas Kesehatan Provinsi Riau, 2019).
From the preliminary research, it is known that of the three puskesmas in Singingi District, the Sungai Keranji Health Center has the lowest achievement for young women who consume iron supplements, namely only 5%, even though the coverage of young women receiving tablet iron supplements in 2021 is 98%.Sungai Keranji Community Health Center has five assisted schools, and Bahrul Ulum Junior High School, which has the highest number of young women, was chosen as the research location.Through interviews with 16 young women at school, many did not understand the dangers of anemia and the importance of taking iron supplements.When asked where they had heard about iron supplements and anemia, almost all young women answered only from counseling given by health center staff who came to school.When asked whether they enjoyed listening to counseling from Puskesmas staff, 25% said they were happy, 56.3% said it was not interesting, and 18.7% said it was a bit boring.
Information from a preliminary survey conducted at the Sungai Keranji Health Center, which was obtained from nutrition program holders, indicates that the form of counseling that has been carried out so far is in the form of lecture methods for young women when health center health workers distribute iron supplements to schools using leaflet counseling media when available.sometimes even without using any counseling media to help young women understand more about the importance of iron supplements, such as using audiovisual media (video playback).Based on the background above, researchers are very interested in examining the effect of counseling with audiovisual media on the level of knowledge and attitudes of young women toward consuming iron supplements at Bahrul Ulum Singingi Junior High School.

METHODS
This research method is quasi-experimental, and the design uses a non-equivalent control group pretest-posttest design.The aim of this study was to determine the effect of counseling with audiovisual media on the level of knowledge and attitudes of young women about consuming iron supplements at Bahrul Ulum Singingi Junior High School.
Vol 5 The research was carried out at Bahrul Ulum Singingi Junior High School in the working area of the Sungai Keranji Kuantan Singingi Health Center.The time for conducting the research was from November 2022 to July 2023.
The population in this study was all 96 young women at Bahrul Ulum Singingi Junior High School in 2023.The sampling technique used in this research was total sampling, meaning that the entire population of 96 people would be the sample, but of the 96 people, there were 8 who did not meet the criteria, so the total sample in this study was 88.
Data collection in this study included: name, age, source of information about anemia and iron supplements, knowledge about anemia and iron supplements, and attitudes towards anemia and iron supplements.Data was obtained using a knowledge and attitude questionnaire.
Because the results of the research data normality test show that the data is not normally distributed, the hypothesis test in this study was carried out using the Mann-Whitney test using SPSS with a confidence index of 95%.This research passed an ethical review by the research ethics committee of the Andalas University medical faculty with ethical number 202/UN.16.2/KEP-FK/2023.All patients who were included in this study were given informed consent and an explanation of the research, objectives, benefits, risks, and research techniques that would be carried out.
The research was carried out at Bahrul Ulum Singingi Junior High School in the working area of the Sungai Keranji Kuantan Singingi Health Center.The time for conducting the research was from November 2022 to July 2023.

The characteristics of the research respondents in
Based on Table 1, it is known that most of the young girls ofBahrulUlumSingingi Junior High School in the experiment group were 14 years old, namely 22 people (50%), 13 people aged 15 years (29.5%), 13 years old as many as 8 people (18.2%), and 12 years old only 1 person (2.3%).In the control group, the majority were the same age, namely 14 years old as many as 15 people (34.1%), followed by those aged 15 years as many as 14 people (31.8%), 13 years old as many as 13 people (29.5%), and only 2 people aged 12 years (4.5%).This shows that the two groups have the same age range.There were 44 people (100%) exposed to information about anemia and iron tablets, which means that all young women in the experiment group had been exposed to information, and the same was the case with the control group; all respondents received this information from health workers.
Vol 5 The effect of counseling with audiovisual media on the level of knowledge of young women in consuming iron supplement can be seen in were no more respondents in the poor category (0%).Meanwhile, in the control group, there was also an increase in the good category, but only 22 people (50%), and there were still 9 people in the poor category (20%).The results of the Mann-Whitney test during the pretest obtained a p-value >0.05 (p=0.531),meaning that there was no significant difference between the experimental group and the control group when the pretest was carried out.The results of the Mann-Whitney test at the posttest obtained a p-value <0.05 (p=0.001),meaning that there was a significant difference between the experimental group and the control group when given the posttest.
The influence of counseling using audiovisual media on the attitudes of young women in consuming iron supplementsare shown in table 3 below.:Based on Table 3, it can be seen that the attitude of the respondents in the experimental group and the control group during the pretest mostly had a negative attitude, namely 33 people (75%) for the experimental group and 32 people (72.7%) for the control group.And only 11 people (25%) in the experimental group had a positive attitude, compared to only 12 people (37.3%) in the control group.There was a change in the attitude of the respondents in the experimental group during the posttest, where the respondents with a positive attitude became 31 people (70.5%), and only 13 people (29.5%) of the respondents still had a negative attitude category.In the control group, there was also a change in attitude.Respondents during the posttest were those who had a positive attitude toward 22 people (50%), and those who had a negative attitude decreased to 22 people (50%).The results of the Mann-Whitney test during the pretest showed that the p-value >0.05 (p = 0.338), meaning that there was no significant difference between the experimental group and the control group when the pretest was carried out.The results of the Mann-Whitney test when the posttest was found to be p-value <0.05 (p = 0.000) meant that there was a significant difference between the experimental group and the control group when the posttest was given.
The average value of acquiring knowledge and attitudes through counseling using audiovisual media is shown in Table 4 below.(p=0.000).This means that there was a higher increase in knowledge and attitudes in the experimental group after being given counseling with audiovisual media than in the control group without audiovisual media.

DISCUSSION
The Effect of Counseling with Audiovisual Media on the Level of Knowledge of Young

Women in Consuming Iron Supplement
From the results above, it can be concluded that there is a significant difference in increasing knowledge between the counseling group that uses audiovisual media and the counseling group without audiovisual media.Providing counseling using audiovisual media had a greater influence on increasing knowledge compared to the counseling group without audiovisual media.The results of this research are in line with research by Janah & Timiyatun, (2020), which states that health education using audiovisual media is more effective than using leaflet media.And also, in accordance with research by Sirvana et al., (2021), the majority of respondents to research on the effectiveness of using audiovisual media had good knowledge of using audiovisual media.Wardana et al., (2022) stated that there was an influence of reproductive health education using audiovisual media with the result of increasing knowledge after the education.
Health education using audiovisual media can increase respondents' knowledge (Berkhout et al., 2018).The use of audio-visual media can increase respondents' motivation and attention so that respondents focus more on the material provided, which has an impact on increasing knowledge (Masruroh & Mukhoirotin, 2022).The advantage of audiovisual learning media is that it covers all aspects of hearing and vision and is used in a balanced and collaborative manner, so that it can hone sensory abilities (Massang et al., 2022) Ridha et al., (2018) stated in their research that, based on Edgar Dale's cone of experience, audio-visual media provides an experience two levels higher than image media.Image media only provides experiences felt through the sense of sight, while audio-visual media provides experiences through the senses of sight and hearing.
The use of audiovisual educational media is effective for increasing knowledge because audiovisual media combines auditory (hearing) and visual (sight) media.This combination will involve all the senses so that respondents will have better retention (memory).When respondent retention is good, respondent understanding will also be good.If the understanding is good, it will increase the respondent's knowledge as well.

The Effect of Counseling with Audiovisual Media on the Attitudes of Young Women toward Consuming Iron Supplement Tablets
From the results above, it can be concluded that there is a significant difference in attitude changes between the counseling group with audiovisual media and the counseling group without audiovisual media.Providing counseling using audiovisual media has a greater influence on changing attitudes in a positive direction compared to the counseling group without audiovisual media.This research is in line with research by Sudarmi, (2021) which states that the use of audio-visual media is more effective than flip sheets in increasing knowledge and changing the attitudes of pregnant women to prevent complications of pregnancy and childbirth.And also in accordance with research by Amelia et al., (2020), education using audiovisual video media can increase knowledge and attitudes about intrauterine device (IUD) contraception.And a study in India stated that parents' knowledge, attitudes, and behavior regarding children's dental and oral health improved with audiovisual assistance (Kajal et al., 2020) Attitude is a view, opinion, or feeling towards a particular object, person, or event.
Furthermore, a person's attitude response is usually expressed in the form of willingness or unwillingness, or it could also be in the form of agreeing or disagreeing.(Puspitasari et al., 2023).The manifestation of attitudes cannot be seen directly but can only be interpreted through closed behavior.Attitude is an individual's tendency to determine whether he likes or vice versa an object.Attitudes cannot be seen directly but are interpreted before behaving based There is a relationship between the level of knowledge and attitude (Ekasari et al., 2021).A good level of knowledge and understanding can trigger the formation of an open and positive attitude (Pantow et al., 2021).Good knowledge will certainly encourage the formation of good attitudes and the implementation of good actions as well.The knowledge a person has becomes the basis for determining attitudes, so that the attitude of someone who has good knowledge tends to be positive.Attitude will form an interest in doing something.
This interest is a function of attitude towards behavior, where attitude is belief in the consequences and results obtained after behaving (Hasibuan & Ain, 2023).This attitude will later determine how to see the situation and act towards the situation or object.A person will behave in accordance with attitudes in dealing with situations or conditions only if they have personal experience or knowledge of this matter (Linawati et al., 2021).
Knowledge influences the formation of attitudes; the knowledge a person has becomes the basis for determining attitudes.The use of audiovisual media is considered effective in increasing knowledge, which is an important domain in determining attitudes.Respondents who have good knowledge tend to have positive attitudes.So it can be said that counseling using audiovisual media indirectly influences improving a person's attitude.

CONCLUSIONS
Based on the results of the study, it can be concluded that: 1.There was an increase in knowledge regarding anemia and the consumption of iron supplement tablets after providing education using audiovisual media.
2. There was an increase in attitudes regarding anemia and consumption of iron supplement tablets after providing education using audiovisual media.
Vol 5 3. Counseling using audiovisual media has an effect on increasing knowledge and improving attitudes among young women regarding anemia and the consumption of iron supplement tablets.
It is recommended for health workers, especially those in the health promotion department, to be able to apply outreach media that are easy to understand, such as audiovisual media, in providing material about health and disseminating health information, especially anemia tablets and iron supplements, to young women.
of the reaction to the stimulus received.Attitude formation consists of three components, namely cognitive, affective, and conative.Cognitive theory, expressed by Greenwald (1968); Petty and team (1981), cited in Wisman, (2020), is a cognitive response analysis, namely an effort to understand what someone thinks when faced with a persuasive stimulus and how thoughts and cognitive processes determine whether they experience a change in attitude and to what extent the change occurs.The persuasive stimulus in this case is education with lectures and audiovisual media regarding blood supplement tablets.The cognitive component is the beginning of an individual's attitude regarding knowledge.This is in accordance with what Biney et al., (2022) stated: knowledge is an important part of forming attitudes and actions.

Table2. The Effect of Counseling with Audiovisual Media on the Level of Knowledge of Young Women in Consuming Iron Supplement
table 2 below : Based on table 2, it can be seen that the knowledge of respondents in the experimental group and control group during the pretest mostly had a lower level of knowledge, namely 35 people (79.5%) in the experimental group and 33 people (75%) in the control group.The knowledge of experimental group respondents increased in the posttest, where there were 34 people (77.3%) in the good category, 10 people in the sufficient category (22.7%), and there

Table 4
displays the increase in knowledge and attitude scores between the experimental group and the control group.The average knowledge gain in the experimental group was 73.16, and the control group was 52.62.The mean attitude gain for the experimental group was 72.55 and for the control group was 25.48.Mann-Whitney test results p-value <0.05 Raidanti & Wijayanti, (2022))stated that it would be very good if an extension service included media as a tool because it was considered capable of representing or explaining what the instructor was unable to convey.The outreach media used in this research is video.Using video media is more effective and efficient than using words or writing.Edgar Dale states in Syarifuddin & Utari (2022) that in a cone called the cone of experience, Edgar Dale states that in general, if someone obtains information at level 1 just by reading, then only 10% of what they read can be remembered; at level 2, if a person obtains information only by hearing, then he can only remember 20% of what he hears; at level 3, if a person obtains information just by looking (for example, pictures), then he can only remember 30% of what he sees; and at level 4, if someone obtains information by seeing and hearing, then what he can remember is 50% of what he heard and saw.This research is level 4 on the Edgar Dale cone.And also,