Implementation of Theory of Planned Behaviors to Participation and IVA Examination in Female Age Women

Cervical cancer is the leading cause of death in the world, with 311,365 cervical cancer deaths. recorded globally in 2018. Cervical cancer is caused by the Human Papilloma Virus (HPV). This viral infection is often found in sexually active women who have multiple partners. Therefore, cervical cancer can be prevented by conducting early examination through Visual Acetate Inspection (IVA). The purpose of the literature review is to determine whether there is a relationship between theory of planned behavior and participation in IVA examinations in women of fertile age. The method uses Literature reviews from the Pubmed, Microsoft Academic, BASE and Google Scholar databases, published in 2015 to 2020, and manually selects and analyzes relevant articles. The results of the literature review show that of the 20 journals found and in accordance with the research questions, namely, 1 journal that discusses the Intention Relationship of the IVA test, 7 journals that discuss the Relationship of the IVA Test Behavior, 9 journals that discuss the Attitude Relationship of the IVA test, 3 journals that discuss the Relationship of Subjective Norms for the IVA test and from the 20 journals that were found active IVA examination, 4 journals and 16 journals that were not active performed the IVA examination. From the results of the analysis of the journal, it was found that there was a lack of knowledge and information about IVA tests so that women of childbearing age did not actively carry out IVA examinations, the importance of counseling and health education regarding early detection of cervical cancer, especially IVA tests, not only for women of childbearing age, but also for their husbands, so that they understand the importance of early detection of cervical cancer and can increase the intention, behavior, attitude and subjective norms towards the activity of the IVA test.


INTRODUCTION
70% cervical cancer is caused by the Human Papilloma Virus (HPV). This viral infection is often found in women who are sexually active. While the triggering factors for cervical cancer are women who have multiple sexual partners, women who smoke, frequent washing of the vagina with anti-septic, low immunity, and use of contraceptive pills.
It is estimated that every day there are 40-45 new cases, 20-25 people die, meaning that every hour an estimated 1 woman dies of cervical cancer. This means that Indonesia will lose 600-750 productive women every month (Ministry of Health, 2015).
Therefore, cervical cancer can be prevented by early detection. The sooner it is known, the sooner treatment can be done before it gets worse. Early detection of cervical cancer can be done in primary health services such as Puskesmas through Visual Acetate Inspection (IVA). The equipment needed is quite simple and does not require expensive costs by observing a visual test using a 3-5% acetic acid solution on the cervix and seeing the change in color. which occurs after basting which aims to see the presence of dysplasia cells as a part of the cervical cancer screening method (Anwar Mallongi, 2018) Cervical cancer cases in Indonesia are caused by a lack of knowledge and awareness to do early detection so that most women who suffer from cervical cancer are found at an advanced stage and result in death because the cancer does not cause symptoms. And every woman has a risk for cervical cancer regardless of social, economic, status and age conditions (Pusdatin, 2015).
To prevent cervical cancer this prevention can be done by providing education to increase knowledge of conducting counseling and health education regarding early detection of cervical cancer, especially IVA test, not only for the mother group, but also for husbands, so that they understand the importance of early detection of cervical cancer in age couples. fertile, so that the husband can provide support to his wife for early detection of cervical cancer. In addition, the role of the husband as a decision maker will greatly affect the behavior of these fertile women in carrying out IVA examinations (Fatimah et al., 2018).

Subjective Norms and Iva Test Examination (5) There is a relationship between Theory of Planned
Behavior and the activity of IVA examination in women of fertile age, while the exclusion criteria are articles that are not free full text and are not relevant to the research question.

RESULTS
This literature review describes two articles that discuss the relationship between Theory of Planned Behavior and IVA examination participation in women of reproductive age. IVA, 66.7% had a non-supportive attitude, and 54.8% were not willing to take the test. The researcher explained that there was a significant relationship between knowledge and attitude with a P-value of 0,000.
According to Fatimah et al., (2018)  The design of this study was cross-sectional. The samples were taken from women who received counseling about cervical cancer during 2016 at districts Health Center by using proportional random sampling. Overall respondents were 198 women.

Relationship of Intention with IVA Examination
intention or intention is a cognitive and conative representation, if the individual does not have the intention to carry out a behavior, the individual tends not to carry out that behavior (Ajzen, 1975).
Research (Fatimah et al., 2018). obtained p value of 0.009. The significance value is below 0.05, which means there is a relationship between intention and the IVA test. Intent can predict the behavior of the IVA test, which means that women who have high intentions are willing to do the IVA test compared to women who have low intentions.

Relationship of the IVA examination behavior
According to the theory (Notoatmodjo, 2010), he must know in advance what the benefits of this behavior are for him. A person will do early detection of cervical cancer by IVA examination if he knows the ways and benefits for himself. What has been done by several studies, namely Sari et al.,  al., (2016). There is a relationship between iva examination and IVA test behavior. The factors that determine IVA behavior are the level of education, information, support of health workers, attitudes and income of WUS. women of childbearing age whose knowledge are more or less at risk will not undergo IVA examinations than mothers with good knowledge.

Attitude Relationship with IVA Examination
Individuals will form a belief about an object that will be assessed positively or negatively. Attitude is one of the predisposing factors that influence women in early detection of cervical cancer (Ajzen, 1991  (2020). It is known that the attitude of the mother in doing the IVA test towards almost all (77.8%) had a positive attitude towards the IVA examination.

Relationship between Subjective Norms and Iva Test Examination.
According to Fishbein and Ajzen (2010), subjective norms are a function based on beliefs called normative beliefs, namely beliefs about the agreement and / or disagreement of a person or group that is important for individuals to a behavior According to Fatimah et al., (2018) and Putu et al., (2020).
women of childbearing age who have positive subjective norms are influenced by the people closest to the respondent so that it provides encouragement for early detection of cervical cancer.

of cervical cancer.The activity of IVA examination in fertile age women
Of the 20 journals found and in accordance with the research questions, namely, 1 journal that discusses the Relationship of Intention with the IVA Examination, 7 journals that discuss the Relationship of IVA Examination Behavior, 9 journals that discuss the Relationship between Attitudes and the IVA Examination, 3 journals that discuss Relationship between Subjective Norms Implementation of Theory of Planned Behaviors..... and IVA Examination and from these 20 journals, 4 journals were found to be active in IVA examination and 16 who were inactive did IVA examination. because higher education is easier to receive information and has more knowledge about IVA examinations.

CONCLUSION
This review literature shows that what causes women of childbearing age not to take IVA examinations are those who are poorly educated with a lack of information and knowledge so that the mother does not know the benefits of the IVA examination, the importance of knowledge about early detection of cervical cancer so that it can increase intention, behavior, attitudes and norms. subjective to the IVA test.

SUGGESTION
Increase the knowledge of conducting counseling and health education regarding early detection of cervical cancer, especially IVA tests, not only for the group of mothers, but also for husbands, so that they understand the importance of early detection of cervical cancer.In addition, the role of the husband as a decision maker will greatly influence the behavior of women women in doing IVA examination.