Analysis of Factors Affecting the Improvement of Open Defecation Free (ODF) behavior in Communities in Kerta Timur

Various problems experienced by the community related to not maintaining environmental hygiene, basically related to low hygiene and sanitation of water used for daily needs, human waste/feces, waste water, garbage, and public places.. The purpose of this study is to analyzethe influence of attitude, support from health workers and social support on increasing Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency. The design of this research is an observational quantitative research with a cross sectional approach with the focus of the research being directed at analyzingthe influence of attitude, support from health workers and social support to increase Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency. The total population is 173 respondents and a sample of 121 respondents is taken by using Simple Random Sampling technique. In the study, it was found that almost half of the respondents had a sufficient category attitude as many as 55 respondents (45%). Almost half of the respondents have sufficient support from officers in the category of 43 respondents (36%). Almost half of the respondents have social support in the sufficient category as many as 52 respondents (43%). Most of the respondents have behavior in the sufficient category as many as 51 respondents (42%).Based on the results of Multiple Linear Regression analysis shows that with a p-value of 0.000 <0.05 then H1 is accepted so it can be concluded that simultaneously there is the influence of attitude, support from officers and social support to increase Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumensep Regency with an influence magnitude of 89.1%. Respondents are expected to defecate in latrines in order to minimize disease transmission due to fecal contamination. To create a clean and healthy environment from all kinds of dirt and disease.


INTRODUCTION
The development of public health from one side is part of the development of Indonesian people as a whole and from the other side a healthy condition is absolutely necessary for development conditions. This is because only healthy people can carry out development activities properly. Health development can support the implementation of development in other fields and so reciprocally. For individuals and communities, healthy conditions are absolutely necessary in their life activities, as well as a basic basic capital in order to achieve a decent degree of welfare.
Good or bad health status can be influenced by environmental factors. Various problems experienced by the community related to not maintaining environmental cleanliness, basically related to low hygiene and sanitation of water used for daily needs, human waste/feces, waste water, garbage, and public places. These problems have a direct impact on public health. The low level of environmental health makes the level of public health also low, causing the productivity level of the population to also be low and the number of illnesses occurring in the community is low.
A healthy environment is an environment free from pollution, the availability of clean water, adequate environmental sanitation facilities (garbage disposal, family latrines), healthy settlements, health-oriented regional planning and the realization of community life that helps each other in maintaining the nation's cultural values. . Environmental-based disease problems caused by inadequate environmental sanitation, both in terms of quality and quantity as well as low community health behavior are indicators of public health status (NasrumDj, 2010).
The behavior of open defecation can have a negative impact on the environment where defecation is an act or process of living things to dispose of solid or semi-solid waste or feces from the digestive system of living things. Eligible disposal of feces is a public health need that is still problematic, due to unhealthy defecation behavior (Supriyono, 2011).
The Community-Based Total Sanitation Strategy (STBM) is an effort to accelerate the increase in access to basic sanitation in Indonesia as stated in the 2015-2019 RPJMN, namely the availability of Universal Access or access coverage of 100% for drinking water. 0% slum settlements and 100% stop free open defecation. As regulated in the Regulation of the Minister of Health of the Republic of Indonesia Number 3 of 2014 concerning Community-Based Total Sanitation. STBM is an approach to change hygiene and sanitation behavior through empowerment with the triggering method. One of the STBM programs is ODF (Open Defecation Free) which is a condition when every individual in the community does not open open defecation (Kemenkes RI Number 852, 2013). However, the facts on the ground, the ODF status has not been in line with the behavior of people who still defecate in any place, for example in rivers. This place is certainly not a proper or healthy place to defecate because it can cause new problems that can endanger human health.
Based on existing data, the Dasuk Health Center, Dasuk District, Sumenep Regency has a working area of 15 villages. Among the 15 villages that have not been ODF, 5 are the village of East Kerta with a total of 429 households. Of the 4 hamlets in East Kerta Village, there are 2 hamlets with a total of 95 families still defecating in any place, including in rivers, gardens, rice ditches, bushes and so on. Meanwhile, the criteria for villages that have ODF are 100% of the community having defecated in the latrine. Things that cause the low level of achievement of ODF (Open Defecation Free) villages include behavioral factors. The behavior of most people who still defecate in rivers, ponds, gardens, ditches, bushes and so on. In addition, in developing countries such as Indonesia, there is still a lot of indiscriminate disposal of feces due to low socio-economic and socio-cultural factors associated with the theory of bad habits in disposing of feces that are passed down from generation to generation, especially in slum rural and urban areas. Dj, 2015).
Based on the above conditions, the authors are interested in researching the analysis of factors that influence the increase in Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency.

METHODS
In this study, the researcher used an observational quantitative design with a cross sectional approach, which is a study to study the dynamics of the correlation between risk factors and effects, by approaching, observing or collecting data all at once (point time approach), that is, each subject The study was observed only once and measurements were made on the status of the character or variable of the subject at the time of examination. This does not mean that all research subjects are observed at the same time (Soekidjo, 2012). This research will analyzethe influence of attitude, support from health workers and social support on increasing Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency. The total population is 173 respondents and a sample of 121 respondents is taken by using Simple Random Sampling technique. Data analysis using Linear Regression test. This research has gone through an ethical test with SK: 2357/KEPK/III/2021.. Based on the results of Linear Regression analysis shows that the p-value is 0.005 < 0.05, then H0 is rejected and H1 is accepted, so it can be concluded that partially there is the effect of health worker support on increasing Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency. c. The Effect of Social Support on Behavior Based on the results of Linear Regression analysis shows that the p-value is 0.002 < 0.05, then H0 is rejected and H1 is accepted, so it can be concluded that partially there is the effect of social support on increasing Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency

Simultaneous
Based on the results of Multiple Linear Regression analysis shows that with a p-value of 0.000 <0.05 then H1 is accepted so it can be concluded that simultaneously there is the influence of attitude, support from officers and social support to increase Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumensep Regency with an influence magnitude of 89.1%.

A. Community Attitudes in East Kerta Village, Dasuk District, Sumenep Regency
The results showed that almost half of the respondents had a moderate category attitude as many as 55 respondents (45%). In addition, a number of 38 respondents (31%) had a poor attitude category. While a number of 28 respondents (23%) have a good attitude category.
Attitude is a reaction or response of someone who is still closed to a stimulus or object. The manifestation of that attitude cannot be directly seen, but can only be interpreted beforehand from closed behavior. According to Randi in Imam (2011), attitude is a general evaluation made by humans against themselves or others for reactions or responses to stimuli (objects) that cause feelings accompanied by actions that are in accordance with the object.
Attitudes clearly show the connotation of a suitability of reactions to certain stimuli (Notoatmodjo, 2007). Attitude consists of various levels, namely accepting means that people (subjects) want and pay attention to the given stimulus (object). Giving answers when asked, doing and completing the given task is an indication of attitude. Because with an attempt to answer a question or do a given task, regardless of whether the job is right or wrong, it means that people accept the idea. Inviting other people to work on or discuss with others on a problem is an indication of the third level of attitude. Taking responsibility for everything he has chosen with all risks is the highest attitude.
According to Azwar (2013), to be able to form the basis for attitude formation, personal experience must leave a strong impression. Therefore, attitudes will be more easily formed if the personal experience occurs in situations that involve emotional factors. In general, individuals tend to have an attitude that is conformist or in line with the attitude of people who are considered important. This tendency is motivated, among others, by the desire for affiliation and the desire to avoid conflict with the person who is considered important. Without realizing it, culture has instilled a line of influence on our attitudes towards various problems. Culture has colored the attitudes of members of the community, because it is culture that gives the experience of individuals in the community they care for. In reporting on newspapers or radio or other communication media, news that should be factually conveyed objectively tends to be influenced by the attitude of the author, consequently affecting the attitudes of consumers. The concept of morals and teachings from educational institutions and religious institutions greatly determines the belief system, it is not surprising if in turn these concepts affect attitudes. Sometimes, an attitude is an emotion-based statement that serves as a kind of channeling frustration or diversion of the ego's defense mechanism According to researchers, attitudes arethe reaction or response of a person who is still closed to a stimulus or object. The manifestation of that attitude cannot be directly seen, but can only be interpreted beforehand from closed behavior. Based on the results of the study, it was found that people tend to have attitudes in ODF which are still classified as low. Because the environment tends to be quite isolated so that not all of the people there have private bathrooms with latrines, even though there are latrines but sometimes there is no septic tank so that the disposal of feces is not properly conceptualized. The community feels that there are still many needs that are more important than having to spend a lot of money to make good latrines,

B. Support from Health Officers in Kerta Timur Village, Dasuk District, Sumenep Regency
The results showed that almost half of the respondents had the support of a good category officer as many as 51 respondents (42%). In addition, a number of 43 respondents (36%) have sufficient support from officers. While a number of 27 respondents (22%) had the support of officers in the category of less.
According to Barbara (2013) support is physical and psychological comfort, attention, appreciation, and other forms of assistance that individuals receive from other people or groups. Support is influenced by social conditions both from within and from outside and is stable.
Setiadi (2013) said that the support of health workers is an activity that is expected from a health worker who provides health services to the community to improve the health status of the community.
According to the Indonesian Ministry of Health (2014) health services are every effort that is carried out alone or jointly in an organization to maintain and improve health, prevent and cure disease and restore the health of individuals, families, groups and communities.
The concept of participation was introduced by French et al in Cholid (2014), that the role shows the process between two or more parties that influence one another in making plans, policies, and decisions. Participation is born from the insistence of psychological needs on each individual. The desire to play is driven by the need for power, the desire to gain recognition, and the desire to depend on others, but also vice versa on which people depend.
Health workers also have an important role in improving the maximum quality of health services to the community so that people are able to increase awareness, willingness, and ability to live a healthy life so that they are able to realize the highest degree of health as an investment for the development of socially and economically productive human resources. Health workers have several officers whose work is interrelated, namely doctors, dentists, nurses, midwives, and other medical personnel (Hena, 2016).

C. Social Support in East Kerta Village, Dasuk District, Sumenep Regency
The results showed that almost half of the respondents had social support in the sufficient category as many as 52 respondents (43%). In addition, 41 respondents (34%) have social support in the less category. While a number of 28 respondents (23%) have social support in the good category.
Social support is information or feedback from others that shows that someone is loved and cared for, valued, and respected, and is involved in a network of communication and reciprocal obligations (King, 2012). Meanwhile, according to Ganster, et al., (in Apollo & Cahyadi, 2012) social support is the availability of relationships that are helpful and have special value for individuals who receive them.
Furthermore, social support according to Cohen & Syme (in Apollo & Cahyadi, 2012) are resources provided by others to individuals that can affect the welfare of the individual concerned. Furthermore, social support according to House & Khan (in Apollo & Cahyadi, 2012) is a helpful action that involves emotions, providing information, instrumental assistance, and positive assessment of individuals in dealing with their problems. According to Cohen & Hoberman (in Isnawati & Suhariadi, 2013) social support refers to the various resources provided by one's interpersonal relationships.
Some forms of social support according to Cohen & Hoberman (in Isnawati & Suhariadi, 2013) are assistance in the form of advice related to solving a problem to help reduce stressors. Real assistance in the form of actions or physical assistance in completing tasks. Support given by others to feelings of competence or individual self-esteem or one's feelings as part of a group whose members have support related to one's self-esteem. Shows a feeling of being accepted as part of a group and a sense of community.
Sources of social support according to Goldberger & Breznitz (in Apollo & Cahyadi, 2012) are parents, siblings, children, relatives, life partners, friends, co-workers, and neighbors. The same thing was also expressed by Wentzel in (Apollo & Cahyadi, 2012) that the sources of social support are people who have meaningful relationships for individuals, such as family, close friends, life partners, coworkers, relatives, and neighbors, friends and teachers at school.

D. Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency
The results showed that most of the respondents had behavior in the sufficient category as many as 51 respondents (42%). In addition, 44 respondents (36%) have behavior in the less category. While a number of 26 respondents (21%) have behavior in the good category.
Open defecation (BABS/Open defecation) is an example of unhealthy behavior. Open defecation is an act of removing feces or feces in fields, forests, bushes, rivers, beaches or other open areas and allowing them to spread to contaminate the environment, soil, air and water (Murwati, 2012).
According to Notoatmodjo (2013), the practice of defecation is a person's behaviors related to excreta disposal activities, including the place for disposal of feces and management of feces that meet health requirements and how to defecate in a healthy manner so that it does not cause adverse health impacts. .
All food that enters the body, will be digested by the digestive organs. During the digestion process, food is broken down into simple substances that can be absorbed and used by the cells and tissues of the body and then the remains of disposal will be excreted by the body in the form of feces, urine or carbon dioxide gas. The end of the digestive process in the form of feces is called defecation (Notoatmodjo, 2013).
Someone who has regular habits, will feel the need to defecate at approximately the same time every day. This is caused by the gastro-colic reflex which usually works after breakfast. Food that has reached the stomach will stimulate peristalsis in the intestines, propagate to the colon, leftover food from the previous day, which at night reaches the cecum, begins to move the contents of the colon and there is a feeling in the perineal area. Intra-abdominal pressure increases with closure of the glottis, contraction of the diaphragm and abdominal muscles, the anal sphincter relaxes, and its action ends. Defecation work is influenced by habitual factors.
Since ancient times, the issue of human waste disposal has always been a concern for environmental health. With population growth that is not proportional to the residential area. The problem of faecal disposal is increasing, feces is a source of the spread of a multi-complex disease that must be addressed as early as possible. Disposal of unsanitary feces can cause various diseases, therefore open defecation behavior should be stopped immediately. Many families still behave unhealthy by defecating in the river. Home yard or inappropriate places. In addition to disturbing fresh air due to unpleasant odors, it is also an early opportunity for the development of the diseasecausing sector due to human behavior habits (Notoatmodjo, 2013).
Lack of attention to the management of excreta disposal accompanied by rapid population growth, will obviously accelerate the spread of fecal-borne diseases. To prevent at least reduce fecal contamination of the environment, the disposal of human waste must be in a certain place or a healthy latrine (Notoatmodjo, 2013).
Open defecation (BABS / Open Defecation Free) is an example of unhealthy behavior. BABS / Open defecation Free is an act of removing feces or feces in fields, forests, bushes, rivers, beaches or other open areas and allowed to spread to contaminate the environment, soil, air and water.

E. The Effect of Health Attitudes on Increasing Open Defecation Free (ODF) Behavior in Communities in East Kerta Village, Dasuk District, Sumenep Regency
Based on the results of Linear Regression analysis shows that the p-value 0.000 <0.05 then H1 is accepted so it is concluded that partially there is the effect of health attitudes on increasing Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency.
Changing people's behavior so that they don't open defecation is not easy, it must be done continuously by referring to the ODF (Open Defecation Free) program. Some people still think that defecating in the river is more practical. In addition, the education level factor and the geographical condition of the village surrounded by rivers also affect the implementation of the ODF program well. Another study stated that the lack of public knowledge about ODF (Open Defecation Free) was due to the fact that ODF program counseling had not been given to the community (Harmura, 2014).
Halenita Saliani's research (2013) also mentions that there is a significant relationship between attitudes and the practice of open defecation in Garuga Village, Mantoh District, Banggai Regency, Central Sulawesi Province. The results showed that the number of respondents who had a less/negative attitude was 35 people (46.7%) while those who had a good/positive attitude were 40 people (53.3%). The results of the chi-square test show a value of ap = 0.000 which means that the null hypothesis is rejected. This is also supported by Farah Nur Amalina (2016) in her research on the behavior of defecating in the river in residents of Sekayu Village, Semarang in 2014. In this study, it was shown that on average the research subjects still had a bad attitude in the use of latrines, so they had poor bowel behavior. This may be influenced by their low knowledge about the use of healthy latrines.

F. The Effect of Health Officer Support on Increasing Open Defecation Free (ODF) Behavior in the Community in East Kerta Village, Dasuk District, Sumenep Regency
Based on the results of Linear Regression analysis shows that the p-value is 0.005 < 0.05, then H0 is rejected and H1 is accepted, so it can be concluded that partially there is the effect of health worker support on increasing Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency.
A healthy environment is an environment free from pollution, the availability of clean water, adequate environmental sanitation facilities (garbage disposal, family latrines), healthy settlements, health-oriented regional planning and the realization of community life that helps each other in maintaining the nation's cultural values. . Environmental-based disease problems caused by inadequate environmental sanitation, both in terms of quality and quantity as well as low community health behavior are indicators of public health status (NasrumDj, 2010).
The behavior of open defecation can have a negative impact on the environment where defecation is an act or process of living things to dispose of solid or semi-solid waste or feces from the digestive system of living things. Eligible disposal of feces is a public health need that is still problematic, due to unhealthy defecation behavior (Supriyono, 2011).
Things that cause the low level of achievement of ODF (Open Defecation Free) villages include behavioral factors. The behavior of most people who still defecate in rivers, ponds, gardens, ditches, bushes and so on. In addition, in developing countries such as Indonesia, there is still a lot of indiscriminate disposal of feces due to low socio-economic and socio-cultural factors associated with the theory of bad habits in disposing of feces that are passed down from generation to generation, especially in slum rural and urban areas. Dj, 2015).
The development of public health from one side is part of the development of Indonesian people as a whole and from the other side a healthy condition is absolutely necessary for development conditions. This is because only healthy people can carry out development activities properly. Health development can support the implementation of development in other fields and so reciprocally. For individuals and communities, healthy conditions are absolutely necessary in their life activities, as well as a basic basic capital in order to achieve a decent degree of welfare.
Good or bad health status can be influenced by environmental factors. Various problems experienced by the community related to not maintaining environmental cleanliness, basically related to low hygiene and sanitation of water used for daily needs, human waste/feces, waste water, garbage, and public places. These problems have a direct impact on public health. The low level of environmental health makes the level of public health also low, causing the productivity level of the population to also be low and the number of illnesses occurring in the community is low.

G. The Effect of Social Support on Increasing Open Defecation Free (ODF) Behavior in People in Kerta Timur Village, Dasuk District, Sumenep Regency
Based on the results of Linear Regression analysis shows that the p-value is 0.002 < 0.05, then H0 is rejected and H1 is accepted, so it can be concluded that partially there is the effect of social support on increasing Open Defecation Free (ODF) behavior in the community in Kerta Timur Village, Dasuk District, Sumenep Regency.
Social support can come from a spouse or partner, family members, friends, social and community contacts, group friends, church or mosque congregation, and your co-workers or superiors at work. (Taylor, et al., 2009). Meanwhile, according to Tarmidi & Kambe (2010) social support can be applied to the family environment, namely parents. So, parental social support is the support given by parents to their children, either emotionally, in appreciation, in information or in groups. Parental support is associated with adolescent academic success, positive self-image, self-esteem, self-confidence, motivation and mental health. Parental social support can be divided into two, namely positive support and negative support.
Social support can be effective in dealing with psychological stress in difficult and stressful times. For example, social support helps students cope with stressors in campus life. Social support also helps strengthen immune function, reduce physiological responses to stress, and strengthen functions in response to chronic disease. (Taylor, et al., 2009).
Social relationships can help psychological relationships, strengthen healthy living practices, and aid recovery from illness only when the relationship is sporting. Social support may be most effective when it is "invisible". When we learn that there are others to help us, we feel an emotional burden, which reduces the effectiveness of the social support we receive. But when that social support is provided discreetly, automatically, thanks to our good relationships, it can reduce stress and improve health. (Taylor, et al., 2009).
Functional aspects are also underlined in explaining the concept of social support. For example, Rook (in Smet 2014) considers social support as one of the functions of social ties (or bonds). Functional aspects include: emotional support, encouraging the expression of feelings, giving advice or information, providing material assistance. Social bonds describe the general level and quality of interpersonal relationships. Moreover, social support should be considered as a different concept, social support simply refers to interpersonal relationships that protect people against the negative consequences of stress.