The Effect of Health Education Using Animated Videos on Elementary School Girls' Behavior in Facing Menarche in Pasaman Barat District

The behavior of elementary school students in receiving menarche depends on several things, including social support and the availability of information. To carry out a learning method, it is necessary to have media that can support or channel the information conveyed through appropriate learning media. Learning media is a means of conveying information about lessons that can arouse students' enthusiasm for learning, thereby encouraging students to learn independently. Objective This research is to determine the effect of health education using animated videos on the behavior of elementary school students in facing menarche in West Pasaman District. The research was conducted in July 2024. The type of research was Quasi Experimental with a One-Group Pret-Post Test design. The population covered in the research were female students in West Pasaman District as many as 68 samples using total sampling technique. The research instrument used a questionnaire. Univariate data analysis was presented in the form of a frequency distribution and bivariate analysis used the Wilcoxon test, data processing used the computerized SPSS program IBM version 25.0. The results of the research show that there is an effect of health education using animated videos on knowledge. The conclusion is that there is an influence of health education using animated videos on the behavior of elementary school students in facing menarche. Suggestions for health education media using animated videos can be included in additional learning programs at schools.


INTRODUCTION
Human growth and development involve a series of processes that begin in the womb and continue into adulthood.During this time, individuals go through a significant developmental phase known as adolescence.According to the WHO (2020), adolescence is defined as individuals aged between 10 and 19 years, which is divided into early adolescence (10-14 years) and late adolescence (15-19 years) (WHO, 2020).Before entering adolescence, individuals experience puberty.This period brings important changes in physical growth and development, transitioning them from childhood to adulthood.For adolescent girls, a key event during puberty is menarche, the onset of menstruation.Menarche, along with other physical changes, is part of the maturation process of the reproductive organs (Abadi et al., 2015).
Puberty involves notable psychological and physical changes.In addition to menarche, adolescent girls also experience changes in secondary sexual characteristics, such as hip and breast development, smoother skin, and increases in height and weight (Rima & A.A, 2020).While the age of menarche varies for each individual, the normal range for this event is between 10 and 12 years.Menarche, along with puberty, is a significant moment that guides individuals through a distinct developmental stage and lays the foundation for their maturity.The first menstruation or menarche typically occurs between the ages of 10 and 16, marking the beginning of the middle adolescent stage when puberty starts before reaching the early reproductive phase (Retnangsih et al., 2018).Menarche holds significant meaning in a girl's life, both socially and medically.The age at menarche has become a focus of extensive research and is identified as a risk factor for various health outcomes in adolescence and adulthood (Haley & Freeman, 2018).Menstruation signifies that an adolescent girl has entered a stage of maturity, particularly concerning the reproductive system.Although menarche is often used as an indicator of sexual maturity, this change is neither the first nor the last during puberty.On average, girls experience menarche at ages 12-14, but it can occur earlier, as early as 9-10 years, or later, up to 17 years.The most common age for menarche is 11 years, but this variation is influenced by several factors, including hormonal development and the individual's maturation (Hussain, 2020).In this context, menarche reflects not only physical changes but also the diversity of development during puberty.Menarche, or the start of a woman's first menstrual cycle, usually occurs 2 to 4 years after the development of breast buds and pubic hair.The age range for menarche is between 10 and 16 years.According to the World Health Organization (WHO) in 2020, early menarche is becoming increasingly common among adolescent girls.The prevalence of early menarche varies by country, for example, 14% in Canada, 10% in China, and Indonesia ranks 15th out of 67 countries with a menarche age acceleration of 0.1 years (Sari et al., 2020).In Indonesia, Sudiknoi et al (2020) reports an average menarche age of 12 years, with some cases of first menstruation beginning at age 8, though this is rare, while the latest age for menarche is 16 years.In West Sumatra, the average age for menarche is 13 years, and in Padang city, it is 12 years (Savitri et al., 2019).The age of menarche shows a tendency to decrease over the years, reflecting variations in adolescent development across different countries due to social, economic, and environmental factors.The occurrence of menarche can trigger varied responses, influenced by knowledge level, attitudes, age, and parental upbringing.According to Juliyatmi (2015), menarche can be categorized into three types: early menarche (<10 years), normal menarche (10-14 years), and late menarche (>14 years (Juliyatmi et al., 2015).Early menarche can impact a girl's knowledge and attitude toward menarche (Mahmudah et al., 2022).It can be a challenging time, often accompanied by fear, anxiety, and confusion, stemming from inadequate information about menstruation.Many adolescents worry about menstruation because it is new to them.Accurate information helps reduce unnecessary anxiety.Typically, girls learn about menstruation from their mothers, but some mothers are reluctant to discuss it openly due to societal taboos surrounding menstruation, leading some girls to view menstruation negatively (Alomair et al., 2022).Studies show that only 6% of 150 girls in Nepal are aware that menstruation is a natural and normal process (Alomair et al., 2022).In India, 64% of adolescent girls are afraid of menarche, and 86% feel unprepared for it (Mahmudah et al., 2022)This is due to a lack of knowledge and preparation for menarche.In Indonesia, research involving 1,403 adolescents from 16 schools in 4 provinces found that 41% of adolescents felt they had inadequate information about menstruation, affecting their preparation and personal hygiene during their first menstruation (Sinaga, 2020).In the Health Office of West Sumatra Province, Suryanti, (2024) found that 54% of early adolescent girls felt anxious about menstruation due to a lack of knowledge about menarche.Meanwhile, 33% felt anxious despite receiving information from various sources such as older siblings, mothers, or social media, remaining confused about what to do during menarche and embarrassed if known by the opposite sex.Only 13% felt prepared for menarche (Suryanti et al., 2024) Research at SDN 24 Ujung Gurun in Padang Barat revealed that 82.9% of students in grades IV-VI had low knowledge before receiving health education about menarche (Nurhayati & Purwandari, 2023).Factors affecting menarche in adolescent girls include unmodifiable factors such as genetics and hormones, as well as modifiable factors such as nutritional status, food consumption, socio-economic conditions, media exposure, sexual behavior, and lifestyle (Makarimah & Muniroh, 2018).Research by Suripa (2016) indicates that 71% of 52 respondents exposed to adult media (pornography) might influence their knowledge about menstruation (Hidayat & Farid, 2016).As community nurses, the role in enhancing adolescents' knowledge about menarche is crucial.According to Sexual and Reproductive Health and Rights (SRHR), nurses are responsible for educating adolescents about reproductive health to prepare them for changes, including menarche (WHO, 2019).Elementary school students in grades IV, V, and VI are mostly aged 10-12 years.At this age, they might begin menstruating, indicating the onset of puberty.An important aspect for children in this age range is comprehensive reproductive health education.In elementary science classes, introducing reproductive organs can help children understand and not feel taboo about menstruation, so they are prepared and able to adapt to these changes (Hussain, 2020).One effective educational method is the use of animated video media.Animated videos can present information in an engaging and understandable way, utilizing multiple senses to enhance student comprehension (Hill et al., 2021).Research by Rahmawati et al., (2023) shows that animated videos significantly improve adolescents' knowledge and readiness for menarche.In Lembah Melintang District, West Pasaman Regency, there is an urgent need to improve knowledge about menarche among elementary school students, particularly at SDN 05 and SDN 12. Initial observations show that many students who have experienced menarche have not received adequate education on this topic.This study aims to evaluate the effectiveness of animated video education in enhancing knowledge and readiness for menarche among elementary school students in West Pasaman.By providing appropriate education and adequate social support, adolescent girls can face menarche with more confidence and readiness, reducing the negative impact of ignorance about menstruation.(Hill et al., 2021) This research is expected to contribute significantly to improving the understanding and readiness of adolescent girls in West Pasaman Regency regarding menarche through the use of effective animated video media.

OBJECTIVE
The purpose of this research is to analyze the effect of health education using animated videos on the knowledge and attitudes of elementary school students in facing menarche in West Pasaman Regency.

METHODS
This research is a quantitative study using an experimental approach with a "quasi-experimental design with one-group pretest-posttest design," which involves one intervention group (Sugiyono, 2016).In this study, the independent variable is the animated video, while the dependent variables include knowledge, attitudes, and behaviors.The statistical analysis is conducted to determine the effect before and after the animated video intervention by measuring the knowledge of elementary school girls in facing menarche (pre-test) and then re-measuring these variables after the animated video intervention (post-test).Population According to Sugiyono (2018), the population is a generalization area consisting of objects/subjects that have certain qualities and characteristics determined by the researcher to be studied and from which conclusions are drawn.The population in this study includes all students from grades IV to VI for the 2023/2024 academic year at SDN 05 Lembah Melintang and SDN 12 Lembah Melintang in West Pasaman Regency, who have experienced menarche, totaling 68 students-28 students from SDN 05 and 40 students from SDN 12 (Sugiyono, 2016).This study obtained ethical permission from the Ethics Committee of the Faculty of Medicine, Andalas University with No. 39.layaketik/KEPKFKEPUNAND.

RESULT Univariate Analysis
Univariate analysis was based on age, grade level, age of menarche, mother's occupation (Table 1).  1, it can be concluded that out of 68 respondents, more than half are in the age range of 12 years, with 45 individuals (66.2%) falling into this category.The majority are in Grade VI, with a total of 55 students (80.9%).The most common age at menarche is 11 years, reported by 40 individuals (58.8%).Additionally, the most common maternal occupation is "Working Mother," accounting for 43 individuals (63.2%).

Bivariate Analysis
Bivariate analysis of the results of testing the normality of knowledge variable data using the Shapiro Wilk test, with the results of a significance value ≤ 0.05, where the knowledge data is not normally distributed.Then testing the difference in the average knowledge of children before and after being given health education with power point media in this study using the Wilcoxon test with the results can be seen in table 2. Based on table 2. shows the results of the Wilcoxon test, there are differences in knowledge before and after being given health education with a p value of 0.000 (p < 0.05) and the difference between pretest and posttest is 3, which means that there is a positive effect of health education with power point media on children's knowledge about preventing tuberculosis

DISCUSSION
The study results show that out of 68 respondents, 36 individuals (52.9%) had fair knowledge before the intervention.This means that more than half of the respondents still needed accurate information about menarche to improve their knowledge.In this study, the average age of respondents is within the 12-year age range, with 45 individuals (66.2%) in this group.Age is one of the factors that influence a person's knowledge (Juliana et al., 2022).Among the respondents with fair knowledge, 26 individuals (38.2%) are in the 12-year age range.Age is closely related to cognitive maturity; as age increases, so does the ability to think rationally, control emotions, and process information more quickly (Juliana The research results, analyzed using the Wilcoxon test, showed a p-value of 0.000 (p<0.05),indicating that animated videos have a significant impact on improving elementary school girls' knowledge about menarche in Pasaman Barat Regency.The animated video was designed to be engaging for the students, featuring a character named Mena, a 10-year-old girl who provides education about the first menstruation to elementary school students.The video, with a duration of 5 minutes and 15 seconds, narrates Mena's adventure in facing menarche.Animated videos combine audio and visual media to capture learners' attention, present detailed objects, and help in understanding complex lessons.This aligns with Nola J. Pender's Health Promotion Model (HPM), which suggests the need for strategies to provide positive health education.Animated videos contribute significantly to changes in adolescents' knowledge, particularly in terms of information and persuasion.Audiovisual media, with its two synergistic elements-sound and sightstimulates both auditory and visual senses, leading to more effective learning outcomes.This is because vision is the primary sensory channel for knowledge acquisition (about 75% to 87%), while other senses contribute less (13% to 25%), making it easier for adolescents to apply the information presented in the video (Suwanti et al., 2021).In this study, the animated video provided information about menstruation, the menstrual cycle, and the changes occurring during menstruation.The engaging presentation of this information influenced the students' knowledge.Aisah et al., (2021)also noted that animated videos are highly effective in health education due to their engaging, artistic, and easy-to-understand nature, making them informative and effective across various age groups and health conditions.This finding is consistent with Hanifah et al. (2021), who studied the effectiveness of health education through animated videos versus PowerPoint presentations.They found a significant difference, with a pvalue of 0.000, indicating the effectiveness of animated videos in enhancing knowledge about menarche.

CONCLUSION
We would like to express our deepest gratitude to all those who contributed to the successful completion of this research study.First and foremost, our sincere thanks go to the participants, particularly the elementary school girls in Pasaman Barat Regency, whose willingness to engage with the educational intervention was invaluable.We are grateful to the school administration and staff for their support and collaboration throughout the study.Your assistance in facilitating the research and accommodating the intervention was crucial.Special thanks to the development team behind the animated video, whose creativity and dedication played a significant role in delivering engaging and informative content.We also extend our appreciation to our research mentors and colleagues for their guidance, feedback, and encouragement.Your expertise and support were instrumental in shaping the direction and quality of this study.Thank you all for your contributions and support in advancing knowledge about menarche and health education.

Table 2 . The Effect of Health Education Using Animated Videos on Students' Knowledge about Menarche (n= 68)
Alomair et al., 2022)larly, Fitrial et al., 2023) found that insufficient knowledge is influenced by factors such as age.The study showed that 47.7% of pretest knowledge about menarche was among early adolescents aged 10-12 years.Early adolescents often experience curiosity about changes in their bodies, develop new thoughts, and become quickly interested in various matters.According to the American Psychological Association (APA, 2016), adolescents need support for optimal health and development, including physical and mental health, sexual and reproductive health, education, social environment, and support in building skills necessary for becoming productive and healthy adults.Based on the questionnaire results, it was found that 43 respondents (63.2%) did not know about menarche, as shown in questionnaire item 4, even though menstruation is a natural process in females(Sukarni et al., 2019).Additionally, many students were unaware of the types of sanitary pads, with only 36 respondents (52.9%) answering correctly in questionnaire item 9. Knowledge about the timing for changing sanitary pads, as shown in questionnaire item 12, was correct for only 38 respondents (55.9%).Insufficient knowledge about menarche can lead to issues with personal hygiene, increasing the risk of reproductive organ infections and resulting in psychological changes such as anxietyAlomair et al., 2022).