Document Type : Original Article


1 Faculty of Medicine, Universitas Sebelas Maret, Indonesia

2 Faculty of Health Sciences, Universitas Aisyiyah Yogyakarta, Indonesia


The aim of this research was to describe the effectiveness of the community development model for health promotion using WhatsApp toward old women behavior in doing an early detection of cervical cancer through the examination of visual acetic acid. The kind of this research was the mixed method and sequential strategy. The model of the mixed sequential method is a procedure of research when the researcher combines the qualitative and quantitative data by mixing in different time. The research of design used sequential explanatory; did the collection and analysis the quantitative data first, then followed by collecting the qualitative data based on the result of quantitative data. The research was conducted on December 2019 to May 2020. The research location was in Bantul District, Special Region of Yogyakarta. The partcicipants in this research were elderly women that had followed the process of quantitative research. The determination of the participants number in this research was undertaken sequentially; determining the limit of the increase until reaching the data saturation to obtain the number of participants which consisted of 15 participants, while for quantitative section, 40 participants were employed. The technique of data collection used in this research was in-depth interview, observation and study documentation. Data analysis was conducted quantitatively and qualitatively. The results indicated that from 87.5 percent of participants (35 participants), 97.5 percent did the early detection of cervical cancer. Based on the results, it was indicated that the community development model for health promotion using WhatsApp was effective in encouraging changes in the behavior of the elderly in early detection of cervical cancer through the examination of visual acetic acid in Bantul District.     

Graphical Abstract

The Effectiveness of Community Development Model by Using Whatsapp toward Old Women Behavior in Early Detection of Cervical Cancer



Cervical cancer is the kind of cancer that attacks woman’s reproductive organ in the cervical part, it is caused by the virus of human papilloma [1]. In Indonesia, cervical cancer is the second highest case after breast cancer. The number of new cases occurs in 2012 was 20.928 of cases with an incidence of 17 per 100.000 of women and the number of deaths was 9498 cases [2].

The national cervical cancer prevalence is 0.8 percent while in Special Region of Yogyakarta Province has the prevalence of cervical cancer is 1.5 percent (Center for Data and Information of the Ministry of Health of the Republic of Indonesia, 2015). Based on the data from Public Health Office of Special Region of Yogyakarta in 2016, a new case has emerged and it is called as cervical cancer malignant neoplasm with 18 outpatients and 9 inpatients. In 2017, the number of outpatients was 486 patients and the number of inpatients was 194 patients. Several factors of cervical cancer risk are sexual activity in young age, changing partner, smoking, oral contraception pill in more five years, family history of cervical cancer, high parity of more three children birth [3]. Poor immunity caused by malnutrition or another systemic disease can encourage the cause of cervical cancer [4].

The coverage of early detection of cervical cancer by the examination of visual acetic acid (IVA) method in Special Region of Yogyakarta Province in the last three years (2015-2017) is 52.478 (2.02 percent). The coverage of early detection in Bantul District in 2018 was 1.31 percent of 141823 of women in the age of 30 to 49. The lack of public awareness and knowledge about cervical cancer and the way of prevention is one of the causes of the low early detection of cervical cancer and the behavior of women who do not want to get checked up because of they are afraid of the examination result, the fear of pain during examination, shame [5,6]. 

One of the innovations and technological advances that can be used in community development by health promotion can reach all society by using communication media and handphone is close to the community [7], in the subsequent developments, most people use the smartphone. In Indonesia, the smartphone user is used by some community both in high and low level [8]. The user of Multi Media Messaging Service has been replaceable with WhatsApp media [9]. WhatsApp is one of popular applications by utilizing the text message, picture and video, therefore it makes the communication easier [10]. The use of information technology both handphone and smartphone have a potential to improve the accessibility, innovation and cost effectiveness in health service and health promotion treatment [7].

According to Kemm & Closse [11] and Orji et al., [12] in Health Promotion Theory and Practice) propose the opinion about Health Belief Model (HBM) that health behavior is determined by individual perception toward health problem faced. There are four factors related to the HBM, such as: 1) individual awareness toward the vulnerability in herself, 2) the problem faced is felt serious enough, 3) the belief toward the prevention effort or treatment done, and 4) the availability of health service.

Referring to the theory of HBM, the community development model in early detection of cervical cancer is done through selecting the target for women that have a risk, and the target are spirituality group in the community of Bantul District. In this case, the target selected are the elderly women in recitation group that can be used for health promotion of cervical cancer activity and early detection. Recitation group consist of various members that come from certain group such as integrated servant post committee, Empowerment of Family Welfare, Dasawisma and Dharma Wanita with various different backgrounds such as education, job and social economy status. Recitation activity which is held routinely in every month and generally they seldom discuss the material relating to the health. Moreover, it is proposed that Islam is the source of motivation in various life aspects, in order human always improve their life quality including in health field. The selection of this community group was undertaken to facilitate the socialization, implementation, monitoring and evaluation activity that all this time discussed the health problem related to the reproduction health including the risk of developing uterine cervical cancer.

World Health Organization [7] defines the health promotion as “the process of enabling people to control over and improve their health”. The definition is interpreted as “the process of community development to maintain, improve and protect their health”. From the definition above, it can be concluded that the health promotion is the process encouraging the community to do the control toward their health through promotive effort prevention and curative effort to reach healthy life as a life style.   

Health promotion is an approach that is planned for a population in order to change behavior and maintain a healthy behavior that has been committed before, therefore, it can improve their health both individual and group or society. By giving the health information in this health promotion, it is expected that there is an improvement of knowledge and behavior and attitude change [13].

Health promotion is conducted as an effort to improve the knowledge and change attitude and behavior so that lifestyle changes to be more positive to improve the health of individuals or communities themselves [14]. Health promotion is an effort directed to improve the quality of health and well-being of individual, family, community and or state through strategy involving a supportive environment, coordination of all necessary resources and respect for personal choice and value [15].

Cervical cancer ranked in fourth in 2012 according to the Global Burden of Cancer (GLOBOCAN) among all women and the second most in women are in aged 15-44 years [2]. In 2012, it was estimated that there were 527,624 new cases of the cervix with 266,000 cases of death [16]. According to GLOBOCAN data, 80 percent of cervical cancer deaths occurred in developed countries in 2002 and 88 percent in 2008, with an estimated 98 percent of cervical cancer deaths occurring in developing countries by 2030 [17]. Cervical cancer is a major public health problem in Central and Eastern European countries, with a high prevalence compared to western Europe [18].

Indonesia is included in the group of developing countries. It is estimated that there are 38 new cases every day and 21 women die from cervical cancer [19]. In developing countries, the prevalence of cervical cancer is 15.7 per 100,000, indicating a higher number, which is 14 per 100,000 people, compared to the global incidence of cervical cancer [15]. It is estimated that there are 38 new cases every day and 21 women die from cervical cancer [19], it means that one woman is estimated to die every hour, while every two minutes is estimated in the world itself.

Every woman has a risk of cervical cancer. To reduce the incidence of cervical cancer it is necessary to increase the coverage of early detection. The effort committed is health promotion with community development model using Video media sent to WhatsApp. The expected results of health promotion activities are increased knowledge, motivation, positive attitude, willingness to do early detection and increased behavior of early detection of cervical cancer so that the coverage of early detection increases and has an impact on the decrease in morbidity and mortality of cervical cancer.

Material and methods

The type of this research was mixed methods and sequential (gradual) strategies. The research was conducted from December 2019 to May 2020. Research location was in Bantul Regency, Yogyakarta Province. The selection of research location was based on the consideration that the prevalence of cervical cancer in the area is quite high at 1.5 percent while the prevalence of cervical cancer nationally is 0.8 percent. The average achievement of early detection of cervical cancer with visual inspection of acetic acid in the Special Region of Yogyakarta area (covering 4 districts 1 municipality) was 17.1 percent. For Bantul District obtained an achievement rate 9.03 percent which was the lowest figure in SRY [20].


Figure 1: Research Design

Quantitative research sample were 38 respondents. It indicated that 8 percent (2 respondents) were added as a backup when there were respondents dropped out, therefore the number of respondents was 40 respondents. Qualitative research subjects were determined by purposive sampling. The determination of the number of informants in this research was through sequential i.e. the limit was determined until it reached the saturation of data and obtained 15 people / informants. The data collection techniques used in this study were in-depth interviews, observations, and documentation study. On the research to assess the changes obtained before and after health promotion about cervical cancer and early detection in the treatment group by using video media that sent to WhatsApp by comparing changes in early detection behavior before and after treatment.

Result and Dissection

After 2 to 4 weeks of conducting the health promotion, the result is presented on Table 1 below:



Table1: Early Detection Behavior


Early Detection Behavior


Not willing


Not Committed









Source: the result of primary data


Based on Table 1, the group treatment of 35 (87.5 percent) that are willing, increase to 39 (97.5 percent conducted the early detection of cervical cancer).

In-depth interviews were about the behavior of participants conducted early detection of cervical cancer and those conducted in the treatment group and it had done early detection of cervical cancer with 15 participants. Most participants that had done early detection of cervical cancer felt motivated as they felt they were at risk. Besides, we observed the motivation of participants to do early detection of cervical cancer because they wanted to know their health so they were willing and do early detection of cervical cancer, and another motivation that encouraged them to do early detection of cervical cancer was to maintain health. 

The result of Pearson Correlation Coefficient in software Nvivo 12 plus is presented below:


Table 2:  External factor related to the suppoprt system encouraging participant to do early detection of cervical cancer


Support System

Pearson Correlation Coefficient


Effective WAG

0, 581007


Strong role of leader

0, 556868



Clear video material

Family support

0, 220669

-0, 288944



Based on Table 2, Pearson Correlation Coefficient values in the category of strong leader role are the supporting factor of participants conducting early detection of cervical cancer. The existence of effective WAG has the highest value which is 0.581007, compared with the effective leadership role which is 0.556868.  While the clear video material category has a value which is 0, 220669 and family support has a value by -0, 288944.

To find out which participants have an effective WAG support system, the role of a strong leader, video content message and family support for cervical cancer detection, are revealed in the form of project map using Nvivo 12 Plus software as follows:


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