Sources of Information and Knowledge of Gonorrhea in Indonesia

Annisa Tristifany

1,2

, Fatihah Arifah Rahmawati

1,2

, Bella Maharany Syahfira

1,2

, Adhitama

Noor Idninda

1,2

, Muhammad Maulana Malik

1,2

, Nina Tiwi Handayani

and Sani Rachman Soleman

Professional Medical Degree, Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia

Ngablak Community Health Center, Magelang, Central Java, Indonesia

Department of Public Health, Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta, Indonesia

Keywords: Sources of Information, Knowledge, Gonorrhea, Indonesia.

Abstract: Gonorrhoea (GO) is the most common sexually transmitted infection (STI) in Indonesia. Many sources of

information are influencing knowledge of GO among the general population. This cross-sectional study aimed

to analyze the association between sources of information and knowledge about GO in Indonesia. The data

were taken from the Demographic Health Survey (DHS) 2018 in Indonesia. Based on a total sampling

procedure, 86.257 respondents were identified. The dependent variable was knowledge, and the independent

variables were sources of information. The data were analyzed by chi-square and binary regression by SPSS

Version 23. Descriptive analysis revealed that the most common source of information was friends (14.8. Chi-

square analysis demonstrated that all sources of information were associated with knowledge of GO. Binary

regression found that all sources of information had a statistically significant correlation, except for radio.

Among them, teachers had the strongest correlation with knowledge of GO (p=<0.01, aOR=9, CI 95%=7.89-

10.27). Overall, all sources of information assessed in this study were associated with knowledge of

Gonorrhoea in Indonesia, except radio. The most commonly used media to obtain knowledge were teachers,

colleagues, and books.

1 INTRODUCTION

Gonorrhoea is a sexually transmitted infection (STI)

caused by gram-negative bacteria Neisseria

gonorrhoeae (Piszczek et al., 2015; Hill et al., 2016).

According to World Health Organization (WHO), the

incidence of GO is increasing by around 78 million

new cases every year, while the global prevalence of

this disease was 0.8% of females and 0.6% of males

in 15–49-year-olds (WHO, 2016; Kirckcaldy et al.,

2019). Risk factors of GO are multi-partner sexual

intercourse, human immunodeficiency virus (HIV),

living in an endemic area, prostitution, low

socioeconomic status, and being homosexual if

https://orcid.org/0000-0003-4167-5816

https://orcid.org/0000-0001-8233-7501

https://orcid.org/0000-0002-9076-4383

https://orcid.org/0000-0002-8095-2217

https://orcid.org/0000-0001-9127-1057

https://orcid.org/0000-0002-0625-0612

https://orcid.org/0000-0002-2815-818X

engaging sexual activity with another person

(Ministry of Health Indonesia [Kemenkes], 2014;

Putu Yuda Hananta et al., 2016; Kirckcaldy et al.,

2019). Patients present to a primary care clinic with

discharge from the genital area accompanied by

dysuria and or dyspareunia. Gonorrhoea discharge

has a specific pattern such as vaginal yeast or

bacterial infection, watery, creamy, or slightly green.

Burning sensations during urination and increased

frequency of urination can also be apparent. Patients

also have other symptoms, including lower

abdominal pain, fever, and a sore throat. However, it

is also possible for people to be asymptomatic

(Walker and Sweet, 2011; Dela et al., 2019).

170

Tristifany, A., Rahmawati, F., Syahﬁra, B., Idninda, A., Malik, M., Handayani, N. and Soleman, S.

Sources of Information and Knowledge of Gonorrhea in Indonesia.

DOI: 10.5220/0010489601700174

In Proceedings of the 1st Jenderal Soedirman International Medical Conference in conjunction with the 5th Annual Scientiﬁc Meeting (Temilnas) Consortium of Biomedical Science Indonesia

(JIMC 2020), pages 170-174

ISBN: 978-989-758-499-2

Effective treatment is required to decrease the

incidence of GO, including both medication therapy

and providing educational information about GO

(Rink et al., 2015). Information can affect four

components of individual outcomes, including

severity, vulnerability, effectiveness, and response

efficacy (9). Following educational information

provision, awareness is raised, particularly among

those who possess factors associated with

susceptibility or who are in the high-risk population

(Samkange-Zeeb et al., 2011). Sources of information

are significant for the transmission of knowledge,

attitudes, and behaviour about GO, and these include

the internet, books, electronic sources, and direct

information from colleagues. The validity of

information must be checked to prevent

misunderstandings about GO. Nowadays, people

receive complete information from the internet and

the other unvalidated sources. There is also a

tendency to avoid formal sources, such as medical

practitioners, due to the stigma about GO;

consequently, many people engage in self-medication

(Nichter, 1996; Lee and Cody, 2020). For others,

family members' role and support are more critical

than unvalidated sources (da Silva and Campos

Tavares, 2015). Family members must facilitate the

knowledge gap, and they may seek medication from

a health facility for signs and symptoms of GO. Most

people infected with GO tend to be discrete about it

due to the risk of stigmatization and of being expelled

from their community (14). However, eventually,

patients seem to be more comfortable discussing it

with their peers (Bhattacharjee et al., 2013).

Concerning knowledge about GO, it is not a

guarantee that those with the highest knowledge or

level of educational background are more aware of it

(Annang et al., 2010). Understanding about GO must

be focused on health prevention and promotion

programs in the community because it is a

preventable disease if people engage in safe sexual

behaviour (Inthavong et al., 2020). In addition, peer

groups in the community should be activated to share

information and discuss GO to focus on prevention

and treatment (Edianto et al., 2019). Sharing,

counselling, and consulting programs are essential

elements in the community to obtain appropriate

information. Lastly, education about GO or STIs must

be formalized in schools to provide students with

additional knowledge (WHO, 1992). The curriculum

must cover all aspects of STIs and focus on

prevention programs. Studies about health promotion

are critical to highlight the phenomena among high-

risk populations to prevent STIs spreading. However,

government and community empowerment programs

must support both policy and regulation to establish

such programs. A health policy should conduct

specific interventions through platforms such as

printed and electronic media and direct consultation

with healthcare workers or teachers. This study aimed

to provide information on the types of media that can

deliver information and knowledge about GO in the

general population. Consequently, prevention and

promotion programs can be implemented to avoid

unwanted or asymmetrical news about it.

2 MATERIAL AND METHODS

A cross-sectional study design with total sampling

was conducted to analyze the association between

sources of information and knowledge of GO in

Indonesia. The respondents in this study were the

adult population: a total of 86.257 participants. There

were two variables: the dependent variable was

knowledge about GO, and the independent variables

included media information such as radio, television,

magazine/newspapers, posters, religious institutions,

teachers, community gatherings, colleagues,

workplaces, the internet, books, and others. The data

were taken from the Demographic Health Survey in

2018 (https://dhsprogram.com/data/available-

datasets.cfm). Permission to use the data was

obtained by sending a short proposal to the

authorities, without ethical clearance. All variables

were analyzed by chi-square and binary logistic test

by SPSS version 23.

3 RESULTS

The infection of GO is found predominantly among

vulnerable demographics, including those engaged in

unsafe relationships, male ex male (MSM),

housewives, drivers, and others. However, many

people do not understand GO due to their educational

background and lack of information. Healthcare

workers' role is vital in delivering appropriate sources

of information related to signs and symptoms and

programs to prevent the spread of the disease. Various

media are essential tools to deliver GO information in

the community, as presented in Table 1.

According to the data shown in Table 1, all

respondents did not have experience and knowledge

of GO; however, among media information,

colleagues were the most likely to get information

about GO, followed by television, the internet, and

healthcare workers.

Sources of Information and Knowledge of Gonorrhea in Indonesia

171

Table 1: Univariate analysis of sources of information and

knowledge about GO in Indonesia.

Media Yes No

n % n %

Radio 626 0.7 % 85.631 99.3 %

Television 9.184 10.6 % 77.073 89.4 %

Magazine/

newspape

2.474 2.9 % 83.783 97.1 %

Poste

692 0.8 % 85.565 99.2 %

Healthcare

workers

3.585 4.2 % 82.672 95.8 %

Religious

institution

141 0.2 % 86.116 99.8 %

Teache

1.477 1.7 % 84.780 98.3 %

Community

gathering

1.307 1.5 % 84.950 98.5 %

Colleagues 12.777 14.8 % 73.480 85.2 %

Workplace 1.837 2.1 % 84.420 97.9 %

Internet 3.940 4.6 % 82.317 95.4 %

Books 202 0.2 % 86.055 99.8 %

Others 313 0.4 % 85.944 99.6 %

Media information is essential to the delivery of

appropriate information about GO in society.

However, the term GO is taboo within the general

community, owing to a lack of knowledge and

information among various demographics. The

stigma around GO is worsening the attempt to prevent

unwanted information about it being shared. Many

different media are essential to the distribution of

information, as presented in Table 2.

According to the analyses presented in Table 2, all

information sources correlated with knowledge about

GO in Indonesia, except for radio. Among them,

teachers were the most strongly correlated with

knowledge of GO, followed by colleagues and books.

In Indonesia, formal education is a suitable medium

to deliver STI information such as GO, because

teachers can provide information about it. Every

school has a specific teacher that focuses on

counselling and has a consulting unit. These teachers

guide students in difficult situations during their

period of study in schools.

4 DISCUSSION

STIs comprise a group of diseases caused by unsafe

sexual behaviour among high-risk populations.

Diagnosis of STIs cases such as HIV/AIDS, syphilis

and GO are sometimes delayed due to a lack of

understanding; such a delay in healthcare access can

increase the complications associated with the

disease. The media play a role in closing the gap

between the onset of symptoms and diagnosis to

prevent complications. According to our study, most

respondents did not receive sufficient information

about it because most of them did not declare their

illness (Suvirya et al., 2018); however, receiving

appropriate information is a component of human

rights among high-risk populations. Healthcare

workers' role is paramount in delivering relevant

information rather than inaccurate sources on the

internet or social media. Based on the descriptive

study above, the most crucial information sources

were from colleagues, television, and the internet,

respectively. Unfortunately, information from

healthcare workers was not dominant. Healthcare

workers play an essential role in distributing relevant

information and guaranteeing that the information is

accurate and providing access to STI prevention

programs among students (Borawski et al., 2015).

The analytical data strengthened this finding that

information about GO by healthcare workers

correlated with knowledge among respondents.

However, this association is weaker than with

teachers, colleagues, books, and other sources. It is

very important to disseminate information to society

to prevent expelling, stigma and ignoring among the

patients (Nyblade et al., 2017). This finding is

important to share with the government, to eliminate

the stigma and to ensure equal health services for all

people. We recommend further study to examine

access to healthcare services among patients and

investigate their perspectives about treatment to

understand how important health worker services are

in treating patients with GO.

Sources of information from teachers are the most

prevalent in our study. Formal education should be

able to transfer knowledge to and guide and prevent

students from being exposed to inaccurate

information about preventing STIs or reproductive

problems among students (Borawski et al., 2015).

This finding also stresses the importance of teaching

reproductive health as part of the school curriculum,

which should be adopted to save further generations

from STIs. Despite delivering a curriculum covering

reproduction, this seems unfamiliar to some students,

but the program must be conducted gradually and

comprehensively. In Indonesia's junior and senior

high schools, there is a particular unit covering

psychological problems among students, called

guiding and counselling unit (UBK) that plays a vital

role for students facing difficulties during their

studies, including reproductive health problems. The

role of counsellor or teacher in the school is also

important to deliver information and guide students to

get relevant news about reproductive issues (Milton

et al., 2001; Joachim C. Omeje et al., 2012). We

assume that this program did not eliminate the gap of

stigma about GO, despite the number of respondents

JIMC 2020 - 1’s t Jenderal Soedirman International Medical Conference (JIMC) in conjunction with the Annual Scientiﬁc Meeting

(Temilnas) Consortium of Biomedical Science Indonesia (KIBI )

172

Table 2: Analysis of bivariate and multivariate sources of information and knowledge about GO in Indonesia.

Media

Chi-square tes

Binary logistic tes

-value OR CI (95%)

-value aOR CI (95%)

Radio <0.01 5.169 4.311

–

6.196 - - -

Television <0.01 6.837 6.444

–

7.254 <0.01 2.586 2.407

–

2.777

Magazine/Newspape

<0.01 7.633 6.978

–

8.350 <0.01 2.471 2.203

–

2.770

Poste

<0.01 10.127 8.675

–

11.821 <0.01 2.983 2.430

–

3.662

Healthcare workers <0.01 7.183 6.644

–

7.766 <0.01 3.236 2.942

–

3.559

Religious institution <0.01 2.999 1.931

–

4.657 <0.01 0.438 0.253

–

0.760

Teache

<0.01 13.753 12.364

–

15.297 <0.01 9.004 7.890

–

10.275

Community gathering <0.01 5.129 4.512

–

5.830 <0.01 2.638 2.257

–

3.083

Colleagues <0.01 8.638 8.160

–

9.144 <0.01 8.310 7.786

–

8.869

Workplace <0.01 10.440 9.463

–

11.518 <0.01 3.681 3.256

–

4.163

Internet <0.01 8.256 7.667

–

8.890 <0.01 3.060 2.784

–

3.364

Books <0.01 12.633 9.567

–

16.683 <0.01 8.820 6.302

–

12.344

Others <0.01 5.326 4.137

–

6.855 <0.01 8.805 6.581

–

11.782

receiving less information than those who did not get

information about it in this study (1.7 vs 98.3%).

To receive information from colleagues, rather

than from teachers, is more prevalent in our study. To

share and discuss with a peer group is more

comfortable and confidential (Bhattacharjee et al.,

2013), but the quality of information given by peer

groups should be evaluated because every person has

a different experience and so the authenticity of the

information cannot be guaranteed. Peer group

sharing's critical role should be explored concerning

how it can solve the problems associated with GO

infections. In the other media sources, printed

information is significantly correlated with

knowledge of GO, particularly books. Unfortunately,

in this data, information on the type of books is not

available. Magazines and newspapers are more

familiar media to access in the community (Amu and

Adegun, 2015), but the content about reproductive

health is limited, so readers receive inadequate

information about it.

Concerning electronic media such as radio,

television, and the internet, these also correlated with

knowledge of GO, particularly television. The

content quality on GO and related reproductive issues

is a concern and should become a focus. Mass media

is pivotal for gaining knowledge and information

about STIs among young adults, mainly information

about safe sexual behaviour (Romer et al., 2009). The

government should allocate time to airing news about

reproductive health because the electronic media is

the easiest way to gain knowledge about GO, to

expand awareness and preparedness about STIs.

Reproductive issues are substantive among

teenagers and young adults as they are prone to sexual

and reproductive problems during their development.

This issue is fundamental as it should urge the media

to deliver qualified information to increase

understanding about these issues. The focus should be

on prevention and promotion programs in the

community to avoid spreading communicable

diseases related to human behaviour, particularly GO

infections. The government should provide greater

access to media (printed or electronic) and formalize

reproductive health inclusion in the school

curriculum.

5 CONCLUSION

In this study, media information correlated with

knowledge about GO. The most interesting media are

colleagues, television, the internet and healthcare

workers, respectively. Among the other media,

teachers, colleagues and books are most highly

correlated with knowledge of GO. Unfortunately, in

this study, respondents tend not to want to receive

information from healthcare workers. Healthcare

workers play an essential role in delivering

information about GO, such as prevention,

promotion, health facility access, and treatment.

Besides, healthcare workers are the most suitable

group to deliver information about GO. Based on this

finding, we recommend to the government that they

mobilize healthcare workers to focus on health

promotion, prevention, and giving priority

information about GO to the general population and

formalizing STI prevention programs within the

school curriculum.

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