Prevention of Postpartum Complications with M-Health Application

"Hallo Manis" Based on Android

Tyas Febriana

, Runjati

and Sudirman

Department of Midwifery, Faculty of Health, University of Pringsewu, Pringsewu3, 35373, Indonesia

Department of Midwifery, Poltekkes Kemenkes Semarang, Semarang, 50268, Indonesia

Department of Nursing, Poltekkes Kemenkes Semarang, Semarang, 50268, Indonesia

Keywords: Application, M-health; Complications, Postpartum.

Abstract: One of the causes of maternal death in Indonesia is the incidence of complications during the puerperium or

complications of the puerperium. Analysis of the implementation of preventing postpartum complications in

the field is still low. The study aimed to determine the effectiveness of the Android-based “Hallo Manis” m-

health application in the prevention of postpartum complications. The type of research is true experiment

research with a posttest-only control group design. The population in this study was all postpartum mothers

>2 hours and the number of research samples was 60 postpartum mothers. This research uses a probability

sampling method with cluster random sampling and simple random sampling. Data analysis used the

Friedman and Mann-Whitney test. The results showed that the mean value of preventing complications was

higher in the intervention group 99.11 than in the control group 93.83. The effectiveness of the "Hallo Manis"

Application on the prevention of puerperal complications (physiological) < 0.0001 and the prevention of

puerperal complications (psychological) < 0.0001. The conclusion is that "Hallo Manis" is effective in

preventing the incidence of postpartum complications assessed from physiological and psychological aspects

with access to utilization of 20-25 with each access duration of 10-15 minutes.

1 INTRODUCTION

Complications during the postpartum period or

difficulties during the postpartum period are one of

the causes of maternal death in Indonesia (Ika

Murtiyarini, Yuli Suryantu, 2020)(Yuanita Viva Avia

Dewi, 2020). This is because, during the postpartum

period, there are changes in physiological and

psychological systems so care and assistance are

needed to prevent continued pathological problems.

In the postpartum period, there is a risk of

experiencing problems or complications during the

postpartum period, including postpartum infections,

breast problems, swelling of the face and extremities

(Preeclampsia), postpartum bleeding, sub-involution,

thrombophlebitis, and psychological problems

(Marmi, 2017). Therefore, providing appropriate

postpartum care services can reduce the risk of

maternal morbidity and death in postpartum due to

postpartum complications (Ika Murtiyarini, Yuli

Suryantu, 2020).

The success of postpartum care services can be

seen from several factors, one of which is compliance

with postpartum visits and the incidence of

postpartum complications (Nuryati & Yanti, 2017).

Bleeding is one of the complications that occurs

during the postpartum period. In 2019, the main

cause of AKI in Indonesia was bleeding with a case

percentage of 30.3% (Kementerian kesehatan

Republik indonesia, 2020). In the health profile of

Central Java province in 2019, the cause of MMR

was bleeding at 24.5% and infection at 6% (25

mothers) (Tengah, 2019). he number of MMR in

Semarang district increased significantly compared

to previous years in 2020 with the main cause being

bleeding cases with a percentage of 32% (Dinas

Kesehatan Kabupaten Semarang, 2020). Sub Other

types of complications that occur during the

postpartum period are sub-involution, postpartum

infections, breastfeeding problems, and

psychological problems of postpartum mothers. In

Mardiana's research (2021), the incidence of uterine

sub-involution in postpartum mothers was 23.33%.

This is to the results of the type of identification of

postpartum infections at the Cilacap District Hospital

in 2016-2018, namely that the majority occurred due

156

Febriana, T., Runjati, and Sudirman,

Prevention of Postpartum Complications with M-Health Application "Hallo Manis" Based on Android.

DOI: 10.5220/0013667500003873

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Medical Science and Health (ICOMESH 2023), pages 156-166

ISBN: 978-989-758-740-5

to ILO post-SC (34.3%) (Susilawati & Kasron,

2019). The incidence of breast milk dams in

postpartum mothers of 30 respondents, 43.3% of

mothers experienced breast milk and problems (Ria

Gustirini, 2021). The psychological problems of

postpartum mothers during the current pandemic are

also quite high, namely 48% of mothers experience

the risk of postpartum depression and 42% of

mothers experience postpartum depression (Rr.

Arum Ariasih, 2020). The description of the results

of postpartum problems/complications above shows

that efforts to prevent postpartum complications are

still less than optimal.

Analysis of the implementation of preventing

postpartum complications in the field is still low. The

results of Lidya's research (2018) showed that 60% of

mothers had a negative level of preventing

postpartum complications, 60% of postpartum

mothers had low knowledge of postpartum, and 50%

had negative behavior regarding preventing

postpartum complications. This is in line with the

description of the level of knowledge of postpartum

mothers regarding the danger signs of perineal suture

wound infection, which is mostly still low (58.1%)

and 25.8% of postpartum mothers also have low

knowledge regarding suture wound care (Tri

Maharani, 2020). The factor of postpartum visits that

are still not fulfilled also influences the incidence of

postpartum complications, this is due to the lack of

receipt of health education and early detection of

complications during postpartum repeat visits

(Khamidah Achyar, 2016).

Existing efforts to prevent postpartum

complications, apart from conducting postpartum

visits, include providing education using various

media (Menteri Kesehatann republik Indonesia,

2021). The media used to convey information can use

various methods adapted to the existing situation and

conditions (Nuryati & Yanti, 2017). During the

Covid-19 pandemic, the use of the MCH Book can be

a medium that can be used in the process of

increasing knowledge of postpartum care so that

complications can be minimized. However, in Nur

Indah's research, it was found that 40% of postpartum

mothers did not use MCH books or did not read them

(Noviyanti & Gusrian, 2021). Apart from using MCH

books, the use of booklets, internet media such as

social media, websites and applications can be an

effort to increase the knowledge of postpartum

mothers in preventing postpartum complications

(Nuryati & Yanti, 2017).

The use of booklets as a medium for delivering

health education has several shortcomings and is less

effective in increasing knowledge from several

existing studies (Li et al., 2021). This is in line with

Ghassani Milatina's research which shows that

education using booklets has an effect on increasing

mothers' knowledge regarding birth canal wound care

but has a low level of influence, r=0.378 (Ghassani,

Martini, Susanti, Nirmala, & Handayani, 2020).

Providing education via social media has an effect on

increasing knowledge of postpartum care but has no

effect on compliance with postpartum visits (p >

0.05) (Nuryati & Yanti, 2017). Therefore, it is

necessary to develop media that is appropriate to the

current Covid-19 pandemic situation regarding visit

compliance and preventing postpartum

complications, namely by providing application

media. The application media used can be M-health

or modified health promotion with information

technology (Gagnon, Ngangue, Payne-Gagnon, &

Desmartis, 2016). The M-health application is an

alternative health promotion opportunity during the

Covid-19 pandemic that is effective and quickly

adapted on a large scale and at low cost (Marcolino et

al., 2018). This is supported by data on the population

who use the internet to download applications in

Indonesia at 64.8%, one of which is health

applications (N. A. Putri, Hilmanto, & Zulvayanti,

2021).

Technological developments can help promote

health by increasing knowledge and attitudes as well

as increasing mothers' awareness of self-care. This is

in accordance with the results of previous research

regarding the "Mommy Postpartum" and "Healthy

Postpartum" applications which have an effect on

increasing the knowledge of postpartum mothers

(Herlina, Fatmasari, Diyah, Sri & Pujiastuti, 2020; N.

A. Putri et al., 2021). The use of the "BUFAS"

reminder application in describing postpartum visit

compliance is almost as complete as the second

postpartum visit, but in the respondent interviews

there were several weaknesses, including in

understanding the content related to the language

used and the appearance or menu (Ika Yuli Krisdiana,

Rahajeng Siti NUr Rahmawati, 2019).

Applications as an effort to increase the

knowledge of postpartum mothers have previously

existed, such as the E-Postpartum application. The

results of research regarding providing the E-

Postpartum application to postpartum mothers are

effective in increasing knowledge with a p-value <

0.001(Khairunnisa, Sumarni, & Supriyana, 2021).

This application has educational features regarding

what parturition is and its stages, the psychological

changes that occur, the correct way to breastfeed,

consultation features and check-up schedule alarms

that can be made independently by the mother.

Prevention of Postpartum Complications with M-Health Application "Hallo Manis" Based on Android

157

Another application related to postpartum in the Play

Store is Postpartum Care with almost the same

educational features as the E-Postpartum application

and WhatsApp chat link. The focus of problem

solving in this research is regarding compliance with

postpartum visits which is expected to reduce the

incidence of postpartum complications. However,

existing applications do not provide automatic

reminders according to the length of postpartum

days. The education provided also does not focus on

preventing postpartum complications holistically. So,

researchers are interested in developing an M-health

application with a focus on education on postpartum

visit compliance and holistic prevention of

postpartum complications and automatic reminders

according to the length of postpartum days or

notifications. Providing education is expected to

stimulate behavior change in preventing postpartum

complications to be able to carry out independent

self-care that focuses on compliance with postpartum

visits and preventing the occurrence of postpartum

complications in one application media package.

Self-care in the postpartum period is one of the

actions needed to maintain the mother's level of well-

being and health (Gessica Kyvia Soare de Lima et al,

2017). Postpartum mothers' self-care needs can be

identified using Dorothea Elizabeth Orem's

theoretical framework. This is in accordance with the

results of Gessica's research regarding the

identification of postpartum mothers' self-care

knowledge needs based on the Orem model, namely

regarding nutrition, prevention of postpartum

infections related to urinary tract infections or suture

wounds, breastfeeding problems, the need for rest,

physical exercise related to uterine involution

problems, myths and needs. counselling (Gessica

Kyvia Soare de Lima et al, 2017).

Emotional well-being related to psychological

changes in postpartum mothers in the early period

also cannot be missed from the results of Orem's self-

care model (Lambermon, Vandenbussche, Dedding,

& Duijnhoven, 2020). The results of the needs of

postpartum mothers based on Orem's theory can be

adopted as the content of M-health education will be

developed into an Android-based application with

modifications to complication education, prevention

of COVID-19 transmission, postpartum visit

schedules and reminders, a chat room for midwives

in optimizing counseling during the COVID-19

pandemic, as well as evaluation of complications and

postpartum visit compliance in one application called

Hallo Postpartum Mama "Hallo Manis". The research

and applications in the Play store regarding the

postpartum period also do not provide packaged

content and education regarding types of postpartum

complications, postpartum visit reminders, and

prevention of COVID-19 transmission with

education and an attractive appearance. The results of

the research are also still limited to the extent that the

output (knowledge and attitudes) not yet see the

outcomes of the resulting M-health model.

Based on the problem identification above,

researchers are interested in researching the Android-

based M-health Hallo Mama Postpartum "Hallo

Manis" application based on the results of Orem's

previous research model on postpartum mothers on

the incidence of postpartum complications. This

Android-based application was created as an

education to prevent postpartum complications by

providing a sequence of self-care schedules,

education on preventing COVID-19 transmission,

daily application notifications, education and

reminders for postpartum visits, complications

questionnaires and chat rooms for mothers and

midwives as an effective effort. prevention of

complications.

2 METHODS

The type of research that will be used in this research

is true experiment research with a posttest-only

control group design. The population in this study

was all postpartum mothers >2 hours in the work area

of the health center, namely the health centers in

Ambarawa, Pringapus, and Bawen sub-districts,

Semarang district on 1-30 March 2022. This research

was conducted in March-May 2022. The number of

samples in this study was based on calculations using

the formula that 27 respondents were obtained, then

3 respondents were added to anticipate dropping out

to 30 respondents. This research uses a probability

sampling method with cluster random sampling and

simple random sampling. The cluster random

sampling technique was used to determine a very

large number of samples, which consisted of 2 stages,

namely the first and second stages. The first stage was

used in selecting the research area which was

determined based on the geographical criteria of

having cellphone and internet access. Semarang

Regency has 26 community health centers, after

carrying out a cluster random sampling technique

based on specified criteria, 6 community health

centers were obtained. Next, a lottery was carried out

from 6 community health centers to 3 selected places

taking into consideration the adequacy of the research

sample and research time. Preliminary test results

show that the average number of mothers giving birth

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per month in the 6 regions taken is 44 mothers. The

selected areas are the Ambarawa Health Center,

Pringapus and Bawen sub-districts. The research

sampling criteria were mothers who had at least a

junior high school education, had no history of

complications or were currently experiencing

complications, and had at least an Android 8 version

of their mobile phone.

This study uses a postpartum complications

questionnaire which has been tested for validity and

reliability with valid results by the researcher ≥ 0.60

as well as the EPDS (Edinburgh Postnatal Depression

Scale) questionnaire which has good consistency and

accuracy with Cronbach's alpha value = 0.87 and

spit-half = 0.88(Hada et al., 2019). The research

stages began when mothers were ≥ 2 hours

postpartum who were provided with conventional

services by utilizing and accessing applications that

had been installed during the postpartum period for

the intervention group at least 20-25 times within 10-

15 minutes/use. The control group was given

conventional services by using the independent MCH

book during the postpartum period at least 6-10 times

within 5-10 minutes for each use. Evaluations were

carried out on postpartum day 2, day 7, day 28, and

day 42. This research uses data analysis, namely the

Friedman and Mann-Whitney tests. Ethical clearance

in this research was requested from the Health

Research Ethics Commission (KEPK) with ethical

number No. 592/EA/KEPK/2021 on December 24,

2021.

3 RESULT

3.1 Respondent Characteristics

The results of this study show that the characteristics

of respondents including age, parity, education,

employment, family support, and ownership of health

insurance in both groups are equivalent, as shown by

the p-value> 0.05, which means that the

characteristics of respondents in the two groups have

no significant differences. which is shown in the table

Table 1: Distribution of Responden Characteristics

Table 1. shows that the characteristics of

respondents including age, parity, education,

employment, family support, and ownership of health

insurance in both groups are equivalent, as shown by

the p-value > 0.05, which means that the

characteristics of respondents in the two groups have

no significant differences. Thus, the characteristics of

both groups can be controlled to ensure that the

results of this research are not influenced by the

characteristics of the respondents before being given

treatment or the characteristics of homogeneous

respondents.

Characteristics

Grou

Total Mean ± SD

Intervension Control

n % n % N % Intervension Control

Age (year)

20 – 35

<20 / > 35

86,7

13,3

83,3

16,7

27,1±5,66 28,3±6,16 0.421

Parit

Primipara 15 50 13 43,3 28 46,7

1,70±8,37 1,93±1,26 0.401

Multipara

Grandemulti

53,3

3,3

51,7

1,6

Education

JHS

SHS

College

63,3

26,7

13,3

56,7

30,0

11,7

60,0

28,3

- - 0.855

Work

Wor

15 50 10 33.3 25 41,7

- - 0.190

Don’t wor

15 50 20 66.7 35 58,3

Famil

ort

Support 20 66,7 17 56,7 37 61,7

6,96±1,35 6,80±1,32 0.624

Non supportive 10 33,3 13 43,3 23 38,3

Health insurance tittle

Yes 20 66,7 17 56,7 37 61,7

- - 0.426

No 10 33,3 13 43,3 23 38,3

Prevention of Postpartum Complications with M-Health Application "Hallo Manis" Based on Android

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3.2 Description of Postpartum

Complications

The frequency distribution of postpartum

complications assessed from physiological and

psychological aspects is shown in the table 2.

Table 2: Description of Compliance with Postpartum Visits

and Incidence of Postpartum Complications

Variabel Group

Intervension Control

n % n %

Postpartum complication (Physiological aspects)

6 hours – day 2

Complication 5 16,7 9 30

Nothing 25 83,3 21 70

Day 3 – 7

Complication 4 13,3 12 40

Nothing 26 86,7 18 60

Day 8 – 28

Complication 1 3,3 9 30

Nothing 29 96,7 21 70

Day 29 – 42

Complication 0 0 5 16,7

Nothing 30 100 25 83,3

Postpartum Complication (Phychological aspects)

Day 3 – 7

Normal 23 76,7 15 50

moderate 4 13,3 9 30

Heavy 3 10 6 20

Day 29

–

Normal 29 96,7 23 76,7

Moderate 1 3,3 6 20,0

Heavy 0 0 1 3.3

Table 2 shows that postpartum complications

were assessed from physiological aspects at 6 hours-

2 days, showing that the majority of respondents who

had no complications were in the intervention group

with a total of 25 respondents or 83.35%. This also

happened in the assessment of postpartum

complications assessed from the physiological aspect

with the number of respondents who had no

complications mostly in the intervention group with

the number of respondents namely when the assessor

was 3-7 days postpartum total 26 respondents or

86.7%, at the time 8-28 postpartum days there were

29 respondents or 96.7% and at 29-42 days

postpartum there were 30 respondents or 100%.

The postpartum complication variable seen from

the psychological aspect during the assessment time

3-7 days after being given the "Hallo Manis"

application shows that the majority of respondents

did not experience symptoms of postpartum blues or

were normal in the intervention group, namely 23

respondents (76.7%). This is greater than the number

of respondents who did not experience symptoms of

postpartum blues in the control group, namely 15

respondents (50%). During the period 28 – 42 days

postpartum, in the intervention group almost all

respondents did not experience symptoms of

psychological problems, namely 29 respondents

(96.7%).

3.3 The Effectiveness of the M-Health

Application "Hallo Manis" in

Preventing Postpartum

Complications Was Assessed from

the Physiological Aspect

The results of the analysis of the effectiveness of the

"Hallo Manis" application in preventing postpartum

complications assessed from physiological aspects

can be shown in the table 3.

Table 3: Effectiveness of the M-health Application "Hallo

Manis" in Preventing Postpartum Complications

(Physiological Aspects)

Postpartum

Complications

(Physiological

Aspects)

Group P-

Value

Intervension

Mean ± SD

Control

Mean ± SD

6 hours – day 2 96,38±9,13 89,33±1,95 0,148

Day 3 - 7 99,04±2,47 94,26±8,38 0,010

Day 8 - 28 99,67±1,85 94,00±1,07 0,005

Day 29 - 42 100,00±0,00 96,00±9,68 0,021

Total 99,11±1,961 93,83±6,83 0,0001

P-value 0,020

0,456

Uji Mann-Whitney*level of significance sig <0,05

Uji Friedman*level of significance sig <0,05

Table 3 shows that the average total score for

preventing postpartum complications in the

intervention group was greater than the control

group. The Friedman test aims to test differences in

the significance of repeated data on postpartum

complications variables. The results of this test

showed a significant value in the intervention group

with a p-value of 0.020 (<0.05) and not significant in

the control group with a value of 0.456 (>0.05). It can

be concluded that the "Hallo Manis" application is

effective in preventing complications.

Table 3. shows that in the period of 6 hours - 2

days, a p-value of 0.148 (p-value>0.05) was

obtained, which means that there was no significant

difference in the score of postpartum complications

assessed from the physiological aspect or the

application of the "Hallo Manis" application. not

effective in preventing postpartum complications in

the 6 hour – day 2 period. In the assessment of

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postpartum complications assessed in the period 3-7

days postpartum between the intervention and control

groups, a p-value of 0.010 (p-value <0.05) was

obtained, which can be interpreted as a difference in

the mean value of the evaluation of prevention of

postpartum complications. Evaluation of the

prevention of postpartum complications during the

period 8-28 days postpartum and 29-42 days

postpartum and the total score between the

intervention and control groups obtained a p-value

<0.05 which can be interpreted as a difference in the

mean value between days 8-28 postpartum, days 29-

42 postpartum and the total incidence of postpartum

complications. It can be stated that the "Hallo Manis"

application is more effective for postpartum mothers

in preventing postpartum complications, assessed

from the physiological aspect of postpartum mothers.

The change in the mean value of prevention of

postpartum complications assessed from the

physiological aspect from the results of the first

evaluation to the fourth evaluation after being given

the m-health application "Hallo Manis" in the

intervention and control groups can be seen in the

figure 1.

Figure 1 shows that the average evaluation

score for prevention of postpartum

complications assessed from physiological

aspects in the intervention group was higher than

the control group with a constant increase at

each visit. The higher the evaluation score, the

higher the health status. The conclusion of the

graph above is that for respondents in the

intervention group, the reduction in the

incidence of complications was better than in the

control group. The intervention group in the

assessment period of 29-41 days postpartum

showed that there were no respondents who had

postpartum complications. The intervention

group that used the "Hallo Manis" application

20-25 times during the postpartum period could

prevent postpartum complications.

Figure 1: Prevention of Postpartum Complication

(Physiological Aspects)

3.4 The Effectiveness of the M-Health

Application "Hallo Manis" in

Preventing Postpartum

Complications Is Assessed from the

Psychological Aspect

The results of the normality test on the postpartum

complications variable are not normally distributed

so the next parametric test uses non-parametric tests,

namely the Friedman and Mann-Whitney tests. The

results of the analysis of the effectiveness of the

"Hallo Manis" application in preventing postpartum

complications assessed from the psychological

aspect can be shown in the table 4.

Table 4. shows that the average evaluation score

for the prevention of postpartum complications in the

psychological aspect with the lowest results was in

the intervention group compared to the control group

in the assessment period of days 29-42 postpartum,

namely 6.90 or the average of respondents in normal

conditions without any Symptoms of postpartum

complications are assessed from the psychological

aspect.

Table 4: Effectiveness of the M-health Application "Hallo Manis" in Preventing Postpartum Complications (Psychological

Aspect)

Uji Mann-Whitney*level of significance sig <0,05

hour-

day 2

day

3-7

day 8

- 28

day

29-

Intervensio

96.38 99.04 99.67 100

control

89.33 94.26 94 96

100

105

Mean

Prevention of Postpartum

Complications

(Physiological Aspects)

Postpartum Complications

(Psychologi-cal Aspect)

Group

P-Value

Intervension (Mean ± SD) Control (Mean ± SD)

Day 3-7 8,23±2,54 10,10±2,52 0,005

Day 29-42 6,90±1,32 9,00±1,68 0,0001

Total 7,57±1,74 9,07±1,94 0,0001

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161

The results of the Mann Whitney test showed a p-

value of 0.005 (p-value<0.05), meaning that the

group given the "Hallo Manis" application was more

effective in preventing postpartum complications,

assessed from a psychological aspect, compared to

providing education with KIA books at 3 - 7 days.

postpartum. Postpartum complications at the second

assessment on days 29-42 and the total score for

evaluating the psychological health status of

postpartum mothers between the two groups were

found to both have a p-value <0.0001 (p-value <0.05)

which can be interpreted as a significant difference.

The value of the evaluation results of psychological

problems between the two groups or it can be

concluded that giving the "Hallo Manis" application

is more effective for postpartum mothers in

preventing postpartum complications is assessed

from the psychological aspect.

The change in the mean value of postpartum

complications assessed from the psychological aspect

from the results of the first evaluation to the second

evaluation after being given the m-health application

"Hallo Manis" in the intervention and control groups

can be seen in graphic figure 2.

Figure 2: Changes in Mean Evaluation Scores for

Prevention of Postpartum Complications in Psychological

Aspects

Figure 2 shows that the average evaluation score

for the prevention of postpartum complications

assessed from the psychological aspect in the

intervention group was lower than the control group.

The conclusion of the graph above is that for

respondents in the intervention group, the reduction

in postpartum blues symptom scores or the incidence

of postpartum complications assessed from a

psychological aspect was higher than in the control

group. The intervention group in the assessment

period of 3-7 days and 29-41 days postpartum showed

that there were no respondents who had symptoms of

postpartum blues or were in normal condition. The

intervention group that used the "Hallo Manis"

application 20-25 times during the postpartum period

could prevent postpartum complications as assessed

from the psychological aspect.

4 DISCUSSION

4.1 Postpartum Complications Are

Assessed from Physiological

Aspects

The results of the effectiveness test from the results

in Table 4.3 show that the results of the effectiveness

test of the "Hallo Manis" application against

postpartum complications were assessed at the first

visit or in the 6-hour – 2-day period, the results were

no difference or not effective. This is related to the

short duration of use of the application and at the

beginning of the postpartum period, the mother is

more focused on the baby and recovering her health

due to postpartum fatigue so she neglects other

activities. This is in line with the results of

preliminary tests at RSIA Sakinan Idaman, which

showed that all 4 people interviewed felt tired after

giving birth (Irianti, Wahyuningsih, & Suwarsi,

2019). Apart from that, from the results of filling out

the questionnaire, some mothers experienced

bleeding, which was related to their nutritional status

and health status during their previous pregnancy.

This is in line with the results of research regarding

the relationship between anemic mothers and the

number of respondents 1082 pregnant women with

iron deficiency anemia and the incidence of

postpartum hemorrhage. The results showed that

there was a relationship between iron deficiency

anemia and the incidence of postpartum hemorrhage

(Terence T. Lao, Lulu L. Wong, 2022).

This is different from the results of the total

postpartum complication score assessment which

proves that giving the M-health application "Hallo

Manis" used by postpartum mothers for 2 hours

within 42 days of the postpartum period with use 20-

25 times is effective as a method of providing

postpartum education packages compared to in the

group that only used the MCH book in preventing

postpartum complications both from physiological

and psychological aspects. In calculating the effect

size to see how effective the application is, the result

was a Cohen's value of 1.051, or very good

effectiveness. The results of this research are in line

with research regarding providing postpartum

mommy applications to increase mothers' knowledge

and skills compared to the group that was only given

day 3-7 day 29-42

Intervensio

8.23 6.9

Control

10.1 9

Mean Score EPDS

Prevention Postpartum Complications

(Psychological Aspect)

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information on postpartum care which obtained a p-

value < 0.05 (N. A. Putri et al., 2021). This is also

supported by research regarding mobile E-

Postpartum services on the knowledge, attitudes and

behavior of postpartum mothers showing that the

third p-value is <0.05 or has an effect on increasing

the knowledge, attitudes, and behavior of postpartum

mothers (Khairunnisa et al., 2021).

Increasing maternal knowledge and behavior in

carrying out self-care will be related to the incidence

of postpartum complications. If the mother has good

knowledge, it will stimulate changes in her self-care

behavior during the postpartum period so that

postpartum problems can be avoided. This is

supported by the results of research conducted to

determine the relationship between a mother's

knowledge and the incidence of postpartum infection.

The result was a p-value of 0.003, which means that

the better the mother's knowledge, the lower the risk

of postpartum infection (Pinem, 2022).

Changes in a person's behavior will occur if

knowledge and attitudes also change. Providing

education using application media as a complete

package will facilitate the transfer of information to

users which will lead to suggestions for decision-

making in this case, namely preventing complications

with appropriate postpartum care (Fifiantyas Amalia,

S.A. Nugraheni, 2018). The use of application media

on smartphones can produce stimulation and a more

comprehensive understanding(N. A. Putri et al.,

2021).

The education in the application features explains

some information about postpartum complications

that can occur. The use of text, audio, and video self-

care tutorials in the application makes it easier for

respondents to get information easily because audio-

visual media uses hearing and seeing elements or uses

more than one sense (Alini, 2018). In the "Hallo

Manis" application, apart from providing educational

packages, there is also a midwife chat room as well as

independent health evaluations regarding postpartum

complications in physiological and psychological

aspects. Even though there is no midwife

appointment room menu for postpartum repeat visits

at health services or home visits, having a midwife

chat room will make it a little easier for midwives and

postpartum mothers to carry out long-distance

counselling. The speed of access that users get to

health workers can also reduce the incidence of

complications, as well as differential diagnosis

(Sunjaya, 2019). This is in line with research by

Wihua Xie et al regarding the results of a meta-

analysis of 32 RCT (Randomized controlled Trial)

studies regarding the effectiveness of providing

telehealth (telemedicine) to pregnant women who

have GDM (Gestational Diabetes Mellitus) which

shows that there is a significant reduction in HbA1c

or glycemic levels. in GDM mothers and reduces the

risk of complications in the baby/fetus compared to

the control group given standard care(Xie et al.,

2020).

4.2 Postpartum Complications Are

Assessed from Psychological

Aspects

The results of the effectiveness of the "Hallo Manis"

application on postpartum complications seen from

the psychological aspect also show effective results

compared to the group that was only given education

using the KIA Book. The effect size test was 0.815,

which can be interpreted as having effectiveness

against postpartum complications assessed from a

very good psychological aspect. This is in line with

research regarding the provision of IEC in

preparation for childbirth and the incidence of

postpartum blues. The results obtained were

influential with a p-value of 0.024 (Dwi Winarni,

Krisdiana Wijayanti, 2017). his is also supported by

the results of the test of the relationship between

maternal knowledge and the incidence of postpartum

blues 1-7 days postpartum, which obtained a p-value

<0.05 (0.015). Mothers who have good knowledge

about how to care for themselves during the

postpartum period so that complications can be

avoided so that mothers are also ready to go through

the postpartum period and to face any changes that

occur (Winarni, D., Wijayanti, K. & Ngadiyono,

2017).

Postpartum complications were assessed from the

psychological aspect in the intervention group after

being given access to the "Hallo Manis" application,

research results showed that an average of 8.23

postpartum mothers did not experience symptoms of

postpartum blues. This is in line with research

regarding the application of Parenting counseling via

WhatsApp in preventing Postpartum Blues during

the Covid-19 pandemic, showing good results or all

respondents who were treated had normal

psychology (Setianingsih, Putri, Dewi, &

Indriyastuti, 2021). he features in the "Hallo Manis"

application also provide a midwife chat service

which will make it easier for respondents or users to

conduct question-and-answer counseling regarding

their health status. This can also be a form of support

from health workers, especially midwives, to be

another source of information so that mothers feel

accompanied during the postpartum period. Good

Prevention of Postpartum Complications with M-Health Application "Hallo Manis" Based on Android

163

social support will reduce the mother's burden and

stress in going through the postpartum phase

(Marwiyah et al., 2022).

The application feature used has information

about postpartum blues and how to prevent and treat

it. In prevention efforts, researchers added Mozart's

music which visualizes natural scenes. This will

make it easier for the mother to relax when the

postpartum mother is breastfeeding or during her rest

time. Several previous research results regarding

giving Mozart classical music to postpartum mothers

can reduce the symptoms of postpartum blues

suffered by mothers. This is in line with the results of

systematic review research regarding the provision of

therapeutic music, one of which is Mozart's classical

music to mothers with postpartum depression in

Indonesia, which is effectively given by midwives

(Restuning Widiasih, Yulia Rais, 2021). Listening to

classical music for 20-30 minutes which has a soft

rhythm, the tones that sound can stimulate alpha

waves and reduce contractions in the limbic brain,

and body muscles, decrease pulse frequency, blood

pressure, and pain to provide a sense of relaxation for

the listener and anxiety gradually decreases is lost

(Arisdiani, Anggorowati, & Naviati, 2021; H. Putri

& Putri, 2022).

5 CONCLUSIONS

The results of this study concluded that the Android-

based "Hallo Manis" M-health application was more

effective in preventing postpartum complications

assessed from physiological and psychological

aspects compared to the control group who only

received standard education using the KIA book with

a p-value <0.0001. The Hallo Manis application can

be a solution to the problem of postpartum

complications which are still high, and can increase

the awareness of postpartum mothers to continue to

empower themselves with guidance through the

postpartum period. Further research can improve the

"Hallo Manis" application by creating a reminder

notification feature that can appear even when the

data is offline, the midwife's appointment room can

be accessed by iPhone/IOS users, can assess the

effectiveness of using the application and what

features influence visit compliance and prevention of

complications. It is also hoped that the healthcare

centers can socialize and implement the use of the

"Hallo Manis" application by postpartum mothers as

one of the programs to ensure compliance with

postpartum visits and prevent postpartum

complications.

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