The Correlation between Interpersonal Factors, Self-Efficacy with
the Choice of IUD Contraception among Women of Childbearing Age
Couples
Aria Aulia Nastiti, Ni Ketut Alit Armini and Dwi Indah Nurani
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
Keywords: IUD, Contraception, Interpersonal factors, Self-efficacy, Health promotion model.
Abstract: The Indonesian government approved the use of the long-acting reversible contraceptive method to
preventpregnancy effectively. One of the long-acting reversible contraceptives is the Intra Uterine Device
(IUD). But nowadays the used of IUDs is low (6.81%). The aims of this study was to analyze the correlation
between interpersonal factors and self-efficacy with the choice of IUD contraception among women of
childbearing age couples. This research used a descriptive analytical study with a cross-sectional approach.
The sample was 115 women from childbearing age couples in Gresik. The variables were interpersonal
factors and self-efficacy and the choice of IUD contraception among women of childbearing age couples.
The data was collected using questionnaires and tested with Spearman’s rho. The result showed the
relationship between interpersonal factors and the choice of IUD contraception (p = 0,000, r= 0,613), and
self-efficacy with the choice of IUD contraception (p = 0,015, r=0,227). If the self-efficacy was high, they
would choose the IUD contraception. The higher interpersonal factor and self-efficacy will increase the
possibility of choosing the IUD contraception in women of childbearing age couples.
1 BACKGROUND
The Long Acting Reversible Contraception is an
effective method for preventing pregnancy and
stopping fertility (Dewi and Notobroto, 2014). The
IUD is one of the reversible MKJPs that is effective
in delaying pregnancy with a failure rate of 0.1%
and it does not need to be replaced for up to 10 years
for CuT-380A (Leveno, Cunningham and Gant,
2009). However, based on interviews with the Head
of Family Planning and Population Control BKBPP
Gresik, until now interest in MKJPs is still low when
compared with non MKJPs.
The number of fertile couples in Indonesia is
47,665,847 people. The choice of IUD as a
contraceptive method by new family planning
participants is still low (6.81%) compared to others,
the injection method (49.93%), pill (26.36%) and
implant (9.63%). In East Java, the percentage of
users of IUDs is 6.32% of total new KB participants,
that is 887,397 people (Kementerian Kesehatan RI,
2016). IUD users in Gresik District represent 2.3%
of new KB participants and 5.2% of active KB
participants (Dinas Kesehatan Jawa Timur, 2015).
Types of IUD are still inadequate with three villages
in Wringinanom that had not met the target for the
number of new IUD acceptors in 2016 and even
failed in meeting the 5.9% target, Sumber Waru
Village, Kepuh Klagen Village and Sembung
Village.
Field Officers in Wringinanom have made
various efforts to increase the number of MKJP
users. Some methods involve direct socialization
such as counseling every village one-by-one, making
banners, and holding events promoting the long
acting reversible contraception method. The Health
Promotion Model Theory is a way to describe the
interaction between man and his physical and
interpersonal environment in various dimensions
(Pender, Murdaugh and Parsons, 2015). Self-
efficacy is understood to be a predictor of human
behavior. Bandura defines self-efficacy as one's self-
confidence for a particular purpose (Pender,
Murdaugh and Parsons, 2015). Thus, self-efficacy is
a key factor for family planning and the benefits of
attitudes toward contraception that can predict
family planning compliance (Heinrich, 1993;
Peyman, Hidarnia and Ghofranipour, 2009). Other
350
Nastiti, A., Armini, N. and Nurani, D.
The Correlation between Interpersonal Factors, Self-Efficacy with the Choice of IUD Contraception among Women of Childbearing Age Couples.
DOI: 10.5220/0008325103500354
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 350-354
ISBN: 978-989-758-336-0
Copyright
c
 2018 by SCITEPRESS – Science and Technology Publications, Lda. All rights reserved

findings suggest that women feel an inability to use
family planning (Ong et al., 2012).
2 METHODS
This research used adescriptive analytic design with
a cross-sectional approach. The research was
conducted in Wringinanom, Gresik. The population
in this study were women of fertile couples in
Wringinanom, Gresik Regency, who became family
planning acceptors. From the data obtained the
number of family planning acceptors in 2016 was as
many as 765 people. The sample consisted of 115
women from fertile couples who met the inclusion
and exclusion criteria. This research uses cluster
sampling, that is the grouping of a sample by region
or population location (Nursalam 2013).
Independent variables in this research are
interpersonal factors and self-efficacy. The
dependent variable is the selection of IUD
contraceptives. Data was collected using
questionnaires. Data was analyzed by Spearman's
rho statistic test.
In Wringinanom, Gresik eligible reproductive
age women were identified through available data
from all governmental health facilities and
interviewed while they had come for the service
within the data collection period. All women of
reproductive age who visited the integrated service
(Posyandu) were included for interview. Data was
collected by using a structured and pre-tested
questionnaire using a face-to-face interview
technique with the women.
The research was conducted after obtaining the
ethical permit from the Health Research Ethics
Committee, Faculty of Nursing, Airlangga
University with ethichal approval number 403-
KEPK. Later, a letter was sent to the Ministry of
Health Indonesia. Permission is obtained from the
facility administration. Oral informed consent was
obtained from each study participant. Women who
refused to participate in the study were not forced.
Each respondent was informed about the purpose of
the study. Confidentiality is guaranteed for
information to be collected by maintaining the
confidentiality of the respondents when filling out
the questionnaire.
3 RESULTS
The results of data analysis using Spearman's rho
statistical test obtained significance value (p) =
0.015 and correlation coefficient (r) = 0.227.
Table 1: Demographic characteristics of research
respondents.
Characteristics
N
%
Mother’s age
<20 years
20-35 years
>35 years
2
94
19
1
82
17
Total
115
100
Religion
Moslem
Christian
113
2
98
2
Total
115
100
Marital Age
1-5 years
6-10 years
11-20 years
>20 years
46
29
29
11
40
25
25
10
Total
115
100
Education
University
Senior high school
Junior high school
Elementary school
Uneducated
18
48
42
3
4
16
42
37
3
3
Total
115
100
Mother’s
Occupation
Government
employee
Private employee
Farmer
Housewife
Others
1
15
5
89
5
1
13
4
77
4
Total
115
100
Family income
< IDR 3.293.506
≥ IDR 3. 293.506
103
12
90
10
Total
115
100
Number of
children now
1
2
>2
42
62
11
37
54
10
Total
115
100
Number of
children wanted
1
2
>2
5
96
4
4
83
12
Total
115
100
Information
resources about
FP
Health workers
Media
Cadre
Close related person
76
9
18
12
66
8
16
10
Total
115
100
Type
contraception
used now
IUD
Implant
Injection
Pills
Tubectomy
8
5
89
12
1
7
4
77
10
1
Total
115
100
The Correlation between Interpersonal Factors, Self-Efficacy with the Choice of IUD Contraception among Women of Childbearing Age
Couples
351

Long use
<1 years
1-5 years
6-10 years
>10 years
6
87
13
9
5
76
11
8
Total
115
100
The value of the correlation coefficient indicates
a probability of less than 0.05, then H0 is rejected
and H1 is accepted. This shows that there is a
relationship between self-efficacy with IUD
contraceptive selection. Correlation coefficient value
indicates there is a weak relationship (0,200-0,399)
with the direction of positive relationship. This
shows that the relationship between self-efficacy is
weak with IUD contraceptive selection where the
higher the respondent's self-efficacy the more likely
they will be to select IUD contraception.
Table 2: Interpersonal factor relationship with IUD
contraceptive choice in Women at Kepuh Klagen Village.
Interpersonal
Factors
Contraceptive choice
Total
IUD
Non IUD
N
%
N
%
N
%
Low
Moderate
High
1
3
4
1
3
3
99
5
3
86
4
3
100
8
7
87
7
6
Total
8
7
107
93
115
100
Spearman
Rho
p=0,000 r=0,613
Table 3: Self-efficacy relationship with IUD contraceptive
choice in Women at Kepuh Klagen Village.
Self
Efficacy
Contraception choice
Total
IUD
Non IUD
N
%
N
%
N
%
Low
High
1
7
1
6
61
46
53
40
62
53
54
46
Total
8
7
107
93
115
100
Spearman
Rho
p=0,015 r=0,227
4 DISCUSSION
Interpersonal factors in IUD contraceptive selection
in Wringinanom, Gresik were mostly low. The
majority of women of fertile couples choose not to
use IUD contraceptives but use other types of
contraceptives such as injections, the pill, implants,
and tubal ligation. Almost all respondents with low
interpersonal factors did not use IUD contraception,
and respondents with high interpersonal factors
chose IUD contraception. The results of analysis
show that there is a strong correlation between
interpersonal factors with IUD contraception choice
in woman of fertile age couples in Wringinanom,
Gresik.
The Health Promotion Model theory explains
that family, peer groups and healthcare providers are
a major source of interpersonal factors that can
increase or decrease the commitment to engage in
health promotion behavior (Alligood, 2014).
Misinformation as well as the environmental
restrictions on contraception to be used may affect
women in choosing to use IUDs or not (Hoopes et
al., 2016). The results showed that there was hope
from health workers to use IUD contraception.
However, respondents did not obtain directions from
their nearest person to use IUD contraception. The
lack of encouragement and example of the family
and the nearest person has caused a low number of
IUD contraceptive users in Kepuh Klagen Village.
This is in line with previous research which states
that focusing health promotion on secondary targets
such as mothers-in-law and husbands is very
important in improving the quality of effective
contraceptive use (Agha, 2010). There are three
parameters in the interpersonal factors that affect
one's actions, social norm, social support and role
models. The results show that the most dominant is
the low support from family and the nearest person
in IUD contraceptive election. Positive support from
the family may affect contraceptive selection as a
result of previous studies (Yunitasari, Pradanie and
Hardiansyah, 2017).
In making the decision to choose IUD
contraceptives there are three stages that require
specific social support for each stage. The first stage
is one must obtain correct and explicit information
from reliable sources on IUD contraception. Here
the role of health workers is needed in providing
clear information. The second stage is listening to
live testimony from people who have used IUD
contraception and have been successful in
preventing pregnancy safely. If a person only listens
to the testimony of a person who is unsuccessful or
dissatisfied with IUD contraception, then fear will
come to them. The last stage is the accompaniment
of the nearest person either the husband or the
family to increase the confidence of the woman as
she goes to the clinic (Gottert et al., 2017).
Respondents who received full support at all three
stages chose to use IUD contraception. While
respondents who do not get social support in three
stages are choosing not to use IUD contraception.
Some respondents with high interpersonal factors
are choosing not to use IUD contraception. The
choice of contraception can be influenced by several
factors, including the number of live children, and
socioeconomic level (Hartini, Ikhsan and Salmah,
2014). There are respondents who still have one
child and want to have more children. Women who
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
352

want to become pregnant are less likely to choose
long-term contraceptive methods (Gomez and
Freihart, 2017). Respondents who have high
interpersonal factors but do not choose
contraception, have less family income than MSEs.
The economic level of a person can also affect the
selection of IUD contraceptives. Users of IUDs will
increase along with the improvement of one's
economic status (İnal et al., 2017).
Most women of fertile couples in the village of
Kepuh Klagen have low self-efficacy levels and
some have high self-efficacy levels. Respondents
with low self-efficacy mostly chose not to use IUD
contraception. The results show that there is a weak
relationship between self-efficacy with IUD
contraceptive selection in women of fertile couples
in Kepuh Klagen Village.
The Health Promotion Model Theories explain
that self-efficacy or a person's belief that he or she
can successfully perform an action will increase
commitment in planning action. Self-efficacy is
influenced by the way a person thinks, feels,
motivates themself, and performs actions (Bandura,
2002). There are three indicators of one's self-
efficacy: the belief in using IUD contraceptives to
prevent pregnancy, information obtained, and
convenience in IUD use. Sufficient information has
been obtained. Respondents believe that IUD
contraceptives can prevent pregnancy. However,
respondents felt anxious about the convenience of
using IUD contraception. Most respondents who
have a high level of self-efficacy choose to use IUD
contraception. Those who have received clear
information about IUD contraception are convinced
to use the contraceptive in preventing pregnancy.
Conversely, respondents who lacked information
about IUD contraceptives were not sure about using
IUD contraceptives.
There are four factors that can affect one's self-
efficacy. First is past experience. Success can build a
person's confidence and self-efficacy. Failure can
tear it down, especially if the failure occurs before
the person's self-efficacy is formed. The researcher
did not identify the prior family history of the
respondent so no data could corroborate the theory.
The second factor is the experience of others who
have succeeded. In Desa Kepuh Klagen, there are
still very few IUD users so that they do not build
self-efficacy in IUD contraceptive selection. The
third factor is social persuasion. Persuasion from the
social environment can increase the motivation to
accomplish the task given. There is a lack of social
support in Desa Kepuh Klagen in IUD contraceptive
selection so that self-efficacy is not formed. The last
factor is the psychological response. Respondents
feel anxious about the convenience of using IUD
contraception so as to decrease self-efficacy.
There are still many females of childbearing age
with a high level of self-efficacy but do not choose
to use IUD contraception. This can be influenced by
several factors such as the level of education and
husband support (Hartini, Ikhsan and Salmah, 2014).
For example, one respondent was under 20 years of
age with basic education. The lack of support from
the husband and the nearest person is seen from the
low interpersonal factors. This may cause the
respondents to choose not to use IUD contraception
despite having high self-efficacy levels.
A person's educational level may affect the
choice of IUD contraceptives. Someone who is more
open to new science chooses effective contraception
as a result of their higher level of education (İnal et
al., 2017). A mother's work is mostly as a
housewife. It can also affect the lack of information
obtained about IUD contraceptives due to lack of
socialization with others. Mothers engage in more
activities at home and socialize only with the
neighbors around them. Social influences also
determine the selection of contraception (Gomez and
Freihart, 2017). The experience shared by the
nearest person who has used the IUD as well as the
direct support of the husband accompanying them to
the clinic to consult on contraceptive choices may
increase women's confidence (Gottert et al., 2017).
Most respondents only obtain information from one
source and the majority gain KB information from
health workers. Lack of information or knowledge
can affect a person's contraceptive choice (Hartini,
Ikhsan and Salmah, 2014). In addition, the type of
KB used at this time and the duration of its use also
a dapt affect one's choice. There were respondents
who had used injectable contraceptives for more
than 10 years. Success can build a person's
confidence and self-efficacy. The respondents have
had high self-efficacy against the use of injectable
contraception so it is not easy to switch to another
type of contraception.
5 CONCLUSIONS
Women of childbearing age in Desa Kepuh Klagen
mostly chose non-IUD contraception i.e. injection.
Women of childbearing age in Desa Kepuh Klagen
mostly have low interpersonal factors in IUD
contraceptive selection and obtain less support from
family or nearest person to use IUD contraception.
Most women of childbearing age in Desa Kepuh
Klagen have low self-efficacy levels in IUD
contraceptive selection and they are mostly
uncomfortable using IUD contraceptives to prevent
pregnancy. The higher the interpersonal factor of a
woman of childbearing age, the more likely she will
The Correlation between Interpersonal Factors, Self-Efficacy with the Choice of IUD Contraception among Women of Childbearing Age
Couples
353

choose to use IUD contraceptives. The higher the
self-efficacy of a woman of childbearing age, the
more likely she will choose to use IUD
contraceptives.
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