The mean age of adolescent informants is 19.4 years, and the mean of additional informants is 45.8 years. The informant’s lowest education level is senior high school and the highest is undergraduate. Most of the informants have no occupation (Table 1).
Table 1
Informant characteristics
Code | Participant | Age (year) | Sex | Education | Occupation |
D1 | Obstetrics and gynecology specialist | 49 | P | Undergraduate | Doctor |
D2 | Head of Health Center/Youth Program holder | 46 | L | Undergraduate | Doctor |
I1 | Information and computer experts | 38 | L | Undergraduate | Lecturer |
R1 | Adolescent | 16 | L | Senior high school | None |
R2 | Adolescent | 24 | L | Senior high school | None |
R3 | Adolescent | 17 | P | Senior high school | none |
R4 | Adolescent | 18 | P | Senior high school | None |
R5 | Adolescent | 20 | L | Senior high school | None |
R6 | Adolescent | 19 | L | Senior high school | None |
R7 | Adolescent | 22 | P | Senior high school | None |
OT1 | Teen parents | 55 | L | Senior high school | None |
OT2 | Teen parents | 41 | P | Undergraduate | Private employee |
Implementation of TAM theory in the use of preconception health e-module
In Table 2, 4 themes are shown consisting of awareness about preconception health, perceived ease of use, use, benefits, and intention to use PHS. The four themes refer to the TAM theory. Each theme consists of one or more sub-themes inferred from informant statements. The theme of awareness is inferred from the perception of informants who assess the topic of PHS as new information. Teenagers are reading about the topic of preconception health for the first time, just realizing that pregnancy needs to be prepared to avoid negative pregnancy outcomes. The intention of adolescents to utilize PHS is driven by the perception that healthy pregnancy needs to be prepared for adolescents. Adolescent intentions are also inhibited by shame and negative stigma if adolescents visit PHS. Adolescents also perceive ease of use of PHS based on simple procedures, affordable places, and service costs. The benefits of PHS are perceived as useful for preventing illness during pregnancy. In more detail, the results of exploring the use of preconception health e-modules are presented in Table 2.
Table 2
Themes and sub-themes implementation of the technology acceptance model theory in the use of preconception health e-module
Quotes | Sub-themes | Themes |
First time reading about preconception health Just realized that getting pregnant needs preparation Just realized that there is a negative outcome of pregnancy | New information for teens | Awareness about PHS |
Adolescents can be screened for nutritional status, risk of reproductive health problems, and immunization Preparation for a healthy pregnancy can start in adolescence Consultation on maintaining healthy behavior as a teenager | Preparation for a healthy pregnancy starts in adolescence | The intention of use of PHS |
Want but embarrassed if you go to the doctor | The embarrassment of visiting the doctor |
Want but afraid of the negative environmental stigma | Stigma negative |
The examination is simple and painless | Easy service procedure | Perceived ease of use of PHS |
Service places are available in many places | Accessible service places |
Don't pay much | Affordable cost |
It would be easier if there were online services | Online service available |
It is better to prevent than to cure It costs a lot if it hurts | Disease prevention benefits | Perceived usefulness of PHS |
Adolescent awareness of PHS
Based on the results of the interview, a new subtheme of information for adolescents was found. This subtheme was concluded from 3 statements from informants including adolescents who read about preconception health for the first time, just realized that pregnancy needs preparation/planning, and just realized that not all pregnancies are in normal status. Here are some statements from informants about preconception health awareness for adolescents after reading the preconception health e-module. Adolescents find the content of the e-module Preconception Health interesting and easy to understand and convey material that is considered new by adolescents such as the following statement.
“...... enjoyed reading this material... Eee... interesting because it involves women's issues, especially adolescent girls.....and... relatively easy to understand the contents..."(R3, 17)
“...... this concerns an important issue for adolescents, especially women ..."(R6, 19)
"...for me, this is a new thing...when it comes to the health of the female organs... I've heard... but... Acute pregnancy problems have never been, ashamed if you want to ask...." (D1, 49)
Other informants assessed that through the use of preconception health e-modules, adolescents have new insights into pregnancy preparation or planning, such as the following statement.
"......in my opinion, this module provides the information adolescents need about their reproductive health, especially in preparing for preconception...." (D2, 46)
“........ Yes, add insight because the content is complete and thorough. If they read and perceive the contents of this module, teenagers will know themselves better so that they can avoid pregnancy at a young age..." (OT,1)
“...... Pregnant adolescents are increasing. It may be influenced by the teenager's ignorance in maintaining his sexual behavior. Well, this module is here to provide insight into the importance of preparation before pregnancy, including knowledge about the ideal age of a healthy pregnancy....." (D1, 49)
Adolescent awareness of poor pregnancy outcomes after reading the preconception health e-module, such as the following informant statement
"... Actually, it's not just teenagers... But all women need to know that health needs to be maintained to avoid bad outcomes like low birth weight, stunting, etc. ......."(D2, 46)
"...I think... pregnant huh... just get pregnant... and gave birth to a baby... yes, I just found out if someone gave birth but the baby was not healthy..." (R4, 18)
"...it turns out that there are also many risks of getting pregnant, yes...babies who are stillborn or deformed......that's eee... can still be prevented huh?..." (R7, 22)
The intention of use of preconception care service
The conclusion of the Thema intention of use is obtained from 3 sub-themes, namely preparation for a healthy pregnancy starting from adolescence, embarrassment of visiting health services, and negative stigma. According to informants, adolescents can take advantage of nutritional status screening services, detection and consultation of risks of reproductive health problems, and immunization, as the following informant statements.
"...that the preconception limitation ... from adolescence to adulthood before pregnancy... so pregnancy preparation is very good if done early... so there are many opportunities for handling if problems are encountered" (D1, 49)
"......for adolescents we provide nutritional statuses screening services such as weight weighing, height and arm circumference....truss there is also although rarely anyone does risk screening for reproducible case problems... It can also be consultation... in addition, vaccination and blood-added tablet are also provided......"(D2,18)
“...... After reading this e-module, I came to know that not only pregnant women visit obstetrics and pregnancy doctors..." (OT1, 55)
".......yes I have been measured my weight and height at school....immunization as well but if I come to the public health center (PHC) or to the doctor it hasn't..." (R1, 16)
Through this e-module, adolescents began to know that many services were available to adolescents, but adolescent informants admitted that they were embarrassed to use PHS, such as the following statement.
".....it is very rare for adolescents to use these services (meaning preconception care services) unless they are already pregnant..." (D2.46)
".........I communicate more often with friends... want to consult a doctor... just ashamed....and thought of various kinds....." (R3, 17)
“... if it's his child... want to say you want to consult.... I must allow it.... Even if I deliver... let me know and can support you if there is a problem...(OT2, 45)
The intention of adolescents to utilize PHS is hindered by negative stigma perceptions, such as the stigma of being a delinquent teenager and the stigma of getting pregnant before marriage. Here are statements from some informants.
"......once I sent a friend to an obstetrician for consultation on menstrual pain... At that time I was very worried if there were other visitors who recognized me.... Heeee...." (R5.20)
"...the average teenager who comes to check is accompanied by parents or relatives...... (D2, 45)
“... Obstetrician …. doctors are pregnant people, …. if we go there... Presumably dah pregnant... Ntar in gossip is pregnant first (meaning pregnant before marriage),..... (R4, 18)
“... I was interested in consultation, but there was a fear of being mistaken for various things (meaning bad deeds)....(R7, 22)
Perceived ease of use of Preconception services
Based on the statements of informants from the interviews, it can be concluded that the theme of perceived use for PHS consists of 4 sub-themes, namely easy service procedures, easy access service places, affordable costs, and online services available. PHS is considered available in many places, such as the following excerpt.
“ ... Teenagers can come to the general practitioner practice, specialist, to PHC, clinic or hospital to get DNA consultation screening services... now it depends on the ability of the teenager himself...... ((D1, 56)
"......I just found out... After reading... consultation can be anywhere....just adjust to the BPJS..... (R2, 24)
“...... means you can consult at the PHC near your house..... (R5, 20)
In addition to being available in many places, informants also convey easy procedures when conducting preconception screening, such as the following statement.
"......as for the examination procedures... Relatively the same as the examination of Mrs. Hami's case... So everyone who wants to seek treatment or check.. must be registered first, then enter the waiting room waiting for their turn....for examination starting from the anamnesis, then examined as needed... After that, get therapy and counseling according to the case, and the procedure is completed...... (D2, 45)
“ ... The procedure is the same as other case patients....maybe what often hampers is the long waiting queue....so it takes a lot of time to check......we overcome it by making an appointment before coming to consult........ (D1.56)
The affordable cost sub-theme is inferred from the following quote.
"....currently almost all services have discovered BPJS, so cost is not a problem when checking....."
"...which requires more money, if a laboratory or other sophisticated examination is carried out... will require additional fees, but......if based on preconception service standards....visitors do not need to pay anymore (D2, 45)
Adolescent informants also know that digital PHS are available, such as the following quote.
“...... I can look on the internet....it turns out that consultation can be done by phone ......."
".......it's good if online services....can consult without many people knowing........"
".........there is also a lack of this online service....in the end even though they come directly for screening....for example blood checks must come or the lab staff who come to the house......"
Perceived usefulness Preconception Health Service
Most informants said that after reading the module, they had a perception of the benefits of this preconception service. The perceived benefit is the preventive benefit. This perception of benefit is inferred from the informant's statement that it is better to prevent than to cure and it costs a lot if sick. In general, informants convey many benefits after reading the preconception health e-module, such as the following excerpt.
“…..the content of this module is very suitable for teenagers because this module discusses things that are often ignored at a young age even though the content is very useful at this age and often occurs in everyday life….”. (R2, 24; R3, 17; R6, 19)
“...... The e-module is easily accessible....because of its content... It's very useful to understand if teenagers read it..." It is very useful to understand if teenagers read it (I1, 38)
“.... It can already open insights for teenagers. Very capable if teenagers want to read and understand the contents of the module..... Yes, because this module contains knowledge that can add insight to teenagers....." it has been able to open insights for teenagers. Very capable if teenagers want to read and understand the contents of the module..... Yes, because this module contains knowledge that can add insight to teenagers (D1, 56; D2, 46)
".........interesting to read...... explain to adolescents, the content of the module is appropriate for adolescents because adolescence is one of the phases that have the opportunity to prepare for the phases of life...."(OT2, 41)
The benefits of preconception nursing services are considered as prevention efforts that are more effective and efficient than treatment efforts, as the following statement.
“... After thinking about it... It is also difficult if there is already a problem of illness,... treating it is difficult....it's better to prevent it first..... (R1.16)
“...... Adolescents should be encouraged to further prevent from treating....this important... Because prevention efforts are often considered to have no results....invisible.... there are results..... (D2, 45)
The perception of benefits to preconception nursing services is assessed as the efficiency of medical costs, as the following quote.
“...... if dah is sick... need additional costs....even if there is insurance..... (OT1.55)
“...... Prevention and treatment efforts are the same cost...only if you are sick... then the cost required... more... plus other miscellaneous expenses... (D2, 45).
The results of the interview can conclude that the e-module provides new insights that are very useful for teenagers. The perception of the benefits of PHS coupled with the perception of ease of use and persieve of use, increases adolescent intention of use towards PHS.