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"Pilihan pengembangan kelembagaan Ibukota Republik Indonesia dapat menjadi tolak ukur rasa keadilan bangsaIndonesia dalam membenahi carut marut pembangunan perkotaan secara menyeluruh di Indonesia. Jika konsepmegapolitan begitu saja di-gol-kan oleh wakil rakyat, maka bangsa Indonesia tengah mengidap penyakit rendahnya rasakeadilan. Megapolitan adalah kota dengan ciri-ciri: (1) jumlah penduduk yang sangat besar; (2) jaringan yang terciptamenggambarkan keterkaitan bukan saja berskala nasional tapi juga internasional; (3) dari sudut ruang, menggambarkanadanya keterkaitan antar berbagai kota secara individual bahkan penggabungan. Kebutuhan mendesak penangananmasalah perkotaan di DKI Jakarta memang terasa tinggi, tetapi tidak boleh menyurutkan rasa keadilan kita sebagaibangsa. Pilihan ke arah sana terbentur oleh kelembagaan kota secara nasional yang tidak jelas.The choice of institutional development for Jakarta as Indonesian capital city can be the barometer of equity andfairness as value to whole developing nation, especially for urban development in Indonesia. If megalopolis conceptproposed by Sutiyoso received without reverse, then we have disease to the equity and fairness values as a nation state.Megalopolis is a city characterized by: (1) huge population and density; (2) national and international networking scale;(3) huge integrated spatial. The problematic situation of urban development in Jakarta is urgent, but it is un-fair and unequalif development of other cities in Indonesia is abandoned. The choice to develop megalopolis is still unclear."

"Hampir setiap orang adalah pejalan kaki. Pejalan kaki adalah suatu bentuk transportasi yang penting di daerah perkotaan, khususnya pada lokasi-lokasi yang memiliki permintaan tinggi dengan jarak pendek seperti pada terminal transportasi. Beberapa penelitian mengenai pejalan kaki di negara-negara Asia, menyimpulkan bahwa standar perencanaan fasilitas pejalan kaki untuk negara-negara Asia sebaiknya didasarkan pada karakteristik lokal pejalan kaki; sehingga standar perancangan lokal dibutuhkan pada fasilitas-fasilitas pejalan kaki di negara-negara Asia. Namun hingga saat ini, sebagian besar studi mengenai pejalan kaki masih diarahkan pada tingkatan makroskopik. Pada tingkatan studi ini tidak mempertimbangkan interaksi atau konflik diantara pejalan kaki dan lingkungan serta tidak cocok untuk memprediksi kinerja arus pejalan kaki di dalam area atau jalur pejalan kaki khususnya untuk di dalam bangunan.Maksud dari penelitian ini adalah untuk melakukan penelitian terhadap interaksi yang terjadi diantara pejalan kaki. Dari interaksi pejalan kaki tersebut akan menimbulkan adanya tundaan dan ketidaknyaman yang akan digunakan sebagai dasar untuk penilaian kinerja arus dari koridor tersebut. Untuk mendapatkan penilaian tersebut maka studi yang bersifat mikroskopik perlu dilakukan pada penelitian ini.Hasil penelitian ini diharapkan dapat digunakan sebagai salah satu acuan dalam kaitannya dengan perencanaan dan perancangan fasilitas-fasilitas transportasi di Jakarta. Populasi yang digambarkan pada penelitian ini diharapkan dapat mewakili perjalanan tipikal pelaku pejalan kaki dari sebuah kota berkepadatan tinggi seperti Jakarta."

"Penelitian ini mempunyai tujuan mengkaji efektifitas penagihan pajak pada Kantor Pelayanan Pajak di bawah Kantor Wilayah Direktorat Jenderal Pajak Jakarta Tiga dan melihat faktor-faktor apa saja yang mempengaruhi efektifitas penagihan pajak tersebut.Teori yang mendasari penelitian ini adalah teori pajak, teori organisasi, teori administrasi. Teori statistik non parametrik digunakan untuk menelaah faktor-faktor apa saja yang mempengaruhi efektifitas, sedangkan statistik deskriptif digunakan untuk melihat gambaran efektifitas penagihan dan upaya-upaya pencairan/pengurangan tunggakan pajak secara garis besar.Teknik analisa data yang digunakan adalah untuk melihat gambaran efektifitas penagihan dan upaya-upaya pencairan/pengurangan tunggakan pajak. Analisa deskriptif berupa analisa tabulasi. Untuk mengetahui faktor-faktor apa saja yang mempengaruhi efektifitas penagihan yang digunakan untuk pra penelitian uji validitas, uji reabilitas, uji konsistensi sedangkan pada penelitian digunakan uji modus.Hasil yang dapat ditarik dari penelitian ini adalah terdapat perbedaan efektifitas sasaran organisasi pada Kantor Pelayanan Pajak di bawah Kantor Wilayah DJP Jakarta Tiga, sedangkan faktor-faktor yang mempengaruhi efektifitas penagihan terdiri dari variabel yaitu dukungan & perhatian pimpinan, jumlah juru sita, pertanggungjawaban penagihan pajak dapat ditindak lanjuti, dan kualitas ketetapan pajak.Hasil penelitian ini dapat menjadi masukan bagi Direktorat Jenderal Pajak dalam mengevaluasi kinerja penagihan dan upaya-upaya pencairan/pengurangan tunggakan pajak dan terdapat faktor-faktor efektifitas seperti: variabel dukungan & perhatian pimpinan Kantor Pelayanan Pajak, jumlah juru sita, pertanggungjawaban penagihan pajak dapat ditindak lanjuti dan kualitas Surat ketetapan pajak dapat mempengaruhi kinerja seksi penagihan dalam mencapai tujuan atau sasaran organisasi.

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This examination is to lesson about effectiveness, of the tax claim at Taxes Service Offices under Region Jakarta III and to get influential factors to effectiveness tax claim.

Theory for this examination is tax theory, organization theory and administration theory. Non Parametric Statistical Theory used to see influential factor, whereas Description theory used to see effectiveness of tax claim and expedients to cash uncollecting tax.

Data analysis technical used to get illustration from effectiveness of tax claim and expedients to cash uncollecting tax. Description analysis as a tabulation is to find influential factors to effectiveness tax claim, for a beginning with validity and reability test. In the examination used mode test

Result from this exam are more differential effectiveness factors between tax service offices under Region Jakarta III, even though that factors are 5 variable that is supporting attention from the leader, total collector, responsibility claim of tax can be follow up, and quality of tax assessment."

"Permukiman Nelayan Muara Angke merupakan permukiman yang dibangun atas dasar perencanaan sebelumnya oleh pemerintah DKI Jakarta. Tujuan pembangunannya adalah untuk memukimkan kembali nelayan-nelayan yang sebelumnya menempati kawasan yang tidak diperuntukkan bagi kegiatan bermukim seperti muara sungai atau tepi laut dari beberapa tempat di DKI Jakarta dan mewujudkan perumahan yang yang sehat, aman, nyaman sesuai dengan pola penghidupan mereka. Tipe rumah tinggal yang telah dibangun adalah rumah tidak bertingkat (rumah), rumah panggung dan rumah susun. Dalam perkembangannya, perumahan nelayan turut memberikan pengaruh terhadap penurunan kualitas lingkungan Permukiman Nelayan Muara Angke. Hal ini menimbulkan pertanyaan bagaimana keberlanjutan Permukiman Nelayan Muara Angke ditinjau dari pengaruh rumah tinggal terhadap peningkatan kualitas sosial budaya nelayan dan lingkungannya. Tujuan penelitian yang hendak dicapai adalah mengidentifikasi pengaruh rumah tinggal nelayan terhadap kualitas sosial budaya penghuninya, mengidentifikasi pengaruh rumah tinggal terhadap kualitas lingkungan dan mengidentifikasi keberlanjutan Permukiman Nelayan Muara Angke ditinjau dari kontribusi yang diberikan oleh rumah tinggal di dalamnya.Hasil penelitian menunjukkan bahwa telah terjadi perubahan kondisi rumah tinggal nelayan berupa rumah, rumah panggung dan rumah susun. Perubahan kondisi rumah disebabkan oleh dua faktor yaitu pertama, kondisi hidrologi berupa banjir dan pasang surut; kedua, peralihan kegiatan ekonomi dari nelayan penangkap ikan menjadi nelayan pedagang. Banjir dan pasang surut yang semakin sering melanda tempat tinggal mereka telah mengubah persepsi terhadap banjir dari semula sebagai hal yang biasa menjadi hal yang tidak menyenangkan (buruk). Persepsi ini telah menimbulkan motivasi penghuni rumah, rumah panggung dan rumah susun untuk melakukan perlawanan terhadap lingkungan. Motivasi perlawanan terhadap lingkungan memacu tindakan-tindakan mengubah rumah tinggal berupa pengurugan tanah dan melapisi permukaannya dengan perkerasan.Peralihan kegiatan ekonomi dari nelayan penangkap ikan menjadi nelayan pedagang disebabkan oleh penurunan kualitas penangkapan ikan karena penggunaan teknologi yang sederhana. Penurunan kualitas penangkapan ikan berpengaruh langsung terhadap penurunan penghasilan nelayan. Kondisi ini menyebabkan perubahan persepsi mereka tehadap kegiatan penangkapan ikan dari semula sebagai profesi yang dapat menghidupkan menjadi kegiatan yang tidak menguntungkan dan membutuhkan biaya operasional yang tidak sedikit. Persepsi ini menimbulkan motivasi nelayan untuk mengubah mata pencaharian kepada kegiatan yang dianggap lebih dapat memberikan kehidupan. Berdasarkan pengamatan keberhasilan orang lain dan pengalaman yang dialaminya, nelayan memilih menjadi pedagang ikan. Perubahan kegiatan ekonomi telah memotivasi mereka untuk menyesuaikan komposisi rumah tinggal yang semula terdiri dari bangunan rumah tinggal dan ruang terbuka sebagai tempat penyimpanan alat-alat perikanan menjadi seluruhnya digunakan untuk bangunan rumah tinggal. Motivasi penyesuaian bentuk rumah tinggal menimbulkan tindakan mengubah penataan ruang rumah untuk menampung kegiatan menetap sekaligus tempat berusaha.Hasil penelitian menunjukkan bahwa kondisi rumah dan rumah panggung memberikan empat pengaruh positif terhadap kecenderungan potensi peningkatan kualitas sosial budaya penghuninya yaitu kemampuan rumah tinggal dalam memberikan dukungan terhadap pemenuhan kegiatan ekonomi, mengakomodasi perkembangan keluarga, mendukung peranan perempuan dalam pengasuhan anak dan memenuhi kebutuhan pencapaian privacy penghuninya. Sedangkan rumah susun hanya memberikan satu pengaruh positif terhadap kualitas sosial budaya penghuninya yaitu kemampuan rumah tinggal dalam memberikan dukungan terhadap kegiatan ekonomi penghuninya. Rumah, rumah panggung dan rumah memberikan satu pengaruh negatif terhadap kualitas sosial budaya penghuninya berupa kecenderungan penurunan interaksi sosial diantara sesama anggota masyarakat lainnya karena penataan ruang rumah tinggal berorientasi ke dalam dan lebih mementingkan pencapaian privacy. Ditinjau dari kondisi rumah, rumah panggung dan rumah susun dalam memberikan pengaruh positif dan negatif terhadap penghuninya maka secara umum dapat dikatakan bahwa kondisi rumah tinggal nelayan cenderung berpotensi meningkatkan kualitas sosial budaya penghuninya.Hasil temuan penelitian menunjukkan kondisi rumah, rumah panggung dan rumah susun memberikan lima pengaruh negatif terhadap kecenderungan penurunan kualitas lingkungan yaitu pertama, kontruksi bangunan yang tidak tepat dengan kondisi tanah rawa sehingga mengakibatkan penurunan permukaan tanah; kedua, penggunaan lahan yang secara maksimal untuk rumah tinggal dan melapisi seluruh permukaan tanah dengan perkerasan sehingga menghalangi peresapan air ke dalam tanah; ketiga peningkatan konsumsi listrik sebagai akibat penyaluran air bersih dan penerangan alami yang tidak optimal serta peningkatan penggunaan peralatan listrik sebagai sarana untuk membantu menyelesaikan pekerjaan rumah tangga ataupun pencarian informasi/hiburan; ketiga pengelolaan sampah yang kurang tepat dimana tempat sampah dibiarkan terbuka sehingga mencemari udara di dalam rumah; keempat, kepemilikan septic tank pribadi justru menyebabkan pengelolaan limbah kotoran manusia menjadi tidak efisien dan manambah kecenderungan pencemaran air tanah; kelima, penyaluran air hujan secara langsung ke saluran lingkungan berpotensi meningkatkan jumlah air di dalamnya sehingga mempercepat terjadinya banjir terutama pada musim penghujan. Kondisi rumah, rumah panggung dan rumah susun hanya memberikan satu pengaruh positif bagi peningkatan kualitas lingkungan yaitu dalam hal pengelolaan air kotor. Penghuni rumah, rumah panggung dan rumah susun menyalurkan air kotor ke saluran lingkungan dan melakukan kegiatan kerja bakti secara rutin membersihkan saluran-saluran di sekitar rumah mereka sehingga mengurangi genangan air dan timbunan sampah yang terbawa saat air pasang. Ditinjau dari kondisi rumah, rumah panggung dan rumah susun dalam memberikan pengaruh positif dan negatif terhadap kualitas lingkungan maka secara umum dapat dikatakan bahwa kondisi rumah tinggal nelayan cenderung berpotensi menurunkan kualitas lingkungan.Hasil penelitian dan perhitungan menunjukkan bahwa kondisi rumah, rumah panggung dan rumah susun lebih besar memberikan pengaruh negatif dibandingkan pengaruh positifnya terhadap kualitas Permukiman Nelayan Muara Angke. Keberadaan perumahan nelayan di dalamnya cenderung berpotensi menurunkan kualitas lingkungan sehingga dapat dikatakan bahwa Permukiman Nelayan Muara Angke tidak berkelanjutan. Kondisi ketidakberlanjutan terjadi karena upaya peningkatan kualitas sosial budaya penghuni diiringi dengan penurunan kualitas lingkungan. Jika kondisi penurunan kualitas lingkungan terus terjadi pada akhirnya dapat membahayakan penghuni yang tinggal dan berkegiatan di dalamnya terutama mereka dari generasi yang akan datang.Berdasarkan uraian di atas maka dapat disimpulkan bahwa Permukiman Nelayan Muara Angke menunjukkan kecenderungan potensi tidak berlanjut karena menyebabkan penurunan kualitas lingkungan. Berkenaan dengan hal tersebut maka saran-saran yang disampaikan agar Permukiman Nelayan Muara Angke dapat terus berlanjut sebagai berikut pertama, keberadaan nelayan penangkap ikan di DKl Jakarta perlu diiringi dengan peningkatan teknologi penangkapan ikan yang lebih maju sehingga kegiatan penangkapan ikan menjadi profesi yang menguntungkan dan menjanjikan penghidupan; kedua, upaya masyarakat mengatasi banjir yang terns menerus perlu diimbangi dengan intervensi pemerintah berupa penanggulan kawasan; ketiga perencanaan pembangunan perumahan nelayan di masa mendatang sebaiknya disesuaikan dengan karakter masyarakat nelayan yang terdiri atas sub-sub kelompok sesuai mata pencaharian mereka yaitu nelayan penangkap ikan, nelayan pembuat sarana, nelayan pengolah ikan dan nelayan pedagang/pemodal; ketiga, pengadaan rumah tinggal nelayan di perkotaan harus berhadapan dengan masalah keterbatasan lahan, sehingga kecenderungan tipe huniannya diarahkan ke rumah susun, dalam perlu diperhatikan adalah luas bangunan dan penataan ruang rumah agar dapat mengakomodasi perkembangan kondisi sosial budaya keluarga nelayan.

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The Fisherman Settlement of Muara Angke is in fact a settlement constructed upon previous planning designed by the government of DKI Jakarta. The purpose of the construction itself is to resettle fishermen who previously inhabited areas not destined for settlement activity such as estuary or sea shores in several locations in DKI Jakarta and also in realize healthy, sale, and eolulnrtable housing suitable to their living pattern, The types of residence built are rumah tidak bertingkat (rumah), rumah panggung, and rumah susun. Within the development, fisherman housing has given influences in the diminution of environmental qualities of the Muara Angke Fisherman Settlement. This, of course, questions the probability of the continuation of Muara Angke Fisherman Settlement observed from the influences of residences to the socio-cultural quality augmentation of the fishermen and their environment. The purpose of the research which is about to be achieved is to identify the influences of the fishermen's residences towards the socio-cultural qualities of the inhabitants, to classify the influences of the residences towards the environmental qualities, and to identify the continuance of the Muara Angke Fisherman Settlement regarded from the contributions donated the residences within.

Research reveals that there have been changes in the fishermen's housing conditions in terms of rumah, rumah panggung, and rumah susun. The alteration of housing conditions is caused by two main factors; the hydrological conditions in terms of floods and tide, and the shift of economical activities from becoming fishing fishermen to merchant fishermen. Floods and tide striking their residences have amended the perception towards floods from what was enjoyable to now unpleasant. This perception has generated motivations to the residents of rumah, rumah panggung, and rumah susun to commit a fight against the environment. This battling motivation against the environment triggers acts of transforming residences in terms of levering the soil and coating the surface solidly.

The transformation of economical activities from being fishing fishermen to merchant fisherman is caused by the diminution of fishing quality due to the simple technological usage. The downgrade of fishing quality affects immediately in decreasing the fishermen's income. This condition triggers the change of their perception towards fishing activity from what was life-supporting profession to non-profit action that needs high operational costs. This perception sets off fishermen's motivation to change their living to activities considered to be able to give more income.

Based on the observations of other people's success and the undergone experiences, fishermen tend to choose to become merchant fishermen. The alteration of economical activities has motivated them to adjust the housing composition that was based upon residential structure and open spaces for storing fishing equipment to become residential structure completely. This motivation of adjusting the residence makes them to alter the house space arrangement so that it would be possible to accommodate settling activities and workplace at the same time.

Research findings reveal that conditions of rumah, rumah panggung, and rumah susun has given six negative influences to the environmental quality diminution, which are first of all, building construction inappropriate for the swamp condition so that it causes the decline of land surface; second, maximum land usage for residence thus having solid covering that prevent water absorption by the soil; third, the increase of electricity as a consequence of clean water distribution and non-optimal natural illumination and the increase of electrical appliances either as a mean to help finishing household chores or as a source of information and entertainment; fourth, the mismanagement of garbage where trash containers are left open thus contaminating the air within the house; fifth, the possession of personal septic tanks which in fact makes human waste management inefficient and add up water pollution; sixth, the distribution of precipitation directly onto the waterway creates the potential to increase water volume thus accelerating floods, especially during rainy season. The condition of rumah, rumah panggung, and rumah susun seems to only contribute one positive impact to the augmentation of environmental quality, which is in terms of filthy water management. The inhabitants of rumah, rumah panggung, and rumah susun distribute filthy water to the waterways and perform routine joint environmental cleaning by cleaning surrounding waterways in order to decrease puddle and garbage pile carried away by tide. Observed from the conditions of rumah, rumah panggung, and rumah susun in contributing positive as well as negative impacts to the environmental qualities, it can be generally said that fishermen's housing conditions tend to downgrade environmental qualities.

Research indicates that the conditions of rumah and rumah panggung give four positive effects to the augmentation of socio-cultural qualities of the inhabitants, which are the ability of the house to provide support to the fulfillment of economical activities, to accommodate family development, to support the role of women in child care, and to fulfill the need of privacy achievement of the inhabitants. On the other hand, rumah susun only gives one positive impact to the socio-cultural qualities of the inhabitants, which is the ability of the house to provide support to the economical activities of the inhabitants. rumah, rumah panggung, and rumah susun donates one negative outcome towards the socio-cultural quality of the inhabitants, which is in terms of a tendency to decrease social interaction among society members because the space management of the housing is oriented inward and aimed more to the privacy achievement. Observing the condition of rumah, rumah panggung, and rumah susun in presenting positive and negative impacts for the inhabitants, therefore it can be concluded in general that the condition of Fishermen's housing tends to augment the socio-cultural qualities of the inhabitants.

Research and calculations indicate that the conditions of rumah, rumah panggung, and rumah susun give more negative influences rather than positive ones to the quality of the Muara Angke Fisherman Settlement. The existence of fishermen's housing there tends to downgrade the environmental qualities so that it can be said that the Muara Angke Fisherman Settlement is not in continuation. This condition of non-continuance happens due to the efforts to increase socio-cultural qualities of the inhabitants followed by the diminution of environmental qualities. If this condition of quality diminution keep on occurring, in the end, it can jeopardize the inhabitants living and doing activities inside, specially those of future generation.

Based on the above explanation. it can be interred that the Muara Angke Fisherman Settlement doesn't show the continuance tendency as it causes environmental quality diminution. Concerning the matter, the suggestions so that the Muara Angke Fisherman Settlement can stay exist are; first, the existence of fishing fishermen in MI Jakarta needs to be followed by the augmentation of fishing technology far more advance so that fishing can be lucrative and promising; second, the ceaseless efforts of the society in dealing with floods needs to be balanced with government intervention in terms of barricading the area; third, the construction design of fisherman housing in the future should be adjusted with the characters of the fisherman society which is based on sub groups according to their methods of living, which are fishing fishermen, facility producers fishermen, fish processing fishermen, and mercantile fishermen; fourth, the establishment of fisherman housing in urban areas has to be able to deal with the problem of land inadequacy, so that the tendency of the settlement type is aimed to rumah susun, and what needs to be noted is the width of the building and the spatial arrangement in order to accommodate the development of socio-cultural conditions of fisherman families."

"ABSTRAKWalaupun angka peserta KB aktif di Indonesia telah cukup tinggi 52,54%; sekitar 24% berhenti menggunakan kontrasepsi sebelum mencapai satu tahun, terutama karena mengalami efek samping kontrasepsi atau masalah kesehatan lainnya. Beberapa penelitian menunjukkan bahwa peserta KB yang mendapat konseling KB, angka putus pakainya lebih rendah daripada peserta yang tidak mendapat konseling KB.Masalah Penelitian Peran swasta dalam memberikan pelayanan KB semakin besar, khususnya bidan praktek swasta. Susenas tahun 2001 menunjukkan 43,56% peserta aktif KB di daerah urban memperoleh kontrasepsi dari bidan praktek swasta. Mengingat peranannya yang cukup besar, pelatihan konseling bagi bidan praktek swasta tampaknya menjadi suatu kebutuhan untuk meningkatkan pelayanan KB yang bermutu, yang pada gilirannya akan menurunkan angka putus pakai kontrasepsi. Keterampilan bidan praktek swasta di perkotaan dalam melakukan konseling KB belum diketahui, padahal peran mereka cukup besar dalam memberikan pelayanan KB. Dalam jangka pendek pelatihan konseling KB bagi petugas merupakan pilihan, untuk selanjutnya di masa mendatang didukung dengan program-program lainnya yang ditujukan bagi klien dan masyarakat pada umumnya. Sebagai dampak pelatihan diharapkan akan terjadi peningkatan partisipasi klien selama konseling berlangsung, dan peningkatan kepuasan serta kepatuhan klien. Keterampilan konseling merupakan keterampilan yang tidak mudah dipelajari. Metode penilaian diri merupakan cara yang relatif murah dan dapat dilaksanakan dengan mudah untuk meningkatkan keterampilan yang baru. Pemakaian metode penilaian diri di Indonesia belum banyak dilakukan. Penggunaan metode penilaian diri untuk memperkuat pelatihan konseling KB bidan puskesmas memberikan hasil yang cukup baik, sedangkan untuk bidan swasta belum diketahui. Metode penilaian diri mungkin dapat dipakai sebagai penguat pelatihan konseling KB bagi bidan praktek swasta, karena walaupun mereka berbeda dengan bidan puskesmas dalam beberapa hal, antara lain bekerja secara independen, tidak ada yang mengawasi dan sepenuhnya bertanggungjawab secara pribadi, tetapi keinginan mereka untuk meningkatkan keterampilannya dalam melayani klien lebih besar karena mempunyai motivasi untuk memperoleh penghasilan yang lebih besar.Tujuan penelitianTujuan umum penelitian ini adalah untuk mengetahui efektivitas metode penilaian diri. Tujuan khususnya adalah: (1) diketahuinya gambaran umum keterampilan bidan praktek swasta dalam melakukan konseling KB; (2) diketahuinya faktor-faktor yang mempengaruhi peningkatan keterampilan bidan praktek swasta dalam melakukan konseling KB dan (3) diketahuinya pengaruh metode penilaian diri terhadap peningkatan keterampilan bidan praktek swasta dalam melakukan konseling KB.Metodologi penelitianPenelitian dilakukan di Propinsi DKI Jakarta, selama sekitar 8 bulan, mulai November 2000, dengan desain pretest posttest control group design. Populasi penelitian ini adalah bidan praktek swasta di DKI Jakarta sebanyak 994 orang. Sampel diambil secara acak sebanyak 360, selanjutnya secara acak dialokasikan masing-masing 120 bidan untuk 3 kelompok studi. Kelompok intervensi 1 hanya mendapat pelatihan konseling KB. Kurikulum yang dipakai adalah kurikulum BKKBN/JHU-PCS yang telah dimodifikasi, dengan lama pelatihan 26,25 jam. Kelompok intervensi 2 mendapat pelatihan konseling KB seperti kelompok intervensi 1, yang diperkuat dengan metode penilaian din selama 8 minggu. Kelompok kontrol tidak mendapat perlakuan. Untuk satu bidan hanya diambil satu orang klien, bisa klien KB baru atau lama dengan masalah. Di akhir penelitian ada 323 bidan yang memenuhi syarat untuk dianalisis.Data kuantitatif dikumpulkan dengan pengisian kuesioner dan melakukan rekaman konseling KB pada 1 minggu sebelum dan 8 minggu sesudah pelatihan konseling. Pengumpulan data kualitatif yang digunakan untuk menerangkan keberhasilan dan kelemahan penelitian dilakukan dengan melaksanakan wawancara mendalam dan diskusi kelompok terarah pada 12 minggu setelah pelatihan konseling KB berakhir, serta penilaian terhadap formulir penilaian din. Pengukuran keterampilan konseling KB dilakukan dengan menggunakan alat ukur yang dikembangkan oleh peneliti dengan melakukan modifikasi terhadap alat ukur yang dikembangkan oleh tim dan Johns Hopkins University/PCS dan University of Wales, UK. Keterampilan konseling KB yang diukur adalah keterampilan bidan swasta dalam melibatkan klien untuk mengambil keputusan.Di tahap analisis, peneliti memutuskan untuk hanya menganalisis konseling KB antara bidan dengan klien baru saja, karena jumlah sampel konseling KB dengan klien lama kurang sehingga reliabilitas instrumen pengukur konseling KB dengan klien lama tidak dapat diteliti. Jumlah bidan yang dapat dianalisis sebanyak 263 orang.Hasil PenelitianSkor keterampilan bidan melakukan konseling KB di awal penelitian temyata rendah; dan 15 subskill, hanya 1 subskill yang menunjukkan skor yang baik yakni keterampilan menanyakan apakah klien sudah mempunyai pilihan. Keterampilan yang seharusnya sudah mereka lakukan sehari-hari misalnya memberikan informasi yang lengkap, ternyata juga tidak baik. Mereka belum terbiasa memberi kesempatan kepada klien untuk berbicara, terlihat dari rendahnya skor subskill mengidentifikasi masalah, minta klien bertanya selama diskusi berlangsung, dan menggali perasaan klien tentang kontrasepsi yang ditawarkan atau akan dipakainya. Mereka juga tidak menyampaikan informasi yang disesuaikan dengan situasi klien. Kenyataan ini menggambarkan komunikasi antara petugas kesehatan dengan klien di Indonesia pada umumnya. Sudah saatnya dilakukan program untuk mengubah keadaan tersebut, karena komunikasi antara petugas dengan klien merupakan faktor yang penting dalam keberhasilan pelayanan kedokteran dan kesehatan.Pascapelatihan terjadi peningkatan pengetahuan, motivasi, persepsi peran, sikap dan efikasi diri bidan tentang konseling KB di kelompok intervensi 1 dan 2. Peningkatan variabel-variabel tersebut sama di kedua kelompok intervensi, kecuali variabel efikasi diri. Peningkatan efikasi diri di kelompok intervensi 2; besarnya 1,70 kali peningkatan di kelompok 1. Di kelompok kontrol terjadi juga peningkatan pengetahuan, sikap dan efikasi diri, tetapi peningkatan ini berbeda bermakna dengan peningkatan di kelompok intervensi 1 dan 2. Peningkatan di kelompok kontrol tersebut diperkirakan karena efek uji praintervensi dan sejarah.Ditemukan korelasi antara peningkatan keterampilan konseling KB dengan beberapa variabel, yakni peningkatan efikasi diri, peningkatan sikap, peningkatan persepsi peran, peningkatan motivasi dan peningkatan pengetahuan; dengan r berkisar antara 0,103 sampai 0,805. Tidak ada kolinearitas antar variabel bebas. Ternyata peningkatan keterampilan konseling terutama dipengaruhi oleh peningkatan efikasi diri dan peningkatan sikap. Peningkatan efikasi diri mempunyai pengaruh yang lebih besar, yang dapat dilihat pada besarnya nilai koefisien Beta (0,521 berbanding 0,323). Motivasi tidak muncul sebagai prediktor, korelasinya dengan peningkatan keterampilan konseling KB relatif rendah (r=0,103, p 0,047). Hal ini mungkin terjadi karena kelemahan instrumen yang dikembangkan peneliti. Instrumen tersebut ternyata kurang dapat menjaring motivasi bidan yang sebenarnya.Ternyata efikasi diri dipengaruhi oleh pelatihan konseling dan metode penilaian diri. Pelatihan konseling mempunyai koefisien Beta 0,609, sedangkan metode penilaian diri 0,389. Penambahan metode penilaian diri terbukti meningkatkan efikasi diri. Dapat disimpulkan bahwa metode penilaian diri meningkatkan keterampilan konseling KB melalui peningkatan efikasi diri. Usaha meningkatkan efikasi diri di kelompok intervensi 2 dilakukan dengan memberi kesempatan kepada bidan untuk melakukan refleksi diri dengan eara menilai sendiri keterampilannya dalam melakukan konseling, dan memberikan kesempatan kepada bidan untuk belajar sendiri (self-learning) dengan cara menjawab pertanyaan-pertanyaan yang ada di dalam formulir penilaian diri secara teratur.Keberhasilan uji coba metode ini adalah karena alat penilaian diri yang dipakai cukup sederhana dan mudah digunakan. Kedisiplinan merupakan kunci pokok dari keberhasilan metode penilaian diri. Sangat penting melakukan langkah-langkah penilaian diri secara teratur sesuai prosedur yang telah ditentukan. Dengan melaksanakan secara teratur, mereka akan terbiasa mengetahui kelemahannya, kemudian memperbaikinya, sehingga akhirnya terbiasa melakukan konseling KB yang benar. Kebiasaan ini akan meningkatkan efikasi diri. Lima belas persen bidan tidak mengisi formulir penilaian diri dengan lengkap; ternyata diskusi kelompok terarah menunjukkan bahwa hal tersebut terjadi karena bidan tidak disiplin mengisi formulir penilaian diri, bukan disebabkan oleh kesulitan pengisian. Penekanan tentang keuntungan yang akan diperoleh mereka menjadi sangat penting; dan sebaiknya disampaikan pada waktu pelatihan penggunaan alat penilaian diri, karena supervisi dalam program penilaian diri ini sangat minimal, hanya 1 kali yakni pada minggu kedua.Pelatihan konseling KB yang diperkuat dengan metode penilaian diri ternyata dapat meningkatkan keterampilan bidan swasta melakukan konseling KB. Peningkatan skor keterampilan konseling KB di kelompok bidan yang mendapat pelatihan KB dan metode penilaian diri ternyata paling tinggi yakni 1,79 kali peningkatan di kelompok yang hanya mendapatkan pelatihan konseling, dan 9,6 kali lebih tinggi daripada peningkatan di kelompok kontrol. Kelompok bidan yang hanya mendapat pelatihan konseling KB peningkatannya 5,3 kali kelompok kontrol. Kelompok kontrol walaupun keterampilannya meningkat, tetapi sangat kecil dibandingkan dengan peningkatan di 2 kelompok lainnya (6,2% berbanding 55,63% dan 33,25%). Semua peningkatan tersebut berbeda bermakna. Peningkatan keterampilan konseling di kelompok kontrol diperkirakan terjadi karena efek uji praintervensi dan sejarah.Pengamatan keterampilan konseling pascaintervensi menunjukkan bahwa ada perubahan yang bermakna antara bidan yang mendapat pelatihan konseling KB dan diperkuat dengan metode penilaian diri, dengan bidan yang hanya mendapat pelatihan konseling KB dalam hampir semua subskill kecuali untuk subskill melakukan probing terhadap kebutuhan atau prioritas klien, dan memberikan informasi secara lengkap. Berarti metode penilaian diri yang dikembangkan peneliti belum berhasil mengubah 2 subskill tersebut.Simpulan dan SaranPenelitian ini menemukan keterampilan konseling KB bidan swasta sebelum mendapat pelatihan masih jauh dari memuaskan. Kenyataan ini menunjukkan gambaran komunikasi petugas kesehatan dengan klien di Indonesia pada saat ini. Diperlukan penelitian lebih lanjut di bidang komunikasi kesehatan, khususnya antara petugas kesehatan dengan klien atau antar petugas kesehatan. Penelitian-penelitian di bidang tersebut akan lebih membuka mata kita bahwa banyak hal-hal yang perlu dilakukan untuk meningkatkan kualitas pelayanan kesehatan, selain perbaikan yang bersifat teknis.Penelitian ini juga membuktikan bahwa metode penilaian diri dapat digunakan untuk memperkuat pelatihan guna meningkatkan keterampilan bidan praktek swasta dalam melakukan konseling KB. Peningkatan keterampilan konseling KB tersebut diperoleh melalui peningkatan efikasi diri. Keuntungan penggunaan metode penilaian diri harus ditekankan pada waktu pelatihan penggunaan alat tersebut. Pengalaman ini dapat dipakai untuk memperkuat pelatihan-pelatihan di bidang kedokteran/kesehatan yang melibatkan perubahan perilaku.Instrumen yang dipakai peneliti untuk mengukur keterampilan konseling KB dapat dipakai untuk mengevaluasi pelatihan konseling KB, atau keberhasilan suatu program yang berkaitan dengan kualitas pelayanan KB. Penelitian-penelitian lebih lanjut akan memberikan sunabangan yang berarti bagi kualitas pelayanan KB, misalnya penelitian tentang dampak pelatihan konseling KB dan metode penilaian diri terhadap partisipasi, kepuasan, dan kepatuhan klien.Data pascaintervensi menunjukkan bahwa metode penilaian diri tidak mengubah keterampilan melakukan probing terhadap kebutuhan dan prioritas klien serta keterampilan memberikan informasi yang lengkap. Pengamatan mendalam perlu dilakukan terhadap alat penilaian diri tersebut untuk perbaikan dan penyempurnaan.Perlu dilakukan uji coba untuk melihat efektivitas kurikulum konseling KB yang dipakai penelitian ini. Bila terbukti lebih efektif, kurikulum ini dapat dipakai untuk penyempurnaan kurikulum asli, atau dapat dimasukkan sebagai muatan dalam kurikulum institusi pendidikan lainnya yang memberikan pendidikan bagi tenaga medik atau nonmedik dalam bidang kedokteran dan kesehatan, khususnya dalam materi konseling atau komunikasi interpersonal.Kelemahan penelitian ini antara lain adalah, keterampilan konseling KB hanya diukur 1 kali, sehingga keajegan keterampilan konseling KB dari masing-masing bidan tidak diketahui. Hanya 10% bidan diukur keterampilannya 2 kali dengan nilai r=0,909. Perlu dilakukan suatu penelitian yang melibatkan 8 sampai 10 klien untuk 1 orang bidan untuk dapat meningkatkan kesahihan penelitian. Pada penelitian ini, motivasi tidak muncul sebagai prediktor keterampilan konseling KB. Tampaknya diperlukan instrumen yang lebih akurat untuk dapat menjaring motif-motif bidan yang sebenarnya.

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ABSTRACT

Introduction

Twenty-four percent family planning users discontinued using contraception before one year; the major reasons were experiencing side effect and other health problems. Results of various researches revealed that clients who were counseled before or after receiving contraception showed lower discontinuation.

Problem Statement

Private midwives have a significant role in family planning services. Data from the National Social and Economic Survey 2001 showed that 43.56% current users in urban areas received contraception from them. Communication between private midwives and clients in urban areas is still unknown, whereas private midwives' role is big enough. Family planning counseling training is a need, which in turn should be supported by other programs directed to increase clients and community participation. In the long run, impact expected from family planning counseling training is the increment of clients' active communication, satisfaction and compliance.

Counseling skills is not easy. It takes time and long process to apprehend.. Training it self, will not automatically improve providers' behavior, or the improved behavior may not be maintained for longer period several self-learning methods were introduced to reinforce training. One of the methods was self-assessment, which was proved in developed countries to be effective and relatively cheap to improve new skills.

This research tried to test the use of self-assessment to improve private midwives' skills in counseling family planning clients. Experience from this research is expected specifically to be a significant contribution for the progress of family planning counseling in Indonesia, and in general for research in health communication in Indonesia. The problems can be stated as follows: (1) how is the description of private midwives' family planning counseling skills in DKI Jakarta? (2) Can self-assessment method strengthen family planning counseling training to improve midwives' counseling skills?

Objectives

The goal of this research is to test the effectiveness of self-assessment method in improving family planning counseling skills of private midwives. The specific objectives are: (1) to know the description of private midwives' counseling skills in DKI Jakarta Province, (2) to study factors which influence the increment of counseling skills and (3) to study the effect of self-assessment method towards the increment of counseling skills.

Methodology

This research was done in DK1 Jakarta Province starting November 2000 for a period of 8 months, using a pretest-posttest control design. The population is the private midwives in Jakarta (N=994). Samples were taken randomly as many as 360, assigned equally and randomly to 3 groups of midwives, namely intervention 1, intervention 2 and control group. Intervention 1 group got 26.25 hours family planning counseling training, intervention 2 groups received family planning counseling training plus self-assessment for 8 weeks, while the control group did not get any intervention. Each midwife counseled t client, either new or continuing client with problem.

Quantitative data were collected using questionnaire and counseling recording. Data were collected 1 week before and 8 weeks after the training. Conducting self-assessment forms evaluation, in-depth interviews and focus group discussion 12 weeks after the training collected qualitative data, which was used to explain the success and the weakness of the intervention. The validity and reliability of measurement were controlled by (1) testing the validity and reliability of the instruments, (2) standardization of method of measurement, and (3) standardization of observers. Measuring the effort of private midwife in involving client to make decision did the measurement of counseling skills. Modifying a tool, which was developed by a team from Johns Hopkins University/PCS and University of Wales, UK, developed this measurement. Using SPSS 11Version did data analysis. At the end of the study 323 midwives fulfilled the criterion of the study, 60 of them performed counseling with continuing clients either pre or post-intervention.

Results

This study failed to analyze counseling with continuing clients because the number was too small, so the reliability of the measurement instrument could not be tested. This study featured only midwives who counseled new family planning clients.

Results showed that before the intervention, private midwives' counseling skills was low. Only 1 sub skill showed sufficient score that was sub skill to ask whether client has contraceptive choice in her mind. They did not give clients chance to talk, which can be seen from the low scores of specific sub skills such as identify problems, ask client to raise questions and explore clients' feeling about offered or preferred contraception. Moreover they did not give complete information. This portrait actually reflects provider-client communication in Indonesia. Action need to be done to improve this condition, as we realize that provider-client communication is very important for the success of health and medical services. The quality of services is in question if this item is ignored.

After the training; knowledge, motivation, role perception, attitude and self-efficacy towards family planning counseling in the intervention groups were increased. The increments of those variables in both groups were not significantly different, except the self-efficacy. The increase of self-efficacy in the intervention 2 group was 1.70 higher than the increase in the intervention I group. In the control group; knowledge, attitude and self-efficacy were increased but the increments were significantly different with the increments in the intervention groups. The increments of those variables in the control group might be caused by the testing and history effect.

The correlations of the increments of several independent variables with the increment of counseling skills were detected. Increments of knowledge, motivation, role perception, attitude and self-efficacy had significant correlations with the increment of counseling skills, with r ranged from 0.103 to 0.805. There was no collinearity between independent variables. The increment of counseling skills was influenced mostly by the increment of self-efficacy and attitude towards counseling. Self-efficacy showed stronger influence than attitude as shown by Beta coefficient (0.521 vs. 0.323). Motivation in this study did not appear to be an important predictor for counseling skills. Its correlation with the increase of counseling skills was relatively low (r = 0.103, p 0.047). The weakness of the instrument, made this study was unable to catch the real motives of the midwives' to counsel clients.

Also this study found that the increment of self-efficacy was influenced by the family planning counseling training and self-assessment, with Beta coefficient 0.609 and 0.389. The addition of self-assessment increased self-efficacy in conducted family planning counseling. It can be concluded that self-assessment increases counseling skills through the increment of self-efficacy. The effort to increase self-efficacy in intervention 2 group was done by allowing midwives to do self-reflection and self-learning. The success of self-assessment method is that because the tool is simple and easy to be used, as mentioned by the midwives during the focus group discussion. Also self-discipline poses a major role for the success of this method. It is very important that they do the task regularly as it should be. By doing the self-assessment regularly they will learn more and get used to counsel clients in a correct way. Practicing a new behavior everyday will give result the mastering of that new behavior. This will increase the self-efficacy in doing the behavior. Fact that 15% of the midwives did not perform the self-assessment well, tell us that motivation to arouse midwives to do the task is very important. This task need to be done during the training of the use of self-assessment tool; because supervision is minimal, only once in 8 weeks.

Family planning counseling training conducted in 26.25 hours using modified BKKBN/JHUPCS curriculum, and strengthened by self-assessment was proved to be successful in increasing counseling skills. The increment of counseling skills in intervention 2 group, was 1.79 times higher than increment in intervention I group (p 0.000); and 9.6 times higher than the control group. Group, which only received family planning counseling training, showed increment 5.3 times higher than the control group. The increase among the control group might happen because of the testing and history effect, and the increase was smaller compared to other groups (6.2% vs. 55.63% and 33.25%). Those increments were significantly different.

The post intervention counseling skills showed that there were significant differences between private midwives who only received training and private midwives who got training and self-assessment, concerning almost all sub skills of the counseling skills. Sub skill to probe the client?s needs/ priorities, and sub skill to give complete information was not significantly different. It means that self-assessment did not improve those skills. This weakness should be overcome by reviewing the self-assessment tool to see opportunities for improvement.

Conclusions and Recommendations

The private midwives' counseling skills before the intervention was low. This fact features the provider-client communication in Indonesia nowadays. More studies need to be done in the area of health communication, specifically to study provider-client communication, and provider-provider communication. Researches in this area will open our eyes that there are other things need to be done beside the improvement of technical matter in improving quality of health services.

This study have proved that self-assessment method can be used to strengthen a family planning counseling training in the effort to increase the private midwives' counseling skills; and the increase of counseling skills were reached through the increase of self efficacy. The advantages of doing the self-assessment task need to be underscore during the training to use the tool. This experience can be used to strengthen any other training, which involves a new behavior to be improved. The instrument used to measure the counseling skills will also be useful for evaluating counseling training program or other program related to the quality of family planning services. Further research will have a significant contribution to family planning quality of services, among others are to study the impact of counseling training and self-assessment towards client's participation, satisfaction and compliance.

While this study is successful in increasing the counseling skills in the intervention 2 group more than in the intervention I group, post intervention data showed that self-assessment did not improve sub skill to probe the client's needs and priorities, and sub skill to give complete information. A thorough review needs to be done to study the self-assessment tool, for opportunities to an improvement.

The modification of BKKBN/JHUPCS family planning counseling training curriculum has not been tested in this study. If this new curriculum will be implemented widely, a study needs to be done to prove its effectiveness. Soon after the test is done and proved to more effective than the previous one, the curriculum can be used for the action of perfecting curriculum in family planning counseling training or to be imbedded into the curriculum of other institutions which teach counseling training or interpersonal communication for medical and non-medical personnel.

The number of counseling session measured for each midwife was only one, so that the consistency of counseling skills of each midwife was unknown. Ten percent of midwives were asked to do 2 counseling sessions, and the reliability test showed r = 0.909. Further research, which includes 8 to 10 clients for each midwife, will increase the reliability of the study. Motivation is also known as an important predictor for performance. In this study, correlation between motives and counseling skills was relatively low even though proved to be significant. A better instrument needs to be developed so that private midwives' real motives can be caught and studied.;Effect Of Self-Assessment Towards Private Midwives' Family Planning Counseling SkillsIntroduction

Twenty-four percent family planning users discontinued using contraception before one year; the major reasons were experiencing side effect and other health problems. Results of various researches revealed that clients who were counseled before or after receiving contraception showed lower discontinuation.

Problem Statement

Private midwives have a significant role in family planning services. Data from the National Social and Economic Survey 2001 showed that 43.56% current users in urban areas received contraception from them. Communication between private midwives and clients in urban areas is still unknown, whereas private midwives' role is big enough. Family planning counseling training is a need, which in turn should be supported by other programs directed to increase clients and community participation. In the long run, impact expected from family planning counseling training is the increment of clients' active communication, satisfaction and compliance.

Counseling skills is not easy. It takes time and long process to apprehend.. Training it self, will not automatically improve providers' behavior, or the improved behavior may not be maintained for longer period several self-learning methods were introduced to reinforce training. One of the methods was self-assessment, which was proved in developed countries to be effective and relatively cheap to improve new skills.

This research tried to test the use of self-assessment to improve private midwives' skills in counseling family planning clients. Experience from this research is expected specifically to be a significant contribution for the progress of family planning counseling in Indonesia, and in general for research in health communication in Indonesia. The problems can be stated as follows: (1) how is the description of private midwives' family planning counseling skills in DKI Jakarta? (2) Can self-assessment method strengthen family planning counseling training to improve midwives' counseling skills?

Objectives

The goal of this research is to test the effectiveness of self-assessment method in improving family planning counseling skills of private midwives. The specific objectives are: (1) to know the description of private midwives' counseling skills in DKI Jakarta Province, (2) to study factors which influence the increment of counseling skills and (3) to study the effect of self-assessment method towards the increment of counseling skills.

Methodology

This research was done in DK1 Jakarta Province starting November 2000 for a period of 8 months, using a pretest-posttest control design. The population is the private midwives in Jakarta (N=994). Samples were taken randomly as many as 360, assigned equally and randomly to 3 groups of midwives, namely intervention 1, intervention 2 and control group. Intervention 1 group got 26.25 hours family planning counseling training, intervention 2 groups received family planning counseling training plus self-assessment for 8 weeks, while the control group did not get any intervention. Each midwife counseled t client, either new or continuing client with problem.

Quantitative data were collected using questionnaire and counseling recording. Data were collected 1 week before and 8 weeks after the training. Conducting self-assessment forms evaluation, in-depth interviews and focus group discussion 12 weeks after the training collected qualitative data, which was used to explain the success and the weakness of the intervention. The validity and reliability of measurement were controlled by (1) testing the validity and reliability of the instruments, (2) standardization of method of measurement, and (3) standardization of observers. Measuring the effort of private midwife in involving client to make decision did the measurement of counseling skills. Modifying a tool, which was developed by a team from Johns Hopkins University/PCS and University of Wales, UK, developed this measurement. Using SPSS 11Version did data analysis. At the end of the study 323 midwives fulfilled the criterion of the study, 60 of them performed counseling with continuing clients either pre or post-intervention.

Results

This study failed to analyze counseling with continuing clients because the number was too small, so the reliability of the measurement instrument could not be tested. This study featured only midwives who counseled new family planning clients.

Results showed that before the intervention, private midwives' counseling skills was low. Only 1 sub skill showed sufficient score that was sub skill to ask whether client has contraceptive choice in her mind. They did not give clients chance to talk, which can be seen from the low scores of specific sub skills such as identify problems, ask client to raise questions and explore clients' feeling about offered or preferred contraception. Moreover they did not give complete information. This portrait actually reflects provider-client communication in Indonesia. Action need to be done to improve this condition, as we realize that provider-client communication is very important for the success of health and medical services. The quality of services is in question if this item is ignored.

After the training; knowledge, motivation, role perception, attitude and self-efficacy towards family planning counseling in the intervention groups were increased. The increments of those variables in both groups were not significantly different, except the self-efficacy. The increase of self-efficacy in the intervention 2 group was 1.70 higher than the increase in the intervention I group. In the control group; knowledge, attitude and self-efficacy were increased but the increments were significantly different with the increments in the intervention groups. The increments of those variables in the control group might be caused by the testing and history effect.

The correlations of the increments of several independent variables with the increment of counseling skills were detected. Increments of knowledge, motivation, role perception, attitude and self-efficacy had significant correlations with the increment of counseling skills, with r ranged from 0.103 to 0.805. There was no collinearity between independent variables. The increment of counseling skills was influenced mostly by the increment of self-efficacy and attitude towards counseling. Self-efficacy showed stronger influence than attitude as shown by Beta coefficient (0.521 vs. 0.323). Motivation in this study did not appear to be an important predictor for counseling skills. Its correlation with the increase of counseling skills was relatively low (r = 0.103, p 0.047). The weakness of the instrument, made this study was unable to catch the real motives of the midwives' to counsel clients.

Also this study found that the increment of self-efficacy was influenced by the family planning counseling training and self-assessment, with Beta coefficient 0.609 and 0.389. The addition of self-assessment increased self-efficacy in conducted family planning counseling. It can be concluded that self-assessment increases counseling skills through the increment of self-efficacy. The effort to increase self-efficacy in intervention 2 group was done by allowing midwives to do self-reflection and self-learning. The success of self-assessment method is that because the tool is simple and easy to be used, as mentioned by the midwives during the focus group discussion. Also self-discipline poses a major role for the success of this method. It is very important that they do the task regularly as it should be. By doing the self-assessment regularly they will learn more and get used to counsel clients in a correct way. Practicing a new behavior everyday will give result the mastering of that new behavior. This will increase the self-efficacy in doing the behavior. Fact that 15% of the midwives did not perform the self-assessment well, tell us that motivation to arouse midwives to do the task is very important. This task need to be done during the training of the use of self-assessment tool; because supervision is minimal, only once in 8 weeks.

Family planning counseling training conducted in 26.25 hours using modified BKKBN/JHUPCS curriculum, and strengthened by self-assessment was proved to be successful in increasing counseling skills. The increment of counseling skills in intervention 2 group, was 1.79 times higher than increment in intervention I group (p 0.000); and 9.6 times higher than the control group. Group, which only received family planning counseling training, showed increment 5.3 times higher than the control group. The increase among the control group might happen because of the testing and history effect, and the increase was smaller compared to other groups (6.2% vs. 55.63% and 33.25%). Those increments were significantly different.

The post intervention counseling skills showed that there were significant differences between private midwives who only received training and private midwives who got training and self-assessment, concerning almost all sub skills of the counseling skills. Sub skill to probe the client?s needs/ priorities, and sub skill to give complete information was not significantly different. It means that self-assessment did not improve those skills. This weakness should be overcome by reviewing the self-assessment tool to see opportunities for improvement.

Conclusions and Recommendations

The private midwives' counseling skills before the intervention was low. This fact features the provider-client communication in Indonesia nowadays. More studies need to be done in the area of health communication, specifically to study provider-client communication, and provider-provider communication. Researches in this area will open our eyes that there are other things need to be done beside the improvement of technical matter in improving quality of health services.

This study have proved that self-assessment method can be used to strengthen a family planning counseling training in the effort to increase the private midwives' counseling skills; and the increase of counseling skills were reached through the increase of self efficacy. The advantages of doing the self-assessment task need to be underscore during the training to use the tool. This experience can be used to strengthen any other training, which involves a new behavior to be improved. The instrument used to measure the counseling skills will also be useful for evaluating counseling training program or other program related to the quality of family planning services. Further research will have a significant contribution to family planning quality of services, among others are to study the impact of counseling training and self-assessment towards client's participation, satisfaction and compliance.

While this study is successful in increasing the counseling skills in the intervention 2 group more than in the intervention I group, post intervention data showed that self-assessment did not improve sub skill to probe the client's needs and priorities, and sub skill to give complete information. A thorough review needs to be done to study the self-assessment tool, for opportunities to an improvement.

The modification of BKKBN/JHUPCS family planning counseling training curriculum has not been tested in this study. If this new curriculum will be implemented widely, a study needs to be done to prove its effectiveness. Soon after the test is done and proved to more effective than the previous one, the curriculum can be used for the action of perfecting curriculum in family planning counseling training or to be imbedded into the curriculum of other institutions which teach counseling training or interpersonal communication for medical and non-medical personnel.

The number of counseling session measured for each midwife was only one, so that the consistency of counseling skills of each midwife was unknown. Ten percent of midwives were asked to do 2 counseling sessions, and the reliability test showed r = 0.909. Further research, which includes 8 to 10 clients for each midwife, will increase the reliability of the study. Motivation is also known as an important predictor for performance. In this study, correlation between motives and counseling skills was relatively low even though proved to be significant. A better instrument needs to be developed so that private midwives' real motives can be caught and studied."

"Gonorrhoea merupakan penyakit kelamin yang masih banyak terdapat dan merupakan salah satu jenis penyakit yang sukar diberantas dibagian dunia manapun. Walaupun tidak memberi akibat seluas syphilis, gonorrhoea setiap tahun menyerang beribu-ribu penderita baru. Dengan demikian penyakit ini bukan hanya merupakan satu masalah medik, tetapi juga satu masalah sosio-ekonomik. Sebagai salah satu negara yang sedang berkembang kita tidak boleh ketinggalan mengadakan penelitian dalam bidang penyakit kelamin. Langkah pertama telah dimulai dengan mendirikan Lembaga Pusat Penyelidikan dan Pemberantasan Penyakit Kelamin (sekarang Lembaga Kesehatan Nasional) di Surabaya pada tahun 1951. Penyelidikan dalam tesis ini dimaksudkan sebagai satu sumbangan dalam bidang yang disebut diatas. Maka tujuan tesis ini ialah mengumpulkan keterangan-keterangan mengenai penyakit gonorrhoea : 1. menilai korelasi antara pendapat klinik pada satu pihak dan hasil pemeriksaan laborarorium pada pihak lain. Untuk tujuan ini dicari terlebih dulu cara pembiakan Neisseria gonorrhoea yang dapat dipercayai; 2. meninjau kepekaan Neisseria gonorrhoea yang diasingkan terhadap beberapa macam chemotherapeuricum; 3. mempelajari khasiat penicillin pada penderita gonorrhoea, 4. mencari berapa banyak orang yang menderita gonorrhoea mempunyai percobaan serologi positif terhadap syphilis; kemudian mencari apakah ada sesuatu hubungan antara gonorrhoea dan hasil percobaan tersebut; 5. mengumpulkan berbagai keterangan sosial (social data) mengenai para penderita gonorrhoea dan mengenai wanita tuna-susila."