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Abstrak :
ASBTRAK
Latar Belakang: Kanker serviks merupakan kanker dengan jumlah kasus baru terbanyak urutan kedua di Indonesia (Globocan 2018). Penyebab kanker serviks yaitu Infeksi Human Papilloma Virus (HPV). Inspeksi visual dengan asam asetat (IVA) merupakan salah satu metode deteksi dini yang dipilih menjadi program nasional di Indonesia. Namun kurang efektifnya pelaksanaan program penapisan kanker serviks ini masih menjadi masalah di Indonesia. Berkembangnya teknologi untuk mengambil gambaran foto serviks menggunakan kamera telepon seluler menjadi suatu gagasan metode penapisan alternatif berupa dokumentasi hasil temuan IVA DoVIA yang dapat disebut sebagai mini colposcopy. Tujuan: Untuk mengetahui hasil kesesuaian temuan dokumentasi IVA (Documentation of Visual Inspection with Acetic Acid / DoVIA) terhadap hasil temuan kolposkopi sebagai metode skrining kanker serviks. Metode : Penelitian ini merupakan penelitian deskriptif, menggunakan desain potong lintang yang dilaksanakan pada April tahun 2017 - Maret 2019 dengan mengikutsertakan 182 sampel foto dokumentasi yang diambil oleh peneliti, menggunakan kamera dengan ketajaman minimal 13 megapixel, memiliki autofokus dan aplikasi pencahayaan assistive light atau lampu sorot, analisis penilaian yang dilakukan 3 penilai yang telah ditentukan yaitu; konsulen onkologi ginekologi, residen obstetri ginekologi dan dokter umum yang telah mendapatkan pembekalan dan pengetahuan mengenai DoVIA dan kolposkopi, dengan kategori penilaian yang dilakukan menilai hasil kesesuaian dengan kappa test adalah ketajaman gambar foto serviks, tampilan sambungan skuamo kolumnar (SSK), kejelasan tampilan white epitel pada serviks. Hasil : Hasil yang didapat pada Dokumentasi IVA DoVIA terhadap kolposkopi, nilai kappa 0.717 (baik), kemudian dilakukan uji inter-rater untuk melihat konsistensi terhadap Dokumentasi IVA, nilai kesesuaian 0.764 (baik) pada penilai konsulen dan residen, nilai 0.703 (baik) pada penilaian konsulen dan dokter umum. Kesimpulan: Nilai kesesuaian Dokumentasi IVA DoVIA terhadap kolposkopi dengan Kappa baik, sehingga dapat melengkapi pemeriksaan IVA sebagai alternatif skrining kanker serviks.

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ABSTRACT
Abstract: Cervical cancer has the second highest number of new cases in Indonesia (Globocan 2018). Human papilloma virus (HPV) infection has been known as the etiology of cervical cancer so that the disease course and early detection methods has been studied. Visual inspection with acetic acid (VIA) is one of the early detection methods chosen as the national program in Indonesia. However, lack of efectiveness in executing cervical cancer screening program is still our biggest problem. Taking photograph of the cervix using mobile phone may become an alternative idea to document VIA results or DoVIA that can be termed as mini colposcopy. Aim : To find out the suitability of Documentation of Visual Inspection with Acetic Acid DoVIA result compare to colposcopy result as a method of cervical cancer screening. Method: This is a descriptive study using cross sectional design that took place from April 2017 until March 2019. One hundred eighty two sampels of documentation photographs taken by the researcher were included, using minimized 13 mepapixel, and the best lighting method such autofocus, and assistive light application. The photographs were reviewed by the 3 selected reviewers: oncology and gynecology consultant, obstetric and gynecology resident, and general practitioner that were trained about DoVIA and colposcopy. The review was based on kappa test which assessed the sharpness, squamo-columnar junction and white epitel visualization on the cervix. Results: Kappa score on DoVIA versus colposcopy was 0,717 (good). Inter-rater test was performed to assess consistency and the result was 0,764 (good) between consultant and resident, 0,703 (good) between consultant and general practitioner. Conclusion: Kappa test of IVA documentation DoVIA gives a good kappa value, so that it is expected to be an alternative screening for cervical cancer.

Abstrak :
Peningkatan kasus kanker serviks di dunia memerlukan upaya yang harus diperhitungkan oleh seluruh pemerintah. Skrining bertujuan untuk mendeteksi secara dini adanya kemungkinan  perempuan menderita kanker seviks. Rendahnya kesadaran perempuan dan keluarga untuk melakukan skrining disebabkan oleh rendahnya pengetahuan, sikap, dan self-efficacy mereka. Penelitian ini bertujuan untuk mengidentifikasi efektifitas penkes FEMALE terhadap pengetahuan, sikap, dan self-efficacy perempuan di Wilayah Kota Banjarbaru. Metode penelitian menggunakan quasi eksperimental pre post design with a control group. Teknik sampling menggunakan convenience sampling.  Jumlah sampel sebanyak 428 responden dengan 215 kelompok intervensi dan 213 kelompok kontrol. Hasil penelitian menunjukkan terdapat perbedaan yang signifikan sebelum dan sesudah intervensi pada pengetahuan, sikap, dan self-efficacy perempuan (p= 0,000, p=0,003, dan p=0,002) di kelompok intervensi. Penelitian ini merekomendasikan agar perawat dapat menggunakan penkes FEMALE untuk melakukan pendidikan kesehatan di masyarakat dalam meningkatkan cakupan skrining kanker serviks. ......The increasing incidence of cervical cancer in the world needs to be taken into account by all governments. Screening test can provide earlier indication of the possibility of women having cervical cancer. The low awareness of cervical screening among women and their families is do to lack of their knowledge, attitudes, and self-efficacy. This research was conducted to identify the effectiveness of FEMALE health education on the knowledge, attitudes, and self-efficacy of women in the Banjarbaru Selatan District, Banjarbaru. The quasi-experimental pre-post test with control group design was used. The sampling technique uses convenience sampling. Data was collected from 428 housewives, with 213 in the control and 215 in the intervention groups respectively. The results showed that there was a significant differences before and after intervention in knowledge, attitudes, and self-efficacy in women (p=0,000, p=0,003, and p=0,002 respectively) in the intervention group which is also different from respondent’s knowledge, attitudes, and  self-efficacy in the control group. This study recommends that nurses could use this FEMALE health education to educate women in the community in order to improve the coverage of cervical cancer screening.

Abstrak :
Latar Belakang: Kanker serviks merupakan ancaman bagi kesehatan reproduksi perempuan di Indonesia. Dengan metode skrining yang cost effective kanker serviks dapat dicegah, sehingga angka morbiditas dan mortalitas kanker serviks dapat diturunkan. Maka diperlukan metode alternatif yang lebih sederhana dan mampu laksana sebagai metode penapisan yang dapat mencakup lapisan masyarakat dengan sumber daya terbatas. Dengan prosedur skrining IVA atau VIA (Visual Inspection with Acetic Acid), diperkirakan mengurangi risiko kanker serviks seumur hidup sebesar 25%. Kekurangan IVA adalah bahwa metode ini bersifat subjektif dan interpretasi dapat bervariasi dari operator ke operator. Oleh karena itu, timbul pemikiran untuk melakukan dokumentasi IVA menggunakan kamera Smartphone yang disebut DoVIA (Documentation Visual Inspection with Acetic Acid). Bermodalkan dokumentasi IVA ini, dapat dilakukan konsultasi dan komunikasi dengan cara mengirimkan melalui aplikasi dan rangkaian kegiatan disebut TeleDoVIA (Telemedicine Documentation Visual Inspection with Acetic Acid). Tujuan: Evaluasi pemanfaatan Portal TeleDoVIA oleh tenaga medis dalam kegiatan skrining kanker serviks dengan metode IVA. Metode: Penelitian ini merupakan penelitian deskriptif. Dilaksanakan dalam periode Juli 2018-Januari 2019 dengan mengikut sertakan 82 orang Praktisi Medis yang mengirimkan 177 foto Dokumentasi IVA. Hasil: Praktisi Medis yang terlibat 59 orang (72 %) adalah bidan, 23 orang (28 %) adalah Dokter Umum yang bertugas di Puskesmas (92.7 %) dan Klinik Swasta (7.3%). Praktisi Medis yang berkonsultasi pada portal TeleDoVIA telah mencakup wilayah provinsi paling barat (Aceh) hingga Provinsi di Timur Indonesia (Papua Barat). Ketajaman gambar foto serviks dikatakan tajam sebesar (89.27%), hanya sebesar (10.73%) foto yang dikatakan kurang tajam. Mayoritas praktisi medis menerima jawaban dari konsultan dalam waktu >6-24 jam sebesar (44.1%). Praktisi medis yang mengaku paham sebesar (100 %) dan mengaku puas (100 %). Alasan praktisi medis melakukan konsultasi dengan alasan Konfirmasi (47.6%), Ragu (29.3%) dan Diskusi kasus (23.2%). Ketepatan diagnosis antara praktisi medis terhadap diagnosis konsultan sebesar (88.1%). Kesimpulan: Dengan Telemedicine Dovia dapat memudahkan praktisi medis mengirimkan dokumentasi IVA sebagai bahan diskusi dan konsultasi jarak jauh yang efektif. ......Background: Cervical cancer is a threat to women's health in Indonesia. With the screening method that is cost effective cervical cancer can be prevented, so that the cervical cancer morbidity and mortality can be reduced. Then an alternative method that is simpler and more feasible as a screening method that can cover a layer of people with limited resources is needed. The screening procedure with IVA or VIA (Visual Inspection with Acetic Acid) has been estimated to reduce the risk of lifetime cervical cancer by 25%. The disadvantage of IVA is that this method is subjective and interpretation can vary from operator to operator. Therefore, the idea arises to conduct documentation VIA using a Smartphone camera. This examination is called TeleDoVIA (Telemedicine of Documentation on Visual Inspection with Acetic Acid). With this VIA documentation, consultation and communication can be done by sending through applications and these activities called TeleDoVIA (Telemedicine Documentation Visual Inspection with Acetic Acid). Objective: Evaluation review of the use of TeleDoVIA Portal by medical personel in the Screening of cervical cancer using the IVA method. Method: This study is a descriptive study and was conducted in the period July 2018 - January 2019 by including 82 medical practitioners who sent 177 IVA Documentation photos. Results: Medical practitioners that involved as much 59 people (72%) were midwives, 23 people (28%) were general practitioners who served in Public Health Center (92.7%) and private clinics (7.3%). The closest home town of medical practitioners is Central Jakarta (24.4%) and the furthest from Fakfak in West Papua (1.2%). The sharpness of cervical photographic images is said to be sharp at 89.27%, only by 10.73% photos that are not sharp enough. The majority of medical practitioners receive answers from consultants within >6-24 hour is 44.1%. the accuracy of diagnosis between medical practitioners and consultant diagnosis is 88.1%. Medical practitioners who claim to understand (75.6%) and claim to be satisfied (76.8%). Medical practitioners consulted the TeleDoVIA portal for reasons of confirmation (47.6%), doubtful (29.3%) and discussion of cases (23.2%). Conclusion: With the presence of Telemedicine Dovia, it can make it easier for medical practitioners to send IVA documentation as a more effective discussion and consultation material even from remote area.

Abstrak :
Latar Belakang: Kanker serviks masih merupakan penyakit keganasan tersering kedua yang mengenai perempuan di Indonesia dimana setiap tahunnya didapatkan hampir 15.000 kasus baru dan setengahnya meninggal.1-4 Oleh karena itu, skrining kanker serviks penting sebagai usaha pencegahan primer. Metode inspeksi visual dengan asam asetat (IVA) merupakan metode alternaltif yang sesuai dengan kondisi Indonesia. Female Cancer Program (FCP)-Fakultas Kedokteran Universitas Indonesia (FKUI) berkolaborasi dengan Universitas Leiden memiliki program see and treat yaitu skrining lesi prakanker serviks dengan metode IVA dan secara langsung dapat memberikan krioterapi pada kunjungan pertama. Sejak 2007 hingga 2011,FCP Jakarta melakukan skrining lesi prakanker serviks dengan metode IVA melibatkan 25.406 perempuan yang tersebar di beberapa wilayah Jakarta. Dengan menggunakan data tersebut, kita dapat mengetahui prevalensi dan faktor-faktor risiko yang mempengaruhi timbulnya IVA positif di Jakarta yang berguna bagi peningkatan performa kegiatan skrining pencegahan kanker serviks. Tujuan: Untuk mengetahui prevalensi IVA positif di Jakarta dari 2007 - 2011 dan faktor-faktor risiko yang mempengaruhi timbulnya lesi prakanker yang ditandai dengan IVA positif. Metode Penelitian: Penelitian potong lintang menggunakan data program see and treat dari Desember 2007-Desember 2011, dilaksanakan oleh FCP di 6 wilayah di Jakarta menggunakan metode IVA yang dilakukan oleh dokter umum serta bidan yang ada di puskesmas dibawah pengawasan teknik oleh dokter spesialis Obsteri dan Ginekologi. Hasil Penelitian: Sejak Desember 2007 hingga Desember 2011 terdapat sebanyak 25.406 perempuan yang mengikuti program see and treat. Dari 25.406 perempuan terdapat 1192 kasus (4,7%) perempuan dengan hasil IVA positif dimana 1162 kasus (97%) diantaranya memiliki luas lesi acetowhite<75% dan sisanya memiliki luas lesi acetowhite>75%. Sebanyak 4745 kasus (18%) perempuan mengalami servisitis dan 19 kasus (0,07%) perempuan sudah menderita kanker serviks. Faktor-faktor risiko yang menunjukkan hubungan kemaknaan (p<0,05) terhadap timbulnya IVA positif yaitu jumlah pernikahan, paritas, kebiasaan merokok dan penggunaan kontrasepsi hormonal dengan odd ratio 1,51;1,85;1.95 and 0,68 secara berurutan. Diskusi dan Kesimpulan: Prevalensi IVA positif masih cukup tinggi pada populasi Jakarta dan faktor risiko jumlah pernikahan, paritas, kebiasaan merokok dan penggunaan kontrasepsi hormonal dapat mempengaruhi hasil IVA. ......Background: Cervical cancer is still the 2nd most frequent cancer in women especially in developing countries that almost 15,000 women were diagnosed with cervical cancer every year in Indonesia and half of them died from the disease.1-4 Therefore screening program is still important to prevent it.Inspection with acetic acid (VIA) is introduced as an alternative method that more suitable with indonesia?s condition. The female cancer program (FCP)-Faculty of Medicine University of Indonesia (FMUI) organization collaborates with University of Leiden has a program called see and treat program that screen precancerous lesions using VIA method and simultaneously offer the immediate therapy on the first visit setting using cryotherapy. Since 2007 until 2011, the FCP from Jakarta Regional has done cervical cancer screening involving 25.406 correspondents patients spreading across several primary health centers and other agencies in several areas of Jakarta. By using these data, we can find out the prevalence and risk factor of VIA positive in Jakarta as a useful data to improve the performance of cervical cancer screening program. Objective: The purpose of the study was to report the prevalence and risk factor of VIA Test-Positive in Jakarta from 2007- 2011. Material and Method: An Observational study using the data from see and treat program that has been conducted at several areas in Jakarta from December 2007 until December 2011. VIA was used as the screening method, and performed by doctors and midwives in community health centers with technical supervision by gynecologists and management supervision by District and Provincial Health Officers. Results: Starting December 2007 to December 2011, there were 25.406 women screened with VIA (Visual inspection with acetic acid). From 25.406 correspondents that had been screened, there were 1192 cases (4,5%) of VIA test positive. The risk factors that significantly (p<0,05) can influence the result of VIA in this study were number of marriage, parity, smoking habits and the use of hormonal contraception with OR 1,51;1,85;1.95 and 0,68 respectively. Disscussion and Conclusions: Prevalence of VIA test-positive is still high in Jakarta population and number of marriage, parity, smoking and the use of hormonal contraception can influence the result of VIA.