How Much do Predisposing, Enabling, and Reinforcing Factors Influence the Use of Immunization in Infants? A Path Analysis Evidence from Bangkalan Regency, Madura

Lidia Aditama Putri1)2), Yulia Lanti Retno Dewi3), Setyo Sri Rahardjo4)

1)Diploma Program in Midwifery, STIKES Insan Unggul Surabaya, Sidoarjo

2)Masters Program in Public Health, Universitas Sebelas Maret

3)Department of Nutrition, Faculty of Medicine, Universitas Sebelas Maret

4)Faculty of Medicine, Universitas Sebelas Maret



Background: Child immunization averts an estimated 2 to 3 million deaths every year from diphtheria, tetanus, pertussis (whooping cough), and measles. However, an additional 1.5 million deaths could be avoided if global vaccination coverage improves. In Indonesia, complete basic immunization (CBI) had been implemented as a disease prevention effort among children. However, the CBI did not yet achieve national target. Bangkalan Regency, Madura, was one of the regencies in East Java with low immunization achievement. This study aimed to estimate the association between predisposing, enabling, and reinforcing factors, and the use of basic immunization, using PRECEDE-PROCEED model.

Subjects and Method: This was a cross sectional study conducted at 10 community health centers, Bangkalan Regency, from August to October 2017. A total sample of 200 infants aged 9-12 months along with their mothers were selected for this study using cluster random sampling and fixed disease sampling. The dependent variable was the use of basic immunization service. The independent variables were education, knowledge, occupation, attitude, distance to healthcare facilities, information exposure, family support, and health workers support. The data were colected using questionnaires and MCH book. The data were analyzed by path analysis.

Result: The use of basic immunization service increased by positive maternal attitude (b= 0.82; 95% CI= 0.10 to 1.55; p= 0.027), health personnel support (b= 0.79; 95% CI= -0.10 to 1.67; p= 0.081), information exposure (b= 1.52; 95% CI= 0.75 to 2.29; p= 0.001), but decreased with distance to healthcare facilities (b= -1.28; 95% CI= -2.13 to -0.44; p= 0.003). The use of basic immunization service was indirectly influenced by family support, knowledge, maternal employment, and maternal education.

Conclusion: The use of basic immunization service increases by positive maternal attitude, health personnel support, information exposure, but decreases with distance to healthcare facilities. The use of basic immunization service is indirectly influenced by family support, knowledge, maternal employment, and maternal education.

Keywords: basic immunization, predisposing, enabling, reinforcing, PRECEDE-PROCEED

Corespondence: Lidia Aditama Putri. Midwifery Program in STIKES Insan Unggul Surabaya,  Jln. Raya Kletek No. 4 Taman, Sidoarjo 61257, Jawa Timur. E-mail: Mobile +6285230752110.


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