The Effect of Pre-Hospital Stroke Life Support Education on Family Knowledge and Self-Efficacy with Stroke Risk Patients

Methods: The study design used a pre-experiment (one-group pre-posttest design). The sample comes from families who have stroke risk patients in the working area of Puskesmas Pacar Keling Surabaya. The sampling technique used purposive sampling with inclusion criteria of having family members at risk of stroke (diagnosis of hypertension, diabetes, cholesterol, heart disease, smoking, alcoholics, obesity, and the elderly), so a sample of 32 people was obtained. The independent variable is health education pre-hospital stroke life support, while the dependent variable is knowledge and self-efficacy. The research instrument used a questionnaire. The research was conducted online via WhatsApp and google form, then analyzed by using the Wilcoxon Signed-Rank Test using SPSS with significance α ≤ 0.05.


INTRODUCTION
Stroke is the first cause of death in Indonesia. Stroke sufferers in Indonesia continue to experience an increase, from 7% permil in 2013 to 10.9% permil in 2018 (Riskesdas, 2018). The knowledge of families in Indonesia regarding the initial treatment given to stroke patients both at home and before being referred to the hospital (pre-hospital stroke life support) which includes early detection, how to activate an ambulance and how to transport stroke patients is still low. Research from Setianingsih et al., Insufficient knowledge will result in low self-of stroke symptoms, the effective time for handling stroke and lack of confidence in identifying stroke This factor is a factor of delay in reaching the time is brain and golden period in providing thrombolysis therapy. This incident resulted in the administration of thrombolysis therapy no longer effective and efficient, resulting in increased intracarnial bleeding, mortality (Diah, 2019). WHO (2018), noted that stroke and heart disease contributed as much as 5.9 million of the total deaths in 2016. Initial analysis of the 2014 Sample Registration Survey, which was conducted by the National Research and Development Agency, shows Indonesia's mortality is dominated by stroke as much as 21% (Regulation of the Minister of Health of the Republic of Indonesia, 2017). East Java, the incidence of stroke was 11.1% permil in 2018 (Riskesdas, 2018). Meanwhile, Surabaya had 12,976 stroke patients in 2019 (East Java Provincial Health Office, 2019). This disease has a low cure rate, as much as 15-30% will experience paralysis or permanent disability, about 25% will experience death in the first year after the initial attack, and as many as 14-15% will experience a second stroke in the same year (Riduan Kusuma Dharma, Dharma Kelana Kusuma, 2018). The Ministry of Health's regulation explains that the success of stroke management depends on the speed, accuracy and accuracy of the initial treatment (Setianingsih et al., 2019). The majority of delays were due to poor public knowledge and awareness of stroke (Farrag et al., 2018) Bandura's theory views human behavior as not merely a reflex stimulus, but also a result of the interaction between the environment and human cognitive itself (Ferianto & Rini, 2016). A person with low self-efficacy will consider himself incapable of doing and tend to give up easily, resulting in a Stroke Pre-hospital Delay Behavioral Intention (SPDBI). This incident resulted in brain cells undergoing infarction within a few minutes of the incident, at the same time that the ischemic penumbra loses function due to reduced blood supply to the brain. The extent of the damage depends on the gradian who is experiencing a lack of blood supply such as paralysis or permanent disability, aphasia, memory problems to death. (Audebert et al., 2017).
Many countries such as Japan, Australia, other methods, so it is hoped that the family will find it easier to understand the symptoms of stroke and call an ambulance. (Meschia et al., 2014). This role is very important considering that 90% of activation of emergency services is carried out by families (Kelly et al., 2017). The research objective with preexperimental design and post-test (one group prepost design) using buzz groups and audiovisual media is expected to increase the knowledge and selfefficacy of families in conducting pre-hospital stroke life support.

METHOD
The

RESULT
Based on table 1, the results of the analysis show that the highest number of respondents by age category is

DISCUSSION
The results of this study include the effect of prehospital stroke life support education with audiovisual media and the buzz group method on knowledge and self-efficacy of families with stroke risk patients.

Stroke Risk Patients
The results of the study in Table 1 Families who have stroke risk patients will be motivated to achieve and improve the optimal level of health. The family will seek all information related to stroke risk disease. This is related to the theory of health care and maintenance functions in the family, Bilon and Maglaya, (1998) in Efendi & Makhfudli, (2009) suggest that one of the duties of family health is to recognize health problems and make appropriate health action decisions. In addition, this statement is supported by the theory of Nurssalam and Efendi, (2008) which explains that the educational process is influenced by individual factors, one of which is the motivation of a person to do education. The theory is in line with research that has been done by Suranto, The educational method using audiovisual media can be said to be effective in increasing knowledge, because during the learning process the brain will absorb information more quickly by using the sense of hearing and the sense of sight. This is influenced by the factor of video playback which has a total duration of 8.5 minutes which will increase interest in the material compared to a longer video duration. This statement is in accordance with the theory put forward by Nursalam & Efendi, (2008) which explains that the educational method by hearing and seeing (audiovisual) has a memory of 50%. The theory is supported by research put forward by Hartiningsih, (2018) which states that the longer the video is played, the less interest will be. The video length of 6-12 minutes will increase the interest in viewing the video.
The buzz group method is a horizontal method, during which the respondents will be invited to discuss and feel what they have experienced in the video. This method can be used as learning for participants when they experience or encounter things similar to cases. Respondents have the same opportunity to express their opinion or discussion regarding pre-hospital stroke, so that each respondent is invited to think critically about the handling of pre-hospital stroke life support. This statement is supported by the theory put forward by Effendi, (2009) explaining that the targets of health education for adults are more appropriate by using classical lecture methods, discussion (buzz groups), demonstrations and role play to increase emotional levels. The results of this analysis are in line with the research conducted by Nababan et.

Stroke Risk Patients
The results of the study in table 2. indicate that there is a significant difference in results between the pre and post test scores at the level of family self-efficacy and stroke risk patients after being given education.
The Wilcoxon sign rank test showed differences in the results before and after being given education with a value of p ≤ 0.05 so that H1 in the research hypothesis was accepted, namely that there was an effect of providing pre-hospital stroke life support education on family self-efficacy with stroke risk. The pre and post test scores show that as many as 5 respondents experienced an increase in the category from low to high after being given education. The results of this analysis also concluded that 23 respondents experienced positive ranks with a mean value of 14.96. This statement is in accordance with Bandura's theory, (2010) which explains that the self-efficacy process is influenced by four processes, namely the cognitive process (thinking and predicting), the motivation process, the affective process, and the selection process. The results of this study are in line with the research conducted by Rizki et al., (2019) which explains that there is an effect of health education on people's knowledge and self-efficacy in carrying out pre-hospital stroke relief measures.
Analysis of the pre-test scores found that 24 respondents were classified as high self-efficacy. This is because these respondents have good knowledge about pre-hospital stroke life support. This statement can be seen from the results of the pre-test regarding knowledge carried out simultaneously. A person who already has good knowledge will influence the coping system and emotions, these two components are elements in forming one's self-confidence in taking action. In accordance with the theory put forward by Bandura (1997) that self-efficacy is influenced by cognitive processes so that it will lead to an increase or decrease in behavior to be carried out. Bandura also explained that self-efficacy is a bridge between knowledge and behavior (Agustin et al., 2018). This statement is in line with Pratama's research (2017) which states that there is a significant correlation between knowledge and self-efficacy in family caregivers of mental disorders patients at RSJD Dr.

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The pre-test value shows that before being given During the discussion process using the buzz group method and using audiovisual media, respondents are invited to think, in the process there is a cognitive construction of the knowledge obtained during the education process, so that in giving opinions about cases, respondents have a theoretical basis for the actions and arguments to be given.
During the learning and discussion process, the brain absorbs information and processes the information into understanding and emotions. These two components give rise to a feeling of self-confidence or self-efficacy. Nuzula (2010: 100) in (Efendi, 2013) explains that self-efficacy is the result of a cognitive process (learning) in the form of decisions, beliefs and expectations to what extent individuals estimate themselves in carrying out tasks to achieve certain goals. Ayu et al., (2019) explained that there were significant results between before and after being given nutrition education with the buzz group method on knowledge and self-efficacy regarding anemia in pregnant women. In addition, this statement is also supported by research conducted by Setiawan, et al., (2020) that education using audiovisual media and booklets is effective to increase knowledge related to menopause and selfefficacy of premenopausal women.
The post-test value shows that after being given health education, 90.6% of respondents who have a low level of self-efficacy are classified as high selfefficacy. In this group, most of them answered statements that contained aspects of optimism in overcoming problems, hopes and beliefs in identifying and providing help for pre-hospital stroke patients who were answered with a statement of agreement and some answered strongly. This is because respondents feel they have sufficient knowledge to identify and provide assistance to prehospital stroke patients. This statement is in accordance with the theory put forward by Lianto, (2019) explaining that the source of one's selfefficacy comes from experiences of success, other people's experiences, verbal persuasion and individual psychological conditions. This statement is also supported by research conducted by Ferianto et., Al (2016) explaining that factors related to nurses' self-efficacy in performing cardiac resuscitation are mastery experience (experience of success) and verbal persuasion (verbal persuasion).

CONCLUSION
Education for pre-hospital stroke life support using audiovisuals with the buzz group method can increase knowledge and self-efficacy of families with stroke risk patients. The results of this study can provide an overview of the method of education by nurses regarding pre-hospital stroke life support with the buzz group method. While the suggestion for further researchers is that it is necessary to conduct research on behavior so that it can be seen whether the provision of pre-hospital stroke life support education can contribute to reducing mortality and morbidity due to stroke.