THE EFFECTIVENESS OF HOLISTIC CARE-BASED HEALTH EDUCATION PREVENTS EARLY TEENAGE MARRIAGE AT ISLAMIC SENIOR HIGH SCHOOL 4 BAOURNO BOJONEGORO

Background : Teenage marriage increase in Bojonegoro East Java Indonesia, it can be have an impact on reproductive health. There are many factors for influence early marriage. Low education and poor economic conditions also cause early marriage. The teenager knowledge about early teenage marriage and its impact is lacking. Early marriages less than 19 years should not be carried out considering the many risks that may occur to the mother and baby. Therefore, it is important to understand the impact of comprehensive holistic care education on efforts to prevent marriage among early teens. Method : The design of this study was quasi-experimental with a pre-posttest control group design. The research population was students of at Islamic High School 4 in Baureno Bojonegoro, with a total of 313 respondents. The sample consisted of 70 respondents using non-probability method using purposive sampling technique. The sample was determined based on the inclusion criteria, namely school-age students was 13-15 years. Data were collected using a questionnaire and Wilcoxon Sign Ranks test was performed at a significance level of 0.05. Result : The results of the Wilcoxon Signed Ranks Test showed a value of p = 0.000 (p<0.05) meaning that there was a significant difference in the level of knowledge after holistic care education was carried out. Conclusion : Holistic care-based education can increase knowledge. Holistic care-based education seen from a biological, psychological, social and spiritual perspective is very suitable for health education, health services and health development that is suitable for adolescent children.


INTRODUCTION
According to the World Health Organization (WHO), adolescents are between the ages of 10 and 19, which is also different from Kemenkes No. 25 of 2014 where teenagers are residents in the age range of 10-18 years.Young people can also be classified as unmarried (BKKBN,2020) aged 10-24.On the other hand, adolescence is a developmental transition period from childhood to adulthood.that it will influence holistic changes both biologically, psychologically, socially and spiritually.Early marriage occurs at the age of under 19 years or adolescence.Early marriage has an impact on youth related to the lack of developmental tasks.This allows for factors that cause individuals to decide to marry early (Nabila, Roswiyani and Satyadi, 2022).Early marriage is a serious violation of children's rights.It is every child's right to learn so they can continue their studies at university.Children's rights are not fulfilled because of early marriage, so that one's potential is not fulfilled either.In general, early marriage will raise concerns both from a biological, psychological and socio-economic perspective.
Biological problems which have an impact on women's reproductive health.Reproductive health side effects for women when deciding to marry at an early age include abortion, anemia, intrauterine fetal death, prematurity, sexual violence, uterine atony, and cervical cancer.(Eka Radiyani et,al, 2018).Mental health issues are increasing stressors that affect the mental health of wives and husbands.This is also one of the effects of the rising divorce rate.
In 2020 Census Data.The number of teenagers (10-24 years old) is 67 million, representing 24% of Indonesia's total population.Almost a quarter of Indonesia's population are teenagers.According to the National Socio-Economic Survey (Susenas) conducted by the Central Bureau of Statistics (BPS) in 2022, data from multiple studies shows that 25% of married women between the ages of 20 and 24 were married before the age of 18.Based on the Indonesian Demographic and Health (SDKI) 2022 Survey, 17% of married women aged 20-24 were married before 18 years old.(Badan Pusat Statistik, 2020) There are many factors for influence early marriage.Low education and poor economic conditions can also cause early marriage.So early marriage reduces the burden on parents both from an economic and other perspective.Low-income parents are more likely to marry early, and economic factors become a barrier to sending their children to higher education.Girls aged 10 to 14 are five times higher to die a result of her reproductive health disorder than women aged 20 to 24. (Wijayati, Soemanto and Pamungkasari, 2017).Globally, death caused by pregnancy is the main cause of death for girls aged <19 years.Parents don't know about negative impacts like this when marrying off their children.The importance of children or teenagers knowing the negative impacts Muhidayati et al : The Effectiveness of Holistic Care Based… Indonesian Midwifery and Health Sciences Journal, 2024, 8 (1), 47-53 49 of self-marriage through holistic health education is expected to minimize cases of selfmarriage in the region.
Indonesia is one example of global progress towards eliminating the practice of child marriage with a five percent decline in prevalence among the published IDHS between 2007 and 2012.However, little is known about trends in The prevalence of child marriage at the local level and how it compares with the national prevalence.Therefore, it is important to know the impact of Comprehensive care educational on efforts to prevents marriage among her pre-teens at Islamic High School 4 in Baureno, Bojonegoro

METHOD
The design of this study was quasi-experimental with a pre-posttest control group design.The research population was students of at Islamic High School 4 in Baureno Bojonegoro, with a total of 313 respondents.The sample consisted of 70 respondents using non-probability method using purposive sampling technique.The sample was determined based on the inclusion criteria, namely school-age students was 13-15 years, early adolescents who have pre-test knowledge scores below 50, and students who could communicate well and were willing to be respondents with a inform consent, The exclusion criteria in this study were students who could not read.The students health condition was getting worse, for example being sick, not attendance.The independent variable of this research was early marriage education, while dependent variable is the growing child's level of knowledge.Data were collected using a questionnaire to measure the depend variable is levels of knowledge teenagers early marriages comprehensive holistic care educational giver before and after.The questionnaire was validity and reliability.Data analyses with Wilcoxon Sign Ranks test was performed at a significance level of 0.05 meaning that there was a significant difference in the level of knowledge after comprehensive holistic care educational was carried out.

RESULT AND DISCUSSION
In this section, the results of the study about the effectiveness of holistic care-based health education prevent early teenage marriage at Islamic Senior High School 4 Baourno Bojonegoro, are explained as follows.The table above shows that 30 respondents (86%)s in the intervention group had low knowledge about early marriage before comprehensive holistic care education, whereas 5 (14%) respondents in the intervention group had moderate knowledge about early marriage.After the intervention, the knowledge level of 23 respondents improved, with a total of 5 (14%) respondents having a high level of knowledge, 18 (51%) respondents having a medium level of knowledge; 12 (34%) respondents had an intermediate level of knowledge.
In contrast to the control group, the control group who experienced a moderate level of knowledge were 4 (11%) respondents and those who experienced a low level of knowledge were 31 (89%) respondents.The control group experienced a decrease in scoring from the questionnaire so that 2 (6%) respondents had a moderate level of knowledge.Meanwhile, the low level of knowledge increased by 2 respondents, so that the total were 33 (94%) respondents.In this way, there is a large difference in the level of knowledge regarding early marriage before and after implementing early marriage education based on holistic care.No intervention was given to the control group.The mean value before treatment (pre) was 6 and after treatment (post) was 7. The Wilcoxon signed rank test result showed a value of p = 0.877 (p > 0.05).This means that there was no significant difference before treatment.The knowledge problem and its aftermath.
Education is an interactive process that facilitates learning, which is an attempt to expand new knowledge, attitudes, and skills by reinforcing specific practices and experiences (Potter & Perry, 2009).Health education is a dynamic process of changing behavior, and the change is not based on a set of steps, but occurs through awareness within an individual, group, or society (Mubarak and Chayatin, 2009).Education may also take the form of researching the effects of early marriage.The negative effects of early marriage on men and women according to Maulidina, 2019, the effects of early marriage generally include the psychological aspects of feeling burdened, anxious and stressed.Similarly, from a health perspective, there are things like premature birth, bleeding, and high blood pressure.Finally, there are the socio-economic consequences of not socializing and the shame of marrying young due to out-of-wedlock pregnancies.
From an economic point of view, they are not yet independent and are still dependent on their parents (Maulidina, 2019).
People's understanding of the conditions for marriage is diminished due to low educational attainment {Formatting Citation}.Holistic care education is one of the aims of providing knowledge about the requirements for marriage so that it can be directly associated with a decline in early marriage.This is consistent with research findings that participants' knowledge increased after training.Low educational attainment is also one of the effects of wrong decision-makers (Siti Nurjannah, 2018).Many things require education because one of the goals of education is to be able to make decisions correctly.
Education here makes individuals know the impact of making the wrong decision so that it can affect it from a bio-psycho-social and cultural perspective.

Table 1
Knowledge early marriage student at Islamic Senior High School 4 Baourno Bojonegoro

Table 2
Pre-test and post-test measurement knowledge after comprehensive holistic care education at Islamic Senior High School 4 Baourno BojonegoroThe table above shows that at the knowledge level at pretest was low in all respondents both the control or treatments groups.After 180 minutes of training, it has improvement.The mean value before (pre-test) was 7 and after treatment (post-test) was 13.The result of the Wilcoxon signed rank test is p = 0.000 (p<0,05)