THE ROLE OF PARENTS IN SHAPING EARLY CHILDHOOD ADHERENCE IN IMPLEMENTATION OF THE HEALTH PROTOCOL IN DAILY ACTIVITY

Covid-19 is a virus SARS-COV-2 corona which causes disease in humans. Based on official government data, 512 children have died due to Covid-19 (Pulungan, 2020). Prevent transmission of the virus by implementing the 5M health protocol. This research aims to determine the determinants of implementing health protocols in early childhood. This research uses an analytical survey design with a cross sectional study approach. The independent variables are knowledge, attitudes and education. Meanwhile, the dependent variable is the implementation of the 5M early childhood health protocol. This research involved 403 early childhood children in TK Alam IT Gladi Insan Cendekia, Metro Barat,, using a checklist to measure children's behavior regarding the implementation of the 5M health protocol. The data obtained were analyzed univariately with percentages, then analyzed bivariately using chi square and continued with multivariate analysis with multiple logistic regression analysis with prediction models. Based on the results of the analysis, all independent variables have an influence on the implementation of early childhood health protocols (p<0.05), and parental education is the variable that has the most influence on early childhood behavior in the new normal period (p=0.000, Exp: 7.637).


INTRODUCTION
Covid-19 is a SARS-COV-2 coronavirus that causes disease in humans.The initial symptoms experienced by Covid-19 positive patients are mild to moderate respiratory disorders such as fever, dry cough, and fatigue (Ministry of Health, 2020).Elderly people and people who have comorbidities such as heart disease, diabetes, hypertension and lung disorders are vulnerable groups to the critical and odirectional threat of the coronavirus (Masrul et al., 2020).Confirmed cases of coronavirus are increasing over time.Based on official government data, there have been 512 children who have died from Covid-19.According to the Indonesian Ministry of Health, the implementation of the 5 M health protocol (washing hands, wearing masks and maintaining distance, avoiding crowds and limiting mobilization) is very important for efforts to prevent the spread of the COVID-19 virus transmission to the community, especially in early childhood because in early childhood a strong immune system has not been formed so it is easy to contract the disease.The implementation of the 5M health protocol is the main key to controlling COVID-19 Because, there has not been found a cure for healing, therefore the application of 5M is mandatory to protect yourself from virus transmission (Office of the presidential staff, 2020).
According to WHO, the total confirmed cases of COVID-19 in the world are 47.8 million people, the death ratio is 1.2 million.According to the Indonesian Ministry of Health (2021), there are 1,755,220 positive confirmed cases of COVID-19 to date, with a death ratio of 49,328 people.According to the Lampung Health Office, the number of confirmed cases of covid-19 in Lampung was 1936 people, the ratio of confirmed deaths was 81 people.According to the Metro City Health Office, the total number of confirmed cases is 66 people.From the central metro sub-district 8 patients, North Metro 3 patients, East Metro sub-district 3 patients and 20 covid-positive patients from the west metro sub-district (Metro City Health Office, 2020).According to the observations of researchers in several areas in Lampung such as metro, trimurjo, tegineneng and natar, there are still many people who have not implemented the 5M health protocol.then Based on the results of presurvey data at TK Alam IT Gladi insan scholar metro barat on October 26, 2020, out of 10 early childhood people, it is known that 7 out of 10 children do not wear masks, 4 out of 10 children do not keep their distance and 2 in 10 do not wash their hands.
The spread of the covid-19 virus spreads through close contact with people who are positive for covid-19 infection.Prevention of transmission of the virus by implementing the 5M health protocol.Lack of knowledge greatly affects compliance with the implementation of 5M health protocols, where good knowledge will form good compliance as well.Compliance with the implementation of the 5M health protocol in pontianak students, according to research (Fitri et al., 2020) entitled The implementation of the New Normal era health protocol and the risk of Covid-19 in students obtained results, from a sample of 230 people who did not apply the 5M health protocol to wash their hands as many as 12 people, who did not wear masks 5 people and who did not maintain a distance of 45 people.Based on the results of research that has been done (Fitri et al., 2020) Dipontianak about "Implementation of New Normal Era Health Protocols and the Risk of Covid-19 in Mahasisa" showed that those who did not implement health protocols kept their distance as much as 19.6%, washed their hands 5.2%, and wore masks 2.2%.According to research (Nismawati &;Marhtyni, 2020) Dimakasar on "Factors Related to Micro Enterprises During the Covid-19 Pandemic" showed that those who did not implement health protocols as much as 56.6% and several factors related to the implementation of 5M health protocols such as knowledge, attitudes, clean and healthy living behaviors and infrastructure.According to the study, there is a relationship between knowledge and the application of health protocols, this is shown by bivariate analysis where p value = 0.001 < 0.
Other research conducted by (Syadidurrahmah et al., 2020)entitled Physical Distancing Behavior of UIN Syarif Hidayatullah Jakarta Students During the Covid-19 Pandemic there is a relationship between physical distancing knowledge and pysical distancing behavior, this is shown by bivariate analysis where p value = 0.030 OR 1.757, and there is a relationship between family support for good physical distancing behavior, it is shown that the results of p value = 0.004 OR = 1.875.Based on research (Wiranti et al., 2020) entitled Determinants of Depok City Community Compliance with Large-Scale Social Restrictions Policy in the Prevention of Covid-19 There is a relationship between attitudes and compliance with PSBB policies, this is shown by bivariate analysis where p value = 0.000.Then Based on research (Nismawati &;Marhtyni, 2020) entitled Factors related to the implementation of health protocols for micro businesses during the Covid-19 pandemic, there is a relationship between attitudes and the implementation of health protocols, this is shown by bivariate analysis where p value = 0.001 < 0.05.
According to research (Zulhelmi, 2020)  Based on the above background, researchers are interested in conducting research at TK Alam IT Gladi Insan Cendekia, West Metro.Because, the highest confirmed cases of covid-19 in the west metro district are 20 people based on data from the metro city health office and the kindergarten is in the west metro district, so researchers are trying to break the chain of transmission of the covid-19 virus by implementing the 5M health protocol (washing hands, wearing masks and maintaining distance).So the researcher raised the title "Factors related to the implementation of the 5M health protocol in early childhood 4-6 years at TK Alam IT Gladi Insan Cendekia, West Metro".

METHOD
This research was conducted by research design with quantitative method analytical survey with cross sectional study approach.Where cross sectional study is a study to study the dynamics of correlation between risk factors and effects, by approaching, observing or collecting data at once at one time (Notoadmojo, 2018), the goal is to determine the determinants that are related and dominant influence with the implementation of the 5M health protocol in early childhood.This means that all variables, both independent and dependent variables, are observed at the same time.
This research was conducted on early childhood 4-6 years at TK Alam IT Gladi Insan Cendekia, West Metro totaling 403 respondents.Data collection in this study used Checklist to measure children's behavior about the implementation of 5M health protocols (washing hands, wearing masks, maintaining distance, avoiding crowds and limiting mobility).Data collection was continued using questionnaires on families to measure independent variables that are likely to be influential factors in the implementation of 5M health protocols such as knowledge, attitudes and education of parents.
While the dependent variable is early childhood behavior.The data obtained will be analyzed univariately with percentages, then analyzed bivariately using chi square and continued multivariate analysis with multiple logistic regression analysis prediction models to examine the most dominant factors affecting the implementation of the 5M health protocol in early childhood.Table 1 shows the frequency distribution of research respondents on each variable.In behavioral variables, as many as 208 respondents behaved in the good category (51.6%).In the knowledge variable, most respondents had good knowledge (73.9%), in the attitude variable had a supportive attitude as many as 255 respondents (63.3%) and in the parent education variable, most of them were in the good category of 87.6%.

*)chi-square
Table 2 shows that there is a relationship between maternal knowledge of children's behavior in the application of the 5M health protocol (p value = 0.037<α).Based on the results of the analysis, the OR value (95%) was 1,610 (CI = 1,028-2,522), which means that mothers with good knowledge have 1.61 times more children who have good behavior about the implementation of the 5M health protocol compared to mothers with sufficient knowledge.

*)chi-square
Table 3 shows that there is a relationship between mothers' attitudes towards children's behavior in implementing the 5M health protocol (p value = 0.000<α).Based on the results of the analysis, it was found that the OR value (95%) was 5,789 (CI = 3,686-9,093), which means that mothers whose attitudes are supportive have 5,789 times more children who have good behavior about the implementation of the 5M health protocol compared to mothers whose attitudes are less supportive.

*)chi-square
Table 4 shows that there is a relationship between parental education on children's behavior in implementing the 5M health protocol (p value = 0.000<α).Based on the results of the analysis, it was found that the OR value (95%) was 9,810 (CI = 4,075-23,619), which means that the education of parents who are in the good category has 9,810 times more children who have good behavior about the implementation of the 5M health protocol compared to the education of parents who are not good.Table 5 shows that all three variables have a p value of <0.25 which means that all variables are eligible for multivariate testing, using logistic regression tests.

*)Logistic Regression
Based on the results of the stage 1 logistic test, the p value of the knowledge variable was 0.579 (>0.05), which means that the knowledge variable was excluded from the logistic regression test, and continued the stage 2 regression test without including the knowledge variable.

*)Logistic Regression
Table 7 shows that the attitude and education variables of parents have a p value of <0.05 with an Exp (B) value in the attitude variable of 5,132 and the parent education variable of 7,637.Based on the table, among the two variables that have a greater Exp (B) value is the parent education variable, which means that teacher education is the most influential variable on early childhood behavior in the new normal period.

Knowledge Factor
Based on the results of the analysis, the distribution of respondents to each variable shows most of them are in the good category results.In the knowledge variable, respondents have good knowledge (73.9%) and sufficient categories (26.1%).The results of the chi square test analysis showed a relationship between maternal knowledge of children's behavior in implementing the 5M health protocol (p value = 0.037<α), with an OR value (95%) of 1,610 (CI = 1,028-2,522), which means that mothers with good knowledge have 1.61 times more children who have good behavior about the implementation of the 5M health protocol compared to mothers with sufficient knowledge.This is in line with the results of research conducted by (Eka et al., 2023), the results of the study showed that there was a significant relationship between the variable of maternal knowledge and the variable of compliant attitude in implementing Covid-19 health protocols in mothers of pre-school children at PAUD Litle Care STIKes Surya Global Yogyakarta.Another study that is in line with the results of this study is research conducted by (Mustofa et al., 2021)shows that there is a relationship between citizen knowledge and compliance with 3M implementation.From the results of the analysis, it was also obtained OR=3,900, meaning that citizens with poor knowledge have a 3.9 times greater risk of not being good at implementing 3M compared to citizens who have good knowledge Knowledge is a result of curiosity through sensory processes, especially in the eyes and ears of certain objects.Knowledge is also the most important domain in the formation of behavior.In addition to knowledge from the community, knowledge, attitudes and actions from community leaders or governments are able to describe their behavior to encourage the community in prevention efforts.So that the community is able to behave properly.Behavior is a portion of a person's actions that can be learned and observed.One of the factors that influence human behavior or society is the level of knowledge (Donsu, 2019).
According to researchers, one of the factors that can affect compliance is knowledge.A person's good knowledge allows someone to have good behavior as well, as well as the application of the 5M process during the new normal era, someone who has good knowledge of the 5M Health Program, is expected to apply his knowledge in compliance with applying the 5M process.

Attitude Factors
In the attitude variable, 255 respondents (63.3%) supported the attitude while the less supportive category was (36.7%).The results of the chi square test showed a relationship between mothers' attitudes towards children's behavior in implementing the 5M health protocol (p value = 0.000<α), with an OR value (95%) of 5,789 (CI = 3,686-9,093), which means that mothers whose attitudes are supportive have 5,789 times more children who have good behavior about the implementation of the 5M health protocol compared to mothers whose attitudes are less supportive.
The results of this study are the same as the results of research conducted by (Mustofa et al., 2021) which shows there is a significant relationship between citizens' attitudes and compliance with 3M implementation.From the results of the analysis, it was also obtained OR=10.897, which means that residents with negative attitudes have a 10.9 times greater risk of not being good at implementing 3M compared to workers who have positive attitudes.Another study that goes along is research conducted by (Rahmiati, Afrianti, 2021) where there is a relationship between attitudes towards COVID-19 health protocols and the results of bivariate analysis (p = 0.006).Where there are 76.1% of people who have a positive attitude towards COVID-19 and 89.6% of people who have good compliance with COVID-19 health protocols.
Attitude is a reaction or response that is still closed from a person to a stimulus or object (Notoatmodjo S, 2010) in (Ikhsan, 2021).The attitude of the community in preventing COVID-19 depends on the factors that influence the attitude of the community.If the influencing factors tend to be positive, the community will also have a positive attitude, but on the contrary, if these factors tend to be negative, then the community will have a negative attitude as well (Ikhsan, 2021).
Researchers assume that mothers who have a good and supportive attitude tend to have high compliance with the application of the health process, while mothers who have a bad and unsupportive attitude tend to have low compliance with the application of the health process.This can also show that the mother's attitude towards the implementation of health protocols will also affect children's behavior in implementing compliance with the 5M health protocol.

Parental Education Factors
In the education variable, parents were in the good category of 87.6%, while the poor category (12.4%).The chi square test shows a relationship between parental education on children's behavior in implementing the 5M health protocol (p value = 0.000<α), with an OR value (95%) of 9,810 (CI = 4,619), which means that parental education in the good category has 9,810 times more children who have good behavior about implementing the 5M health protocol compared to poor parental education.
Parents must have good knowledge about preventing transmission of COVID-19 in order to help children in implementing these behaviors.Children need more behavior change support to prevent transmission of COVID-19 from their parents, so parents or must give a good response to children when children ask or show a desire to implement healthy behaviors to prevent COVID-19 such as washing hands, using masks and maintaining distance (Jameel &; Faiz, 2020) in (Pangesti &;Purnamaningsih, 2021).

The Most Dominant Factor in Early Childhood Behavior in the Application of the 5M Health Process in the New Normal Era
The results of the logistic regression test analysis showed that the parental education variable had a p value of <0.05 with a greater Exp (B) value of parental education compared to other variables of 7,637, which means that teacher education is the most influential variable on early childhood behavior in the new normal period.
According to Rohita in (Pangesti &;Purnamaningsih, 2021) children need to get direct assistance, especially at home to practice directly carrying out self-prevention activities from COVID-19 transmission.A child needs a role model as someone who sets an example and assists in making efforts to protect themselves from COVID19 transmission.Efforts that can be made include the skill of washing hands with soap with a minimum of 20 seconds, avoiding holding areas that are at risk of COVID transmission such as the mucosa, eyes, nose, or mouth, the importance of using masks, and maintaining distance.Children also need the implementation of Covid-19 protocols such as immediately changing clothes when leaving the house.Other habits that need to be given direct examples include covering the mouth when coughing or sneezing.
The role of parents in child care is as a guide, educator, guard, or supervisor of children and parents become role models for children.Caregivers play a very large role in the life, growth and development and health status of children (Aryanti et al., 2019).Likewise in providing health education regarding health protocols.Mothers who have good knowledge, will provide role models to their children so that children will have knowledge and application of good health protocols as well.According to (Octavianto et al., 2019) That this is what makes it important to provide understanding to parents about how to care for children.The key to forming behavior in children is good parenting.Good parenting is mostly done by parents who have sufficient knowledge or understanding of parenting techniques.Not only that, experience in parenting also contributes to parenting techniques.
Researchers assume parents as role models and who provide education to children have good knowledge and positive attitudes, so that children will imitate these positive attitudes which can then form and bring out positive behaviors in children as well.This positive behavior also includes children's behavior in compliance with implementing the 5M process.

LIMITATION OF THE STUDY
This study is a cross-sectional study, which means that this study only observes at one particular time, not continuously and at different times.In addition, there is a possibility of bias in data collection caused by respondents who are not honest and not serious in filling out questionnaire sheets.

CONCLUSIONS AND SUGGESTIONS
Based on this study, all observed factors such as knowledge, attitudes and parental education are related to early childhood behavior in the new normal period, and among these factors the variable of parental education is the most influential factor on early childhood compliance behavior in implementing the 5M health process.Researchers suggest that other researchers can make the results of this study a benchmark and can develop this research with better research methods, can also add data collection methods with interviews accompanied by questionnaires to get more valid results.

Table 1 .
Frequency Distribution of Respondents Proportion of Research Variables

Table 2 .
The Relationship of Maternal Knowledge to Behavior in the Implementation of the 5 M Health Protocol in Early Childhood in the New Normal Period

Table 3 .
The Relationship of Mothers' Attitudes Towards Behavior in the Implementation of the 5 M Health Protocol in Early Childhood in the New Normal Period

Table 4 .
The Relationship of Parental Education on Behavior in the Implementation of the 5 M Health Protocol in Early Childhood in the New Normal Period

Table 5 .
The p value result of the Bivariate Test for Each Independent Variable

Table 6 .
Results of Logistic Regression Analysis of Each Independent Variable on Behavior in the Implementation of the 5 M Health Protocol in Early Childhood in the New Normal Period

Table 7 .
Results of Logistic Regression Analysis of Teacher Attitude and Education Variables on Behavior in the Implementation of the 5 M Health Protocol in Early Childhood in the New Normal Period