Reproductive Health Education Based on Cognitive Psychology Approach

Reproductive health can be done with various approaches, one of which is through reproductive health education based on the Cognitive Psychology Approach (CPA). Juveniles and reproductive health are closely related. The meaning of reproductive health itself is a healthy condition both physically, mentally and socially related to reproductive systems, functions and processes. Cognitive psychology is a science that focuses on how the information process goes or in other words, this psychology focuses more on the event that individuals get information and process it in the brain, then then it is realized in daily behavior. This study aims to find out how reproductive health education based on the Cognitive Psychology Approach (CPA) influences adolescent reproductive health knowledge. The type of research used is quasi-experimental using a pre and post-test approach where students are given interventions to see student knowledge about reproductive health based on the Cognitive Psychology Approach (CPA). The sample in this study was 81 people selected through accidental sampling. The results of this study show the influence of Reproductive Health Education based on the Cognitive Psychology Approach on undergraduate students at the State Islamic University of North Sumatra. The results of this study are also expected to make a positive contribution in the health sciences so that it has a broad impact on adolescent health conditions and knowledge related to reproductive health based on a Cognitive Psychology Approach (CPA).

The condition of adolescent reproductive health in Indonesia today is still not as expected, when compared to conditions with other ASEAN countries. Indonesia is still far behind in health aspects, including adolescent reproductive health (BKKBN, 2012).
Reproductive health problems that can occur in adolescents include unwanted pregnancies, abortions, sexually transmitted diseases, sexual violence, limited access to information and lack of health services. The limited access to information for adolescents in Indonesia related to reproductive health is in fact due to the fact that Indonesian people still assume that sexual and reproductive health issues are still taboo and do not deserve to be communicated openly. Parents who are actually the closest individuals to teenagers at home still feel uncomfortable giving explanations about these two things to their children who are starting to grow into teenagers, and teenage children also tend to feel embarrassed to ask their parents openly (BKKBN, 2012).
The main problem faced by adolescents in Indonesia is their ignorance of what action to take regarding the development they are experiencing, especially reproductive health problems. This is indicated by the low knowledge of adolescents about reproductive health. Adolescent girls who just found out about the fertile period reached 29% while for boys it was 32.3%. Adolescent girls and boys who know the risk of pregnancy if they have sexual intercourse for the first time only reached 49.5% and 45.5%, respectively. Adolescent girls and boys aged 14-19 years who claimed to have had sexual relations before marriage reached 34.7% and 30.9%, respectively, while girls and boys aged 20-24 years who claimed to have a partner have had sexual intercourse outside of marriage as many as 48.6% and 46.5%, respectively (BKKBN, 2012).
For example, there are still many teenagers who do not understand the importance of reproductive health education so that it affects their knowledge of how to anticipate when sexual violence occurs which has a direct impact on reproductive health and even psychologically. This is indicated by the overall number of sexual violence that occurred in Indonesia as of January 1, 2022 in real time amounting to 18,426 cases with details of male victims 2,974 cases, and women occupying the highest cases of 16,898 cases and if we look at the number of cases of sexual violence by age, the age range of 18-24 years is in the highest category of 6,501 cases and the possibility of experiencing an increase in new cases is still potential (Kemenppa RI, 2022).
Parents as the closest people to adolescents have an important role in providing reproductive health education at home. 90% of parents said that the most effective way to prevent reproductive health problems in adolescents is to provide early reproductive health education, establish warm relationships, and meet the needs of adolescents according to the stages of age and adolescent development (Yimer & Ashebi, 2019).
The role of the closest people at home such as fathers, mothers, brothers and sisters as well as teachers at schools when providing reproductive health education to adolescents is very important in efforts to assist adolescents in getting access to appropriate information and knowledge about reproductive health (Kemenkes RI. 2018). Sexuality education including reproductive health must be provided by parents comprehensively which consists of providing sufficient information, motivation, and strategies needed to develop children's sexual literacy from an early age (Abdullah et al, 2020).
Many studies suggest optimizing parental involvement in reproductive health education, that parental involvement in reproductive health education is very necessary, besides that involvement and conversation between parents and children can create a harmonious relationship and stronger affection. In addition, the emotional relationship of parentsadolescents can affect communication between them about sexual and reproductive health issues (Harchegani et al, 2021).
Access to appropriate reproductive health information and knowledge can guide adolescents towards being better and more responsible. On the other hand, inappropriate access to reproductive health information and knowledge has an impact on wrong perceptions of adolescents themselves (Ardiyanti & Muti'ah, 2017).
Cognitive psychology is a science that focuses on how the information process works or in other words, this psychology focuses more on individual activities to get information and process it in the brain, which is then manifested in daily behavior. Cognitive psychology also tells about how information is processed and then how that information can be transformed as an effort to solve problems (Puspasari, 2016).
Along with the development of knowledge in the field of research, especially research on adolescent reproductive health, many studies use cross-disciplinary approaches as an effort to obtain diverse research results. Such as using a social approach, affective communication approach, habituation approach, peer approach, cultural approach, and cognitive psychology approach.
In this study, researchers chose to use a cognitive psychology approach in an effort to provide reproductive health education on the grounds that this approach was considered appropriate if researchers wanted to provide reproductive health education focusing on the psychological realm of adolescents. The approach was originally developed by Piaget who is one of the figures in cognitive psychology, the stages of formal operational development occurring in adolescence called hypothetical deductive reasoning is a concept that adolescents can develop hypotheses about various ways to solve problems and reach a conclusion systematically (Utami & Fidora, 2022).
The cognitive-proactive method in reproductive health education is seen as more effective in providing education to adolescents when compared to the lecture method because the cognitive-proactive method focuses more on how counselors make adolescents more active and participatory so that the teenager can understand and conclude a problem based on his understanding so that it can be concluded that this method is considered more appropriate when compared to the lecture method in class. This cognitive-proactive method can be done with peers or together with a counselor (Taukhit, 2014).
This study aimed to determine the effect of reproductive health education based on the Cognitive Psychology Approach (CPA) on students at the State Islamic University of North Sumatra Medan.

Participant characteristics and research design
The characteristics of the respondents in this study are 1). Active Student, 2). Willing to fill out the informed consent of the research, and 3). Have internet access. This research design is quantitative with the quasi-experimental pre and post-test method. The time of this research is from May to August 2022.

Sampling procedures
The sampling procedure in this study uses accidental techniques, which is a sampling technique based on field events or the research sample is selected when the researcher is directly at the research location. This research has passed the ethical test from the Health Research Ethics Commission (KEPK) Universitas Prima Indonesia with Number: 059/KEPK/VII/2022.

Sample size, Power, and Precision
The number of samples in this study were 81 undergraduate students at the State Islamic University of North Sumatra. The intervention in this study was distributing questionnaires containing the origin of the faculty, age, gender, knowledge related to reproductive health education, and knowledge of the concept of CPA.
Furthermore, reproductive health education materials are arranged in the form of a questionnaire consisting of 25 questions using 2 answer options, namely "Yes and No" with details, knowledge of the anatomy and physiology of reproductive organs as many as 5 questions, knowledge of tips on maintaining and caring for reproductive organs as much as 5 5 questions, knowledge about sexually transmitted infections 5 questions, knowledge about sexual violence 5 questions, and knowledge about drug and alcohol abuse and addiction 5 questions. Then the CPA contains 6 statements using a Likert scale: agree, strongly agree, neutral, disagree and strongly disagree.

Measures and Covariates
The entire questionnaire from the two research variables the researchers adopted and developed according to the needs of various previous studies with details, the knowledge questionnaire about the anatomy and physiology of the reproductive organs came from Lukmana's research (2017), the knowledge questionnaire about tips on maintaining and caring for the reproductive organs came from Rachma's research (2016), the knowledge questionnaire about sexually transmitted infections comes from Triningtyas' research (2015), the knowledge questionnaire about sexual violence comes from the Kelrey study (2015), the knowledge questionnaire about drug and alcohol abuse and dependence comes from the Madania research (2014) and for the CPA questionnaire from Widhiarso (2019).
The measurement results of knowledge about reproductive health education and its components were categorized into 3 forms, namely Good, Enough and Less. The respondent's knowledge questionnaire about CPA consists of 6 statements with 4 categories of answers: Agree, Strongly Agree, Disagree, and Strongly Disagree.

Data analysis
The study's results were analyzed using the SPSS application with the Wilcoxon test which aims to determine the effect of reproductive health education based on the Cognitive Psychology Approach (CPA).

RESULTS AND DISCUSSION
Based on table 1, of the 81 respondents who took part in research activities, students from the public health faculty had the highest number of respondents as research respondents, namely 20 people (25%) then followed by the tarbiyah and teacher training faculties as many as 15 people (19%), faculty shari'ah, the faculties of ushuludiin and islamic studies, islamic economics and business, and the faculties of science and technology each as many as 8 people (10%), then the da'wah and communication faculty and the social sciences faculty as many as 7 people (8%). Based on age, most respondents were aged 20 years, namely 35 people (43%), then 19 years old as many as 32 people (40%) and age 21 years as many as 14 people (27%). And based on gender, the majority of respondents were female, as many as 55 people (68%) and male as many as 26 people (32%). According to table 2, respondents' knowledge about the anatomy and physiology of the reproductive organs with the most answers located on the 5th question item by answering Yes as many as 81 people (100%) and the lowest on the 4th question item with the answer Yes as many as 45 people (55%). Knowledge about tips for maintaining reproductive organs with the highest answers in the 5th question item with Yes answers as many as 77 people (95%) and the lowest being in the 1st question item with Yes answers as many as 55 people (68%). Knowledge about sexually transmitted infections with the highest answer lies in the 1st question item by answering Yes as many as 78 people (96%) and the lowest is in the 3rd question with the answer Yes as many as 55 people (68%). Knowledge about sexual violence with the most answers lies in the 2nd question item with the number of answers No as many as 78 people (96%) and the lowest is in the 3rd question item, which is 55 people (68%). Knowledge about drug and alcohol abuse and dependence with the highest number of answers is in the 2nd question item with the number of Yes answers being 55 people (68%) and the lowest is in the 4th question item with a Yes answer of 34 people (42%).
According to table 3, the majority of respondents responded agree with the statement given by the researcher where for the 1st question respondents chose to agree with the statement as many as 50 people (62), strongly agree as many as 32 people (38%). The second statement of respondents chose to agree as many as 40 people (50%), strongly agree as many as 30 people (37%), disagree as many as 9 people (11%) and strongly disagree as much as 2 people (2%). The 3rd statement respondents chose to agree as many as 55 people (68%), strongly agree as many as 19 people (23%) and disagree as many as 7 people (9%). The 4th statement respondents chose to agree with 35 people (43%), strongly agree 37 people (46%), disagree 6 people (7%) and strongly disagree 3 people (4%). The 5th statement respondents chose to agree as many as 20 people (25%), strongly agree as many as 35 people (43%), disagree as many as 20 people (25%) and strongly disagree as many as 6 people (7%). And then the statement of the 6 respondents chose to agree as many as 17 people (21%), strongly agree as many as 46 people (57%), disagree as many as 10 people (12%) and strongly disagree as many as 8 people (10%). Do women with irregular menstrual cycles every month have an impact on the health of their reproductive organs? 1) Do women with irregular menstrual cycles every month have an impact on the health of their reproductive organs? 2) Can washing the genitals after defecation prevent the occurrence of reproductive organ disorders? 3) Is changing underwear often effective to maintain the health of reproductive organs? 4) Can consuming healthy food maintain the health of reproductive organs? 5) Can regular exercise maintain the health of reproductive organs?

5.
Knowledge of Drugs and Alcohol Abuse and Addiction 1) Is genetic factor a risk factor for drug and alcohol abuse? 2) Are people without a history of depression more at risk for drug abuse? 3) Are tightly educated adolescents at high risk of drug abuse? 4) Is drug dependence a chronic health problem? 5) Do adolescents from alcoholic parents have 3-4 greater chances of becoming alcoholics when compared to non-alcoholic parents?  According to table 4, the results of the Wilcoxon test found data that the negative rank or negative difference between the results of the CPA-based RH pre and posttest was 0 both in the N value, the mean rank, and the sum of ranks. The value of 0 indicates that there is no decrease (reduction) from the pre-test value to the post-test value. Positive range or positive difference between the results of the CPA-based RH pre and posttest. There are 81 positive data ((N) which means that 81 respondents feel the influence of CPA-based reproductive health education with the mean rank or average value of the influence being 41.00 while the number of positive ranks or sum of ranks is 3321.00. Then the Asymp value. Sig. (2-tailed) is worth 0.000. Because the value is 0.000 less than 0.05, it can be concluded that there is an influence between CPA-based reproductive health education.
Reproductive health education given to adolescents can increase the knowledge possessed by adolescents where the results of this study are in line with the results of research conducted by Passe et al (2021) which said that there was an influence of reproductive health education on the level of knowledge of adolescents about health education related to sexual behavior. teenagers at SMA Negeri 4 Palopo. This research is in line with the research of Utami and Fidora (2022) which shows that there is a difference in the average level of knowledge of adolescents before and after the intervention with a standard deviation of 13.68. While the pvalue is 0.0001 with an alpha value = 0.005 so it can be concluded that there is a significant influence between the implementation of adolescent reproductive health education on the level of knowledge. Ristraningsih (2017) and Setyawan (2018) in their research say that the level of knowledge of adolescent reproductive health is influenced by health education. Then research conducted by Suryafma (2020) on 66 young women in the city of Padang, said that there was reproductive and sexual health education with cognitive-proactive methods that had an effect on increasing knowledge in adolescents.
Another similar study, such as that conducted by Astuti et al (2021) who conducted a study of 53 respondents stated that the majority gave respondents a good assessment of adolescent reproductive health education.
Reproductive health education by utilizing counselors positively impacts the participants' cognitive psychology (Bokaie et al, 2022). With health education provided, adolescent knowledge will increase if counseling guidance and adolescent cognitive abilities are emphasized and paid attention to so that adolescents' knowledge of reproductive health is getting better and making students more concerned about their health, especially reproductive health (Rasminto et al, 2021).
Ease of getting access to information contributes to creating youths who are aware of their reproductive health. This ease of access can take the form of disseminating information in public facilities, schools, mass media, print and electronic so that issues related to adolescent reproductive health problems can be prevented and handled as early as possible (Mutea et al, 2020).
It is hoped that this provision will make students and adolescents receive special attention regarding their reproductive health (Tabong et al, 2018) so it can be concluded that the provision of reproductive health education for adolescents is considered very important.

CONCLUSION
From the results of the research that has been carried out, it was found that there was an influence between reproductive health education based on the Cognitive Psychology Approach (CPA) on students at the State Islamic University of North Sumatra so that in the future the researchers hoped that policy makers or the authorities would participate in paying attention to the needs of students outside of their academic needs. so that in the future the campus will not only be a place or place for students to gain knowledge formally but also become a forum for students to get knowledge and guidance on reproductive health based on the Cognitive Psychology Approach (CPA). The results of this study are also expected to make a positive contribution in the field of health sciences so that it has a broad impact on the health conditions and knowledge of adolescents related to reproductive health based on the Cognitive Psychology Approach (CPA).