Contextual Effect of Community Health Center on Visual Inspection Acetic Acid Uptake in Magelang, Central Java: A Multilevel Analysis

Abstract

Background: Cervical cancer is a major problem in women's. Cervical cancer can be prevented by early examinations i.e. visual inspection acetic acid (VIA). This study aimed to analyze contex-tual effect of community health center on VIA uptake in Magelang, Central Java. Subjects and Method: This was analytic observational study with cross sectional design. The study was conducted at 25 community health centers in Magelang, Central Java, from Septem-ber to October 2019. A total sample of 200 women aged 30 to 50 years was selected randomly. The dependent variable was VIA uptake. The independent variables were knowledge, observational learning, behavioral reinforcement, cues for action, access to information, family support , attitude, self-efficacy, outcome expectation, and contextual factor of community health center. The data were collected by questionnaire and analyzed by a multilevel multiple logistic regression run on Stata 13. Results: VIA uptake increased with good knowledge (b= 4.02; 95% CI= 0.61 to 7.42; p= 0.021), observational learning (b= 2.28; 95% CI=-0.35 to 4.93; p= 0.090), strong behavioral reinforcement (b= 4.11; 95% CI= 0.82 to 7.40; p= 0.014), strong cues to action (b= 5.36; 95% CI= 0.65 to