THE EFFECT OF HEALTH EDUCATION WITH AUDIOVISUAL MEDIA ON THE LEVEL OF KNOWLEDGE AND SKILLS OF EARLY DETECTION OF FIBROADENOMA MAMMAE (FAM) IN YOUNG WOMEN

The lack of knowledge and skills of young women about breast self-examination to detect fibroadenoma mammae is caused by the lack of information among young women about early detection of fibroadenoma mammae. The purpose of this study was to determine the effect of health education with audiovisual media on the level of knowledge and skills of early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo. This study uses a quasi-experimental quantitative research design with the Non Equivalent Control Group Design method, with a Stratified Random Sampling technique obtained a sample of 125 students. The dependent variable is health education with audiovisual, the independent variable is the level of knowledge and skills of young women. Data analysis used Wilcoxon test and Mc Nemar test. The results showed that in the intervention group there were 55 respondents (87.3%), while in the control group there were 3 respondents (4.8%). And it was found that young women who had qualified skills in the intervention group were 63 respondents (100%) while in the control group 31 respondents (49.2%). The results of the Wilcoxon and Mc Nemar Test statistical tests obtained a significance value of 0.000 (<0.05), it can be concluded that there is an effect of health education with audiovisual media on the level of knowledge and skills of early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo. Audiovisual media is effective for increasing knowledge and skills of early detection of fibroadenoma mammae in young women because respondents can not only listen to the material given, but also see firsthand the steps for early detection of fibroadenoma mammae on video.

The lack of knowledge and skills of young women about breast self-examination to detect fibroadenoma mammae is caused by the lack of information among young women about early detection of fibroadenoma mammae. The purpose of this study was to determine the effect of health education with audiovisual media on the level of knowledge and skills of early detection of fibroadenoma mammae (FAM)

in adolescent girls at SMA Ibrahimy Wongsorejo. This study uses a quasi-experimental quantitative research design with the Non Equivalent Control Group Design method, with a Stratified Random Sampling technique obtained a sample of 125 students. The dependent variable is health education with audiovisual, the independent variable is the level of knowledge and skills of young women. Data analysis used Wilcoxon test and Mc Nemar test.
The results showed that in the intervention group there were 55 respondents (87.3%), while in the control group there were 3 respondents (4.8%). And it was found that young women who had qualified skills in the intervention group were 63 respondents (100%) while in the control group 31 respondents (49.2%). The results of the Wilcoxon and Mc Nemar Test statistical tests obtained a significance value of 0.000 (<0.05), it can be concluded that there is an effect of health education with audiovisual media on the level of knowledge and skills of early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo. Audiovisual media is effective for increasing knowledge and skills of early detection of fibroadenoma mammae in young women because respondents can not only listen to the material given, but also see firsthand the steps for early detection of fibroadenoma mammae on video. Keywords

INTRODUCTION
Fibroadenoma mammae or benign breast tumor is a lump in the breast that can be moved and well-defined. Young women aged around 16-20 years are at risk of developing FAM (Artini et al., 2021). This disease occurs asymptomatically in 25% of women and often occurs in adolescence and its peak is between the ages of 15 to 35 years (Brave, 2009. Cunningham (2010) explained that the incidence of fibroadenoma in adolescence is related to the incidence of changes in hormone levels. The hormone referred to in the occurrence of fibroadenoma mammae is the hormone estrogen .
If FAM growth is allowed, then the risk of breast cancer will be high and recurrence will occur if FAM is not removed completely (Price, 2013). The results of a study conducted by the American Cancer Society (revised 2016) found that women diagnosed with FAM were 1.5 to 2 times more likely to develop breast cancer than women with normal breasts. The prognosis will be better if detected early (Price, 2013in Hanifah, 2017. One of the early detection of breast tumors is breast selfexamination (BSE). Breast self-examination (BSE) is an efficient and effective method for early detection of tumors in the breast . Based on the existing phenomena, the term BSE has not been fully socialized and there are still many young women who do not know the term BSE and its application properly and correctly (Nikmah & Lutfiasari, 2018).
In Indonesia, FAM disease data reports are still incomplete, but it is estimated that up to 100 people are exposed to benign breast tumors by mid-2011(Indonesian Cancer Foundation, 2012. In the study of Sidauruk (2013) reported as many as 103 cases of FAM at Santa Elizabeth Hospital Medan for the period 2007-2011. Of the 103 FAM patients, most were found at the age of less than 35 years, which was 72.8% of cases (Hanifah, 2017).
Globocan (2018) explains that there are 18.1 million new cases of FAM every year with a mortality rate of 9.6 million deaths, where one in five men and one in six women in the world experience cancer. Globocan (2018) also explained that one in eight men and one in 11 women, died of cancer.
From the results of interviews that researchers got, a high school student Ibrahimy Wongsorejo said that he had never received information or education about FAM and how to detect FAM early. The results of the interviews on the skills of students to do breast early detection showed that almost all of the students said that they had never checked their own breasts due to lack of knowledge and information about breast selfexamination to detect lumps or FAM in their breasts.
One of the efforts that can be done to introduce and increase the knowledge of young women about BSE is to provide health education (Rachman & Putri, 2020). Health education is a health promotion activity in the form of providing health information or messages to provide or improve knowledge and attitudes about health to encourage healthy behavior (Notoatmodjo, 2012in Pratiwi et al., 2019). However, the success of health education also depends on the media used in counseling (Rachman & Putri, 2020).
Interesting media will add motivation of the audience to learn and understand the extension material. One of the interesting types of extension media is video media (Rachman & Putri, 2020). Extensions with audio-visual media are media that contain elements of sound and also contain elements of visual images that can be viewed such as videos, with various sizes of films, sound slides, etc. Audiovisual ability is considered better and more interesting because it contains two elements that can be seen and heard (Epita et al., 2020).

METHODS
The type of design used in this research is Quasi-Experiment with Non Equivalent Control Group Design method. The population in this study were all students of class X and XI, totaling 185 students. The sample size in this study was 125 students using the Stratified Random Sampling technique. Then tested using Wilcoxon and Mc. Nemar's test with a significance value <0.05 then H1 is accepted, which means that there is an effect of health education with audiovisual media on the level of knowledge and skills of young women of early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo.

DISCUSSION
This study consisted of 125 respondents who were divided into 2 groups, namely 63 respondents in the intervention group and 63 respondents in the control group. Of the 125 respondents involved, their characteristics were analyzed based on age, class, never received information, had not been aware of it, and had no previous history of FAM.   In this study, it was found that of the 63 respondents in the intervention group, the skills of all respondents regarding early detection of fibroadenoma mammae(FAM) at the time of the pre test were not able, namely 63 respondents (100.0%) and skills during the post test were able, namely 63 respondents. (100.0%). Meanwhile, from 63 respondents in the control group, it can be seen that the skills of all respondents regarding early detection of Fibroadenoma Mammae (FAM) at the time of the pre test were not able, namely 63 respondents (100.0%) and skills during the post test were mostly unable, namely 32 respondents. (50.8%) but there was an increase in 31 respondents (49.2%) from being unable during the pre test to being able during the post test.  a. Based on negative ranks.

b. Wilcoxon Signed Ranks Test
The results of statistical tests using the Wilcoxon test obtained a significance value of 0.000 which means <0.05, so H1 is accepted which means that there is an effect of health education with audiovisual media on the level of knowledge of young women about early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo. The results of statistical tests using the Mc Nemar Test obtained a significance value of 0.000 which means (<0.05), it was concluded that there was a significant difference between before and after giving health education with audiovisual media. So H1 is accepted, which means that there is an effect of health education with audiovisual media on the skills of young women about early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo.

Knowledge of young women about early detection of fibroadenoma mammae (FAM) at SMA Ibrahimy Wongsorejo before being given health education
The results of the research conducted showed that from 63 respondents in the intervention group who were given health education with audiovisual media and from 63 respondents in the control group who were given health education with leaflets as another form of intervention, most of the respondents had less knowledge about early detection of fibroadenoma mammae (FAM) before being given health education, there were 48 respondents (76.2%) in the intervention group and 50 respondents (79.4%) in the control group. These results are supported by data on respondent characteristics where from 63 respondents in the intervention group and from 63 respondents in the control group, most of the respondents never received previous information about BSE, namely 54 respondents (85.7%) in the intervention group and 53 respondents (84.1%). in the control group. It is assumed that most respondents still lack knowledge about early detection of breast fibroadenoma mammae (FAM). Lack of knowledge in respondents is caused by several factors, one of which is lack of information.
The researcher concludes that the factors that most influence the knowledge of respondents' characteristics are interests and sources of information. It is proven in this study that when someone has a high interest in knowing something new and is given supporting information, it will be easier to absorb knowledge and apply it, and it is easy to increase one's knowledge. Respondents (adolescent girls) have not received the correct information in early detection of fibroadenoma mammae (FAM) and have not processed memory in the brain, so that respondents have less knowledge. This is in accordance with the theory which states that knowledge can be obtained either from direct experience or from other people.

Young women skills regarding early detection of fibroadenoma mammae (FAM) at SMA Ibrahimy Wongsorejo before being given health education
The results of the research conducted showed that from 63 respondents in the intervention group who were given health education with audiovisual media and from 63 respondents in the control group who were given health education with leaflets as another form of intervention, all respondents were not able to perform early detection of fibroadenoma mammae (FAM) before given health education, namely 63 respondents (100%) in the intervention group and 63 respondents (100%) in the control group. These results are supported by data on respondent characteristics where from 63 respondents in the intervention group and 63 respondents in the control group, most of the respondents never received previous information about BSE, namely 54 respondents (85.7%) in the intervention group and 53 respondents (84.1%) in the control group. And it is known from 63 respondents in the intervention group and 63 respondents in the control group, all respondents have never done BSE, namely 63 respondents (100%) in the intervention group and 63 respondents (100%) in the control group.
Researchers argue that skills are also influenced by the level of knowledge of the respondents. If the respondent's knowledge about early detection of fibroadenoma mammae (FAM) is lacking, it will affect the respondent's skill level in providing health education. So it can be concluded that before giving health education, respondents have skills that are less marked by indicators of respondents not being able to carry out BSE procedures.

Knowledge of young women about early detection of fibroadenoma mammae(FAM) at SMA Ibrahimy Wongsorejo after being given health education
Based on the results of the research conducted, it is known that of the 63 respondents in the intervention group who were given health education with audiovisual media, they had sufficient knowledge during the pre-test to be good at the post-test and of 63 respondents in the control group who were given health education with leaflets as another form of intervention, have less knowledge during the pre-test to be sufficient during the post-test. Knowledge can be said to be good if the respondent can correctly answer the questionnaire questions that have been given by the researcher which consists of several indicators, namely: Definition of early detection of fibroadenoma mammae(FAM), the purpose of early detection of fibroadenoma mammae(FAM), time of early detection of fibroadenoma mammae(FAM) and how to perform early detection of fibroadenoma mammae(FAM). This is evidenced by the score of 76-100% or can answer the statement correctly at least 8 out of 10 statements. 55 respondents from the intervention group had good knowledge, this was evidenced by the results of the questionnaire scoring between 76-100% or being able to answer 8 out of 10 statements. The other 8 respondents have sufficient knowledge, as evidenced by the results of 56-75% or can only answer the statement correctly a maximum of 7 questions out of 10 questions. 3 respondents from the control group have good knowledge, this is evidenced by the results of the questionnaire scoring between 76-100% or can answer 8 out of 10 statements, 31 respondents have sufficient knowledge, this is evidenced by the results of the questionnaire scoring between 56-75% or can answer 7 out of 10 10 statements and 29 other respondents have less knowledge, this is evidenced by the score <56% or can only answer 5 out of 10 questions. The researcher argues that after receiving education about early detection of fibroadenoma mammary (FAM), from the beginning, knowledge was less into a good category in the intervention group and lack of knowledge became a sufficient category in the control group, with indicators that respondents began to understand the definition of early detection of fibroadenoma mammary (FAM), the purpose of early detection of fibroadenoma mammae(FAM), early detection of fibroadenoma mammae(FAM) and how to perform early detection of fibroadenoma mammae(FAM). This is one of the goals in providing health education about early detection of fibroadenoma mammae (FAM).

Young women skills regarding early detection of fibroadenoma mammae (FAM) at SMA Ibrahimy Wongsorejo after being given health education
Based on the results of the research conducted, it is known that the skills of 63 respondents in the intervention group who were given health education with audiovisual media, after giving health education were able, namely 63 respondents (100.0%) and the skills of 63 respondents in the control group who were given health education with leaflets as another form of intervention, after giving health education, most of them were still not able, namely 32 respondents (50.8%) but there was an increase in 31 respondents (49.2%) from being unable before giving health education to being able after giving health education.
It can be concluded that after being given health education, respondents in the intervention group had good skills or were able to perform BSE, while in the control group, only some respondents had good skills or were able to do BSE with the indicator that respondents were able to carry out the procedures listed on the assessment sheet. observation. This is due to several factors, including the existence of health education itself accompanied by live video playback which will make it easier for respondents to receive information, making it easier for respondents to imitate existing movements.
The effect of providing health education with audiovisual media on the level of knowledge of young women about early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo Based on the results of the Wilcoxon statistical test on the knowledge variable, it can be seen that the significance value is 0.000 which means <0.05, so H1 is accepted which means that there is an effect of health education with audiovisual media on the level of knowledge of young women about early detection of fibroadenoma mammary (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo.
Researchers assume that one way to increase adolescent knowledge about a health material is the health education method. Health education is an approach to respondents in conveying messages, materials or information about health and there are several things that affect the success of health education, namely the material presented and interesting delivery media, one of which is by using video or audiovisual media. Video or audiovisual media is media that contains sound elements and also contains visual image elements that can be viewed such as videos, with various sizes of films, sound slides, etc. In addition, video or audiovisual media can also make respondents focus on the material given, because there are movements that make the eyes focus on seeing the movements in the video rather than just still images which tend to be monotonous.

The effect of providing health education with audiovisual media on the skill level of young women regarding early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo
Based on the results of the Mc Nemar Test statistical test on the skill variable, it is known that the significance value is 0.000 which means (<0.05), it is concluded that there is a significant difference between before and after the provision of Health education with audiovisual media. So H1 is accepted, which means that there is an effect of health education with audiovisual media on the skills of young women about early detection of fibroadenoma mammary (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo.
The researcher concluded that the provision of education could improve the respondent's skills in early detection of fibroadenoma mammae(FAM). In addition, one's skills are also influenced by many factors, including health factors, attention, interests, and one's talents. An increase in the skills of these respondents will be very necessary in increasing the awareness of young women about their breast health in order to avoid the incidence of FAM which increases the occurrence of breast cancer and can lead to death.
In the end, it is hoped that young women will be able to carry out early detection of fibroadenoma mammary (FAM) properly and correctly. Providing education regarding early detection of fibroadenoma mammae(FAM) is very important and useful to improve skills or skills in first aid for women, especially adolescent girls. In addition, it is also beneficial for increasing the number of trained young women so that they can minimize the incidence of FAM in the community.

CONCLUSION
There is an effect of health education with audiovisual media on the level of knowledge and skills of early detection of fibroadenoma mammae (FAM) in adolescent girls at SMA Ibrahimy Wongsorejo. Audiovisual media is effective for increasing the knowledge and skills of early detection of mammary fibroadenoma in young women because respondents can not only listen to the material provided, but also see directly the steps for early detection of mammary fibroadenoma on the video.
It is hoped that the knowledge and skills that have been obtained from counseling can be applied by young women in life, especially early detection of fibroadenoma mammae (FAM) through BSE and is carried out once a month to find out whether there are abnormalities in the breast and provide information to family, friends and the surrounding environment to know the importance of early detection of mammary fibroadenoma (FAM).