Dunia Keperawatan: Jurnal Keperawatan dan Kesehatan DOI: 10.
20527/dk.
Received July 2025.
Accepted November 2025
@JDK 2025
eISSN: 2541Ae5980.
pISSN: 2337-8212 The Effect of Using Quiet Book Media on Improving Personal Hygiene Skills in Children with Intellectual Disabilities Uyun Mafitroh1.
Deisy Sri Hardini2* Nursing Science Study Program.
Faculty of Health Sciences.
Universitas Muhammadiyah Purwokerto.
KH.
Ahmad Dahlan Street.
Dusun i.
Dukuhwaluh.
Kembaran District.
Banyumas Regency.
Central Java.
Indonesia, 53182 *Corresponding email: deisysrihardini@ump.
ABSTRACT
Children with intellectual disabilities experience cognitive limitations that affect their ability to perform self-care tasks, including maintaining personal hygiene.
This study aims to analyze the effect of using quiet book media on improving personal hygiene skills among children with intellectual disabilities at SLB C and C1 Yakult Purwokerto.
A pre-experimental design with a one-group pretest-posttest approach and a quantitative method was used.
Data were analyzed using the Wilcoxon Signed Rank Test.
A total of 30 students were selected through total sampling.
Data were collected using questionnaires and observation The results showed a significant improvement in personal hygiene skills after the intervention, with a p-value of <0.
The quiet book media proved effective in enhancing children's behavioral skills in selfcare.
Therefore, this media can serve as a practical alternative learning tool to support the independence of children with intellectual disabilities, particularly in fulfilling personal care needs.
Keywords: Personal Hygiene.
Quiet Book Media.
Tunagrahita Children Cite this as: Mafitroh U and Hardini DS.
The Effect of Using Quiet Book Media on Improving Personal Hygiene Skills in Children with Intellectual Disabilities.
Dunia Keperawatan.
: 250-261.
DOI:
20527/dk.
INTRODUCTION
may also hinder their ability to help and care for themselves .
Children with special needs are those who differ from other typically developing children in their growth and developmental processes, as well as in their readiness in terms of mental, physical, intellectual, social, and emotional regulation.
This broad category includes individuals with disabilities, hearing impairments, visual impairments, speech impairments, and emotional or behavioral disorders .
Intellectual disability is one of the conditions found in children with belowaverage intelligence, often marked by limitations in performing daily activities .
One of the major challenges faced by children with intellectual disabilities in their daily lives is their ability to maintain self-care and personal hygiene such as keeping their body clean, washing hands, cleaning their face and feet, brushing teeth, urinating, eating and themselves, and interacting socially with others .
Children with intellectual disabilities are characterized by intellectual and mental development that is significantly below These limitations cause them to experience obstacles in social, academic, and communication tasks.
Intellectual impairments and limited potential among children with intellectual disabilities According to data from the World Health Organization (WHO), the number of individuals worldwide with mental developmental disorders is estimated to Dunia Keperawatan.
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These disorders account for approximately 12% of the global disease burden, and the figure is projected to rise to 15% by 2020 .
Furthermore, a survey conducted by UNICEF in collaboration with the University of Wisconsin in 2008 found 4% of children aged 6Ae9 years who were still attending school experienced difficulties performing daily fundamental aspect of maintaining physical health and preventing disease, encompassing both physical and psychological well-being for oneself and It includes cleanliness and care of the head, hair, eyes, nose, ears, nails, skin, hands, feet, and genital areas .
Findings from Sriasih et al.
, .
revealed that self-care activities are among the most essential yet most challenging needs for children with special needs to perform independently .
One of the key components of selfcare in daily activities is personal hygiene .
The Indonesian Ministry of Education and Culture (Kemendikbu.
recorded that 69,403 children in Indonesia have intellectual disabilities.
Data from the Basic Health Research 2018 also revealed that 3.
3% of children aged 5Ae17 years in Indonesia are categorized as persons with disabilities.
Meanwhile, data from the Center for Data and Information Technology (Pusdati.
of the Ministry of Education and Culture in 2021 indicated that there were 530 children with autism in Central Java Province .
In Banyumas Regency, the number of individuals with mental retardation during the 2020Ae2024 period reached 2,630, reflecting an increasing need for special education services in the Research by Sri Wulan Sari et al.
showed that most children with intellectual disabilities aged 9Ae17 years had low levels of independence in selfcare .
Approximately 38.
6% of children with intellectual disabilities in Banyumas Regency.
Central Java, were able to perform self-care independently in more than two aspects, while the rest still required assistance.
According to Tonara et al.
, many children with intellectual disabilities do not receive sufficient attention from their families because parents must devote extra time and special care to their children, often perceiving hygiene as a secondary concern .
Children with special needs generally exhibit greater limitations in self-care skills compared to typically developing children .
Self-care refers to an individualAos ability to perform daily activities independently without relying on assistance from others.
Children with intellectual disabilities often face difficulties in regulating themselves, which leads to dependence on others to complete routine daily tasks .
Interviews conducted on Friday.
October 4, with the principal of SLB C and C1 Yakut Purwokerto revealed that students with intellectual disabilities were only taught basic aspects of personal hygiene, such as handwashing and basic self-care, without the use of instructional media.
The school had established competency targets for students with intellectual however, in practice, many older students who should have achieved self-care demonstrated low ability in these areas.
Unhealthy behaviors may increase the risk of illness due to poor personal hygiene and can lead to a higher likelihood of social isolation within the community .
Personal hygiene is a Preliminary interviews with several parents of children with intellectual Mafitroh U and Hardini DS.
The Effect of Using.
disabilities regarding personal hygiene at home showed that 85% of the children still required parental assistance for tasks such as toothbrushing and changing On October 7Ae8, 2024, further interviews with a teacher responsible for student activities revealed that there were 201 students with intellectual disabilities across elementary to high school levels.
personal hygiene, using theoretical approaches .
Based on these considerations, this study aims to explore the effectiveness of Quiet Book media as a health education tool to improve personal hygiene skills among children with intellectual The Quiet Book is designed using a combination of cotton and flannel fabric in contrasting colors, complemented by three-dimensional images and symbols.
Its tactile and interactive features are intentionally developed to address the challenges identified in the preliminary study, where many students at SLB C and C1 Yakut Purwokerto still struggled with basic hygiene tasks such as brushing their teeth and changing clothes.
As part of the preliminary study, the researcher distributed 20 observation questionnaires to students in grades VII and IX to obtain an initial overview of their personal hygiene abilities.
The findings showed that many students across mild, moderate, and severe disability categories continued to demonstrate limited independence in performing basic hygiene tasks such as brushing their teeth and changing clothes after bathing.
These preliminary results highlight the need for interventions aimed at improving personal hygiene skills among students with intellectual This approach aims to attract the interest and attention of children with intellectual disabilities in learning hygiene materials while simultaneously enhancing their skills through interactive activities within the medium.
According to the National Education Association (NEA), manipulable objects that can be seen, heard, read, or discussed when used effectiveness of instructional programs .
The results of these interviews emphasize the crucial role of personal hygiene in improving the quality of life of individuals, particularly those with special needs such as children with intellectual disabilities.
Personal hygiene is not only related to physical cleanliness but also contributes to self-confidence.
Proper hygiene practices can foster independence and encourage social engagement.
Research by Ramadhani & Sudarsini .
also demonstrated that the Quiet Book is well-suited to the characteristics of children with intellectual disabilities and is designed to help develop their practical and cognitive skills, enabling them to participate in learning more effectively .
This medium has proven to be an effective educational tool for improving both individual and group learning outcomes among children with intellectual disabilities.
Based on this rationale, the present study seeks to further investigate AuThe Effect of Quiet Book Media on Improving Personal Hygiene Skills in Children with Therefore, nurses play an essential role in delivering structured education and hands on hygiene training as part of promotive and preventive interventions.
In addition to offering guidance and support to parents, nurses are responsible for teaching and assisting children with special needs in performing self-care Dunia Keperawatan.
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Ay unable to perform, 1 = requires full assistance, 2 = requires partial assistance, 3 = independen.
The definitions for each item.
for example.
AutoothbrushingAy involved preparing the brushing adequately, rinsing, and cleaning up afterward.
METHODS
This study employed a quantitative approach with a pre-experimental design of the one-group pretestAeposttest type, without a control group.
The research was conducted at SLB C and C1 Yakut Purwokerto with a total of 36 respondents, consisting of students from grade VII .
, grade Vi .
, and grade IX .
Total sampling was used because the population of junior high school students was fewer than 100 and met the inclusion criteria.
Respondents were selected based on specific observable limitations in personal hygiene skills, including difficulty brushing teeth, washing hands, changing clothes cleanliness after bathing.
Students who required partial or full assistance in at least two of these tasks were included as Observers completed the score sheet while directly watching students perform each task.
Two expert validators assessed the content validity of the adapted instrument, and the reliability test yielded a CronbachAos Alpha value of An inter-rater reliability test was also conducted to ensure consistent scoring between experts and raters.
Data collection procedures included structured observation sheets and questionnaires.
Data quantitatively using the Shapiro Wilk As the data were not normally distributed, the Wilcoxon Signed-Rank Test was used for hypothesis testing.
This research adhered to ethical guidlines approved by the Health Research Ethics Committee Universitas Muhammadiyah Purwokerto (KEPK/UMP/46/VII/2.
All research procedures ensured the protection of participantsAo rights, including obtaining informed consent and maintaining the confidentiality of respondentsAo data.
The instrument used in this study was an adapted version of the Autism Child Module Score Sheet developed by Daniel & Sukamto .
This instrument was designed to measure fine motor and cognitive skills based on indicators adjusted to the studentsAo specific needs.
Although originally designed to assess fine motor and cognitive abilities in children with autism, the instrument was adapted to evaluate personal hygiene skills in children with intellectual disabilities by toothbrushing, handwashing, changing clothes, and maintaining cleanliness after RESULTS AND DISCUSSION This study was conducted at SLB C and C1 Yakut Purwokerto involving 30 respondents who met the inclusion criteria as research samples.
The characteristics of the respondents included age, gender, and grade level.
The adapted sheet consisted of 12 items, each scored on a 4-point scale .
= Mafitroh U and Hardini DS.
The Effect of Using.
Table 1.
Respondent Characteristics Respondent Characteristics Age of Respondent :
12 Years 13 Years 14 Years 15 Years Total Gender:
Male Female Total Grade :
VII
Vi Total Birth Order First Child Second Child Third Child Fourth Child Total Frequency .
Percentage (%) Table 2.
Pre-Test and Post-Test Results of Personal Hygiene Using Quiet Book Media Variable Skills Mean Std.
Deviation Minimum Maximum Grade VII Grade Vi Grade IX Pre-test Post-test Pre-test Post-test Pre-test Post-test Based on Table 1, the frequency distribution of respondents by age shows that the majority were 14 years old .
7%).
The distribution by gender indicates that male and female respondents were equal in number .
Meanwhile, distribution based on grade level shows that most respondents were in grade IX, .
0%).
Furthermore, the table also shows that first-borns, accounting for 50.
0% of the total Based on Table 2, which presents the frequency distribution of skill scores among children with intellectual disabilities, a comparison was made between grade VII, grade Vi, and grade IX students.
Before the intervention, grade VII students had a mean score of 29.
00, with a standard deviation of 0.
906, a minimum score of 24, and a maximum score of 32.
After the intervention, the mean score increased to 40.
38, with a standard deviation of 3.
116, a minimum score of 21, and a maximum score of 47.
Dunia Keperawatan.
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00, with a standard deviation of 1.
011, a minimum score of 23, and a maximum score of 34.
After the intervention, the mean skill score improved to 45.
10, with a standard deviation of 1.
703, a minimum score of 32, and a maximum score of 50.
were categorized as less skilled.
After the intervention, 1 respondent remained in the less skilled category, 2 respondents were classified as fairly skilled, and 7 respondents showed improvement and were categorized as In grade IX, before the intervention, 9 respondents were categorized as less skilled and 3 respondents as fairly skilled.
Similarly, for grade IX students, the mean score before the intervention was 58, with a standard deviation of 184, a minimum score of 24, and a maximum score of 36.
After the intervention, the mean score increased to 75, with a standard deviation of 360, a minimum score of 35, and a maximum score of 52.
These findings demonstrate a consistent improvement across all grade levels after the implementation of Quiet Book media, indicating its effectiveness in enhancing personal hygiene skills among children with intellectual disabilities.
After the intervention, 1 respondent remained fairly skilled, while 11 respondents showed improvement and were categorized as skilled.
These results demonstrate a consistent increase in personal hygiene skills across all implementation of the Quiet Book media, suggesting that the intervention effectively enhanced studentsAo ability to perform personal hygiene independently.
The results of the normality test using the ShapiroAeWilk method in Table 4 indicate that for grade VII, the pre-test value of 0.
327 (> 0.
suggests that the data were normally distributed, while the post-test value of 0.
008 (< 0.
indicates a non-normal distribution.
For grade Vi, the pre-test value of 0.
315 (>
also shows a normal distribution, whereas the post-test value of 0.
027 (<
indicates that the data were not normally distributed.
In grade IX, the Based on Table 3, which presents the distribution of respondentsAo skill levels in the pre-test and post-test phases, it was found that in grade VII, before the intervention, 8 respondents were categorized as less skilled.
After the intervention, 4 respondents were classified as fairly skilled and 4 respondents as skilled.
In grade Vi, before the intervention, 10 respondents Table 3.
Frequency Distribution of RespondentsAo Skill Levels in Pre-Test and Post-Test Using Quiet Book Media Grade VII Grade Vi Grade IX Pre-test Post-test Pre-test Post-test Pre-post Post-test Less Skill Fairly Skill Good Skill Total Category Mafitroh U and Hardini DS.
The Effect of Using.
Table 4.
Normality Test Results of Skill Level After Intervention Variable Grade VII Pre-test Post-test Grade Vi Pre-test Post-test Grade IX Pre-test Post-test Sig Explanation Normal Distributed Not Normally Distributed Normal Distributed Normal Distributed Normal Distributed Not Normally Distributed Table 5.
The Effect of Using Quuite Book Media on Personal Hygiene Variable Respondent Skill Level Pre-test
Post-test
Intervention Z-Score
p-value Use of Quietbook
0,000
pre-test value of 0.
053 (> 0.
demonstrates a normal distribution, while the post-test value of 0.
004 (<
non-normal the Republic of Indonesia in the Indonesia Health Profile .
, which states that the age range of 12Ae16 years is categorized as early adolescence, 6Ae11 years as childhood, and 17Ae25 years as late adolescence .
According to the Ministry of Health, school-aged children are defined as those older than six years but younger than eighteen years.
During this period, children go through two major stages of life childhood and In the school phase, psychosocial development, including enhanced interaction skills, achievement motivation, and creative expression.
They also begin to develop an industry pattern, or a sense of productivity that helps them overcome feelings of Based on these results, it can be concluded that the post-test data in all classes were not normally distributed.
therefore, the overall data in this study did not meet the assumption of Consequently, a nonparametric test (Wilcoxon Signed-Rank Tes.
was applied to determine the effect of Quiet Book media on personal hygiene improvement.
Based on the bivariate analysis results presented in Table 5, the p-value was 000 (O 0.
, indicating that the null hypothesis (HCA) was rejected.
Therefore, it can be concluded that there was a significant effect of using Quiet Book media on improving personal hygiene behavior skills among children with intellectual disabilities at SLB C and C1 Yakut Purwokerto.
Most respondents in this study were of school age and diagnosed with developmental stage, children with intellectual disabilities possess the potential to perform daily self-care activities, though they still require structured training.
Referring to OremAos Nursing Theory, they fall under the The classification of age refers to the guidelines of the Ministry of Health of Dunia Keperawatan.
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The use of Quiet Book learning media as an intervention in the school environment proved effective in enhancing the childrenAos ability to perform self-care more independently.
capacity to engage effectively in the learning process.
The findings of this study show that the number of male and female students in each class was proportionally balanced.
According to Sari et al.
, male and female students with intellectual disabilities demonstrate similar levels of understanding in problem-solving and decision-making .
However, this result is not entirely consistent with the findings of S.
Sari et al .
, which indicated that female students tend to achieve higher academic performance compared to their male counterparts .
School age is a critical period in a childAos growth and development.
At this stage, children begin to express individuality and gradually learn to self-care Research Ulfatulsholihat .
revealed that children with intellectual disabilities possess a strong desire to live Furthermore.
Buyan .
emphasized the importance of teaching self-care skills within schools.
To develop these abilities, individuals require appropriate information, media, and guidance.
The results of this study showed that 15 respondents were first-born children.
While this study did not statistically analyze the relationship between birth order and personal hygiene scores, the finding may provide contextual insight into parental readiness.
Parents who are caring for a child with intellectual disabilities for the first time often have limited experience in teaching daily selfcare routines, which may influence the development of personal hygiene skills.
This result is supported by the study of Puspita .
, which highlights that parental involvement plays a crucial role in fostering independence among children with intellectual disabilities.
This study involved three grade levels VII.
Vi, and IX, selected according to predetermined inclusion criteria.
The grade level played an essential role in ensuring the smooth implementation of the study.
In grade VII, most students exhibited lower levels of concentration and responsiveness to learning, with behavior, requiring parental assistance to In contrast, students in grades Vi and IX were generally more capable of following instructions and engaging with the learning material according to standard procedures, although some still required additional These differences in behavior during the intervention phase are presumed to be influenced by age variations across grade levels, which affect studentsAo maturity and their Supporting this.
Alfita .
explained that independence is not an innate ability but a skill that must be taught gradually from early childhood through consistent practice and parental support.
These studies highlight the importance of providing parents especially first-time caregivers with appropriate education and structured tools to assist their children in developing self-care abilities.
In this context, quiet book media can serve as a practical educational aid that helps parents guide their children through step-by-step hygiene routines in Mafitroh U and Hardini DS.
The Effect of Using.
a more In grade Vi, prior to the intervention, all respondents .
%) were categorized as less skilled.
Although this study did not statistically analyze the relationship between birth order and personal hygiene performance, observations suggested that children of first-time caregivers often showed lower levels of personal hygiene skills.
This may be related to parentsAo limited experience and understanding of how to introduce and reinforce hygiene routines from an early age.
Supporting this view.
Alfita independence is not an innate trait or a skill that emerges spontaneously.
it must be taught gradually from early Through consistent practice and parental guidance, children can develop confidence, self-reliance, and the ability to carry out daily tasks After the intervention, 10.
0% of respondents remained less skilled, 20.
were fairly skilled, and 70.
0% showed improvement, achieving the skilled Meanwhile, in grade IX, before the intervention, the majority of respondents .
0%) were categorized as less skilled.
After the intervention, a significant improvement was observed, 7% of respondents classified as These results demonstrate consistent improvement in the personal hygiene skill levels of students across all grade levels following the implementation of Quiet Book media.
The difference in skill levels among grades VII.
Vi, and IX before and after the intervention was evident from the variations in mean The mean skill score before the intervention was 32.
58, with a minimum score of 23 and a maximum of 38, whereas after the intervention, the mean score increased to 52.
45, with a minimum of 46 and a maximum of 55.
This aligns with findings from (Sari & Santy, 2.
, who noted that family support plays an important role in shaping the personal hygiene abilities of children with intellectual disabilities, as well as Ramawati et al.
, who emphasized that both internal and external parental factors influence a childAos capacity to perform self-care tasks .
Therefore, providing structured educational tools such as quiet book media can assist parents, particularly first-time caregivers, in This improvement aligns with the fundamental learning characteristics of children with intellectual disabilities, who typically benefit from concrete, visual, and repetitive instructional The Quiet BookAos manipulative and three-dimensional features provide tangible learning experiences that help students understand personal hygiene tasks step-by-step.
Its sensory elements support better attention and memory sequencing within the pages allows for repeated practice and modeling two essential strategies for developing independence in self-care.
Therefore, the Quiet Book media effectively responds to the specific learning needs of children with intellectual disabilities, contributing Based on the findings and data presented in Table 3 there were clear differences observed among grades VII.
Vi, and IX regarding skill levels before and after the intervention.
In grade VII, before the intervention, the majority of respondents .
%) demonstrated low levels of personal hygiene skills .
ess skilled After the intervention, 50.
of respondents were categorized as fairly skilled and the remaining 50.
0% as Dunia Keperawatan.
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development and to help students participate more effectively in the learning process.
The use of Quiet Book media was proven to be effective in improving the abilities of children with individual and group learning contexts.
This is supported by the statistical results of the Wilcoxon Signed-Rank Test, which showed a p-value of 0.
indicating a significant difference before and after the intervention.
The variation in improvement across grades can be attributed to differences in age and developmental stages among students, which affect the learning It can therefore be concluded that the age stage plays a significant role in the ability to receive and process Fundamentally, children with intellectual disabilities have cognitive limitations and memory delays, requiring more time to comprehend new learning materials and acquire new skills.
Overall, the use of Quiet Book media has a positive impact on increasing the awareness and ability of children with intellectual disabilities to perform selfcare activities independently, thereby supporting their overall functional and adaptive development.
Therefore, it can be concluded that there was a significant effect of using Quiet Book media on improving personal hygiene behavior skills among children with intellectual disabilities at SLB C and C1 Yakut Purwokerto.
The increase in scores between the pre-test and posttest phases further supports this finding.
Based on these differences, it can be concluded that Quiet Book media is effective in enhancing personal hygiene skills among children with intellectual LIMITATIONS This study had several limitations.
Some respondents demonstrated a lack of focus during the learning process and required parental assistance to ensure that the intervention sessions ran smoothly.
addition, differences in comprehension levels among classes affected the studentsAo ability to absorb the material, resulting in variations in the duration of intervention sessions across grade levels.
In this study, the Quiet Book was used as an educational medium to teach self-care through engaging and visually appealing The colorful and interactive elements of the Quiet Book captured the studentsAo interest and enthusiasm, allowing them to learn and play This interactive learning process encouraged students to better absorb and understand the intended educational messages.
ACKNOWLEDGEMENTS
The authors would like to express their deepest gratitude to Allah SWT for His blessings and guidance throughout the completion of this article.
The authors also extend heartfelt appreciation to their parents and families for their continuous support, and to the supervisor.
Ns.
Deisy Sri Hardini.
Kep.
Kep.
Sp.
Kep.
An.
, for her valuable guidance and encouragement during the research The findings of this study are consistent with those of Ramadhani & Sudarsini .
, who reported that the Quiet Book is a learning medium well-suited to the characteristics of children with intellectual disabilities .
The medium was designed to facilitate skill Mafitroh U and Hardini DS.
The Effect of Using.
CONCLUSION
Based on the results of this study, it can be concluded that the use of Quiet Book media has a significant effect on improving personal hygiene behavior skills among children with intellectual disabilities at SLB C and C1 Yakut Purwokerto.
This supported by the differences in pre-test post-test intervention, which demonstrated an increase in the respondentsAo self-care The Quiet Book has proven to be an effective and interactive learning tool that aligns well with the characteristics and learning needs of children with intellectual disabilities.
RECOMMENDATIONS