The Effect of Choking Management Education for Toddlers
Aged 1-5 Years on Parents Knowledge
Rafidaini Sazarni Ratiyun1*, Vellyza Colin2, Ida Rahmawati3, Lala Nor Safitri4, Noza Anita5
1,2,3,4,5

Ners Program Study, STIKES Tri Mandiri Sakti Bengkulu
*correspondence author:

Submission : 18-3-2022 ; Accepted : 09-3-2023
Doi : 10.36858/jkds.v11i1.371

ABSTRACT
Choking is an emergency condition that must be treated
quickly, if it takes too long it will result in a lack of
oxygen and lead to death due to blockage of the
respiratory tract by foreign objects in the form of food,
toys, etc. Choking can lead to death due to lack of
knowledge of handling choking. The purpose of this
study was to determine the effect of education on
handling choking in children under five on the
knowledge of parents in the working area of the Ratu
Agung Health Center, Bengkulu City. The design of this
study was pre-experimental design with a one group
pretest posttest design. To determine the number of
samples using the Paul Leedy formula with the results
obtained are 30 parents who have toddlers aged 1-5
years. The research instrument used a questionnaire on
parental knowledge about choking in children. The
research data were analyzed using paired t-test with a
significance level of p<0.05. Respondents to this study
consisted of 30 parents. Research shows that parents'
knowledge after being given education is higher than
before being given education. The average knowledge
after being given education is 35.63. The results of data
analysis obtained p-value = 0.000 <0.05 which means
that there is an effect of education on choking
management in toddlers aged 1-5 years on parents'
knowledge. Providing education using booklets, is
effective in increasing parents' knowledge in handling
choking in toddlers aged 1-5 years.

ABSTRAK
Tersedak merupakan kondisi gawat darurat yang harus
cepat ditangani, bila terlalu lama akan mengakibatkan
kekurangan oksigen dan mengakibatkan kematian
karena kondisi tersumbatnya saluran pernapasan oleh
benda asing yang berupa makanan, mainan, lain-lain.
Tersedak dapat mengakibatkan kematian karena
kurangnya
pengetahuan
penanganan
tersedak
Penelitian ini bertujuan untuk mengetahui pengaruh
edukasi penanganan tersedak pada balita usia 1-5
tahun di wilayah kerja puskesmas Ratu Agung Kota
Bengkulu. Desain penelitian yang digunakan peneliti
adalah pre-eksperimental design dengan rancangan one
group pretest posttest. Untuk menentukan jumlah
sampel menggunakan rumus Paul Leedy dengan hasil
yang didapat adalah 30 orang tua yang memiliki balita
usia 1-5 tahun. Responden dalam penelitian ini terdiri
dari 30 orang tua, Penelitian menunjukkan
pengetahuan orang tua setelah diberikan edukasi lebih
tinggi dibandingkan sebelum diberikan edukasi. Ratarata pengetahuan setelah diberikan edukasi adalah
35,63. Hasil analisis data diperoleh nilai p-value =
0.000 <0.05 yang berarti bahwa terdapat pengaruh
edukasi penanganan tersedak pada balita usia 1-5
tahun terhadap pengetahuan orang tua. Pemberian
edukasi
menggunakan
booklet
efektif
dalam
meningkatkan pengetahuan orang tua dalam
penanganan tersedak pada balita usia 1-5 tahun.
Kata Kunci: Pendidikan Kesehatan, Pengetahuan,
Tersedak

Keyword: Education, Knowledge, Choking

*Correspondence author: rafidainisazarni@gmail.com

Jurnal Kesehatan dr. Soebandi Vol. 11, No.1
http://journal.Universitasdrsoebandi.ac.id/
Publisher : LPPM Universitas dr. Soebandi Jember

How to Cite : Ratiyun, R. S., Colin, V., Rahmawati, I., Nor Safitri, L., & Anita, N. (2023). THE
EFFECT OF CHOKING MANAGEMENT EDUCATION FOR TODDLERS AGED 1-5
YEARS ON PARENTS KNOWLEDGE. Jurnal Kesehatan Dr. Soebandi, 11(1), 1-7.
https://doi.org/10.36858/jkds.v11i1.371

1

Introduction:
Choking is an emergency condition that
must be treated quickly, if it takes too long it
will result in a lack of oxygen and lead to death
due to blockage of the respiratory tract by
foreign objects in the form of food, toys, etc.
Choking can lead to death due to lack of
knowledge of handling choking. The purpose of
this study was to determine the effect of
education on handling choking in children under
five on the knowledge of parents in the working
area of the Ratu Agung Health Center,
Bengkulu City. Choking in children is most
often caused by food that is not chewed
properly, food with pieces that are too large, and
hard candy. Small objects such as coins, nuts,
marbles, or pins that like to be put in your
mouth can also be a cause of choking (Adhi,
2020). Centers for Disease Control for nonfatal
choking episodes in children admitted to the
emergency department, 13% of choking
episodes were attributed to coins and 19% to
candy or chewing gum. Latex balloon was the
most likely fatal foreign body aspiration,
accounting for 29% of foreign body aspiration
deaths between 1972 and 1992. Over the same
time period, hot dogs were the most fatal food
aspiration, accounting for 17% of food-related
aspiration deaths (Duckett et al., 2022)
Data from the Emergency Ambulance
Foundation 118 (2015) children aged <5 years
experienced 90% death caused by obstruction of
foreign bodies in the airways (Siahaan, 2019).
Indonesia in Grobogan, Central Java, data from
Soedjati Soemardiardjo Purwodadi Hospital for
the period 2016 - April 2018 there were 4 cases
of toddlers experiencing choking who were
treated (Rahmawati & Suryani, 2019).
Basically, choking case can be handled by
anyone, especially families with toddlers. Skills
for first aid in children is the next step that must
be taken by parents or caregivers. Because the
quick skills of parents or caregivers greatly
affect the safety of children. Knowledge is also
important for individuals who have children
under five. Lack of knowledge will have an
impact on the behavior of parents or caregivers
in dealing with choking in children. If the
behavior in handling choking in children is
Jurnal Kesehatan dr. Soebandi Vol. 11, No.1
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correct, it will avoid the threat of death, and vice
versa. One way to increase knowledge about
handling choking is to provide health education.
This is related to the role of nurses as educators
(Dwi et al., 2015). Based on its function as a
distribution of health messages (media), this
media is divided into three, namely print media,
electronic media, and board media. Electronic
media include videos and slides, print media
include flipcharts, booklets, rubrics, photos, and
posters (Sulistiyani & Ramdani, 2020). The
educational media used in this research is a
booklet. The advantage of using booklet media
is that it can be studied at any time, contains
relatively more information than posters, and
users can view its contents at leisure (Ansen,
2020).
Research conducted by (Nurhayati et al.,
2017), shows the results obtained are that there
is an influence between health education about
handling foreign body choking in toddlers on
maternal self-efficacy. Initial data collection
was carried out by interviewing 5 parents who
had toddlers in Sidodadi, Bengkulu City, the
results obtained were actions when choking on
toddlers were recommended to drink lots of
water, and pat the child's back. From the data
obtained, the family had never received
education regarding the handling of choking in
children before. From the results of these
interviews, it can be concluded that some
parents taking action to handle choking in
toddlers are not appropriate.
Methods:
The research design used by the researcher
was a pre-experimental design with a one group
pretest posttest design. To determine the number
of samples using the Paul Leedy formula with
the results obtained are 30 parents who have
toddlers aged 1-5 years in the working area of
the Ratu Agung Health Center in Bengkulu city.
This study was conducted to determine the
effect of education on handling choking for
toddlers aged 1-5 years on the knowledge of
parents in the working area of the Ratu Agung
Public Health Center, Bengkulu city. Research
data collection was carried out on 19 - 26 June
2

2021, using interview techniques and filling out
questionnaires that had been prepared.
The population of this research is all
parents who have toddlers aged 1-5 years in the
working area of the Ratu Agung Health Center
in Bengkulu city. Many samples used were 30
parents who have toddlers aged 1-5 years in the
working area of the Ratu Agung Health Center
in Bengkulu city. The sampling method is
purposive sampling with the number of samples
using the Paul Leedy formula, namely purposive
sampling is based on certain considerations
made by the researcher himself based on the
characteristics and characteristics of the
population that have been known previously.
This study was conducted to determine the
effect of education on handling choking for
toddlers aged 1-5 years on the knowledge of
parents in the working area of the Ratu Agung
Public Health Center, Bengkulu city. Research
data collection was carried out on 19 — 26 June
2021, using questionnaires that had been
prepared. The population in this study were all
parents who had toddlers aged 1-5 years who
were in the working area of the Ratu Agung
Health Center in Bengkulu city. Sampling was
carried out using a purposive sampling
technique with the Paul Leedy formula to
determine the number of samples.
At the time of this study, the researcher
gave an explanation of the research to the
respondents and asked for the signature of the
consent form, if they were willing to become
respondents. After obtaining the respondent's
consent, the researcher gave a questionnaire
about parents' knowledge about handling
choking in toddlers, and asked the respondent to
give a check mark until all questions were filled
in (pre-test). Then proceed with providing
education using booklets to respondents. It is
recommended for each respondent to be able to
re-read the booklet in order to increase
knowledge and understand the contents of the
booklet for 1 week, so that it is hoped that the
respondent can apply the handling method if
choking occurs in a toddler. One week after
giving the educational booklet to the
respondents, the researcher gave a questionnaire
about choking in toddlers to see if the
Jurnal Kesehatan dr. Soebandi Vol. 11, No.1
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respondent had read or studied the booklet that
had been given, and see if there was an increase
in knowledge.
The data collection technique used for this
study was a questionnaire about knowledge of
handling choking in toddlers. This questionnaire
was conducted by distributing a list of questions
in the form of forms, submitted in writing to a
number of parents with toddlers aged 1-5 years
to get responses, information, answers, and so
on. The questionnaire about parents' knowledge
in handling choking in toddlers used in this
study consisted of 4 topic sections, namely 1.
first aid mechanisms for choking toddlers,
which consisted of 11 statements; 2. Sandwich
Back Slap or Back Blows, consisting of 10
statements;
3.
Chest
Thrust
(Chest
Pressure/Chest Compression), consisting of 8
statements; 4. The Heimlich Maneuver
(emphasis on the stomach just below the ribs),
consists of 12 statements. The total statements
in this questionnaire are 51 statements.
Respondents must answer each statement by
ticking the "yes" and "no" options. The
minimum score for this questionnaire is 0, and
the maximum score is 51. The questionnaire in
this study was adopted from research conducted
by Tarigan in 2019.
The normality test is the distribution of the
research data using the Shapiro-Wilk technique.
The results of the data normality test using
Shapiro Wilk obtained a significance value of
knowledge about handling choking before being
given education of 0.679 and the significance of
knowledge after being given education was
0.050, meaning that both data variables were
normally distributed with a p-value > 0.05.
Univariate analysis used to describe the
characteristics of each research variable.
Bivariate analysis was carried out on two
variables that were thought to be related or
correlated. Bivariate analysis was used to
determine the Effect of Choking Handling
Education on Parents' Knowledge in the work
area of the Ratu Agung Health Center in
Bengkulu City by using the Paired Sample TTest statistical test.

3

This research was conducted based on the
recommendation of a research permit numbered
070/448/B.Kesbangpol/2021.
Results:
Table 1. Characteristics of Respondent
Variable

n

Age

Percentage
(%)

30

Education:
Junior High
School
Senior High
School
College
Work:
Housewife
Farmer
Employee
Teacher

Mean (SD)
30.6 (6.93)
Min – Max
21 – 44

12
13
5

40
43.3
16.7

19
1
8
2

63.3
3.3
26.7
6.67

Table 1 shows that the average age of
the respondents is 30 years, with the youngest
being 21 years old, and the oldest being 44
years old. Almost half of the respondents have
high school education, that is 13 (43.3%). Most
of the respondents work as housewives, that is
19 (63.3%).
Table 2. Score Difference of parents' knowledge
before and after giving education.
Parents’
knowledge
Pretest

Posttest

Mean
(SD)

Min

Max

21.33
(3.356)

15

29

35.63
(3.792)

29

41

CI
95%
20.08
–
22.59
34.22
–
37.05

P

0.000

Based on table 2, it can be seen the
knowledge of parents before education has an
average = 21.33 (less) and std. Deviation =
3.356, with the lowest score of 15 and the
highest score of 29. After education, the
knowledge of parents has an average = 35.63
(good) and std. Deviation = 3.792, with the
lowest score of 29 and highest score of 41. The
results of the t-test of the two related samples
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(Paired sample t-test) obtained the value of t =
18.745 with p-value = 0.000 <0.05 significant,
then the results are Ho is rejected and Ha is
accepted. So the conclusion is that there is an
effect of education on handling choking in
toddlers on the knowledge of parents in the
working area of the Ratu Agung Health Center,
Bengkulu city
Discussion :
The results of the analysis using the
Statistical Paired Sample t-test by showing the
value of t = 18.745 with p-value = 0.000 <0.05
significant. The results show that there is an
effect of education on handling choking for
toddlers aged 1-5 on the knowledge of parents
in the working area of the Ratu Agung Health
Center in Bengkulu city. This study is in line
with the results of research conducted by
(Sulistiyani & Ramdani, 2020), using the paired
t-test sample test above that the average value is
-26.50 with a Standard Deviation of 23,568, tscore of -6.159, and p-value 0.0001. The results
of statistical tests can be concluded that there is
an effect of health education with booklet media
on handling choking in children on the level of
knowledge of Posyandu cadres in Karangsari
Village. The results of the study showed that
before being given education there were most of
the 30 parents who had less knowledge and had
an increase after education was given. It is
necessary to provide re-education by the
Puskesmas to the community in the working
area of the Ratu Agung Health Center,
Bengkulu City. So that the public can increase
knowledge about choking and prevent deaths
from choking.
Based on the results of the study, it can be
seen that the frequency distribution of parental
knowledge about handling choking in toddlers
aged 1-5 years before educating parents in the
working area of the Ratu Agung Public Health
Center in Bengkulu City is from 30 parents
there are 23 parents (76.7%) have less
knowledge, 7 parents (23.3%) have sufficient
knowledge, and none of the parents (0%) have
good knowledge. The results of this study are in
line with research conducted by Tarigan (2019),
it was found that the description of mother's
4

knowledge of first aid for choking toddlers in
Tuntungan II Village was mostly less
knowledgeable as many as 32 respondents
(62.7%), with good knowledge only 7
respondents (13.7%). %) and have sufficient
knowledge of 12 respondents (23.6%). Based on
Harigustian, 2020), lack of knowledge of
mothers on first aid for choking toddlers at
Graha Sedayu Sejahtera Housing based on
observations, respondents who work as
housewives, are less interested in increasing
knowledge because there is no interest in trying
and pursuing something to gain deeper
knowledge.
For parents in the working area of the Ratu
Agung Health Center, Bengkulu city, the results
of the analysis showed that they did not know
how to properly handle choking, especially with
the Chest Thrust technique. Most parents will
pat the back if the child is choking, and provide
plenty of water to drink. For knowledge of the
Heimlick Maneuver technique, some parents
know, but do not understand how to do it.
According to Yusniawati et al., (2022) shows
that there are benefits of providing health
education about handling choking on foreign
bodies in children on mothers' knowledge about
choking, so providing education is important to
do.
Knowledge after educating parents in the
working area of the Ratu Agung Health Center
in Bengkulu city showed that from 30 parents
there were 4 parents (13.3%) who had sufficient
knowledge, and 26 parents (86.7%) who had
good knowledge. The results of (Dwi et al.,
2015) family knowledge pretest - posttest
education about prevention and treatment of
choking in children, before education as many
as 19 people (95%) had less knowledge and 1
person (5%) had sufficient knowledge, while
after being given education as many as 20
people (100%) in good category. When
providing education, parents pay close attention
to the explanation given by the researcher. In
addition to explaining, the researcher instructed
parents to read the booklets that the researchers
had prepared as educational media that had been
prepared. So that parents can better understand
how to handle choking in toddlers. Based on
Jurnal Kesehatan dr. Soebandi Vol. 11, No.1
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(Oktaviani, 2019), after conducting health
education using the demonstration method,
post-test data showed that most of the
respondents had been able to perform
observations, Heimlich maneuvers, evaluations
and were able to perform sequentially. At the
time of the interview, the mother stated that she
understood more.
In this study, the post-test questionnaire
given was the same as the pre-test questionnaire
which was conducted 7 days after education on
the handling of choking in toddlers aged 1-5
years. The time interval given after the
education is intended so that respondents can
better understand and re-read the booklets that
have been given. Based on the research of (Putri
et al., 2016) the tool used in the questionnaire is
a questionnaire that uses a self-administered
questionnaire. The first thing to do is fill in the
informed consent and pre-test data. Then the
counseling was given and a post test was
conducted using the same questionnaire as the
pre-test questionnaire on the 7th day for 20
minutes to measure memory retention after the
counseling. In the analysis of the results of 4
parents who had sufficient knowledge after
choking management education, it was found
that from education on how to handle choking,
namely the booklet that had been given to
parents did not read it again. So that the number
of correctly answered questionnaires is around
24-30 with sufficient categories.
The average value of parents in the working
area of the Ratu Agung Health Center in
Bengkulu city before and after education
experienced an increase in knowledge, namely
with an average value of 21.33 (less) to 35.63
(good). This is in accordance with research
conducted by (Dwi et al., 2015) which shows an
increase in knowledge scores after family
education, an increase in knowledge scores
between before and after family education with
a mean Pre-test score of 15.95 and an increase
of 15.85 points to 31.80 on the average Post-test
score. A person's knowledge can increase if it is
supported by various factors, one of which is the
availability of sufficient tools or facilities such
as the information needed according to
5

problems that the respondent does not know
about.
The assessment of parental knowledge in
the working area of the Ratu Agung Health
Center in Bengkulu City was taken based on the
results of distributing questionnaires before and
after providing education on choking
management. From the questionnaire, it was
found that before education was carried out
there were 23 people who had less knowledge,
after being given education there were 19
people who had good knowledge and 4 people
had sufficient knowledge. While there are 7
people who have sufficient knowledge before
being given education and after education all
have good knowledge.
According to (Suparti & Amelia, 2019), an
assessment of the success of the implementation
of the activity can be seen from the results of
the questionnaire distributed to the women of
Aisyiyah cadres given before and after the
activity. Based on the results obtained, there is
an increase in public knowledge.
The use of media in health education also
affects the level of knowledge of posyandu
cadres. In this study, in addition to using the
lecture and question and answer method, the
researchers also used booklets as a medium for
delivering health education. Media booklets can
provide more complete information, attractive
designs and have many pictures so that readers
are interested in reading, and can be stored so
that they can be read repeatedly. This is in line
with Rathore et al., (2014) that there is an
increase in knowledge of mothers after being
given health education with booklet media, so
that information on booklets is very effective for
increasing knowledge of mothers. Booklets will
give an impression to readers if they are
presented with attractive images so that they are
not formal and rigid. The advantages of
booklets are that they can be stored for a
relatively long time, can be studied
independently, and can help other media.
The limitations of this study were that
the researcher could not assess whether the
respondent actually read the booklet that had
been given at home, and this study also did not
determine the duration of time for the
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respondent to read the booklet, and did not carry
out a posttest after being given education
(before being given the booklet) to see
differences in knowledge before being given the
booklet and after being given the booklet.
Conclusions:
The parents’ knowledge about handling
choking for toddlers aged 1-5 in the working
area of the Ratu Agung Health Center,
Bengkulu City before and after given education
has increased and can be concluded that there is
significant effect of education on handling
choking for toddlers aged 1-5 on the knowledge
of parents in the working area of the Ratu
Agung Health Center, Bengkulu City. In further
research, it is hoped that more than 1 post-test
can be carried out to see knowledge retention
after being given education, and providing
education through demonstrations about
handling choking on parental knowledge and
skills can be used as a variable for further
research.
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