Validation of Picayo Training Module for Increasing Trust in Mental Health Experts on Adolescent

Abstract

The lack of training media used as a source of information for content and functionally validated mental health experts in adolescents causes the low level of trust in mental health experts in adolescents. The objective of the study was to determine the validity of the PICAYO module to increase trust in mental health experts. A quantitative approach with a quasi-experimental design. Nonrandomized Pretest-Postest Control Group Design was chosen in this study. Students of SMA state 12 Semarang who have trust in mental health experts who have low scores were selected as research subjects. Subjects were divided into an experimental group (12 people) and a control group (14 people). The instrument used is a scale of trust in mental health experts. Validation was carried out through content validity and functional validity tests. Aiken's V technique was used to obtain content validity. The results obtained from the content validity test ranged from 0.75 to 0.90, which means that the PICAYO module has a moderate to very valid category. Functional validity was obtained through empirical testing with experimental methods. The research data were then processed using the Mann Whitney U Test technique with the help of data processing software. The results of the functional validity test showed that there were differences in the pretest and posttest scores in the experimental group, with a different test result of -3.960 with a significance of 0.000 (p less than 0.05). It was also found that the posttest score in the experimental group was superior to the control group, with a different test result of -2.580 with a significance level of 0.10 (p less than 0.05). Based on these results, it can be concluded that the PICAYO module is valid for increasing trust in mental health experts in adolescents.

Abstrak: Belum banyaknya media pelatihan yang digunakan sebagai sumber informasi terhadap ahli kesehatan mental yang tervalidasi secara isi dan fungsional pada remaja menyebabkan rendahnya tingkat kepercayaan terhadap ahli kesehatan mental pada remaja.Tujuan dari penelitian ini adalah untuk mengetahui validitas modul picayo untuk meningkatkan kepercayaan terhadap ahli kesehatan mental. Pendekatan kuantitatif dengan desain eksperimen kuasi Nonrandomized Pretest-Postest Control Group Desaign dipilih pada penelitian ini. Siswa SMA Negeri 12 Semarang yang memiliki kategori kepercayaan terhadap ahli kesehatan mental yang mempunya skor rendah dipilih sebagai subjek penelitian. Subjek terbagi menjadi kelompok eksperimen (12 orang) dan kelompok kontrol (14 orang). Instrumen yang digunakan adalah skala kepercayaan terhadap ahli kesehatan mental. Validasi dilakukan melalui uji validitas isi dan validitas fungsional. Teknik Aiken’s V digunakan untuk memperoleh validitas isi. Hasil yang didapatkan dari uji validitas isi berkisar antara 0,75 sampai dengan 0,90 dengan arti bahwa modul picayo memiliki kategori valid sedang hingga sangat valid. Validitas fungsional diperoleh melalui uji empirik dengan metode eksperimen. Data hasil penelitian kemudian diolah menggunakan teknik Mann Whitney U Test dengan bantuan software pengolah data. Hasil uji validitas fungsional menunjukkan terdapat perbedaan skor pretest dan posttest pada kelompok eksperimen, dengan hasil uji beda sebesar -3,960 dengan signifikansi 0,000 (p kurang dari 0,05). Didapatkan pula hasil skor posttestpadakelompokeksperimenlebihungguldibandingkandengankelompokkontrol,dengan hasil uji beda -2,580 dengan taraf signifikansi 0,10 (p kurang dari 0,05). Berdasarkan hasil tersebut, maka dapat ditarik kesimpulan bahwa modul picayo valid untuk meningkatkan kepercayaan terhadap ahli kesehatan mental padaremaja.

Introduction

Mental health problems are one of the psychological conflicts that occur in adolescents. As explained by the Indonesian Ministry of Health, in 2018 adolescents aged more than fifteen years experienced an increase in mental health disorders by 9.8%. The reason is because awareness about mental health knowledge is quite low, including about mental health experts. (depkes.go.id downloaded on 22 May 2019). The negative public stigma towards people who go to mental health experts causes low public creedence, especially adolescents, to visit mental health experts.

Preliminary studies have been conducted on 59 adolescents and obtained data as much as 62.7% of adolescents choose to hide the problems they face than to come to a mental health expert. These data can illustrate how low the level of creedence of adolescents in mental health experts. The experience of adolescents when venting to others who get negative feedback adds to the bad stigma of adolescents for sharing their problems. Creedence is a person's psychological acceptance of the vulnerability of other people's behavior (Rousseau et al in Lynon, Mollering & Sunders, 2012:31). Aspects of self-creedence include disclosure, sharing acceptance, support and cooperation (Johnson & Johnson, 2000:35).

Getting adolescent to reach a level of creedence is not easy and requires a process that is not instant. One of the processes used to introduce mental health experts is through counseling. Meanwhile, in counseling in the environment where adolescents are most familiar, namely at school, counseling is usually done to children who have “problems” or behavior that deviates from school rules. Thus, it reinforces the youth's stigma that it is “people problem” who tell their problems to health experts. In addition, they are not familiar with mental health experts, and the difficulty of reaching mental health experts is one of the causes. So now an online media for counseling has been created to make it easier for adolescents to access information about mental health and mental health experts.

However, these efforts are considered less than optimal in reaching all youth. So, a training was created that combines the psycho-education process, counseling practice and assisted by the introduction of online counseling media to make adolescents more understand and trust mental health experts. The PICAYO module, which is based on the trust aspect of Johnson & Johnson, incorporates these processes. So, module validation is needed to assess whether the PICAYO module is valid for increasing creedence in mental health experts on adolescent. The previous module validation research was conducted by Alfiyah & Martani (2015) regarding the validation of the war play module. In addition, there is a validation of the proficient mode used to improve social skills in new students by Agustini & Andayani (2017). The objective of the module validation is to find out whether the PICAYO module is valid for increasing trust in mental health experts.

Methods

The research subjects were students of SMA state 12 Semarang aged between 15-19 years and who had low trust in mental health experts. The selected subjects are 26 students. Furthermore, the subjects were divided into the experimental group and the control group. The experimental group consisted of 14 and the experimental group consisted of 12 subjects.

There are two variables in this study, with the independent variable (X) being the PICAYO module, namely the media in the form of a book containing training psycho-educational procedures that aim to increase trust in mental health experts. The dependent variable (Y) is trust in mental health experts. Trust in mental health professionals is a concept related to the condition of an individual who is able to open up to mental health professionals, share problems, receive input and suggestions, and be able to support and cooperate with mental health professionals.

There are two types of validity used in this study, namely content validity and functional validity. The purpose of content validity is to determine the alignment between the contents of the PICAYO module and aspects of creedence. Identification of the components of the module based on the aspect of creedence is carried out before jumping into content validity. Part of the PICAYO module contains the starting point (opening), let's share, and let's accept. The content validity test involved 10 expert judgments, 1 psychologist and 9 trainers. Using the Aiken's V technique, the task of expert judgment is to assign a value to the relevance of the PICAYO module with belief theory. Then the score that has been obtained from expert judgment is calculated manually using the Aiken's V formula.

Furthermore, a functional validity test was conducted to determine the extent to which the PICAYO module was able to make adolescents believe in mental health experts through an experimental process. Quantitative approach with a quasi-experimental design nonrandomized pretest-posttest control group design. Dividing subjects into two groups, namely control and experiment with distribution without randomization is also known as quasi-experimental (Seniati, Yulianto, & Setiadi, 2017:126). In addition, before and after treatment, measurements were taken in both groups, which then the results will be compared to determine the effect of the treatment (Azwar, 2017:172).

Functional validity data were taken using a creedence scale for mental health experts for pretest and posttest. The pretest was conducted to find out that the subject's level of knowledge was relatively the same. Then the subjects were divided into control and experimental groups. The control group was not given any treatment. While the experimental group was given treatment from the Picayo module. Furthermore, the pretest process was carried out, to obtain data after treatment. The data that has been obtained is then processed using the help of data processing software with the Mann Whitney U Test technique.

After the content validity and functional validity tests were carried out, data analysis was carried out to obtain validity conclusions. As done in previous research by Alfiyah & Martani (2015) and Agustini & Andayani (2017). This research is validity research so it is different from intervention research. The validity research uses the same theory between the independent variable and the dependent variable so that the theoretical construct of the PICAYO module with the variable being measured is the same, namely trust in mental health experts.

Results and Discussion

Content validity was obtained from the expert judgment score which consisted of psychologists and trainers (table 1).

Table 1 shows that the PICAYO module scores are in the range of 0.75 to 0.9, which means that the PICAYO module is in the moderate to very valid validity category. So, it can be concluded that the PICAYO module is in accordance with the objectives and theory of belief.

Table 1. PICAYO Module Content Validity Test

Aspects	Indicators	Item	Validity Test
Disclosure	Share information, ideas, thoughts, feelings, opinions with mental health professionals	1	0.875
		3	0.825
		16	0.8
		6	0.85
	Want to show reactions to various things that he experiences to mental health experts	4	0.9
		7	0.825
		17	0.825
		21	0.85
Sharing	Willing to help each other to seek information or help from mental health professionals	8	0.85
		15	0.875
		18	0.825
		23	0.85
Reception	Willing to communicate and accept opinion when need opinion	9	0.825
		10	0.775
		14	0.85
		22	0.875
Support	Willing to be involved, and support each other with mental health experts in solving problems they face	11	0.775
		13	0.875
		19	0.825
		24	0.825
Collaborating	Have the hope of cooperating with mental health experts in order to achieve the goal.	2	0.85
		5	0.8
		12	0.775
		20	0.775

Table 2. Results of the Mann-Whitney Test Experimental Group

	Group	N	Mean Rank	Sum of Ranks
Experimental Score	PRETEST	12	6.50	78.00
	POSTTEST	10	17.50	175.00
	Total	22

Table 3. Results of the Mann-Whitney Test Experimental Group

	Experimental Score
Mann-Whitney U	.000
Wilcoxon W	78.000
Z	-3.960
Asymp. Sig. (2-tailed)	.000
Exact Sig. [2*(1-tailed Sig.)]	.000b

Functional validity test has been carried out through the Mann Whitney U Test technique. The experimental group based on different tests before and after the following treatment are showed in table 2.

The table 2 shows a quite significant difference, namely the mean before treatment is 6.50 and after treatment is 17.50. With the results of the z difference test of -3.96 with a significance level of 0.000, a significance value of less than 0.05 can be concluded that there is a difference between the subject's creedence value before and after the study.

Table 4. Different Test of Control Group

	Control Score
Mann-Whitney U	42.000
Wilcoxon W	147.000
Z	-2.580
Asymp. Sig. (2-tailed)	.010
Exact Sig. [2*(1-tailed Sig.)]	.009a

The control group also experienced differences in pretest and posttest with a Z value of -2.580 and a significance level of 0.010. So, it can be concluded that there is a difference between the pretest and posttest (table 3).

Table 5. Gain Score Difference Test a. Grouping Variable: GROUP b. Not corrected for ties

	GAIN SCORE
Mann-Whitney U	31.000
Wilcoxon W	136.000
Z	-2.729
Asymp. Sig. (2-tailed)	.006
Exact Sig. [2*(1-tailed Sig.)]	.005b

Table 4 shows that the Z value is -2.729 with a significance level of 0.006. The data states that there is a difference between the values ??after treatment between the experimental group and the control group. The results showed that the value after treatment of the experimental group was higher than that of the control group. The reason for this is because the experimental group received treatment from the PICAYO module. However, there are also differences in the pretest and posttest scores in the control group. This shows that there is a threat of validity, namely proactive history where individuals essentially have their own intelligence and experience that causes them to be able to learn from previous behavior (Seniati, Yulianto & Setiadi, 2017:68).

As explained above, regarding one of the limitations of the study experienced by researchers. So, here are the limitations of the research that can be used as evaluation material:

1. The training is conducted online, so observing the behavior of research subjects has difficulty.
2. Prior to conducting the research, the researcher did not conduct intelligence tests on the subject, resulting in a threat of validity, namely proactive history.
3. The research was conducted for two days and online, so that there were subjects who took part in the training in the middle of the trip. So there is another validity threat, namely experimental mortality.
4. Limited time from partners causes long-term follow-up can't be done

Conclusion and Recommendation

The data from the analysis and discussion can be concluded that the PICAYO module is valid in increasing creedence in mental health experts on adolescents. The PICAYO module provides an overview of the content of the training which is able to provide additional knowledge to youth. So, it can be concluded that the hypothesis from the research is accepted.

The researcher's suggestion is that for further research, it is necessary to tighten the internal validity of the research by using intelligence tests. A clearer and stricter agreement for the subject to follow the research process from beginning to end also needs to be given. In addition, the research should be carried out face-to-face so that it is easy to observe the subject. It is also expected that further researchers will carry out long-term follow-up to find out how far the resistance of the given treatment is.