MANUSKRIP

FAKTOR YANG MEMPENGARUHI PERILAKU MAKAN SAYUR PADA

KELUARGA BINAAN DI DAERAH KRESEK DAN TEGAL ANGUS,
BANTEN, INDONESIA

Disusun Oleh:

Kelompok 9
Febrian Alam Vedaxena 1102014098
Intan Pratama Dewayanti 1102012131
Ismy Drina Mutia 1102013141
Selvi Alfrida KP 1102013266

Pembimbing:

dr. Erlina Wijayanti, MPH, DiplDK

KEPANITERAAN KEDOKTERAN KOMUNITAS

BAGIAN ILMU KESEHATAN MASYARAKAT
FAKULTAS KEDOKTERAN UNIVERSITAS YARSI
19 NOVEMBER – 24 DESEMBER 2018
 FACTOR INFLUENCING VEGETABLE INTAKE BEHAVIOUR IN

SELECTED FAMILY IN KRESEK AND TEGAL ANGUS AREA,

BANTEN, INDONESIA

Febrian Alam Vedaxena1, Intan Pratama1, Ismy Drina1, Selvi Alfrida1,

Erlina Wijayanti2

1
Faculty of Medicine YARSI University
2
Department of Public Health, Faculty of Medicine YARSI University

Abstract

Introduction: Vegetables are beneficial to health, but consumption in Indonesia

still low, under normal daily recommendation of 250 gr vegetables. Many factor
contributed to vegetable intake behaviour, such as psychosocial factor and
sociodemographic factors. The aim of this study is to examine correlation of factor
influencing vegetable eating behaviour in Kresek and Tegal Angus, Banten,
Indonesia, because data still lacking, and can be used to guide health promotion
programs.
Methodology: a qualitative, cross-sectional study performed in December 2018.
Study population was selected family by local community health centre of 176
people and total sampling were used. The variable used in study are vegetable
eating behaviour (frequency & quantity), vegetable knowledge, gender, age,
occupational, education and income using questionnaire.
Results: prevalence of bad vegetable intake behaviour was (125, 71% ± 6,7), with
good frequency (110, 62,5% ± 7,15), but bad quantity (88, 50% ± 7,39). There is
no correlation between vegetables knowledge and behaviour (P > 0,05). All
sociodemographic characteristics shows no correlation to vegetables intake
behaviour (P > 0,05).
Conclusion: Many factor contributed to vegetable intake behaviour. This study
shows no correlation between vegetable knowledge and sociodemographic
characteristics. Bad vegetable intake behaviour can be explained by another factor
such as environment, personal factor, family factor and other factors. Another study
needed to explain the another factor to help promote vegetable consumption for
better health.
Keywords: vegetables intake, behaviour factor

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Introduction

Epidemiological studies have shown that vegetables intake is beneficial to

heath, being associated with decreased risk of a range of chronic diseases including
cardiovascular disease1, stroke2, and a number of cancers3, mainly in digestive
system4,5. In General, vegetables are among the main sources of vitamins, minerals,
and dietary fibre, and play a protective role as antioxidant and phytochemical
compounds6,7.

Worldwide, the low consumption of fruit and vegetables are considered one
of the 10 leading risk factors for mortality8, up to 2.7 million lives could be saved
annually with sufficient fruit and vegetable consumption9. Despite the multiple
benefit attributable to vegetable intake, their consumption is below usual
reconditions10, especially in resource-constrained setting. Fruit and Vegetables
intake is far less than recommended in many low and middle income countries10.
Among these are some countries where the majority of population is engaged in
agriculture, which confound the arability and accessibility hypothesis of vegetables
consumption11.

World Health Organization (WHO) recommend the consumptions of

vegetables for a healthy living within 250 gr vegetables in a day or 2,5 servings in
a day12. In Indonesia, dietary guidelines developed by health authorities recommend
the consumptions of vegetables and fruit among child around 300 – 400 gr and
among adolescent to adult around 400 – 600 gr, which 2/3 portion are vegetables,
or 3-4 vegetables servings in a day12.

Population surveys in Indonesia in 2013 suggest, however that consumption

of fruit and vegetables among age group > 10 year consume low vegetables (93,6%
in all population). Consumption of low vegetable intake around 2007 and 2013 not
increased significantly, however many provinces have a very high low vegetable
consumption rate, like Banten (94%)13.

To inform effort to promote increased vegetables intake, a large body of

research has been conducted in effort to understand the determinants of fruit and

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vegetable consumption14. The majority of that research has focus upon
understanding the psychosocial15 and sociodemographic correlates of fruit and
vegetable intake, such as knowledge, perceived benefits and barrier, self-efficacy,
sex and social status16-22. According to Social Cognitive Theory, psychosocial
factors might influence eating behaviour, as it has been theorized that cognitive
process plays an important role in acquisition and retention of new behaviour
patterns23. Psychosocial factors such as food knowledge have been found to be
associated with higher consumption24. However, other studies have not found
consistent association between these psychosocial factors and vegetable intake25,26.
Studies have investigated correlates of low vegetable intake in different populations
and identified several sociodemographic and behavioural factors such as place of
residence, socioeconomic status, educational attainment, occupational category,
household income along with non-modifiable factors such as age, gender and
ethnicity16-20.

To date, nutrition intervention aimed at promoting increased vegetables

consumption in Indonesia have not met with a success, because, there is no decrease
in low vegetable intake proportion. This is may be due, in part to a poor
understanding of the specific factor influencing the behaviours. Study to determine
factor associated with low vegetable intake behaviours is lacking in Indonesia, and
only within adolescent range21,22. A more thorough understanding of the
behavioural factors is likely to be part of practical significance, since it can be used
to guide intervention and other health promotion programs14. The aim of this paper
is to examine associations between knowledge and sociodemographic to vegetable
intake among selected family in Tegal Angus and Kresek Area, Tangerang, Banten
and can be used to guide health promotion programs.

Methods

This quantitative non-experiment, cross-sectional study, performed in Tegal

Angus and Kresek Area, Tangerang Regency, Banten, Indonesia in December
2018. This study population was composed of people in selected family whom
selected by local community health centre (puskesmas) composed by 176 people.

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The sampling techniques used in this study is total sampling, which include all
selected family members.

The vegetables knowledge questions were based on importance of eating

fruit and vegetables, importance of eating many nutrient in different type of
vegetables, beneficial compound in vegetables (vitamin, mineral and fibre), the
function of vegetables and effect on non-vegetable dietary. 5-6 correct question
categorized to good knowledge, 0-4 correct question categorized to bad knowledge.

The vegetables intake behaviour question were based on frequencies to eat

vegetables in last month (above once per day, once per day, one to five times per
week and less than two per month) and quantity of one servings (<3 average cup, 3
– 4 average cup and > 4 average cup). If frequencies > 1 servings a day and quantity
of one servings are 3-4 or more, the vegetables intake behaviour is good. If the
frequencies are below than 1 servings and quantity of servings is less than 3, the
vegetables intake behaviour is bad.

The sociodemographic characteristics information including gender (male

& female), age (0-5, 6-12, 13 – 18 and ≥ 19), occupational category (employed &
unemployed), educational category (low education for not entering school and
elementary school; high education for above junior high school) and income (below
regional minimum standard wage [UMR Rp 3.555.000,-], same as regional
standard, higher than regional standard)

Data was collected by deep interview and questionnaire. Interview

conducted by group of researchers assignment to subsequent area (Kresek and
Tegal Angus) and were trained before starting research activities. During visits to
village, potential participants were informed about the nature of the study and were
asked to participate. Completing the questionnaire took approximately 10 minutes.

All analysis were conducted using IBM SPSS statistical software package
25.0 (SPSS Inc., Chicago, IL, USA) and Microsoft Excel 2016 (Microsoft Inc,
Redmond, WA, USA). Descriptive statistics were used to summarize the
demographic and vegetable intake behaviour of the sample. Independent Chi-

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Square test and Fischer test were conducted to determine association between
knowledge of vegetables and participant’s sociodemographic factors to vegetable
intake behaviour.

Results

In Table 1, a total 176 participants from all selected family in Kresek and
Tegal Angus area were enrolled. Of these, none data were excluded due to lack of
information. 91 (51,7% ± 7,38) were women and 85 (48,3% ± 7,38) were men.
Adult (55,7% ± 7,34) were the majority of the participants. 106 (60,2% ± 7,23) of
them did not had education, did not finish elementary school and completed primary
school. 72 (40,9% ± 7,26) of them unemployed and only 12 (6,8% ± 3,72) had
income higher or same as regional standard.

Table I. Respondent Characteristics of the Study Participants

Variable Frequency Percentage
(n = 176)
Gender
Male 85 48,3
Female 91 51,7
Age (years)
Children (0-12 years) 41 23,3
Adolescent (13 – 18 years) 18 10,2
Adult (19 – 59 years) 98 55,7
Elderly (> 60 years) 19 10,8
Occupation
Unemployed 72 40,9
Student 24 13,6
Employee 14 8
Civil Servant 1 0,6
Entrepreneur 16 9,1
Service Provider 6 3,4
Farmer/Labourer 33 18,8
Other 10 5,7
Education
No Education 29 16,5
Elementary School (Not Finished) 38 21,6
Elementary School (Finished) 39 22,2
Junior High School (Not Finished) 9 5,1
Junior High School (Finished) 20 11,4

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Table I. (Continued)
Variable Frequency Percentage
(n = 176)
Education
Senior High School (Not Finished) 5 2,8
Senior High School (Finished) 36 20,5
University 0 0
Income
Below RMW 164 93,2
Same as RMW 9 5,1
Above RMW 3 1,7
RMW, Regional Minimal Wage [UMR]

Table 2 shows that 137 (79% ± 6,02) of vegetable knowledge in respondent

is bad. 125 (71% ± 6,7) respondents had a bad vegetable intake behaviour. The
majority of respondents eat vegetable above once per day (110, 62,5% ± 7,15), but
less than two average cup of vegetables per servings (88, 50% ± 7,39).

Table II. Respondent Vegetables Intake Characteristics

Frequency
Variable Percentage
(n = 176)
Vegetable knowledge
Good 37 21
Bad 139 79
Vegetable intake behaviour
Good 51 29
Bad 125 71
Frequency of vegetable servings per last month
Above once per day 110 62,5
Once per day 49 27,8
One to five times per week 11 6,3
Less than two per month 6 3,4
Quantity of vegetable per servings
Above than four average cup 27 15,3
Three to four average cup 61 34,7
Less than two average cup 88 50

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 The correlation between vegetable knowledge and respondent’s
sociodemographic characteristic to vegetable intake behaviour showed in Table 3.
There is no correlation between vegetables knowledge and behaviour (P > 0,05).
All respondent sociodemographic shows no correlation to vegetables intake
behaviour (P > 0,05). All odds ratio of variables (age, gender, education, occupation
and income) has no significant at all.

Table III. Adjusted OR (95% CI) for the likelihood of Vegetable Intake Behaviour
and Correlation Between sociodemographic and knowledge to vegetable intake
behaviour
Vegetable Intake Behaviour
OR
Variables Good Bad P-value
(95% CI)
n (%) n (%)
Knowledge
Good 16 (43,2) 21 (56,8) Ref. 0,051
Bad 35 (25,2) 104 (74,8) 2,2 (1,0 – 4,8)
Age
Infant & Children 19 (32,2) 40 (67,8) Ref. 0,621
Adolescent & Adult 32 (27,4) 85 (72,6) 1,2 (0,6 – 2,4)
Gender
Male 26 (30,6) 59 (69,4) Ref. 0,773
Female 25 (27,5) 66 (72,5) 1,1 (0,6 – 2,2)
Education
Low Education 30 (28,3) 76 (71,7) Ref. 0,942
High Education 21 (30) 49 (70) 0,9 (0,4 – 1,7)
Occupation
Unemployed 23 (31,9) 49 (39,2) Ref. 0,580
Employed 28 (26,9) 76 (73,1) 1,2 (0,6 – 2,4)
Income
Below RMW 47 (28,7) 117 (71,3) Ref. 0,988
Same/Above RMW 4 (33,3) 8 (66,7) 0,8 (0,2 – 2,7)
OR, Odds Ratio
RMW, Regional Minimal Wage [UMR]

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Discussion

In this study, the vegetable intake in this population was very low in both
frequency and quantity. Although people eat vegetables more than once in a day,
the daily quantity of vegetable is low. A greater frequency of vegetables
consumption was not a sign of health awareness among people; rather, poverty
makes preferred meat or fish unaffordable, and as a result, people tend to eat more
low-costly vegetables. The prevalence of inadequate vegetable intake in Indonesian
adults was very high (93,6%)13.This study finding is similar to that of the World
Health Survey 77,6% men and 78,4% women from 52 Low and Middle-Income
Countries (LMICs) consumed less than the minimum recommended 5 daily
servings of vegetables10. Indonesia was among the participating countries in the
survey during 2002-2004, and since then, the situation has not improving. Low
consumption of vegetables is not unique to Indonesian population, it is a Asian
phenomenon. Kanungsukkasem, et al27 reported inadequate consumption of
vegetables among Asian adults.

This study investigated the association of sociodemographic factor and

knowledge of vegetable with vegetable intake behaviour. This result shows no
correlation at all of factors above to vegetables intake. Published evidence suggests
that sociodemographic factors account for around 10% of the variation in FAV
consumption, and individual factors account for about 25%30. According to
Rasmussen et al26,28, there is no systematic difference between diet knowledge and
vegetable intake behaviours in many study. Another study also reported knowledge
associated with vegetable intake, but this was not the case in this study18,19. The OR
of knowledge shows some significant, but because the p-value shows no
correlation, the knowledge phenomenon maybe best explained by lack of
representative sampling of all populations.

There is no correlation between age and vegetable intake in this study. This
result consistent with Rasmussen, et al26,28. There is no systematic differences in
age groups or instrument used for measuring vegetable intake exist that identified
differences in vegetable consumption and those that did not. Ten papers found that

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fruit and vegetable consumption decreases with increasing age. In nine papers, no
effect of age was observed. This finding suggests that all age groups may eat the
same amounts of fruit and vegetables but that the younger age groups eat fruit and
vegetables more frequently than the older age groups or that there is an age related
response bias by assessment instrument used.

In this study, gender had no correlation for vegetable intake. This result not
consistent with that of another population-based study17. Researchers have
attributed phenomenon to women’s awareness and willingness to follow a healthy
diet, observing that women are significantly more likely than men to meet the target
for vegetable intake. Higher intake of vegetables in women may be related to the
dominant cultural concepts and their gender roles in the society17. This positive fact
for women is probably not a result of their preference but is culturally driven in
low- and middle-income families because women eat the leftovers, after the rest of
the family members have eaten. Mostly, little or none of the preferred meat or fish
is left for them. However, this may not be the case in this study.

As in previous studies29,30, higher levels of education were associated with

greater intake of fruits and vegetables. Education might influence the lifestyles
chosen as well as the awareness of several preventive measures in this population
group. Despite this, levels of consumption in the better educated group were still
low.

As in most population-based studies, income and education had a significant

effect on vegetables intake11,17. These two factors serve as a function of several
possible individual and social determinants. In a low-income population such as
that in Indonesia, cheap sources of energy such as grains, rice in particular, are used
as staple diet. Once basic energy needs are met, households start diversifying their
diets by including animal sourced foods, including dairy products, and only after
that, vegetables11. But this was not in case in this study, probably because sampling
method in this study not representable to all population and selected family used in
this study is not evenly distributable.

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 DiNoia, et al25 reported those best supported by evidence of vegetable intake
were race/ethnicity (with intake consistently higher among Hispanic as compared
with African American and white youth), fruit and vegetable preferences, and
maternal fruit and vegetable intake. For many potential determinants, the
consistency of evidence could not be examined because of a lack of studies.

One of the limitations of this study was not assessing sociodemographic

factor such as race/ethnicity25, environmental factors such as supply-side and
demand-driven factors, including availability, cost, and social networks, which may
act either as barriers or facilitators for access to vegetable intake. Different
psychosocial, cultural, and livelihood actors, such as food culture, dietary attitudes,
food habits, food belief, lifestyle choices, and cooking skills in different areas, can
also affect different levels of vegetable consumption11. Fruit and vegetable
preferences, maternal fruit and vegetable intake also not covered in this study30.
Another factor can influencing the behaviour not included in this study according
to Rasmussen, et al26,28 are sociodemographic factor (race/ethnicity, urbanization),
personal factors (preferences, attitudes, perceptions) and family related factor
(parental intake, home availability, parental style and parental support).

Conclusion

Many factor contributed to vegetable intake behaviour. This study shows no

correlation between vegetable knowledge and sociodemographic characteristics. To
vegetable intake behaviour. Bad vegetable intake behaviour can be explained by
another factor such as environment, personal factor, family factor and other factors.
Another study needed to explain another factor to help promote vegetable
consumption for better health in Indonesians.

Acknowledgements

The authors are grateful to local community health centre in Kresek and Tegal
Angus and also all selected family whom contributed to this study.

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