Comprehensive Child and Adolescent Nursing ISSN: 2469-4193 (Print) 2469-4207 (Online) Journal homepage: https://www.tandfonline.com/loi/icpn21 Improving Food Safety Behavior through Mind Map Methods in School-Age Children Achiroh Dinul Islam Meivi Sesanelvira, Sigit Mulyono & Sukihananto To cite this article: Achiroh Dinul Islam Meivi Sesanelvira, Sigit Mulyono & Sukihananto (2019) Improving Food Safety Behavior through Mind Map Methods in School-Age Children, Comprehensive Child and Adolescent Nursing, 42:sup1, 97-107, DOI: 10.1080/24694193.2019.1578301 To link to this article: https://doi.org/10.1080/24694193.2019.1578301 Published online: 13 Jun 2019. Submit your article to this journal Article views: 6 View Crossmark data Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=icpn21 COMPREHENSIVE CHILD AND ADOLESCENT NURSING 2019, VOL. 42, NO. S1, 97–107 https://doi.org/10.1080/24694193.2019.1578301 Improving Food Safety Behavior through Mind Map Methods in School-Age Children Achiroh Dinul Islam Meivi Sesanelviraa, Sigit Mulyono b , and Sukihananto b a Institute of Health Science Achmad Yani Cimahi, Indonesia; bFaculty of Nursing, Universitas Indonesia, Depok, Indonesia ABSTRACT ARTICLE HISTORY School-age children who do not practice safe food behavior are at risk of experiencing health problems. The aim of the study was to determine the effect of education with mind map methods on safe food behavior in school-age children. The study design was a quasi-experimental with pre- and posttests design, involving 88 school-age children, and each group consisted of 44 respondents who were divided into intervention group and control group. Multistage random sampling was used to determine the research area and school where the research was conducted, while the research subject was selected using simple random sampling. Measuring instruments used questionnaires from previous researchers regarding food safety behavior in school-age children. The results showed that the mind map method significantly affects knowledge (p-value = 0.000), attitude (p-value = 0.000), and skill (p-value = 0.000) for safe food. This study recommends that the mind map method be applied in an effort to improve clean and healthy living behavior in school-age children. Received 30 November 2018 Accepted 21 January 2019 KEYWORDS Food safety behavior; school age children; mind map method Introduction School-age children are children between the ages of 6 and 12 (Allender, Rector, & Warner, 2014). The school-age times are a time to develop knowledge, establish a healthy lifestyle, and develop physical skills (Gunarsa, 2008). Risk factors that affect children’s health consist of biological factors, physical and social environmental factors, and behavioral factors (Allender et al., 2014). School-age children are at risk of problems related to clean and healthy behavior (Stanhope & Lancanster, 2016). School-age children must be healthy to improve their physical growth and cognitive development (Gunarsa, 2008). Safe and nutritious food in sufficient quantities is the key to maintaining a healthy lifestyle (WHO, 2017). Food safety means a healthy balanced diet of food with nutritional content that is safe from contaminating microorganisms and harmful CONTACT Sigit Mulyono sigit@ui.ac.id Faculty of Nursing, Universitas Indonesia, Depok, West Javam, Indonesia Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/icpn. © 2019 Taylor & Francis Group, LLC 98 A. D. I. MEIVI SESANELVIRA ET AL. chemicals that can cause disease (Gross & Kahan, 2016). Food safety is needed during the process of selecting, processing, storing, and serving food so that the food will be nutritious and disease-free, thus safe for consumption (Joint FAO/WHO Expert Committe of Food Safety, 2002). In 2015, Africa had the highest rate of food poisoning in the world with casualties as many as 91 million people per year, and the death rate reached 137,000 people (Badan POM, 2016). In 2016, food poisoning in Indonesia based on the cause group ranged from 3,000 cases, which consisted of 2,733 cases of food poisoning due to food, 1,068 cases of food, due to 1,259 cases of drinkings, as many as 792 cases of chemical exposure and as many as 771 cases from the effects of pesticides (Badan POM, 2016). West Java Province experienced the highest food poisoning compared to other provinces with the incidence of food poisoning in the period April–June 2017 with a total of 1,498 victims with 8 deaths, 19.35% (Badan POM, 2017). Based on the distribution of street food examination results in 60 schools in Karawang regency in 2016, the results of examination were 33.34% positive foods containing harmful chemicals such as rhodamine B (22.2%), borax (4.3%), and formalin (6.84). Types of snacks that contain rhodamin B include destitute crackers, Chinese girlfriends, bowl cakes, and layer cakes, while types of snacks that contain borax are gendar crackers, and types of foods containing formaldehyde include meatballs, sausages, fried tofu, cilok, scallops, cireng fill, and nugget (Dinas Kesehatan Kabupaten Karawang, 2016). The government makes promotive and preventive efforts through health education regarding food safety. An effective health education program to improve children’s knowledge about the characteristics of microorganisms and food contamination, and personal hygiene behavior (Losasso et al., 2014) was organized. Health education for school-age children in China regarding balanced nutrition and safe snacks can change children’s behavior in consuming nutritious and safe food (Zhou et al., 2016). Health education methods are not adjusted to the growth and development of school-age children. The method of health education is usually carried out on school-age children through the lecture method. School-age children need an interesting health education method in accordance with the child’s growth and development such as mind map method. Mind map is a way of describing the whole brain in a graphic infrastructure to inform good health behavior (De Poter & Hernacki, 2013). Mind map helps children to solve problems, brainstorm creative ideas, remember, make notes, and improve reading skills (Buran & Filyukov, 2015). Mind map helps students to be honest, be creative, think critically, be responsible, and be respectful to others (Tenriawaru, 2014). Children COMPREHENSIVE CHILD AND ADOLESCENT NURSING 99 can have skills in describing an information message that is obtained in the description of the sentence and is able to explain the contents of the learning information message (Naqbi, 2011). Mind map makes children think rationally, solve problems, think creatively, plan effectively, and manage success (Lupu, 2013). Writing uses the mind map method, then all information that will be released from the brain will be easily removed so that it becomes a complete text or book (Windura, 2016). Educational methods using mind map make children think rationally, solve problems, become imaginative, and have good planning. Learning methods using mind map work according to the natural way of working of the human brain (Windura, 2016). The work of the mind map image shows the working element between the left brain and right brain which are actively and concurrently involved (Windura, 2013). The mind map method can increase children’s knowledge in consuming fruits and vegetables with 300% increase in knowledge (Isna & Fitriana, 2016). Mind map can develop creative abilities and interactive and dynamic learning in increasing knowledge and skills in school-age children (Mar, Hasanah, & Saraswati, 2014). Discussion map is a development in modifying the mind map method in the form of pictorial map, and the results of the study explain that discussion map can change food safety behavior (Gold, Yu, Buro, & Garden-Robinson, 2014). Picture and word media on the mind map can stimulate children to know the form of words and images so that they can form skills in speaking to children (Asril, Hendrayani, & Wirya 2015). The use of images can support health education aimed at improving the risk of food safety in school children snacks (Faccio et al., 2017). Methods Design This study incorporated a quasi-experimental design with pre- and posttests using the control group method. The design of this study was to measure the effect of mind map interventions on improving food safety behavior in school-age children. Population and study setting The total number of respondents was 88, and each intervention group and control group consist of 44 respondents. Multistage random sampling was used to determine the area and school where the research was conducted, while the subject of the study was determined using simple random sampling. SD Negeri 1 Kutapohaci was selected to be the intervention group, while SD Negeri 2 Mulyasi was selected to be the control group. 100 A. D. I. MEIVI SESANELVIRA ET AL. Variables The data collection tool used in this study is a questionnaire based on the guideline of previous research (Mulyono 2015) regarding food safety behavior in school-age children. The results of the validity and reliability test show that the instrument is valid and reliable as a measure of food safety behavior, with 14 questions of knowledge variables (r > 0.361; Cronbach’s alpha = 0.872), 8 questions of attitude variables (r > 0.361; Cronbach’s alpha = 0.837), and 10 questions of skill variables (r > 0.361; Cronbach’s alpha = 0.862). Procedure Research on this intervention was conducted six times over 3 weeks, with a frequency of two periods every week and a duration of 60 min. The initial measurement was carried out before the mind map method was intervention, and the final measurement was taken after a 1-week internalization phase. The researchers provide health counseling about food safety in the control group as much as one time after final measurements (Figure 1). Data analysis Bivariate analysis was conducted to measure the effect of education with mind map methods on behavior change (knowledge, attitudes, and skills) regarding food safety in school-age children. The bivariate test used was the paired t-test, the mean differences in the measurement results before and after the intervention in the same group, and the pooled t-test was used to find the difference in mean measurement results after intergroup intervention (intervention and control). Ethical aspects This study applies ethics in research to each respondent are benefit (benefit), respect for human dignity (respect for persons), non-harm (non-maleficence), and justice (justice). It has been approved by the Faculty of Nursing Ethics Committee. The results passed an ethical test by the Ethics Committee issued on May 28, 2018, with letter 243/UN2.F12.D/HKP.02.04/ 2018. Results The results of the analysis of frequency distribution and percentage of data are based on the characteristics of respondents including based on age level—the majority of respondents aged >10 years (90.9%), more than half of respondents with female gender (56.8%), more than half of respondents sometimes have breakfast habits (61.4%), almost half of the respondents never brought food to school (43.2%), and more than half of COMPREHENSIVE CHILD AND ADOLESCENT NURSING Stages 1 101 Aim Explanation Apersepsi Time : 10 minutes Ice breaking Stages 2 Read booklet Provide A3 paper, pens, markers, colored pencils and picture paper Time : 15 minute concurrently when the child reads the booklet Explain the mind map technique Make a mind map Mentoring and direction Decide ona theme → look for branch topics → look for relationships between branch topics Session 1 : balanced nutrition material Time : 20 minutes Session2 : food safety material Stages 3 Evaluate the results of the mind map picture Time : 10 minutes Figure 1. Stages of educational implementation with mind map method. the respondents had a low amount of pocket money (54.5%) which is ≤ Rp. 5,000/day. Based on the work of parents, the majority of fathers work (88.6%) and more than half of mothers do not work (68.2%) with the average amount of income each month mostly < UMR (65.9%). The results of analysis on the knowledge, attitude, and skills variables show significant differences before and after education using the mind map method. In the control group, there was no significant difference in the mean value of the knowledge, attitude, and skills variables (Table 1). The results of the analysis showed differences that there was a significant effect in the knowledge, attitude, and skills variables between the intervention group and the control group after intervention in the treatment group (Table 2). 102 A. D. I. MEIVI SESANELVIRA ET AL. Table 1. Results of the paired t-test of knowledge, attitude, and skill variables on school-age children in the Karawang regency in 2018 (n = 88). Intervention group After Mean SD 13.39 1.528 37.59 1.716 9.2 0.93 Control Group After Mean SD 6.57 1.822 25.2 1.912 4.95 1.478 Before Variable Knowledge Attitude Skills Mean 7.77 27.32 5.64 Variable Knowledge Attitude Skills Mean 7.52 26.34 5.55 SD 1.764 2.457 1.526 Before SD 1.517 2.542 1.454 Differentiate in mean 5.614 10.273 3.568 p-Value 0.000 0.000 0.000 Differentiate in mean −0.955 −1.136 −0.591 p-Value 0.019 0.016 0.072 Table 2. Results of the pooled t-test of knowledge, attitude, and skill variables on school-age children in the Karawang regency in 2018 (n = 88). Variable Knowledge Attitude Skills Group Intervention Control Intervention Control Intervention Control Mean 13.39 6.57 37.59 25.2 9.2 4.95 Differentiate in mean 5.614 −0.955 10.273 −1.136 3.568 −0.591 95% CI 6.105–7.531 p-Value 0.000 11.616–13.156 0.000 3.727–4.773 0.000 Discussion Educational methods using mind map can be done on school-age children in grade V. It can be seen from the results of the mind map drawing made by Class V children according to the technique of making a mind map. Learning methods with mind map can have a positive influence in increasing learning motivation of fifth-grade students of Margoyasan Elementary School Yogyakarta (Handoko, 2015). Mind map can improve the learning outcomes of fifth-grade elementary school students (Hikmawati & Suprayitno, 2013). The average score on the knowledge variable has increased significantly between before and after education with the mind map method in the intervention group. A significant increase in knowledge in the intervention group is influenced by educational methods with the mind map method. A statement that shows an increase in scores on knowledge variables including four pillars of balanced nutrition, types of foods that contain biological, physical, and chemical hazards, processing in the use of cooking utensils, serving food. Education through the mind map method is effective to increase self-awareness of school-age children toward clean and healthy behavior. The mind map method iss an alternative in improving children’s cognitive ability to food safety behavior. COMPREHENSIVE CHILD AND ADOLESCENT NURSING 103 The mind map method in accordance with the way the brain works naturally can improve a child’s cognitive abilities. Mind map can develop children’s cognitive abilities in designing ideas in learning. Mind map can improve children’s memory, because creating a mind map image involves a unique combination of imagination, color, and visualization that can remember longer than the usual method of recording and learning by memorization (Windura, 2016). The educational method with lectures has the disadvantage of learning that is tedious and easily sleepy, there is an element of compulsion to listen, evaluation of the learning process is difficult to control, and the learning process focuses on words only, so that children cannot receive information messages as a whole (Simamora, 2009). But the educational method with mind map can make children focus on concentrating so that children can absorb learning material well compared to children who only listen. The mind map method can be used in all fields and can help children to think (Dodd, 2014). The mind map method makes children think rationally, solve problems, become imaginative, plan effectively, and manage successfully (Lupu, 2013). Writing uses mind map method, so all information that will be released from the brain will be easily removed so that it becomes a complete text or book (Windura, 2013). The mind map method can increase the motivation and learning outcomes of children to increase children’s knowledge in receiving learning material (Nurbaiti, 2016). Learning activities are needed in the teaching and learning process (Oemar, 2013). The existence of learning activities can develop children’s understanding and critical thinking. The making of mind map can make the child’s focus to concentrate, so that the child will focus on the information message. Learning by using mind map will make children have positive thoughts in remembering information (Herdin, 2017). Researchers using media in the form of colors and images will naturally be able to help the work of the right brain, the use of images and colors when creating images of mind map can help memory of information. The results of the analysis on the attitude variables show significant changes in attitude between before and after the education method with mind map in the intervention group. Attitude is a reaction or response that is still closed from someone to a stimulation or an object (Notoatmodjo, 2010). A statement of increasing scores on attitude variables including diverse foods, handwashing, physical activity, avoiding biological and chemical hazards in food, serving food, and food packaging. A meaningful change in attitude can occur because the mind map method is used as education can improve children’s cognitive abilities so that it stimulates the child’s response to the stimulus to do a positive attitude toward food safety. When an individual is willing to accept influence from other people or from other groups, he or she hopes to get a positive reaction or response from the other party. Willingness to accept the influence of other parties usually does not come from a person’s small heart, but rather a way to just get a positive reaction, such as praise, support, sympathy, and the like while avoiding things that are considered positive (Azwar, 2009). If the influence of 104 A. D. I. MEIVI SESANELVIRA ET AL. positive attitudes is obtained from the increased knowledge of the child’s knowledge after being given education with a mind map, then the child will positively assume the response to healthy behavior toward food safety. The results of the analysis on the skill variables show significant changes between before and after education with a mind map method. Skills are the actions of students towards the educational method provided. Actions will be positive if supported by knowledge (Notoatmodjo, 2010). Significant increase in knowledge of food safetys that can support children’s skills in choosing food safety. Statements that increase scores on skill variables include skill in choosing foods that contain balanced nutrition, safe from food hazards, and skill in choosing, processing, and serving food safety. The use of images can support health education aimed at improving the risk of food safety in schoolchildren snacks (Faccio et al., 2017). The use of food menu images on the mind map media can change the child’s perception and behavior to consume fish. Children can distinguish healthy and unhealthy food for consumption, so that children have a perception that fish is a healthy food for consumption. Changes in perception in the child can stimulate the child to behave to eat fish, children who previously did not like fish can like fish to eat as a healthy food menu (Mitterer Daltoé et al., 2017). Mind map can develop creative abilities and interactive and dynamic learning in improving knowledge and skill in school-age children (Mar et al., 2014). Mind map can improve speaking skill in children after applying the playing method using mind map (Asril et al., 2015) Figure 2 shows the results of the mind map Figure 2. The results of mind map images of fifth-grade students. COMPREHENSIVE CHILD AND ADOLESCENT NURSING 105 drawing of school-age children after education was carried out using the mind map method. Conclusion Health education with mind map method can improve food safety behavior in school-age children. Health education method with mind map is in accordance with the stages of development of school-age children. The mind map method is a learning concept that can accelerate the process of behavior change, which can help improve the cognitive abilities of school-age children. The mind map method is a nursing intervention in conducting health education for school-age children. The mind map method can be integrated into the school’s learning curriculum and the School Health Unit (UKS) program activities as a health promotion program for food safety behavior. Subsequent research must be carried out to identify health education method by involving parents, teachers, and peers. In addition, the mind map method can be applied to other health themes, such as the prevention of helminthiasis, diarrhea, dental, and oral health. Acknowledgments The authors acknowledge all parties who supported this research, especially Hibah PITTA 2018, the Directorate of Research and Community Service (DRPM) Universitas Indonesia, and the students of SDNegeri Kutapohaci 1 and SDNegeri Mulyasari 1 District Ciampel, Regency Karawang, who participated in the study as research respondents. Funding This work was supported by Hibah PITTA 2018 and funded by the Directorate of Research and Community Service (DRPM) Universitas Indonesia No.1858/UN2.R3.1/HKP.05.00/2018. ORCID Sigit Mulyono http://orcid.org/0000-0002-4665-0047 Sukihananto http://orcid.org/0000-0003-4813-8538 References Allender, J. A., Rector, C., & Warner, K. D. (2014). Community & public health nursing promoting the public’s health (8th ed). Philadelphia, PA: Lippincott Williams & Wilkins. Asril, N. M., Hendrayani, C. I. D., & Wirya, I. N. (2015). Penerapan Metode Bermain Dengan Media Mind Map, 3 Azwar, S. (2009). Sikap Manusia Teori dan Pengetahuan Edisi 2. Yogyakarta, Indonesia: Pustaka Pelajar. 106 A. D. I. MEIVI SESANELVIRA ET AL. Badan POM. (2016). Keracunan Makanan. Jakarta, Indonesia: Author. Retrieved from http://ik. pom.go.id/berita-keracunan Badan POM. (2017). Keracunan Makanan. Jakarta, Indonesia: Author. Retrieved from http:// ik.pom.go.id/berita-keracunan/berita-keracunan-bulan-april-juli-2017 Buran, A., & Filyukov, A. (2015). Mind mapping technique in language learning. Procedia Social and Behavioral Sciences, 206(November), 215–218. doi:10.1016/j.sbspro.2015.10.010 De Poter, B., & Hernacki, M. (2013). Quantum Learning “Membiasakan Belajar Nyaman dan Menyenangkan”. Bandung, Indonesia: PT Mizan Pustaka. Dinas Kesehatan Kabupaten Karawang. (2016). Hasil Pemantauan Jajanan Anak Usia Sekolah. Karawang, Indonesia: Author. Dodd, L. (2014). Learning to think: Thinking to learn. Retrieved from http://www.lancsngfl.ac. uk/nationalstrategy/literacy/files/TheBrainandLearning.pdf Faccio, E., Costa, N., Losasso, C., Barrucci, F., Mantovani, C., Cibin, V., … Ricci, A. (2017). Drawing instead of answering to evaluate the effectiveness of food safety programmes in primary school. Health Education Journal, 76(1), 15–28. doi:10.1177/0017896916643102 Gold, A., Yu, N., Buro, B., & Garden-Robinson, J. (2014). Discussion map and cooking classes: Testing the effectiveness of teaching food safety to immigrants and refugees. Journal of Nutrition Education and Behavior, 46(6), 547–553. doi:10.1016/j.jneb.2013.11.014 Gross, C., & Kahan. (2016). Survey of parents, nurses, and school principals on their perceptions of the controversial rol of schools in health promotion. Pediatrics International, 48(1), 44–47. doi:10.1111/j.1442-200X.2006.02168.x Gunarsa, S. D. (2008). Psikologi Anak : Psikologi Perkembangan Anak dan Remaja. Jakarta, Indonesia: PT BPK Gunung Mulia. Handoko, P. S. (2015). Pengaruh Penggunaan Mind Map Terhadap Hasil Belajar Ips Kelas V Sd Negeri Margoyasan Yogyakarta. Yogyakarta, Indonesia: Universitas Negri Yogyakarta. Herdin. (2017). Tujuh Rahasia Mind Map, Membuat Anak Genius. Jakarta, Indonesia: PT. Elex Media Komputindo - Gramedia. Hikmawati, C. R., & Suprayitno,. (2013). Penerapan Strategi Mind Map Untuk Peningkatan Hasil Belajar Siswa. Jakarta, Indonesia. Isna, P., & Fitriana, N. (2016, February 1–8). Penerapan metode mind mapping pada mata Pelajaran. The Implementation of mind mapping method on the craft subject to increase knowledge of fruit and vegetable consumption on. Yogyakarta, Indonesia. Joint FAO/WHO Expert Committe of Food Safety. (2002). Pan–European conference on food safety and quality (Final Report). Rome: FAO & WHO. Kementrian Kesehatan RI. (2014). Pedoman Gizi Seimbang. Jakarta, Indonesia. Losasso, C., Cappa, V., Cibin, V., Mantovani, C., Costa, N., Faccio, E., … Ricci, A. (2014). Food safety and hygiene lessons in the primary school: Implications for risk reduction. Lupu, N. (2013). 4 fun and creative mind map to develop kids’ multiple intelligences. Retrieved from http://elearningindustry.com/4-fun-and-creative-mind-map-to-develop-kidsmultiple-intelligences Mar, A., Hasanah, A., & Saraswati, S. (2014). Indonesian journal of guidance and counseling : Theory and application. Indonesian Journal of Guidance and Counseling: Theory and Application, 3(4), 39–46. Mitterer Daltoé, M. L., Breda, L. S., Belusso, A. C., Nogueira, B. A., Rodrigues, D. P., Fiszman, S., & Varela, P. (2017). Projective mapping with food stickers: A good tool for better understanding perception of fish in children of different ages. Food Quality and Preference, 57, 87–96. doi:10.1016/j.foodqual.2016.12.003 Mulyono, S. (2015, June 4–5). Pengembangan model kolaborasi guru, siswa, dan keluarga (Kogusiga) sebagai asuhan keperawatan kesehatan sekolah untuk meningkatkan keamanan COMPREHENSIVE CHILD AND ADOLESCENT NURSING 107 makanan anak Sekolah Dasar di Kota Depok. Collaboration model development for teacher, student, and family a. Indonesia. Naqbi, S. A. (2011). The use of mind mapping to develop writing skills in UAE schools. Education, Business and Society: Contemporary Middle Eastern Issues, 4, 120–133. doi:10.1108/17537981111143855 Notoatmodjo, S. (2010). Promosi Kesehatan dan Ilmu Perilaku. Jakarta, Indonesia: Rineka Cipta. Nurbaiti, T. (2016). Penerapan Metode Mind Mapping Untuk Meningkatkan Motivasi dan Hasil Belajar PKN Siswa Kelas IVB SD Negeri 10 Metro Timur. Oemar, H. (2013). Proses Belajar Mengajar. Jakarta, Indonesia: PT. Bumi Aksara. Simamora, R. H. (2009). Buku Ajar Pendidikan Dalam Keperawatan. Jakarta, Indonesia: EGC. Stanhope, M., & Lancanster, J. (2016). Community health nursing (4th ed.). St. Louis, MO: Mosby Year Book. Tenriawaru, E. P. (2014). Implementasi Mind Map Dalam Kegiatan Pembelajaran Dan Pengaruhnya Terhadap Pendidikan Karakter. Prosiding Seminar Nasional, 1(1), 85–91. WHO. (2017). Food safety. Retrieved from http://www.who.int/entity/foodsafety/databases/en/ Windura, S. (2013). Mind Map untuk Siswa, Guru, dan Orang Tua. Jakarta, Indonesia: PT Elex Media Komputindo – Gramedia. Windura, S. (2016). Mind map, langkah demi Langkah. Jakarta, Indonesia: PT. Elex Media Komputindo – Gramedia. Zhou, W., Xu, X., Li, G., Sharma, M., Qie, Y.-L., & Zhao, Y. (2016). Effectiveness of a school-based nutrition and food safety education program among primary and junior high school students in Chongqing, China. Global Health Promotion, 23(1), 37–49. doi:10.1177/1757975914552914