Identification of the Needs Couples Against Prenatal Class Program in Badung Regency

Background: Pregnancy causes changes in physical and psychological. Sometimes it causes a maturation crisis. The husband's support is expected to be optimal. So far, pregnancy education has focused on the mother, so the husband cannot carry out his role optimally. Objectives: This study aims to identify the information needs of couples about the materials, methods, media, repetitions, and duration of couple prenatal class in Badung Regency.


INTRODUCTION
Pregnancy causes changes in physical and psychological aspects so that sometimes it causes a maturation crisis (1) (2). If this can be overcome, the mother becomes ready to adapt to her role (2). Conversely, if it fails, it will harm the health of the mother and fetus. The fetus may experience developmental delays or emotional disturbances at birth (3). The physical and psychological qualities of a child are determined by the physical and psychological qualities of the mother during pregnancy (1). Psychological conditions such as anxiety and stress, which can continue after delivery, develop adverse reactions (3). This condition can be transmitted to the fetus through biochemical processes, so the baby will show symptoms of depression such as restless sleep and refusal to drink (1). Support from health workers and families, especially husbands, is needed. The husband, as the closest person, is expected to be able to work together to meet the needs of pregnant women and their fetuses so that pregnant women and their fetuses are prosperous. Husband's support is very important for pregnant women who experience anxiety. The husband's emotional support can cause feelings of pleasure in him (4).
Pregnancy education only focuses on increasing the mother's knowledge; the husband's involvement is still limited so that in his daily life, the husband is not able to optimally carry out his role (5). Couple Prenatal Class is an

MATERIALS AND METHODS
The design is a mixed-method sequential exploratory model. The first stage aims to help develop or inform the second (quantitative) method (6). Qualitative research respondents were couples who had a pregnancy checkup at a midwife's practice in the Kuta area. The research sample was 10 couples who were chosen randomly, until the data was saturated.  Table 1, it can be seen that the age of the respondents is mostly included in the category of healthy reproduction, namely the age of 20-35 years with a total of 85%. Most of the husbands are between 20-40 years, which is 92%. The characteristics of respondents in this study based on the number of pregnancies were mostly multigravida with a total of 54% and prigravida amounting to 42%. Table 2, the results show that the most needed pregnancy material is fetal stimulation with a brain booster, danger signs and complaints that often occur in pregnancy, and how to overcome them. Table 3, the results showed that the materials most needed about childbirth were pain management techniques, the husband's role, and early initiation of breastfeeding. Table 4, the study results show that the materials most needed in postpartum care are danger signs, breastfeeding problems, and ways to overcome and care for the postpartum period. Table 5, the results show that the most needed materials for newborn care are  bathing and caring for the umbilical cord, growth and development, and baby massage.

Based on
Based on Table 6, the identification of the needs of pregnant women and their husbands for health education media other than the KIA book, which is already owned by pregnant women, is measured by a questionnaire.
Based on Table 7, the results of the study showed that the most desirable health  Based on Table 8, the study results obtained data on the duration of health education  Based on Table 9, the study results showed that not all material presented in health education in the Couple Prenatal Class had to be given repeatedly.

DISCUSSION
The results showed the identification of the needs of pregnant women and their husbands for pregnancy health education materials in the couple prenatal class identified by questionnaires using a Likert scale obtained from the maximum score on each question about pregnancy material, and it was found that the material most needed was stimulation of the fetus in the womb with brain booster, danger signs in pregnancy and complaints that often occur in pregnancy and how to overcome them. Brain booster is an evidence-based obstetric service that has positive benefits for fetal brain development. Brain booster is a fetal stimulation and nutritional fulfillment to increase the potential of fetal intelligence (12). Provision of stimulation and proper nutrition is expected to increase the potential for intelligence in children (12).
Children's intelligence is influenced by 3 things, namely genetics, nutrition and environmental factors. The fulfillment of brain lever nutrition must be synergized with the provision of stimulation so that the results are optimal (13).
Stimulation is done by inviting talking, chatting, singing songs, and reading prayers and religious songs while stroking the mother's belly (13). The fetus can hear the mother's voice since 18 weeks of gestation (14). Experimental research with experimental animals, found the effectiveness of sound stimulation with music affects increasing brain cell proliferation (14). Giving a brain booster to pregnant mice with the music of Al-Quran Murrotal surah Ar-Rahman during pregnancy on days 6-17, stimulated several cerebrum and cerebellar neurons of newborn mice (15). The earlier the health education is known by pregnant women and husbands, it will also be done earlier.  (18) is important to be given clearly and completely.
The third most needed material is physiological complaints of pregnancy and how to overcome them. Couples should be given health education about the occurrence of and adrenaline to be released into the blood circulation (19). Yoga can increase a sense of well-being in body and mind (20). A quasiexperimental non-equivalent control group for pregnant women in the third trimester who did prenatal yoga, found a significant difference in the complaints of pregnant women before and after prenatal yoga with = 0.000 (19). Research on the role of husbands in childbirth and postpartum care, data obtained husbands play a passive role, meaning that the husband's role is not optimally carried out due to a lack of understanding of his role (21). Labor pain, if not handled properly, causes worry, tension, fear, and stress so that it impacts the occurrence of prolonged labor (22). This causes discomfort, causing trauma. Reviewing articles on pain in a normal delivery, data showed that most mothers had a negative impression of labor pain (23). Support can be done by massage, providing a comfortable position, relaxation, touch, visualization, and counterpressure (22).

The next material respondents need is
Early Initiation of Breastfeeding (IMD). Evidence-based, the program benefits both mother and baby. In a systematic review, it was found that the delay in doing IMD in the first 1 hour after the baby's birth increases the risk of death in the baby (24). This is positively correlated with the benefits obtained by the mother, namely, stimulating the hormone oxytocin (24). Most The dangerous signs of postpartum that must be understood by mothers and husbands include bleeding, fever for more than two days, smelly discharge from the birth canal, swelling of the face, hands, and feet or headache accompanied by seizures, the mother looks sad, moody and cries for no reason. depression) and breast swelling, redness, and pain (18). This is at risk of an emergency, so the knowledge and ability to perform early detection must be optimal. The second material for health education that is much needed by couples is the problem of breastfeeding and how to overcome it. A cross-sectional study found postpartum problems, including symptoms of depression, lactation problems, sexual intercourse after childbirth, and urinary incontinence. The problem was detected within six weeks after delivery (26).
Breastfeeding problems are at risk of causing anxiety in the mother and the failure of exclusive breastfeeding. Anxiety includes a lack of self-confidence, and stress affects the relationship between mother and baby and inhibits the release of the hormone oxytocin so that it has an impact on the breastfeeding process (27). The third material for health education during the puerperium that is needed In the health education process, the media is one of the most critical components so that the delivery of information can be well received.
Media are all forms and channels used to distribute information (31). Learning media by learning activities will create an effective and efficient learning activity so that the material presented can be absorbed optimally (31). The use of technology can improve the learning process if used correctly, and in health education, technology that is commonly used videos, power points, or information in the form of health articles presented on the web (32).
Media is the most important component to deliver information that can be received well. Media are all forms and channels used to distribute information (31). Media that is by learning activities will create effective and efficient learning so that the material presented can be absorbed optimally (31). The use of technology can improve the learning process if used properly; commonly used media include videos, power points, or health articles on the web (32). Video can be used in various ways online, offline, and blended learning. Instructors must consider several elements, including managing cognitive function so that information is conveyed properly, maximizing the active role of participants, and effectively promoting interesting and useful educational media (33). Media helps clients understand and capture the information contained in the message conveyed (34). Video is easily accessible, effective, and efficient, so it is widely used as a means of health promotion and education (34).
The media needs that respondents want other than the MCH Handbook are interactive learning media. Research on the implementation of learning media found that the use of interactive learning media (audiovisual) was more effective in improving learning outcomes than print media (35).
The results of another study using a scoping review approach (34) concluded that video in providing education was proven to significantly increase patient knowledge in various age groups and disease groups. Another advantage is the presence of audio, making it easier to understand the information provided (34). The effectiveness of the video can also be seen from the length of information that can survive in memory so that when recalled, the group with 3D media is better able to remember more information than the 2D group (34). This is considered efficient and practical, easy to understand, and can be broadcast repeatedly so that it is effective in changing the views of the target to be intervened (36). Video media rely on hearing and sight from the target, where the use of audiovisual involves all senses, so the more senses are involved in receiving and processing information, the more likely the information content can be understood and retained in memory, and with the effect of moving images and images. Sound effects can make it easier for the audience to understand the content of the news so that it can increase knowledge (36) (37).
The "cone of experience" theory proposed by Edgar Dale (1946) states that it can be concluded that a person's memory can receive better when utilizing more than one sense when receiving health education (38). The results of experimental research on health education related to maternal health literacy who were given health education using audiovisual with video were higher than using visual media such as brochures (39).  (41). Health education, by using strategies based on client needs, aims to make changes in health behavior, prepares for client acceptance of information, and increases the client's ability to access needed information (42). His learning includes all aspects of the learning experience adults need; the process provides knowledge and is equipped with skills.
Psychologically, knowing the client's needs in educational activities, it is easy to determine the learning conditions that must be created, what content of the material should be given, what strategies, techniques and methods are suitable for use (41). Determination of the method considers aspects of the objectives to be achieved.
The outline of the adult learning program is divided into two types, namely: 1) Process design to encourage adults to be able to organize and fill in new experiences by referring to the past that has been experienced, for example, skills training, discussion, question and answer, sensitivity training and others so that they can provide new insights for each individual to be able to take advantage of what is already known. The implementation of health education is based on adult learning; the learning time is "not long" because one of the characteristics of the learning is that more/dominant is a place to share or justify or clarify experiences or increase knowledge, skills, and attitudes or values (43). The weakness of using video as a medium is that it is possible for students not to get any information by the learning objectives because they do not listen well to the information content presented. A good instructor must ensure that information is presented concisely and clearly in making educational videos. The duration of the delivery of information in the video is expected to be short (33).
The main thing about using video as a medium is to ensure that the duration of the video is not long so that it does not cause boredom, decreased concentration, difficulty capturing the message conveyed (33). The average effective duration is about 6 minutes, and when the viewing duration is added according to the intervention, it is found that it causes a decrease in the concentration of the receiver (33). Another thing that influences the use of video is language style. The use of a more familiar language is more attractive to the message recipient to watch the video. The narrator should convey the information in the video in an attractive, enthusiastic style, with the right intonation, and stimulate the activity of the recipient of the message (33).
One of the advantages of using interactive learning media in videos for skills material is the ease in the learning process. Pregnant women and husbands can repeatedly study the material/topics given independently at home. This will greatly affect the achievement of the expected health education goals. Repetition and reinforcement have been shown to play a role in changing health behavior. These two things are important in the clarity of the learning objectives and the active involvement of the recipients of health information/education. They support each other. Reinforcement of information increases the likelihood that something new in the form of informed health behavior will be repeated in the future, while repetition causes the health behavior to be more attached to be adopted (44).
Repetition is done by repeatedly providing health education, ensuring that the recipient understands the information provided. The repetitions can be done continuously in successive times, or the repetitions can be done not in successive times (44).

CONCLUSIONS AND RECOMMENDATION
Based on the study results, it was found