RELATIONSHIP OF KNOWLEDGE, ATTITUDE, AND PERCEPTION OF DISEASE WITH THE UTILIZATION OF HEALTH SERVICES FOR NON- CONVERTIVE DISEASES IN RSUD

Currently, the health challenge in Indonesia is the epidemiological transition, which is known as three disease burdens, namely the high prevalence of infectious diseases, the increase in non-communicable diseases and diseases that should have been resolved before but have re-emerged. Non-communicable diseases require more attention, as the productive age increases in Indonesia, several factors such as lifestyle, diet, and others make non-communicable diseases increase, so health needs to receive attention in increasing the degree of public health, one of which is health services. This study aims to determine the relationship between knowledge, attitudes, and perceptions of pain with the utilization of health services for patients with noncommunicable diseases at Regional General Hospital (RSUD) Haji Makassar. This research is a quantitative study with an observational approach using a cross sectional design. The population in this study were 1037 patients with non-communicable diseases at Haji Makassar Hospital. The sample selection used accidental sampling technique, in order to obtain a sample of 87 people. Data analysis used univariate and bivariate analysis. The results of this study indicate that knowledge of non-communicable diseases (ρ = 0.000), attitude of officers (ρ = 0.100), and perception of pain (ρ = 0.016). Suggestions to the hospital to make improvements regarding the condition of the hospital, the availability of facilities, types, or variations of health services that are more complete. Doctors, nurses or officers give more special attention to the patient's condition when providing services and further explain the patient's health condition.


INTRODUCTION
Currently, the health challenge in Indonesia is the epidemiological transition known as Triple Burden Disease or three disease burdens, namely high infectious diseases (infectious diseases), increasing non-communicable diseases and diseases that should have been resolved before but have reappeared. Global data from Burden of Disease 2010 explains that the first rank that causes death is Non-Communicable Diseases, namely Stroke, several years ago, Non-Communicable Diseases were the most common disease in health services. [1] The 2018 Riskesdas data shows that the rate of asthma at the age of 65-74 years is 72.3% in rural areas as much as 61.9% and in urban areas as much as 54.5%, while for stroke disease at the age of 75 years and over it is 50.2. % in urban areas as much as 12.6% and in rural areas as much as 8.8%. Meanwhile, other non-communicable diseases which were quite high were hypertension (69.5%), diabetes mellitus (6.3%), heart disease (4.3%), and cancer (4.62%).
Non-Communicable Diseases (PTM) require more attention, because as the productive age increases in Indonesia, several factors such as a healthy lifestyle, diet and so on make non-communicable diseases increase from time to time. [1] Health needs attention in improving the public health status, one of which is health services. Individual health service facilities and a part of health resources are hospitals which are indispensable in supporting the implementation of health efforts. Hospital is a health service institution that provides complete individual health services that provide inpatient, outpatient and emergency services. [2] Hospitals in carrying out their roles cannot be separated from problems, one of the problems in the hospital is the low level of efficiency of several hospitals in Indonesia. Hospital efficiency is an indicator of hospital performance, and the Bed Occupancy Rate (BOR) is an indicator of the level of hospital efficiency. [3] One of the hospitals that have a low level of efficiency is the Regional General Hospital (RSUD) Haji Makassar Province of South Sulawesi, which is one of the hospitals owned by the South Sulawesi Provincial Government with a B accreditation. [4] Based on data sources, RSUD Haji Makassar for 3 consecutive years has a presentation of BOR values that have not reached the standard of the Indonesian Ministry of Health (2005) and have fluctuated. In 2016, the indicator value of bed utilization efficiency reached 51.57%, then in 2017 the efficiency indicator value of bed utilization increased, namely 55.67%, and in 2018 the efficiency indicator value of bed utilization decreased, namely 50.57%. this shows that the utilization of the bed in the Makassar Haji Hospital is not yet efficient.
Utilization of health services which is a process of interaction or relationship between consumers of health service users and health service providers, in a very complex interaction process can be influenced by many factors. By knowing the influence of the determinants that exist, it can be seen the process of consumer choice in choosing health services. This is why researchers are interested in examining the relationship between knowledge, attitudes, and perceptions of pain and the utilization of health services for patients with noncommunicable diseases at Haji Makassar Hospital.

II. METHODS
This type of research is a quantitative study with an observational approach using a cross sectional design. This research was conducted at Regional General Hospital (RSUD) Haji Makassar. The population in this study were 1037 patients with non-communicable diseases at RSUD Haji Makassar. The sampling technique used in this study was Accidental Sampling, then obtained as many as 87 people. The data analysis used was univariate and bivariate analysis with the chi square test. The data that has been analyzed are presented in tabular and narrative form to discuss the results of the study.

III. RESULTS
The results of the analysis of the characteristics of the respondents consisted of age, gender, education and occupation. Most of the respondents were in the age group 18 -39 years as many as 36 respondents (41.4%) and at least in the age group> 60 years as many as 10 respondents (11.5%). Most of the respondents in this study were women with a total of 49 respondents (56.3%). While male respondents were 38 respondents (43.7%). Most of the respondent's education with the latest education was graduated from high school as many as 28 respondents (32.2%) and at least 2 respondents (2.3%) had a degree or diploma. Most of the respondent's occupation is housewives (IRT) as many as 25 respondents (28.7%) and the least is labor as many as 4 respondents (4.6%) ( Table 1).  Knowing the relationship between variables and utilization of health services in Regional General Hospital (RSUD) Haji Makassar, the results showed that of the 66 respondents who had high knowledge, 60 respondents (90.9%) utilized health services and 6 respondents (9.1%) did not utilize health services. While respondents who had low knowledge, of the 21 respondents, there were 8 respondents (38.1%) who took advantage of health services and 13 respondents (61.9%) who did not take advantage of health services. The attitude variable of the officers, of the 78 respondents who rated the officers' attitudes as good, there were 63 respondents (80.8%) who used health services and 15 respondents (19.2%) did not take advantage of health services. Furthermore, respondents who considered the attitude of the officers to be less good, from 9 respondents there were 5 respondents (55.6%) who took advantage of health services and 4 respondents (44.4%) who did not take advantage of health services. The variable of perception of pain, from 76 respondents with positive perception of illness, 63 respondents (82.9%) used health services and 13 respondents (17.1%) did not utilize health services. While respondents with negative perceptions of pain, out of 11 respondents there were 5 respondents (45.5%) who took advantage of health services and 6 respondents (54.5%) who did not take advantage of health services (Table 3). Table 3 The Source: Primary Data, 2020.

IV. DISCUSSION
The importance of knowledge of non-communicable diseases is motivated by the tendency to increase in prevalence of non-communicable diseases in society, including among the people in Indonesia. Public knowledge has a significant share in the use of public health services. The higher the knowledge they have, the more people will know the importance of health and health services. [5] The level of individual knowledge will greatly affect the awareness of participating in an activity and have an impact on behavior. However, if analyzed further, the process of forming a consciousness is not only influenced by knowledge. Behavior change or adoption is a complex process and requires a relatively long time. [6] The results of statistical tests using Chi Square obtained a value of ρ = 0.000, which means that there is a relationship between the variable knowledge of non-communicable diseases with the variable utilization of health services at Haji Makassar Hospital. This is in line with Nursafa's research which states that there is a significant relationship of knowledge with the utilization of health services for BPJS health patients in the work area of the Jumpandang Baru Community Health Center in Makassar City. [7] However, this is not in line with the research of Siti Fatimah and Fitri which states that there is no relationship between knowledge and utilization of services at the Kagok health center. [8] Having a good attitude is meant if the attitude shown by the officer in providing health services is in the form of respect, attention to patients, listening to patient complaints, willing to communicate with patients, maintaining patient confidentiality, and being friendly. [9] In this study, it was found that the health workers had a good attitude so that most of the respondents had a good assessment of the services provided by the officers. This can be seen from the respondents' answers regarding the communicative attitude and friendly attitude of the officers. In addition, respondents believed in the competencies of health workers at Haji Makassar Hospital. However, there are still respondents who think that the officers' attitude is good but they do not take advantage of health services, this is because there is still a lack of public awareness of the importance of health services and they have not received full service, for example obtaining an explanation of the diagnosis and treatment flow.
The actions or ways of officers in providing services are things that greatly influence patients in making decisions about the use of health services. If there is good treatment from and full attention from the officers, this will become a special attraction in providing services to patients. Psychology and motivation for patients to take advantage of health services are influenced by the attitudes given by the officers. Law Number 36 of 2014 concerning health workers states that health workers have an important role in improving the maximum quality of health services to the community so that people are able to increase awareness, willingness and ability to live healthy so that the highest health status will be realized. [10] The results of statistical tests using Fisher's Exact Test obtained a value of ρ = 0.100, which means that there is no relationship between the attitude variable of officers and the variable utilization of health services at Haji Makassar Hospital. This is in line with Bambang Irawan's research which states that perceptions of the attitudes of health workers do not affect the use of health services in the work area of the Payakabung Health Center, Ogan Ilir Regency in 2018 with a value of ρ = 0.091 (ρ> 0.05). [11] However, this study is not in line with Alamsyah's research which states that there is a significant relationship between doctor and nurse services and the utilization of health services at Hasanuddin University Hospital. [12] Turkish Journal of Physiotherapy and Rehabilitation; 32(3) ISSN 2651-4451 | e-ISSN 2651-446X Perception is considered to determine how a person chooses, collects and arranges, and gives meaning which will then influence the responses (behavior) that will emerge from him. In addition, perception can also influence a person in making a decision as a reaction to a problem, because every decision requires interpretation and evaluation of information. [13] A person in the perception process will determine which messages will be received, or which will be considered positive, hereinafter referred to as positive perceptions and which messages will be rejected which are considered negative, hereinafter referred to as negative perceptions. [14] The results of statistical tests using Chi Square obtained a value of ρ = 0.016, which means that there is a relationship between the variable perception of pain and the variable utilization of health services at Haji Makassar Hospital. This is in line with Irianti's research which states that there is a relationship between the perception variable of illness and the variable utilization of health services in Garassikang Village. [15] V. CONCLUSION Based on the results of research conducted at Regional General Hospital (RSUD) Haji Makassar regarding factors related to the utilization of health services for non-communicable disease patients at RSUD Haji Makassar, it can be concluded that there is a relationship between knowledge of non-communicable diseases (ρ = 0,000) and perception of pain (ρ = 0.016) with utilization of health services for patients with non-communicable diseases in RSUD Haji Makassar, and there is no relationship between the attitude of the staff (ρ = 0.100) and the utilization of health services for patients with non-communicable diseases at RSUD Haji Makassar. Suggestions to the hospital to make improvements regarding the condition of the hospital, the availability of facilities, types, or variations of health services that are more complete. Doctors, nurses or officers give more special attention to the patient's condition when providing services and further explain the patient's health condition.