EVALUATION OF HYPERTENSION POSTER ON THE VISITORS OF ...

EVALUATION OF HYPERTENSION POSTER ON
THE VISITORS OF TALAGA HEALTH CENTER
IN MAJALENGKA DISTRICT
Thesis Summary
Health Behavior and Promotion
Public Health Study program
Faculty of Medicine
Presented by:
ICCA STELLA AMALIA
09/293328/PKU/10861
POSTGRADUATE SCHOOL OF PUBLIC HEALTH SCIENCES
FACULTY OF MEDICINE
UNIVERSITAS GADJAH MADA
YOGYAKARTA
2011

EVALUATION OF HYPERTENSION POSTER ON
THE VISITORS OF TALAGA HEALTH CENTER
IN MAJALENGKA DISTRICT
Icca Stella Amalia 1 , Kristiani 2 , Rendra Widyatama 3
ABSTRACT
Background: The results of a preliminary study showed morbidity rates
on hypertension in Talaga Health Center that became the top 10 diseases
with a prevalence of 6.07% in 2009. However, efforts of health promotion
over the issue have not been done. One medium that can be used for
health promotion is a poster. Posters specific and in accordance with
hypertension have not been present. Given the aforementioned facts,
posters need to be designed as appropriate, in this case hypertension,
and then be evaluated.
Objective: Assessing the interest and understanding of Talaga Health
Center visitors on the hypertension poster in aspects of design, message
content and place of installation.
Methods: This was a descriptive study with qualitative methods using a
design of phenomenology. Subjects in this study were the visitors of
Talaga Health Center. The other informants were the officer of health
promotion, Head of the Health Center and Head of Health Promotion in
Majalengka District. The data were collected through document review,
focus group discussions (FGD), in-depth interviews and observation.
Results: The visitors’ interest to the poster on hypertension was due to
the use of bright colors, with combination of green, yellow and red colours,
readable font size with a simple font, clear images and in accordance with
daily life, simple layout, simple delivery, and the strategic installation. The
visitors’ understanding could be seen from the way they knew the purpose
and benefits of the message. The visitors easily understood the message
because there were images, simple words and sentences, the use of
everyday language, the use of color and installation position that was easy
to read. The place of installation was expected to be propagated in the
waiting room, in the treatment room and in every village.
Conclusion: Overall, most visitors were interested in and understood the
hypertension poster. The hypertension poster in Sundanese version was
acceptable as a medium for health promotion by Talaga Health Center
visitors who had an interest in the design and content of the message in
the hypertension poster.
Keywords: evaluation, hypertension poster, health center visitors
1. Jatipamor Village, Talaga sub District, Majalengka District
2. Magister, Health Service Management and Policy, Faculty of Medicine,
Gadjah Mada University
3.
Faculty of Letters, Ahmad Dahlan University, Yogyakarta

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INTRODUCTION
Indonesia as a developing country still has a wide range of health
problems, one of which is hypertension. (1) The prevalence of hypertension
in Indonesia has reached 31.7% of the total adult population, amounting to
6.8% of the proportion of death causes in all age groups in Indonesia. (2)
The 2007 Basic Health Research (Riskesdas) in Majalengka showed the
proportion of hypertension as non-communicable diseases occupied the
third position by 10.6%, after joint disease and stroke with 24.6% and
11%, respectively. (3)
At the Talaga health center, hypertension becomes the top ten
diseases with a prevalence of 6.07%. Although not placing on the first
position, hypertension has not received attention. (4) Hypertension needs to
get attention because if it is not controlled, it can be a risk factor for the
emergence of other more serious diseases such as stroke, heart failure
and kidney failure. One way that can be done is with the campaign to
prevent hypertension. Health promotion can be carried out by the use of
media. (5) The media widely used in Talaga health center is posters. From
some existing posters, there are no specific posters about hypertension.
A poster is a medium that combines images of visual elements
such as lines, images and words to attract attention and communicate a
message briefly. (6) A poster has advantages in attracting people with a
special interest, because a poster can deliver or present the subject of a
problem. (7) A study on the effectiveness of posters on knowledge and
attitudes of a family about high-risk pregnancy and danger signs of
pregnancy showed that the use of posters was less effective in increasing
knowledge. (8) From some of the results of previous studies, it was note
that there were differences about the effectiveness of poster; thus, to be
able to assess the effectiveness of poster needed evaluation of the poster
media.

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Trials and evaluation concerning the use of posters in Talaga
health center were never conducted. In fact, trial and evaluation of media
is very important. Media evaluation is done by looking at the provided
media whether they have been appropriate and can achieve the goal or
not, whether the distribution of media is on target or not, whether they are
relevant or not, whether the content deliveres a message or information
which is easily understandable and appropriate or not, and whether the
placement or installation of the media is appropriate or not. (9) One of the
learning points gained in a process of using posters to be effective must
carried out evaluation of the media. (7) Some of the factors underpinning
successful media communication are, among others, that the media can
increase interest and understanding of the audience. (1) Based on these
explanations, the problem formulation of this study is: "How are the
interest and understanding of the health center’s visitor on the poster
concerning hypertension?". Based on the formulation of the problem, the
objective of this study is to evaluate the posters on hypertension to the
visitors of Talaga health center by studying visitors’ interest and
understanding on hypertension in the aspect of poster design, message
content and place of installation.
MATERIALS AND METHODS
This study was a descriptive study with qualitative methods using a
design of phenomenology. The study was conducted at the Talaga health
center with consideration based on the results of preliminary studies that
found no specific posters about hypertension and had never conducted an
evaluation of posters. Another reason was because the Talaga health
center was the health center with most visitors in comparison to other
health centers in Majalengka District. (3)
Selection of informants was done purposively based on the purpose
in which the subject was as the unit of analysis considered in accordance
with the requirement. (10) Core informants in this study were Talaga Health

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Center visitors and key informants were the Head of Health Promotion of
Majalengka District, Head of health center and staff of health promotion in
Talaga Health Center.
Data was collected through in-depth interviews to 11 visitors, focus
group discussions (FGD) to 14 individuals consisting of two visitor groups.
The first group of visitors was as many as seven people who did not suffer
from hypertension and the second group was seven people visitors who
suffered or had once suffered hypertension. Observations were carried out
to find a situation where posters on hypertension and posters visitor
interacted.
RESULT AND DISCUSSION
1. Visitors’ interest
Visitors’ interest to the poster on hypertension could be seen
from several aspects:
a. Design
Interest in hypertension poster of the design elements were
grouped again in a few things, namely:
1) Color
Based on the survey results, it was revealed that poster in
Sundanese version received more attention and was read by
the visitors. The visitors were interested in the poster on
hypertension because of its bright, contrast and varied colors.
Bright colors attracted the eye, so that the visitors took a look
at and read the poster on hypertension.
The results were consistent with previous study that showed
that the most preferred selection of basic colors in a medium
was white, green or red. (10) Another study reinforced the
results of this study where the preferred and interesting color
was the neutral colors such as green. (11) A poster should be
eye-catching in order to make people stop and read it. (12)

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In terms of color, the visitors felt that not too contrasting
and striking colors helped in reading. Background colors and
contrast font made the visitors read the poster easily. Letters
and background color were made contrast so that the poster
was easy to read and emphasis that required special
emphasis could be delivered. (6)
The use of color in a graphic design has several functions,
namely to attract attention, generate psychological effects,
develop associations, build retention and create a fun
atmosphere. (13)
The combination of contrasting color into a
single unit in a poster will help facilitate the delivery of a
message. Conversely, if the blending colors do not contrast, it
will make difficulty in the one’s sight. The colors should be
complementary and the use of too many colors can weaken
the communication. (13)
2) Font size
Based on the results of in-depth interviews and group
discussions, the visitors felt that the font size was quite easy to
see. The visitor’s opinion to the font size in the poster is shown
on the statement as follows:
“the font size must be large because it is good..... if it is
big, it is visible to the health center’s visitors” (IW6).
The largest font size on the hypertension poster was 13 mm
and the smallest 6 mm. To facilitate the legibility of the font
size should not be smaller than 18 points or 5mm. (13)
The font used Microsoft Sans Serif and was written capital.
The use of letters in the hypertension poster was not too
complicated and high artistic that could make it difficult to
read. Another study supported the results of this study,
suggesting that the use of font that was not unbending and
cumbersome assisted in enabling people to read. (11)
To

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facilitate the legibility should use clear and simple font, such
as Microsoft Sans Serif. (14)
The use of color on the font affected the ease of visitors
to read the contents of the message in the hypertension
poster. Writing letters with color variations could also provide
attraction. (11) Contrast font color with the background of the
poster’s overall colors helped to facilitate legibility. (6)
3) The compactability between image and writing
Based on the results of the study, the presence of the
image became the main attraction. The image most often said
to attract the attention of the visitors was the image that there
was an element of regionalism (the Cepot). The visitors felt
that the drawings and writings fit as in the following statement:
“it refelcts compactability between image and writing,
like vegetable image having to be drawn like real
vegetables” (IW2).
The use of regionalism in the form of puppet characters
in the Pasundan picture intentionally was for providing
something different. Other images were considered interesting
because they fit the visitors’ daily life such as vegetables and
fruit images, images of people blowing the flute and pictures of
people who were exercising. The use of pictures should attract
the attention of the target; this can be done by using images
that are familiar with the life goals. (15)
The study was
supported by the previous research, namely making posters
with visuals that corresponded to the social and political
characteristics successfully foster the participation of Chinese
ethnic group in dealing with malaria. (16)
The use of original image (photo) attracted the attention
of visitors, helped simplify and remember the messages
conveyed in the poster. This was consistent with the previous

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study that the use of posters was less effective because the
message was difficult to remember and the cause was the
illustrated image did not use an original image that was
considered less attractive. (8) Photo serves to increase
motivation and interest, develop language skills, and help
interpret and remember the content of messages regarding
the photos. (15) In addition to attracting attention, the picture
can help explain things so much easier to understand, clarify
the parts that are important and condense a long
description. (6)
4) Layout
These results indicated that the layout of the posters
was judged fairly simple and easy to remember. Selection of a
key element of either letters or illustrations could be done so
that the reader could quickly grasp the message. (17) In this
hypertension poster, elements that were highlighted were from
the image into supporting and reinforcing the message
conveyed.
In the poster with the version of the Indonesian
language, images that attracted the attention were the pictures
of vegetables and fruits. Laying out the image on the first
sequence could be said to attract attention. Sundanese
language version was added a poster image that had an
element of regionalism, the puppet (cepot). Figure of Cepot
was placed in the top left corner, and based on survey results
this revealed that the cepot image became the first thing that
attracted the attention of the visitors. Other images were
sorted by condition and approximate cause of hypertension
from the greatest to the smallest roles.
The layout of the colors was also a visitor's attention.
Placement of base color into the background with the overall

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content of the message was judged contrast and helped easy
to read. Writing letters with color variations could give
attraction. (11) Font color contrast with the background of the
poster’s overall colors helped to facilitate legibility. (6)
Placement of font size was also one interesting thing. The title
used a larger font than the subtitles and the contents of the
message. This became important because with the proper
placement of the letters in each part of the message this
allowed the reader to view the message.
b. Message contents
The content of the message is a matter which will be
delivered by communicators to express intention. (18) Results from
in-depth interviews and FGD showed that the visitors felt the
contents of the message was appealing for the content was
information about hypertension, such as the following statement:
“interesting about hypertension, so know the result of eating
less nutritious foods leading to hypertension, smoking can
cause hypertention too. High blood could be a stroke, heart
disease, kidney failure. So we're not going to eat but at
home, lack of exercise, smoking, excessive salt intake so
scared, we have fear” (IW2)
Words and sentences that made up the message also
received close attention. The words in the hypertension poster
were assessed memorable because they were words in the daily
conversation. Phrases used were considered simple, not
convoluted and straight to the point of the matter. The visitors’
interest in words and sentences can be seen in Figure 1.

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Clear
wording
Daily
words
Interest in
words and
sentences
Simple
sentences
Use of
Sundanese
Figure 1. The visitirs’ interest in the use of words and sentences
in the poster
The technique of message delivery in the hypertension
poster became one of the subject in in-depth interviews as well
as FGD. The opinion of the visitors related to the way of the
message delivery can be seen from the following statement:
“simple .. simple .. [messaging] because not many words that
are not clear so just direct to the core problem”
(IW2)
Messages that cause certain feelings in the reader can get
someone interested and apply the message. The previous study
successfully conveyed a message with visuals that made people
excited to use seatbelts. (19) The election of theme was said to be
in accordance with public health conditions in Majalengka which
were still considered high in terms of hypertension rates by one
key informant. The suitability of themes and issues of concern
was very important so that the poster was made readable,
understandable and memorable. (20)
c. Location of installation
Based on the observations, it was known that the visitors
who came mostly just passed through the location without seeing
a poster. Some visitors were around the location, but did not pay
attention to the existence of a poster; anyone noticed the poster
but did not read; but there were those who also took a look at
and read the poster.

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Assessment of the visitors to the location of posters can
be seen from the results of in-depth interviews and FGD.
Opinions about the location of installation can be seen from
Table 1.
Location
In Talaga Health center
Table 1. Location of poster installation
Informant’s opinion
- In outpatient waiting room
- In front of inpatient room
Outside Talaga Health Center
- In balai desa (village hall)
- In post office
- In other health centers
Based on this research, it was known that the visitors
could see the poster in the place of installation because the place
was quite spacious. In addition to the size of the posters, the
existence of the posters became the main attraction when the
visitors were around the place of installation. The visitors were
interested in reading the hypertension poster, because the poster
was judged appropriate with the position of the visitors’ eyes, so
that it was not difficult to read.
Location of the posters can be in public places where
people often congregate as well as in government offices. (21) The
results of the previous study showed that the placement of
posters in strategic places could foster a desire to use the
stairs. (22) Another study had shown that a person would be in the
waiting room in a long time making it possible to be able to
convey health messages. (23) The position or location of the poster
must easily be accessible by the senses of sight, so it can attract
people's attention. (24)
2. Visitors’ understanding
The visitors’ understanding of the messages was from the
knowledge of informants against the benefits and intent of the

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message content and there were efforts to implement message
content. Informants argued that the contents of the message were
an invitation to a healthy life. Some things that were understood
and not understood can be seen in Table 2.
Table 2. Things which were understood and poorly understood by
the visitors from the hypertension poster
Understood
- Eating vegetables and
fruits makes healthy
body
- Cigarrette can cause
hypertention
- Over salt consumption
causes hypertention
- Hypertention can lead
to blindness, stroke,
and heart failure
- Alcohol causes
hypertention
Poorly understood
- Figure of proccessed meat
- Figure of a person with
stressful face
- The cause of hypertention
which was only lifestyle or
gebetic factors
- Words in Sundanese “cara
tuang nu kirang lereus”
- Word ‘stroke’ in an
Indonesian languange
poster
Understanding of the message content was associated with
the manner of delivery, comprehensiveness and use of picture.
Most informants felt the message in the hypertension poster was
quite simple. The words and sentences were judged simple and
uncomplicated. The contents of the message were easy to
understand and be understood because they were directly on the
core issues. Another statement came from interviews with key
informants that the poster was judged good because the
information about hypertension was said to be beneficial to society.
Completeness of the message was considered to adequately
represent the necessary information about hypertension. Too many
messages were perceived to be difficult to remember and
understand because the reading time was limited. These results
were supported by a statement of a key informant who argued that

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in print media such as posters; too many words would make it
difficult to understand.
The visitors said that to understand and remember the
message was because of the pictures. In addition to drawing
attention, it might also help explain things so much easier to
understand, clarify the parts that are important and condense a
long description. (6) In a previous study, it was known that one
cause of the message difficult to remember was because of the
use of illustrative images that were not using the original image. (8)
Photo serves to increase motivation and interest, develop
language skills, and help interpret and remember the content of
messages regarding the photos. (15)
The visitors understood and appreciated the message
because of the use of Sundanese. In a previous study, it was
demonstrated the role of a culture and language in relation to
patient safety. (25) Vernacular language or dialect is said to be a
version of language with specific and easily recognizable traits
socially or regionally that have sentence construction, vocabulary,
and pronunciation with a unique and distinctive pattern. (26)
Language has an important role in the communication and helps in
understanding a thing.
Everyone will have different capacities to receive a message.
In the ELM theory, it is described that message or information will
be accepted depending on the motivation of every person and his
ability to be able to process and interpret the message. (27) High
ability will make visitors feel the given message becomes a thought
and a focus on the quality of the message, leading to many
opinions. Visitors’ low motivation and ability will see the message as
a whole without seeing something important, so it does not appear
to be more in-depth opinion.

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CONCLUSION AND RECOMMENDATION
The informants were interested in the poster’s colors which were
bright, with combination of green, yellow and red colours, readable font
size with a simple font, clear images, and close to their daily lives, with
simple layout. Judging from the message content, the informants were
interested because the theme of hypertension was presented with simple
use of words, sentences and everyday language. Strategic location, a
place that was adequate and the position of posters that could be seen by
the sense of sight made the poster more interesting to be read by the
visitors.
The messages could be understood because the text was
supported with clear images, the use of Sundanese language, and the use
of words and short sentences with no other meanings. The simple
contents of the message could be understood by the visitors better.
Overall, most visitors were interested in and understand the hypertension
poster. The hypertension poster in Sundanese version was acceptable as
a medium for health promotion by Talaga Health Center visitors who had
an interest in the design and content of the message in the hypertension
poster.
Health Center and Health Office as the institution that produces or
distributes the media should be able to create their own posters
appropriate to the situation and condition of Majalengka District, using the
Sundanese language, and may consider aspects of local culture. In
addition, the posters should been evaluated in order to find and produce
media in accordance with community expectations.

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