Implementation of the TENANG Method as a Participatory Educational Approach in Self-Monitoring of IUD Strings

Annisa Andriyani; Indarwati Indarwati; Tri Susilowati; Anjar Nurrohmah

doi:10.70716/mohr.v4i2.542

Authors

Annisa Andriyani Faculty of Health Sciences, Aisyiyah University Surakarta, Indonesia
Indarwati Faculty of Health Sciences, Aisyiyah University Surakarta, Indonesia
Tri Susilowati Faculty of Health Sciences, Aisyiyah University Surakarta, Indonesia
Anjar Nurrohmah Faculty of Health Sciences, Aisyiyah University Surakarta, Indonesia

DOI:

https://doi.org/10.70716/mohr.v4i2.542

Keywords:

tenang method, IUD, contraceptive acceptors, education, long-term contraception

Abstract

The intrauterine device (IUD) is a highly effective long-term contraceptive; however, failure still occurs, often due to limited acceptor involvement in routine self-monitoring. Existing educational approaches tend to focus on information delivery and lack structured, participatory components that support consistent self-monitoring practices. This study aims to analyze the effectiveness of the TENANG (Find the Thread) method as a participatory educational approach to improve knowledge and the application of IUD string self-monitoring among contraceptive acceptors. A quasi-experimental design with a one-group pre-test and post-test was used with 336 IUD acceptors in Banjarsari District. The intervention was conducted over three months using structured education and monitoring tools. The results showed a significant increase in knowledge after the intervention (χ² = 325.000; p < 0.001), with 94.9% of respondents attaining a high level of knowledge. In addition, 75.3% of participants applied the TENANG method. Educational level was identified as a significant factor influencing implementation (p = 0.002). The study highlights the novelty of integrating participatory education with structured self-monitoring tools in improving contraceptive-related behavior. The TENANG method demonstrates potential as a practical and scalable approach to strengthen acceptor involvement and enhance the effectiveness of long-term contraceptive use.

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References

Amna, A. D. A., Suryantara, B., & Hanifa, F. N. (2026). Effectiveness of a digital pocketbook in improving knowledge of long-acting contraceptive methods among women of reproductive age. Indonesian Health Issue, 5(1), 105–114. https://doi.org/10.47134/inhis.v5i1.162

Averbach, S. H., Ermias, Y., Jeng, G., Curtis, K. M., Whiteman, M. K., Berry-Bibee, E., Jamieson, D. J., Marchbanks, P. A., Tepper, N. K., & Jatlaoui, T. C. (2020). Expulsion of intrauterine devices after postpartum placement by timing of placement, delivery type, and intrauterine device type: A systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 223(2), 177–188. https://doi.org/10.1016/j.ajog.2020.02.045

Centers for Disease Control and Prevention. (2024). U.S. selected practice recommendations for contraceptive use, 2024. MMWR Recommendations and Reports, 73(3), 1–77. https://doi.org/10.15585/mmwr.rr7303a1

Durante, J. C., Sims, J., Jarin, J., Gold, M. A., Messiah, S. E., & Francis, J. K. (2023). Long-acting reversible contraception for adolescents: A review of practices to support better communication, counseling, and adherence. Adolescent Health, Medicine and Therapeutics, 14, 97–114. https://doi.org/10.2147/AHMT.S374268

Efendi, F., Sebayang, S. K., Astutik, E., Reisenhofer, S., & McKenna, L. (2023). Women’s empowerment and contraceptive use: Recent evidence from ASEAN countries. PLOS ONE, 18(6), Article e0287442. https://doi.org/10.1371/journal.pone.0287442

Faculty of Sexual & Reproductive Healthcare. (2023). FSRH guideline (March 2023): Intrauterine contraception. BMJ Sexual & Reproductive Health, 49(Suppl. 1), 1–142. https://doi.org/10.1136/bmjsrh-2023-IUC

Fitria, M., Laksono, A. D., Syahri, I. M., Wulandari, R. D., Astuti, Y., Matahari, R., & Nugroho, P. S. (2026). Determinants of permanent contraceptive use among multiparous women in Indonesia: The role of education and other demographic factors. Clinical Epidemiology and Global Health, 37, Article 102280. https://doi.org/10.1016/j.cegh.2025.102280

Glanz, K., Rimer, B. K., & Viswanath, K. (Eds.). (2024). Health behavior: Theory, research, and practice (6th ed.). Jossey-Bass.

Hale, N., Dehlendorf, C., Smith, M. G., Stapleton, J., McCartt, P., & Khoury, A. J. (2024). Contraceptive counseling, method satisfaction, and planned method continuation among women in the U.S. southeast. Contraception, 132, Article 110365. https://doi.org/10.1016/j.contraception.2024.110365

Harzif, A. K., Shadrina, A., Yo, E. C., Reviani, N., & Hestiantoro, A. (2023). Influence of internet, mobile phone use, and sociodemographic factors on women’s knowledge and attitude towards contraception in Indonesia. Obstetrics & Gynecology Science, 66(1), 42–48. https://doi.org/10.5468/ogs.22277

Kupoluyi, J. A. (2025). Long-acting reversible methods of contraception: Trends, levels, and predictors among married women of reproductive age in Nigeria. Contraception and Reproductive Medicine, 10, Article 49. https://doi.org/10.1186/s40834-025-00385-0

Kusumaningrum, W., Damayanti, R., Storey, J. D., & Yelda, F. (2020). Improving a long-acting reversible contraception usage by understanding client perspectives. Medical Journal of Indonesia, 29(2), 204–212. https://doi.org/10.13181/mji.oa.203149

Meekers, D., Elkins, A., & Obozekhai, V. (2024). Tools for patient-centred family planning counselling: A scoping review. Journal of Global Health, 14, Article 04038. https://doi.org/10.7189/jogh.14.04038

Myo, M. G., & Nguyen, B. T. (2023). Intrauterine device complications and their management. Current Obstetrics and Gynecology Reports, 12, 88–95. https://doi.org/10.1007/s13669-023-00357-8

Narasimhan, M., Hargreaves, J. R., Logie, C. H., Abdool-Karim, Q., Aujla, M., Hopkins, J., Cover, J., Sentumbwe-Mugisa, O., Maleche, A., & Gilmore, K. (2024). Self-care interventions for women’s health and well-being. Nature Medicine, 30(3), 660–669. https://doi.org/10.1038/s41591-024-02844-8

Nutbeam, D., & Lloyd, J. E. (2021). Understanding and responding to health literacy as a social determinant of health. Annual Review of Public Health, 42, 159–173. https://doi.org/10.1146/annurev-publhealth-090419-102529

Rahayu, T. B. (2023). Kepatuhan kunjungan ulang akseptor KB intra uterine devices (IUD). Jurnal Cakrawala Ilmiah, 2(10), 3931–3940. https://doi.org/10.53625/jcijurnalcakrawalailmiah.v2i10.5854

Sundewall, J., Williams, A., Strauss, M., & George, G. (2025). Self-care interventions for sexual and reproductive health: A strategic health systems investment. BMJ Global Health, 10(Suppl. 6), Article e019030. https://doi.org/10.1136/bmjgh-2025-019030

UNESCO. (2023). Ready to learn and thrive: School health and nutrition around the world. UNESCO.

United Nations Population Fund. (2021). State of world population 2021: My body is my own: Claiming the right to autonomy and self-determination. United Nations Population Fund. https://doi.org/10.18356/0d04faec-en

Verplanken, B., & Orbell, S. (2022). Attitudes, habits, and behavior change. Annual Review of Psychology, 73, 327–352. https://doi.org/10.1146/annurev-psych-020821-011744

Wahyuningsih, S., Setyowati, Yuliansyah, A., Sulistyaningsih, T., Subagyo, E., & Utami, E. (2022). Profil kesehatan Kota Surakarta 2022. Dinas Kesehatan Kota Surakarta.

World Health Organization. (2020). Family planning/contraception methods. World Health Organization.

World Health Organization. (2022). WHO guideline on self-care interventions for health and well-being, 2022 revision. World Health Organization.

World Health Organization. (2023). Integrated people-centred care. World Health Organization.

Zeal, C., Paul, R., Dorsey, M., Politi, M. C., & Madden, T. (2022). Young women’s preferences for contraceptive education & development of an online educational resource. PEC Innovation, 1, Article 100046. https://doi.org/10.1016/j.pecinn.2022.100046