Factors Related to Pregnant Women’s Satisfaction with Antenatal Care Services at Puskesmas Purwokerto Utara II

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INTRODUCTION
Every pregnant woman faces different risks of problems that can harm her health or even kill her.The maternal mortality rate is increasing along with the increasing number of pregnant women who experience health problems or even die during their pregnancy [4].The maternal mortality rate is the ratio of maternal deaths that occur in terms of the process during pregnancy, childbirth, and not due to accidental causes [14].
Antenatal Care is a service that provides pregnant women with regular health checks to detect pregnancy problems and educate about lifestyle, pregnancy, and childbirth.Pregnant women and health workers can monitor the condition and growth of the fetus in the womb through the regularity of routine meetingsantenatal care, which ISSN: 2808-1021 allows effective treatment of pregnancy-related problems.However, many mothers pregnant women who continue to miss routine visits antenatal care one of the reasons is that pregnant women have unfulfilled expectations regarding satisfaction with the services they receive [6].
Patient satisfaction is the level of one's feelings when comparing the performance or results achieved with the expectations and needs received [12].Patient expect knowledgeable, friendly, and communicative health care providers in addition to prompt and correct care.Patient satisfaction will increase as a result of quality health care, which will also benefit the health care setting as a whole through competition, promotion, and expansion of services in the future [10].However, the patient will feel dissatisfied if the health services obtained do not meet their needs, desires or expectations, so the patient will seek alternative health service providers who can meet needs [16].Thus, satisfaction will arise because fulfillment patient's health needs as a result of the services provided by personnel health.According to Maslow's theory, needs in each hierarchy must be satisfied including need health, where needed health is included physiological needs [9].
According to Rahayu [11], there is a significant relationship between the sub-variables studied and the satisfaction of pregnant women with services antenatal care, the sub variables include reliability, responsibility, assurance, empathy, facilities.According to research conducted by Fitriyani [6] which examined sub-variables tangibles, reliability, responsiveness, assurance, and empathy, the results of the study explained that it was necessary to increase the sub-variables tangible and emphaty.Facilities dominate the level of satisfaction according to Wati (2019), with sub-variables that studied, namely facilities, waiting time, service quality, and a minimum service standard of 10T [17] .
The goals to be achieved in this study are: 1) Knowing the description of the factors of empathy, facilities, assurance, reliability, responsiveness, responsibility and satisfaction of pregnant women with services antenatal care.2) Knowing the relationship factor empathy, reliability, assurance, facilities, responsiveness, and responsibility with pregnant women's satisfaction with services antenatal care.3) Knowing the most dominant factor related to the satisfaction of pregnant women with services antenatal care.

RESEARCH METHOD
This research is a quantitative research, with an approach cross sectional.In this study, there are two variables, the independent variables, namely satisfaction factors (empathy, assurance, responsiveness, facilities, reliability, and responsibility) and the dependent variable, namely satisfaction of pregnant women.The sample of this research is 33 respondents, who are pregnant women who visit to do the examination antenatal care at the Puskesmas Purwokerto Utara II.Technique sampling that is used consecutive sampling.Methods of data collection using a questionnaire.The data in this study were not normally distributed, so that researchers in conducting data analysis used non-parametric statistics, namely bivariate analysis using the spearman's rho to determine the relationship of satisfaction factors with the satisfaction of pregnant women, and multivariate analysis using multiple logistic regression analysis to determine the most dominant factor.

RESULT AND DISCUSSIONS
3.1.Univariat Based on table 1, it is known that the majority of respondents stated that health workers provide services antenatal care very empathetic with a frequency of 25 people (75.8%), very secure with a frequency of 31 people (93.9%), very responsive with a frequency of 27 people (81.8%), very reliable with a frequency of 30 people ( 90.9%), the facilities provided were very adequate with a frequency of 24 people (72.7%), and the responsibility of health workers was high with a frequency of 20 people (60.6%).Based on table 2, it is known that many respondents expressed satisfaction as many as 19 people (57.6%) and the remaining 14 people (32.4%) said they were quite satisfied.
Antenatal Care is a health service for pregnant women during their pregnancy which is carried out by experts and carried out with the principles of antenatal care services [5] .Patient satisfaction is a measure of the quality of service provided and refers to the patient's feelings about the performance of the health services received, if the patient's expectations, needs and desires are met, then the patient feels satisfied [11] .

Bivariat
Table 3 Rahayu (2019), where the empathy factor is related to the satisfaction of pregnant women [11].Assurance is to provide certain information, as well as the ability of service providers to gain consumer trust [13].Satisfaction of pregnant women can be seen from the patient's trust in health workers, so there is no need to doubt the truth, even though there is no significant relationship with satisfaction of pregnant women.The results of this study are in line with the research of Jibriel et al. [8], namely that there is no significant relationship between the dimensions of assurance and satisfaction of pregnant women.In contrast to Safitri [13], there is a relationship between pregnant women's satisfaction based on the guarantee dimension.Responsiveness is a strategy to help and provide fast and appropriate services to clients, by conveying clear information [17].In terms of responsiveness shown in the form responsive attitude and handle quickly and appropriately health workers in providing health services.The results of this study are in line with research conducted by Bintang et al. [3], responsiveness factor related to patient satisfaction in the services provided.
Facilities are the appearance of physical facilities, equipment, personal and communication media which can include cleanliness, neatness and comfort of the room, arrangement interior andexterior, completeness, cleanliness, appearance of officers [11].Facilities in this case are available facilities where the more adequate the existing facilities at the service site will affect the level of patient satisfaction the better.The results of this study are in line with research conducted by Apriani & Kusumaningrum [2], which states that facilities have a relationship with the level of satisfaction of pregnant women.Reliability is a satisfaction factor related to quality, assessment of the professional attitude of officers, examinations carried out by health workers, administration of drugs or treatment according to an agreed plan [13].Satisfaction of pregnant women can be seen from the reliability of officers in examining pregnancy, so there is no need to doubt it even though there is no significant relationship with satisfaction of pregnant women.The results of this study are in line with research according to Safitri [13], showing that there is no relationship between satisfaction of pregnant women based on the reliability dimension.It is different from the research by Suparta et al.,[15] which suggested that there is a relationship between reliability and satisfaction of pregnant women.Responsibility is a person's willingness to prepare themselves to face even the worst risks, provide compensation or information for actions that have been taken [7].The responsibilities given by health workers have the ability to help patients and provide good service to resolve patient complaints.The results of this study are in line with research conducted by Rahayu [11], that the factor of responsibility is related to the satisfaction of pregnant women.and P=0.024 is the lowest, when compared with other sub-variables, this shows that the most dominant factor is related to the satisfaction of pregnant women with services antenatal care at the Puskesmas Purwokerto Utara II, namely responsibility.

Multivariate
When carrying out their duties, health workers are expected to be accountable for everything they do, because patient safety is very important in every health service [7].In this study, there is no need to doubt ISSN: 2808-1021 Proceedings homepage: https://conferenceproceedings.ump.ac.id/index.php/pshms/issue/view/30176 the responsibility of the health workers given, as evidenced by the results of research showing that pregnant women feel satisfied and are the most dominant factor related to satisfaction of pregnant women at the Puskesmas Purwokerto Utara II.

CONCLUSION AND RECOMMENDATION
Based on the results of the study it can be concluded that the majority of respondents stated that health workers were very empathetic, very secure, very responsive, very reliable, high responsibility and the existing infrastructure was very adequate, so that the results of the satisfaction of pregnant women were mostly that they were satisfied with the service.The factors of empathy, responsiveness, means, responsibility have a significant relationship with the satisfaction of pregnant women, while the assurance and reliability factors have no significant relationship with the satisfaction of pregnant women.The most dominant factor with pregnant women's satisfaction with services antenatal care at the Puskesmas Purwokerto Utara II, namely the responsibility of health workers.It is hoped that the research results obtained can be used as material for policy considerations in improving health services so that the needs and satisfaction of pregnant women are met.Based on the research results, it was found that the most dominant factor related to pregnant women's satisfaction with antenatal care services is responsibility, therefore it is hoped that the head of the community health center can recommend to the antenatal care service staff to further increase their sense of responsibility in providing services to maintain patient satisfaction and be able to further increase patient satisfaction.It is also hoped that there will be an increase in the factors of empathy, assurance, responsiveness, facilities and reliability.Because in this study the researchers only examined 6 factors that were related to satisfaction with antenatal care services, so it is recommended that future researchers add other factors that are thought to be related to satisfaction.

Table 2 .
Frequency Distribution of Satisfaction Pregnant mother (n=33) . Relationship Between Satisfaction Factors and Satisfaction Pregnant mother (n=33) Factors that are not significantly related (P>0.05) namely assurance and reliability.Empathy is a tendency to feel what other people do, if that person is in someone else's situation [1].In providing services antenatal care, health workers give full attention, and understand the needs of patients.The results of this study are in line with research conducted by