The Effect of Peer Education on the Behavior of Snack Consumption in Gorontalo Regency

Teenagers are very vulnerable to the influence of their environment. A socio-cultural environment that is not positive is a risk factor for adolescents in unhealthy behavior. Snack habits are part of behavior in the form of action. The habit of consuming snacks for students in Gorontalo reaches 78.4%. The research objective was to see the effect of peer education on knowledge, attitudes and actions of snack consumption among adolescents. This research was a quasi-experiment with a pre-test post-test control group design. The research was conducted on 19 adolescents at SMP Negeri 1 Limboto Barat and 19 adolescents at SMP Negeri 1 Boliyohuto. Duration of intervention twice a week for two weeks. Data analysis used paired t-test and independent t-test. The results showed that there were no differences in the characteristics of gender (p = 0.330), class (p = 0.744), age (p = 0.148) and pocket money (p = 0.461). There is an effect of peer education on knowledge (p = 0.001) and attitude (p = 0001). Based on the difference between the peer education group and the leaflet, there was a difference in the score selection for knowledge (p = 0.001) and attitude (p = 0.001), but there was no difference in the score selection for the measures (p = 0.805). The conclusion of this study is that the peer education method has an effect on increasing knowledge and attitudes regarding snack consumption. Peer education suggestions can be used as an approach by schools for students to reduce the number of snack consumption habits in adolescents.


Introduction
According to the National Population and Family Planning Agency (BKKBN), the age range for adolescents is 10-24 years old and unmarried. Growth and development during adolescence is divided into three stages, namely early adolescence (ages 11-14 years), middle adolescents (ages 14-17 years) and late adolescence (ages 17-20 years). Teenagers are very vulnerable to the influence of their environment. A socio-cultural environment that is not positive is a risk factor for adolescents in unhealthy behavior (Wiratini, 2015). One of the problems faced by adolescents is a problem related to nutrition. Based on the results of a preliminary survey conducted at SMP Negeri 1 Limboto Barat, it showed that the types of food consumed by students were more high in calories, carbohydrates, saturated fats and the number of fast food consumption by students as well as student food consumption exceeding the daily portion requirement or more than 2475 kcal causing adolescents to be overweight (3.8%) and obese (16.5%) (Hatta, 2019). So the aim of this research is to see the effect of peer education on knowledge, attitudes and actions about snacks in adolescents.

Methods
The type of research used was a quasi-experimental with a nonrandomized pre-test post-test control group design. The number of samples in this study were all students of SMP N. 1 Limboto Barat and SMP N. 1 Limboto, each of which amounted to 19. The sampling technique used in this study was purposive sampling, where samples were selected based on criteria. The inclusion criteria of this study were VIII grade students of SMP N. 1 Limboto Barat and SMP N. 1 Boliyohuto, willing to become respondents by signing the informent consent sheet and being in the same class as the educator. The exclusion criteria were absent on the day of respondent selection, the respondent's educator resigned and students who never ate snacks at school. The research instrument used was a food frequency questionnaire. Statistical test using paired t-test and independent t-test. The intervention was carried out twice a week for two weeks.  Table 2, the characteristics of the respondent's family based on father's education, mother's education, father's job and mother's job, there is no difference between peer education and the control group.  Table 3, there is a difference before and after knowledge in the peer education group and the control group (p = 0.000). Whereas in the control group there was no difference in knowledge before and after the intervention (p = 0.790). In table 4, there are differences before and after towards attitudes in the peer education group (p = 0.000). Whereas in the control group there was no difference in attitude before and after the intervention (p = 0.404). In Table 4, there was no difference before and after the measures in the peer education group (p = 0.710). Whereas in the control group there was no difference in attitude before and after the intervention (p = 0.565).  Table 6, shows that there is a difference in the composition of knowledge scores after the intervention between the peer education group and the leaflet (p = 0.000).  Table 7 shows that there is a difference in the selection of attitude scores after the intervention between the peer education group and the leaflet (p = 0.000).  Table 8, shows that there is a difference in the selection of post-intervention action scores between the peer education group and the leaflet (p = 0.000

Results and Discussion
The results of this study indicate that there is an effect of peer education on knowledge in the intervention group. Based on the knowledge presentation, there was an increase in the knowledge score after being given education by the educator, namely 7.84, increasing to 13.89.
These results indicate that there is an effect of peer education (0 <0.05) on knowledge.
When the intervention is carried out on the respondent, the learning process occurs for each respondent. Learning is a process of changing human behavior or skills due to the interaction between individuals and individuals with their environment, so that they are better able to interact with their environment (Afandi, 2012).
Peer education can increase children's knowledge allegedly because in the discussion process there is an exchange of information known to the child. All respondents in this study had never received peer education on snacks. The results of this study are in line with Alwi's research (2019), which was carried out in Makassar, which stated that peer education could increase students' knowledge of nutrition related to vegetable and fruit consumption.
The knowledge score of the leaflet group before being given treatment was 8.68 and the knowledge score after being given treatment was 8.58 where there was a decrease in the score of 0.1 and statistically there was no effect of the leaflet (p> 0.005) on knowledge.
This research is in line with the research conducted by Herman et al (2020), at SMA 10 Makassar which stated that there was no difference in knowledge of vegetable and fruit consumption before and after giving leaflets.
Based on the results of the unpaired t test, it shows that there is a difference in knowledge between the peer education group and the control group as seen from the value of p = 0.000 <0.05, this result illustrates that the increase in students' knowledge in conveying information about snacks is more effective through peer education than through leaflets.
With peer educators students can carry out discussions together in the form of groups so that the provision of information is felt to be interactive enough and peer education is more trusted as a source of information for adolescents because adolescents can communicate comfortably (Fatimah et al., 2019).
The same thing was shown in Ghasemi's (2019) research in Iran, that peer education has a big influence on knowledge compared to other methods such as education by teachers, health workers, lectures, pamphlets, leaflets and booklets.
There was an increase in the attitude score before and after education in the peer education group, namely 43.53, increasing to 50.63. This increase in attitude score was probably due to the timing of the attitude measurement after the activity was too close. This close time affects the knowledge about snacks that are still remembered by students, thus affecting their attitudes in the habit of consuming snacks.
The low attitudes of adolescents regarding snacks in the leaflet group were due to their lack of knowledge. Lack of information then becomes the background for the lack of knowledge and low attitudes of adolescents. One of the factors that underlie the formation of a person's attitude is knowledge (Azwar, 2013).
This is in line with Setiani's research (2020), which was conducted on pre-monopouse women, that intervention using leaflet media in adolescents did not affect attitudes. This is because the research was carried out only distributing leaflets to respondents without providing counseling and it would be more effective if collaborating with other teaching aids.
Based on Mulyawati's research (2017), attitudes are also influenced by other people who are considered important, because other people around us are one of the social components that influence our attitude. In general, individuals tend to have conformist attitudes or in line with the attitudes of people who are considered important.
This is in line with the research of Andriyan et al (2020), which was conducted on female adolescents in high school, that peer education can increase knowledge and attitudes of ALSO. The peer method is an effective method for increasing knowledge and attitudes in adolescents. Giving information through peers, respondents will receive information into knowledge, and knowledge can shape attitudes.
Education using the peer education method is not effective enough to change students' habits of consuming snacks at school. This is because there are still many factors that influence the snacking habits of students at school. According to Wowor (2018), which was carried out in Manado elementary schools, a factor related to snack behavior is the habit of carrying supplies. Not only that, this snacking habit is influenced by peers and breakfast habits. Where school children like to eat street food, the reasons include school children not having time to eat breakfast at home.
This research is in line with Marda (2020), which was carried out on adolescents 13-15 years old in Bone Regency, there was a decrease in the action score of consuming soft drinks. This shows that the intervention in the form of peer education is not effective in reducing consumption of soft drinks both before and after the intervention.
Based on the independent t test to determine the comparison of the action scores between the peer education group and the leaflet group, it shows a p value <0.005, so that statistically there is a significant difference between the peer education group and the leaflet group after being given treatment. This is in line with Linda's research (2020), in Riau that there is a difference in the score selection of perineal hygiene measures for girls after the intervention between peer education and control groups.

Conclusion
There is an effect of peer education on knowledge in the intervention group. Based on the knowledge presentation, there was an increase in the knowledge score after being given education by the educator, namely 7.84, increasing to 13.89. These results indicate that there is an effect of peer education (0 <0.05) on knowledge. There was an increase in the attitude score before and after education in the peer education group, namely 43.53, increasing to 50.63.