13 CHAPTER 2 LITERATURE REVIEW
2.1 Understanding Concept
2.1.1 Definition of Understanding
Knowledge is a result of curiosity through sensory processes, especially in the eyes and ears of certain objects. Knowledge is an important domain in the formation of open behavior or open behavior (Donsu in Afnis, 2017).
Knowledge or knowledge is the result of human sensing or the result of knowing someone about an object through the five senses they have. The five human senses for sensing objects, namely sight, hearing, smell, taste and touch. At the time of sensing to produce knowledge is influenced by the intensity of attention and perception of the object. A person's knowledge is mostly obtained through the sense of hearing and the sense of sight (Notoatmodjo in Afnis, 2017).
Knowledge is influenced by formal education factors and is very closely related. It is hoped that with higher education, the knowledge will be wider. But people with low education are not absolutely knowledgeable too. Increased knowledge is not absolutely obtained from formal education, but also obtained from non-formal education. Knowledge of an object contains two aspects, namely positive aspects and negative aspects.
These two aspects will determine a person's attitude, the more positive aspects and objects that are known, the more positive attitude towards certain objects will arise (Notoatmodjo in Afnis, 2017).
2.1.2 Knowledge level
According to Notoatmodjo (in Wawan and Dewi, 2010) the factors that influence knowledge are as follows:
2.1.2.1 Internal factors
a. Education
Education is the guidance that is given to someone for the development of other people towards certain dreams or ideals that determine humans to act and fill life in order to achieve safety and happiness. Education is needed to obtain information in the form of things that support health so that it can improve the quality of life. According to YB Mantra quoted by Notoatmodjo, education can affect a person, including behavior towards lifestyle, especially in motivating attitudes and in development in general, the higher a person's education, the easier it is to receive information.
b. Age
Age is the age of an individual that counts from birth to birthday.
2.1.2.2 External Factors a. Work
According to Thomas quoted by Nursalam, work is an evil that must be done in order to support his life and the life of his family.
b. Environmental factor
The environment is all the conditions that exist around humans and their influence can affect the development and behavior of individuals or groups.
c. Socio-cultural
Socio-cultural systems in society can influence attitudes in receiving information. Knowledge in general can be described as follows:
1) Non-Scientific Knowledge or Ordinary Knowledge ( Common sense )
Non-scientific knowledge is knowledge obtained using methods that are not included in the scientific method category. In general, non-scientific knowledge is the result of human understanding of a certain object found in everyday life
2) Scientific Knowledge
Scientific knowledge is all the results of human understanding obtained by using the scientific method.
Scientific knowledge is knowledge that is more perfect because it already has and fulfills certain requirements with a distinctive way of thinking, namely scientific methodology 3) Noetic Knowledge (Philosophy)
Noetic knowledge (philosophy) is knowledge that does not concern boundaries, so that what is sought is the most essential causes. Knowledge that is interested in achieving knowledge of the original truth which contains the sciences of metaphysics, logic, rhetoric, ethics, economics, politics and aesthetics or knowledge whose object is arche, namely the main principles that include epistemology and metaphysics, ontology and actionology. Therefore, the object contains two aspects, namely positive aspects and negative aspects. These two aspects will determine a person's attitude, the more positive aspects and objects that are known, the more positive attitude towards certain objects will arise (Notoatmodjo in Afnis, 2017).
2.1.3 Knowledge Level Criteria
According to Nuryani et al (2017) knowledge is interpreted with a qualitative scale, namely:
1. Good Knowledge : > 75%
2. Adequate Knowledge: 56% - 74%.
3. Lack of knowledge: < 55%.
2.2 Behavior Concept
2.2.1 Definition of Behavior
According to KBBI, that is everyone's response to a stimulus and environment (Setiawan, 2019). Behavior is a person's response to
stimuli that arise from outside the subject. The answers are divided into 2, namely passive and active answers. A passive reaction is an internal reaction in a person, it cannot be observed directly by others, while an active reaction is considered a reaction if other people can observe the behavior directly (Artini, 2019).
2.2.2 Behavior Classification
According to Okwian (2015) in Halima (2018) Types of individual behavior:
2.2.2.1 Conscious behavior is what is done from the central nervous system and brain performance.
2.2.2.2 Unconscious behavior is something that occurs spontaneously or instinctively.
2.2.2.3 Visible and invisible behavior.
2.2.2.4 Simple behavior to complex.
2.2.2.5 Affective, psychomotor, cognitive and volitional behavior.
2.2.3 The Process of Forming Behavior
The process of forming behavior is divided into 3, namely:
2.2.3.1 Conditioning can be achieved by getting used to continuing to behave as expected. Habits are based on the habit theory presented by Pavlov, Skinner and Thorndike, although there are several conflicting opinions, Pavlov, Thorndike and Skinner have the main point of view and are not much different from one another.
2.2.3.2 Understanding (insight) the formation of behavior and insight based on the existence of cognitive learning theory, namely learning accompanied by understanding. According to Thorndike, the important thing in teaching includes practice questions, from Kohler's research, what is important and prioritized in learning is understanding. Kohler is a Gestalt psychology figure in terms of cognitive.
2.2.3.3 Use of the Model The process of forming behavior is based on social or observational theory. This is given to examples of leadership or older people who can be used as role models (Putra, 2018).
2.2.4 Factors Influencing Behavior
According to Lestari (2016) in Putra (2018), there are factors that can influence the formation of attitudes, including:
2.2.4.1 Environmental aspects are the strongest dominance in changing and shaping behavior. The new and constantly changing environment requires humans to be able to adapt and interact as social beings by adjusting the existing atmosphere. After that, human behavior will adapt to the needs of each individual in his new environment.
2.2.4.2 Psychosocial Supporting Environment With the formation of various organizations directly psychologically and mentally, individuals will learn the ability to adapt slowly, because later culture will guide the formation of behavior. With an organizational base capacity, people can indirectly help shape character, which then becomes behavior.
2.2.4.3 Stimulus driving behavior is formed because it is caused by the environment, which is influenced by the introduction of previously unknown rules. So that it can change the way everyone thinks about something that can shape their thinking behavior
2.2.5 Behavior Level
According to Fannisa (2019) behavior can be divided into 2 namely : 2.2.5.1 Bad Behavior if 0-50%
2.2.5.2 Good Behavior if 51-100%
2.2.6 Age Characteristic
According to Steinberg (2020) based on age, adolescence is classified into three stages, namely :
2.2.6.1 Early adolescence (10-13 years old) 2.2.6.2 Middle adolescence (14-17 years old) 2.2.6.3 Late Adolescence (18-21 years old)
2.3 Pruritus Scabies Concept 2.3.1 Definition of Scabies
Scabies skin disease is a disease that is easily transmitted. This disease can be transmitted directly (skin to skin contact) for example by shaking hands, sleeping together, and through sexual intercourse. Indirect transmission (through objects), eg clothing, towels, sheets, pillows, and blankets (Djuanda et al., 2010). This disease is easily transmitted and many factors contribute to its spread, including poverty , poor individual hygiene and an unhealthy environment . Scabies is a skin disease caused by infestation and sensitization of the mite Sarcoptes Scabies variant hominis and its products in the body . Scabies is a skin disease caused by the mite Sarcoptes scabies (mutaqqin & sari, 2011). Sarcoptes scabies can be found in tunnels of the horny layer of the skin at predictable places (Marwali, 2010)
2.3.2 Causes of Scabies
Scabies is a common skin parasitic infection caused by Sarcoptes scabies var hominis which causes itching. It is an endemic disease in tropical and subtropical regions around the world. The 0.4 mm mite burrows in the
host's epidermis to lay its eggs. The manifestations of this disease are mainly due to infestation by Sarcoptes mites and the host's immune response to the parasitic mites, eggs and other by-products. The immune response causes intense itching in response to just a few mites. Under typical conditions, mites can survive on the host for 24-36 hours.
Transmission via clothing or linen is more likely with a higher parasite load, as seen in crusted scabies. Scabies disease often occurs in people with crowded living conditions such as evacuation, making it easier for various infectious diseases, especially skin diseases, to occur. Poverty, with its characteristic consequences; Inadequate living conditions, overcrowding, and low levels of education appear to be significant driving forces for maintaining a high incidence and prevalence of the disease (Seetan et al., 2021).
2.3.3 Etiology
The cause of scabies was known more than 100 years ago as a result of a mite infestation called acarus scabies or in humans it is called sarcoptesscabies variant hominis. Sarcoptes scabies belongs to the arthropod phylum, archmid class, order acarina, super family sarcoptes.
Morphologically, this mite is 15 oval and flattened, dirty white in color, translucent with a more oval dorsal than the abdomen, colorless, the female is 300-350 microns in size , while the males are 150-200 microns in size.
The adult stage has 4 pairs of legs, 2 pairs are the front legs and the other 2 pairs are legs 8 behind. The life cycle from egg to adult lasts one month.
The female Sarcoptes Scabiei has whip feathers on the 3rd and 4th pairs of legs. Whereas in males, these whip feathers are only found on the 3rd pair of legs (Marwali, 2010) .
2.3.4 Epidemiology
Factors that support the development of this disease include low socioeconomic status, poor hygiene, sexual intercourse and its promiscuous nature (changing partners), misdiagnosis and demographic and ecological developments. In addition, transmission factors can be through sleeping together in one bed, through clothes, bedding or other objects. The method of transmission (transmission) is direct contact, for example shaking hands, sleeping together and sexual contact. Indirect contact, for example through clothing, towels, bed linen, pillows, and so on (Djuanda et al., 2010).
2.3.5 Pathophysiology
Scabies mites can cause transient symptoms in humans, but they are not the cause of persistent infestations. The most efficient mode of transmission is through direct and prolonged contact with an infected individual. Scabies mites can survive up to three days on human skin so media such as sleeping places or clothing are alternative sources of transmission. The life cycle of the flea lasts 30 days and is spent in the human epidermis. After copulation, the male lice will die and the female lice will burrow into the skin layer and lay a total of 60-90 eggs. Eggs that hatch take 10 days to become larvae and adult lice. Less than 10% of the eggs can produce adult lice. The scabies mite then moves through the upper layers of the skin by secreting proteases that degrade the stratum corneum. Scybala (feces) are left behind as they travel through the epidermis, creating the clinical condition of the lesion which is recognized as a burrow (Mutaqqin & sari, 2011). It is suspected that every 30 year cycle an epidemic of scabies occurs. Many factors contribute to this disease , including low socioeconomic status, poor hygiene, promiscuous sexual relations, misdiagnosis, and dermographic and ecologic developments. This disease can be included in STI (Sexually Transmitted Infection). According to the World Health Organization (WHO) the
incidence of scabies in 2014 was 130 million people in the world.
According to the International Alliance for the control of Scabies (IACS) the incidence of scabies varies from 0.3% to 46%. Scabies is found in all countries with varying prevalence. In some developing countries, the prevalence of scabies is around 6% -27% of the general population, affecting all races and age groups and tends to be high in children and adolescents. According to the World Health Organization (WHO), the incidence of scabies in 2014 was 130 million people in the world.
According to the International Alliance for the control of Scabies (IACS) the incidence of scabies varies from 0.3% to 46%. Scabies is found in all countries with varying prevalence (Riyadhy Ridwan et al., 2017).
2.3.6 Signs and Symptoms of Scabies
The signs and symptoms of scabies are the result of a hypersensitivity reaction to the proteins released by the mites and usually manifest with severe itching and a characteristic patch of skin. lesion consisting of erythematous burrows and papules that are frequently excoriated. The characteristic lesions are most often found on the webs of the fingers, the flexor aspects of the wrists, the trunk - especially in the genital area - and on the feet (Bae et al., 2020b). There is a tunnel (cuniculus) in places where the parasite must live temporarily or permanently (predilex). The response that appears can resemble an allergic reaction, in the form of a skin rash, persistent itching which usually occurs at night, especially in areas of skin folds such as between the fingers, wrists, armpits, folds and buttocks, under the breasts, and sometimes accompanied by fever . In infants and young children, lesions can also be found elsewhere, such as the face, head, neck, palms and soles. Often also accompanied by secondary bacterial infection, resulting in purulent lesions/ pustules (Engelman et al., 2013). Severe infections with large numbers of parasites can be seen in children and adults with poor nutrition and low immune status .
2.3.7 Factors Associated with Scabies a. sanitation
Based on research (Wardhani, 2007) , 33 people (84.6%) suffering from scabies. Scabies is a skin disease associated with poor sanitation and hygiene, when there is a lack of water and no body cleaning facilities, lack of food and crowded living, especially in slum areas with very poor sanitation. Bad. Scabies can also be caused by poor sanitation.
b. Knowledge
Based on research (Khotimah, 2006), analysis results obtaining a P value <0.05 means that there is a significant correlation between knowledge, attitudes, and personal hygiene with the occurrence of scabies. Scabies is still a disease that is difficult to eradicate, in humans, especially in the community environment in residential areas closed with a simple lifestyle, as well as a low level of education and knowledge, treatment and control is very difficult .
c. Population density
Based on the problems that related to the incidence of scabies in Islamic boarding schools is that s scabies is a skin disease that affects many students, cases occurs in densely populated areas and the number of cases is large in children school age. Scabies disease (scabies) is detected when it infects more from 1 person in a family.
d. Behavior
Based on research shows 70 people (54%) suffer from scabies, there is a correlation between density occupants, bathing habits, changing clothes habits, using habits tools shared with scabies sufferers.
e. Alternate use of toiletries, clothes and prayer tools
Transmission through indirect contact such as through bedding, clothing, or towels play an important role (Mansyur et al., 2006). Based on the results of the research , showed 44 people (62.9%) were affected
by scabies, and there was a positive correlation significant difference between the habit of using bath soap, usage habits towels, habit of changing clothes, habit of sleeping together, habit use of bed blankets and the habit of washing clothes together with scabies sufferers with scabies incidence.
f. Water
Water is the most essential thing for health, not only in production efforts but also for domestic consumption and utilization (drinking, cooking, bathing, etc.). Promotion that increased from infectious diseases that can be deadly or detrimental to health transmitted through polluted water. At least 200 million people are infected through contact with the water invested by 23 parasite. Some water-related diseases are communicable, These diseases are generally classified according to various environmental aspects that can be intervened by humans.
g. Personal hygiene
Humans can be infected with scabies mites regardless age, race or gender and regardless of social and economic status, but poor hygiene and promiscuity increase infection. The 1993 GBHN mandated the need for efforts to improve public health, including through environmental hygiene and health. Cleanliness is the state of being free from dirt, including, among other things, dust, garbage, and odors. In Indonesia, the problem of cleanliness is always became a growing polemic. Concerned cases Hygiene problems are always increasing every year . Cleanliness is a symbol of a person's personality, if a place residence, clothing and body condition, looks clean then it is certain that person is a clean and healthy human being .
h. Sexual Intercourse
Scabies disease mostly affects men 57.26%. female 42.74%. People who often have sexual intercourse with multiple partners, is a population at risk of contracting scabies, the transmission is through body contact (Muslimin in (Fernawan, 2008)). Transmission of scabies
is through direct contact, for example shaking hands, sleeping together in one bed, and sexual intercourse.
2.3.8 Scabies Prevention
Patients as a source of infection must be treated perfectly. Contact with sufferers or animals should be avoided . Besides that, always maintain body hygiene by bathing twice a day, always maintain body hygiene by bathing twice a day with soap regularly and maintaining cleanliness, washing and soaking bedding and pillows used by sufferers in boiling water. (Prof. Dr. Soedarto, 2016).
2.3.9 Scabies Treatment
Parasites can be eradicated by emulation of 25% benzoyl benzene, 1%
gamma benzene hexachloride or 25% monosulfiram. Antibiotics are given if there is a secondary infection by germs, and antihistamines are given to treat the intense itching that is complained of by sufferers (Prof. Dr.
Soedarto, 2016). All clothing and clothing should be washed in very hot water and dried in a hot dryer, as scabies can live up to 36 hours on linen.
If bed linen or patient clothing cannot be washed in hot water, dry cleaning is recommended. After scabies treatment is complete, the patient must apply an ointment such as topical corticosteroids to the skin lesions because scabicide can irritate the skin. Patients are advised not to apply more scabicide (because this action will increase irritation and increase itching). All family members and people who are closely related should be treated simultaneously to get rid of scabies. If scabies is sexually transmitted, the patient may also need treatment for other sexually transmitted diseases.(Mutaqqin & sari, 2011)
2.3.10 Variations of Scabies
Scabies has three clinical presentations namely classic, crusted, and nodular.
a. Classic scabies is common scabies, presenting with severe pruritus (worse at night), fatigue, irritability, and in some patients fever from secondary impetigo or cellulitis. Parasites in classic skies are usually few with an average of 10 to 12 Selma mite infestations in the first 3 months (McCarthy et al., 2004). On the skin a gray line is formed which is the result of mite secretions that are moving (Burgess, 1994).
b. Crusted scabies occurs in patients with weakened immune systems, such as those on long-term immunosuppressive therapy (i.e., recipients of organ transplants) or those infected with HIV or type 1 lymphocyte infection. Other vulnerable groups are patients with mental or physical disabilities such as those with have paralyzed limbs, sensory neuropathy, or leprosy, because in that condition you cannot feel an itch or a scratch (Cargill et al., 1997). The mites that cause crusted scabies are the same as the mites that cause classic scabies, but the number of mites makes the difference between the two. The mites in crusted scabies are much larger and can range from thousands to millions per patient, whereas in classic scabies there are only 10-12 mites. This difference causes crusted scabies to be much more contagious than classic scabies. Treatment of patients suffering from crusted scabies is quite difficult because eradication of the mites and the weight of the eggs from the skin area is very large and difficult to do (Heukelbach & Feldmeier, 2006).
c. Nodular scabies is a rare type of scabies characterized by intensely itchy reddish-brown nodules up to 2 cm high that are usually found on the genitals, buttocks, groin, and axillae. Nodules are thought to be the result of a hypersensitivity reaction to mite products because the mites are almost never identified on this lesion (Chosidow, 2000).
Based on the Dermatologist Clinic book (Soutor & Hordinsky, 2013), scabies has three clinical presentations, namely:
a. Nodular scabies is a type of scabies that usually presents with multiple, highly pruritic, salmon-reddish nodules and is usually found in the axillae, groin, and male genitalia. Nodular scabies is
an hypersensitivity reaction that usually occurs after a previously successfully treated scabies infection and does not always indicate active infection.
b. Scabies bolusa is a type of scabies with a blister appearance that generally occurs on the palms and soles of babies infected with Sarcoptes Sabies. Bolsa scabies usually presents as a large bolus eruption, mostly in elderly adults. Often there is a misdiagnosis of bolusa scabies with bolusa pemphigoid.
c. Crusted scabies is a type of scabies that presents as thick, crusty or scaly plaques and is often misdiagnosed as psoriasis. Crusted scabies usually affects individuals who are disabled, elderly, disabled or infirm. These patients often do not exhibit the characteristic pruritus and scratching. The number of mites in crusted scabies is much larger, ranging from thousands of mites.
This causes crusted scabies to be highly contagious.
2.4 Pruritus Concept
2.4.1 Pruritus Definition
Pruritus, or itching, is a sensation that creates a strong urge to scratch.
This definition has even been expressed by Samuel Hafenreffer about 340 years ago. In general, pruritus is a symptom of various skin diseases, both primary and secondary, although there are pruritus caused by systemic factors without skin lesions. Pruritus that is not accompanied by skin disorders is called essential pruritus (pruritus sine materia). Primary skin lesions which are the main diagnostic stage can undergo obiteration or change to form secondary skin lesions, so the diagnosis becomes difficult to enforce. Scabies infestations impose a high burden on individual patients, often due to unbearable itching. Symptoms last as long as scabies lasts, but can become chronic due to persistence after infestation therapy. Thus, scabies should be excluded in cases of
persistent pruritus especially with a history of itching in persons with close skin contact. Itching may be worse at night, however, not specifically for Scabies, as other common skin diseases also show increased itching, namely atopic dermatitis and psoriasis. Regarding other clinical symptoms, Brenaut et al. found that the burning sensation accompanying itching was significantly less common than with other pruritic skin diseases (Ständer & Ständer, 2021).
2.4.2 Pruritus Type
According to Twcross, the types of causes of pruritus can be classified into: (1) pruritoceptive; (2) neuropathy; (3) neurogenic; and (4) psychogenic. Pruritoceptive itching is itching that originates from the skin and occurs due to the presence of pruritogens, such as dry skin, inflammation, and skin damage. Neuropathic itching is itching that occurs due to lesions in the afferent pathways for conducting impulses, such as neuralgia and cerebrovascular disorders. Neurogenic itching is itching that originates from the center (central) without being accompanied by pathological conditions. An example is a blockage of the gallbladder which will increase the levels of opioid compounds which will trigger pruritus. Meanwhile, psychogenic itching is itching that tends to be caused by psychological activity and repetitive habits. For example, a fear of parasites (parasitophobia) can cause an itchy sensation.
2.4.3 Pathophysiology
It is known that chemical substances and physical (mechanical) stimuli can trigger pruritus. Stimulation of free nerve endings located near the dermoepidermal junction is responsible for this sensation. Synapse occurs at the dorsal root of the spinal cord (grey substance), synapsing with a second neuron that crosses to the middle, then to the contralateral spinothalamic tract to terminate in the thalamus. From the thalamus, there
is a third neuron that transmits information to the perceptual center in the cerebral cortex. It was once thought that pruritus had a function to attract attention to stimuli that were not too dangerous (mild surface stimuli), so it was hoped that there would be anticipation to prevent something from happening. However, along with the development of medical science and the discovery of microneurographic techniques (in which the action potential of C nerve fibers can be measured using very fine glass electrodes) succeeded in finding nerve fibers that are specialized to transmit itching impulses, and thus have changed the paradigm that pruritus is a stimulus. mild pain. 5 The nerves that transmit the sensation of itching (and the tickling sensation) are the same nerves that are used to transmit pain. At present it has been discovered that nerve fibers that specifically transmit pruritic stimuli, both in the peripheral nervous system, and in the central nervous system. 4 These are type C nerve fibers – unmyelinated. This is evidenced by the phenomenon of disappearance of itching and tingling sensations when a blockade of pain nerve conduction is performed in an anesthetic procedure. 3 However, nerves have also been found that only transmit pruritic sensations. At least, about 80% of type C nerve fibers are polymodal nociceptors (respond to mechanical stimuli, heat, and chemical); while the remaining 20% are mechano-insensitive nociceptors, which are not stimulated by mechanical stimuli but by chemical stimuli. Of these 20% nerve fibers, 15% do not stimulate itching (called negative histamine), while only 5%
are histamine positive and stimulate itching. Thus, histamine is the most studied pruritogen to date. Besides being stimulated by pruritogens such as histamine, the latter nerve fibers are also stimulated by temperature.
2.4.4 Pruritus Measurement
Measurement of pruritus or itching in this study used the 5-D Pruritus Scale from (Elman et al., 2010). This scale has been used in various research and clinical studies to study various skin conditions associated
with itching, such as atopic dermatitis, psoriasis, and urticaria. The 5-D itch scale was developed as a brief but multidimensional questionnaire designed to be useful as an outcome measure in clinical trials. The five dimensions are duration, degree, direction, disability and distribution.
a. Duration
Shows how long the itch lasts, from momentary to chronic or long- lasting
b. Degrees
Indicates the severity of itching, from very mild to very severe c. Directions
Shows how often someone scratches or rubs the itchy skin area, from never to very often.
d. Disability
Indicates how much itching interferes with daily activities, from not bothersome to very annoying.
e. Distribution
Shows how many areas of the skin are itchy, from just one small area to the whole body.
The scores for each of the five domains are achieved separately and then summed together to get a total score of 5-D. A 5-D score could potentially range between 5 (no pruritus) and 25 (pruritus worst).
2.4.5 Pruritus Management 2.4.5.1 Pharmacological
a. Permethrin b. Gamectacin
c. Sulfur Presipitatum Ointment 2.4.5.2 Non-pharmacological
a. Personal Hygiene
Personal Hygiene as an act of maintaining one's hygiene and health for physical and psychological well-being. By
applying it, the degree of health will increase, prevent various diseases, increase self-confidence and create beauty (Yulianto et all, 2020).
Personal hygiene is the practice of caring for one's body to keep it clean, healthy, and able to improve one's health status so that one can effectively deal with physical and social health problems. Personal hygiene involves improving personal hygiene, maintaining personal health, preventing disease, increasing self-confidence and generating attractiveness (Purnama & Susanna, 2020)
b. Moisturizer
Moisturizing is the prevention or treatment of dry, rough, cracked, or itchy skin. This moisturizer is also often used to soothe minor skin irritations caused by diaper rash or radiotherapy procedures . These moisturizers can be found in a variety of skin and beauty products. Petroleum jelly, also known as vaseline, is a semitransparent material that is usually used as a lubricant or moisturizer in skin and cosmetic products. Potreleum jelly has 2 functions, namely:
1) Helps maintain the outer skin, protecting the skin from the effects of weather and exposure.
2) Helps maintain the inner skin by preventing the natural loss of water from our skin. This allows the skin to be naturally moisturised and soft from within the skin itself.
(Jimmy Wales, 2010 in (Zahara & Dewi, 2016).
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The Level Of Pruritus In
Scabies 2.5 Conceptual Framework
The conceptual framework in research is the framework for the correlation between the concepts that will be measured or observed through the research that will be carried out. The diagram in the conceptual framework must show the correlation between the variables to be examined. (Sugiyono, 2019)
Scheme 2.1 Conceptual Framework Independent Variable
Dependent Variable
Information :
: Researched : Not researched
2.2 Hypothesis
The hypothesis is a temporary answer that the truth is to be tested through research (Yam & Taufik, 2021). Meanwhile, according to Kumar (2019) in (Nursalam, 2020) a hypothesis is a question of assumptions about the correlation between two or more variables that are expected to answer a question in research.
Each hypothesis consists of a unit or part of the problem.
H a : There is a correlation between the level of understanding and behavior with the level of pruritus in scabies at the Darul Hijrah Puteri Islamic Boarding School
H 0 : There is no correlation between the level of understanding and behavior with the level of pruritus in scabies at the Darul Hijrah Puteri Islamic Boarding School
Level Of Understanding
Incidence of Scabies Behavior
