The growth of the elderly in the world reaches 1065 million people, divided into 645 million women, 420 million men and it is estimated that by 2030 the number of elderly people will reach 2 billion people [1]. The problem of the elderly today is something that really needs to be discussed, this is because the number of elderly people is increasing. Globally, the elderly population in Indonesia is predicted to increase higher than the elderly population in the world after 2100, which is 41% [2].

Data from the World Health Organization in 2015, shows that the elderly who do not maintain personal hygiene are estimated at 38.2% in the world [3]. Data on the elderly population in Indonesia shows that the elderly who do not maintain personal hygiene are estimated to be around 18.2% of the total elderly population. The need for personal hygiene must be a top priority for the elderly because with good personal hygiene, the elderly are more acceptable in society [4]. Maintaining the health of the elderly and personal hygiene is one of the basic factors because individuals who have good personal hygiene will have a lower risk of getting disease [5]. 

Physical health of the elderly is influenced by personal hygiene [6]. Apart from the physical condition of fulfilling the personal hygiene needs of the elderly, it is related to the knowledge of the elderly about the importance of fulfilling the personal hygiene of the elderly [4]. Someone who has knowledge about personal hygiene will affect the person's personal hygiene practice. Knowledge of personal hygiene includes understanding, goals, benefits and impacts of personal hygiene. Knowledge of personal hygiene is very important because good knowledge can improve health. Individuals with knowledge about the importance of personal hygiene will always maintain personal hygiene to prevent illness or disease [5,7]. 

Based on the description of the background above, the researchers interested in conducting research on the relationship between knowledge and the fulfillment of personal hygiene on the elderly in Gorontalo Province.

Study Design and Participants

A descriptive cross-sectional study design. Data were collected from March to April 2021. The population in this study were all elderly people in Leboto Village, Kwandang District, Gorontalo Regency. The sampling technique used in this research is purposive sampling. The inclusion criteria are elderly men and women who live in Leboto Village, Kwandang District, North Gorontalo Regency, aged 60-69 years and willing to be respondents. The elderly who were not present at the time of the study and who were not willing to be respondents were excluded.

Measurements

The research instrument used in this study was a questionnaire. The questionnaire used is a knowledge questionnaire about personal hygiene taken from the previous researcher Onya Rosalina De Fatima Lopes and the personal hygiene questionnaire from the previous researcher Sri Sistari Wahyu Ningsih and modified by the researcher and has been tested for validity and reliability. Cronbach's alpha value for the knowledge questionnaire is 0.950>0.7, meaning that the questionnaire is reliable or consistent. Cronbach's alpha value for personal hygiene questionnaire is 0.968>0.7, which means that the questionnaire is reliable or consistent.

The first questionnaire contains questions posed to respondents about knowledge on personal hygiene, with total 10 questions. This question consists of 4 indicators, namely the understanding of personal hygiene, the purpose of personal hygiene, the benefits of personal hygiene and the impact of personal hygiene. This question is a multiple choice question, the data is measured using the Guttman scale with a score of True = 1, False = 0.

The second questionnaire contains statements submitted to respondents regarding the fulfillment of personal hygiene totaling 15 statements. This statement only consists of one item, namely a favorable item, in this statement it consists of 5 indicators of personal hygiene, namely skin hygiene, hair hygiene, dental hygiene, eye, nose and ear hygiene, as well as hand, foot and nail hygiene. This statement is a statement with a clear Yes and No answer, the data is measured using the Guttman scale with a score of Yes = 1, No = 0.

Study Procedure 

Ethical approval was obtained from the Institutional Review Board of Muhammadiyah Gorontalo University. In addition, permission to conduct research was obtained from the village head prior to conducting the research. The researcher looks for potential respondents by visiting the target villages and then selecting respondents according to the inclusion criteria. If the elderly met the inclusion criteria and agreed to participate in the study, they were asked to complete written informed consent and complete a questionnaire.

Data Analysis

The data were analyzed using SPSS version 17. Descriptive statistics (frequencies, percentages, mean and standard deviation) were used to present demographic factors, knowledge and personal hygiene. Chi-square test were used to examine the associations demographic factors, health characteristics and the intention to undergo cervical cancer screening among Indonesian women.

Table 1: Demographic Factors of Study Sample (n = 41)

Table 2: Relationship among Knowledge and Personal Hygiene of Study Sample (n = 41)

Demographic Factors and Health Characteristics

Table 1 shows that less than a quarter of the respondents were 63 years old (n = 8,19.5%). Most of the elderly are male (n = 22, 53.7%), have a low level of education (n = 38, 92.7%) and work as farmers (n = 20, 48.8%).

Knowledge and Personal Hygiene

Table 2 shows the crosstab of the relationship between knowledge and the fulfillment of personal hygiene in the elderly. The results show that from 41 respondents, respondents who have good knowledge and good personal hygiene are 16 respondents (39%), respondents who have less knowledge but good personal hygiene are 2 respondents (4.9 %) and respondents who have less knowledge and less personal hygiene are 23 respondents (56.1%). Based on the results of statistical tests using the Chi-square test, the p-value = 0.000 (p< = 0.05) means that there is a relationship between knowledge and the fulfillment of personal hygiene in the elderly. The contingency coefficient value is 0.920 which is interpreted that the strength of the relationship between knowledge and the fulfillment of personal hygiene in the elderly is very strong and the direction of the relationship is positive.

Based on the results of this study, it shows that most of respondents have less knowledge, namely as many as 25 respondents (61%) this is due to the education level of respondents who 100% have a low level of education, namely Elementary School. In accordance with the theory of education is an attempt to develop personality and abilities. The higher a person's education, the easier it is for that person to receive information and the more information that comes in, the more knowledge he gets [8]. This is in line with previous research which states that there is a significant relationship between the level of education and the level of knowledge [9]. Because it is undeniable that the higher a person's level of education, the higher they receive information so that the more knowledge they have. According to the theory of the low knowledge of the elderly can be caused by low education [10]. This low level of education makes knowledge less so that the elderly do not understand in determining good and correct behavior.

Respondents who have good knowledge are 16 respondents (39%) this is because most of the respondents are female, as many as 10 respondents (62.5%). Women tend to have high motivation in learning something so that they have more knowledge than men [11]. Based on the results of this study, it showed that most of the respondents had poor personal hygiene, namely 23 respondents (56.1%). This is in accordance with the previous study that the elderly when over 65 years old will experience a process of decreasing function that is increasingly visible, especially in carrying out daily activities such as going to the bathroom, eating, dressing and others [12]. There is a decrease in the ability to carry out daily activities, where the main factor that determines the level of independence of the elderly is age.

Based on the results of this study, 23 respondents (56.1%) lacked knowledge and personal hygiene, this was due to the lack of information obtained by respondents, especially regarding information about personal hygiene both from the mass media and direct socialization. This is in accordance with previous study if someone has a low level of education, but gets good information from various media such as television, radio, newspapers, magazines and others, then this can increase one's knowledge [13]. Knowledge is one of the factors that affect the incidence of declining personal hygiene in the elderly. Elderly people who have low memory knowledge will not understand how to do good and correct personal hygiene [14]. In line with previous study that the results show that there is a relationship between knowledge and the incidence of decreased personal hygiene in the elderly. Knowledge is one of the factors that affect the incidence of decreased personal hygiene in the elderly [4,15].

Limitations

This study has several limitations. First, data were collected from the elderly living in Gorontalo Province, where this population cannot be generalized to other populations. This study has a small sample size, so further research should take a larger sample size.

The knowledge of the elderly about personal hygiene and the fulfillment of personal hygiene in the elderly is still lacking. There is a relationship between knowledge and the fulfillment of personal hygiene in the elderly in Gorontalo Province.

Acknowledgment

Thank you to Sumarmi and Rezky Aulia Yusuf for editing manuscript.

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