Abstrak

Kejadian jatuh merupakan penyebab utama cedera tidak disengaja pada anak usia taman kanak-kanak, dan sebagian besar terjadi di lingkungan rumah. Cedera akibat jatuh pada usia dini berpotensi menimbulkan dampak jangka panjang terhadap perkembangan fisik, kognitif, dan fungsi neurologis pada anak. Penelitian sebelumnya lebih berfokus pada identifikasi faktor risiko dan kejadian cedera, sementara penelitian ini bertujuan memodelkan keberhasilan pencegahan jatuh anak berdasarkan kerangka manajemen risiko berbasis rumah tangga. Pendekatan ini mengintegrasikan Safety I–III dan juga teori Graceful Extensibility (TGE) untuk mengevaluasi kapasitas protektif dan adaptif sistem keluarga dalam mempertahankan keselamatan anak secara berkelanjutan. Penelitian menggunakan desain cross-sectional dengan 167 pendamping utama anak usia TK di Depok, yang mendampingi anak di lingkungan rumah tangga. Data dikumpulkan melalui kuesioner yang dikembangkan berdasarkan empat faktor utama: anak, rumah, agen, dan pengetahuan pendamping. Analisis dilakukan secara bertahap melalui Rasch measurement untuk menguji validitas dan reliabilitas instrumen, Principal Component Analysis (PCA) untuk menentukan skor faktor, Receiver Operating Characteristic (ROC) untuk menetapkan batas (cut-off point) kategori protektif, serta Bayesian Network dan Bayesian Logistic Regression untuk memetakan hubungan probabilistik antar faktor. Hasil menunjukkan bahwa 65,3% anak mengalami setidaknya satu kejadian jatuh dalam enam bulan terakhir. Instrumen yang dikembangkan terbukti valid dan reliabel dalam mengukur kapasitas protektif keluarga terhadap pencegahan jatuh pada anak. Berdasarkan hasil pemodelan, baseline probabilitas keberhasilan pencegahan jatuh anak sebesar 42% mencerminkan keterbatasan kapasitas protektif sistem keluarga dalam kondisi aktual. Melalui analisis sensitivitas, faktor rumah dan faktor anak diidentifikasi sebagai faktor protektif utama terhadap keberhasilan pencegahan jatuh. Kondisi rumah dan anak yang protektif meningkatkan peluang keberhasilan sistem sebesar tiga kali lipat (OR = 3,14). Selanjutnya, simulasi skenario what-if menunjukkan bahwa penguatan faktor rumah dan faktor anak merupakan titik pengungkit utama sistem yang dapat meningkatkan probabilitas keberhasilan pencegahan masing-masing 53% dan 52%. Faktor pengetahuan pendamping dan faktor agen berperan sebagai penguat adaptif pada lapisan proteksi berikutnya. Implikasi temuan ini adalah perlunya penyusunan program pencegahan jatuh berbasis rumah tangga dalam bentuk sistem proteksi berlapis (barrier-based approach). Barier pertama memprioritaskan penguatan faktor rumah dan faktor anak secara paralel dan interaktif melalui perbaikan lingkungan fisik rumah serta peningkatan pengetahuan dan pembentukan perilaku dasar keselamatan anak sesuai tahap perkembangan. Barier kedua menitikberatkan pada penguatan pengetahuan pendamping, sedangkan barier ketiga berfokus pada pengendalian faktor agen melalui penataan furnitur dan permainan anak. Keberhasilan pencegahan jatuh pada anak usia taman kanak-kanak di rumah merupakan hasil kinerja sistem keluarga yang adaptif dan dinamis. Integrasi manajemen risiko, Safety I–III, dan Theory of Graceful Extensibility memungkinkan pencegahan jatuh dipahami sebagai positive safety outcome yang dihasilkan melalui kapasitas sistem keluarga. Kata kunci: Pencegahan jatuh anak, keselamatan rumah tangga, manajemen risiko, Safety I–III, Bayesian Network

Falls are the leading cause of unintentional injuries in preschool-aged children, and prinarily occur in the home environment. Injuries from falls at an early age have the potential to cause long-term effects on a child's physical, cognitive, and neurological development. Previous research has focused more on identifying risk factors and the occurrence of injuries, while this study aims to model the success of fall prevention in children based on a household-based risk management framework. This approach integrates the Safety I–III and the Theory of Graceful Extensibility (TGE) to evaluate the protective and adaptive capacity of family systems in sustaining child safety. The study used a cross-sectional design with 167 primary caregivers of preschool-aged children in Depok, who care for children in household settings. Data was collected through a questionnaire developed based on four main factors: the child, the home, the agent, and the companion's knowledge. The analysis was conducted in stages using Rasch measurement to test the validity and reliability of the instrument, Principal Component Analysis (PCA) to determine factor scores, Receiver Operating Characteristic (ROC) to establish the cut-off point for protective categories, and Bayesian Network and Bayesian Logistic Regression to map the probabilistic relationships between factors.
The results show that 65.3% of children experienced at least one fall in the past six months. The developed instrument proved to be valid and reliable in measuring the protective capacity of families against falls in children. Based on modeling results, the baseline probability of successful fall prevention for children, at 42%, reflects the limitations of the family system's protective capacity in actual conditions. Through sensitivity analysis, home factors and child factors were identified as the main protective factors against the success of fall prevention. Protective home and child conditions triple the system's chances of success (OR = 3.14). Furthermore, the what-if scenario simulation shows that strengthening home and child factors are the main leverage points in the system that can increase the probability of success in prevention by 53% and 52% respectively. Companion knowledge and agent factors play a role as adaptive enhancers in the next layer of protection.
The implication of these findings is the need to develop a household-based fall prevention program in the form of a layered protection system (barrier-based approach). The first barrier prioritizes strengthening home and child factors in parallel and interactively through improving the physical environment of the home and increasing knowledge and shaping basic child safety behaviors according to the developmental stage. The second barrier focuses on strengthening caregivers' knowledge, while the third barrier concentrates on controlling agent factors through arranging furniture and children's toys.
The success of fall prevention in preschool-aged children at home is the result of the adaptive and dynamic performance of the family system. Integrating risk management, Safety I–III, and the Theory of Graceful Extensibility allows fall prevention to be understood as a positive safety outcome resulting from the family system's capacity.