Journal of Health Promotion and Behavior
e-ISSN: 2549-1172 Publisher: Masters Program in Public Health, Sebelas Maret University, Jl. Ir Sutami 36A, Surakarta 57126, Central Java, Indonesia Editor in Chief: Dr. Rohmaningtyas Hidayah Setyaningrum, dr., Sp.KJ., M.Kes Sebelas Maret University, Solo, Indonesia Aim and Scope The Journal of Health Promotion and Behavior (JHPB) is a peer-reviewed, open-access international journal that publishes original research articles, systematic reviews, and meta-analyses on a quarterly basis. Since its establishment on May 21, 2015, JHPB has served as a scholarly platform for advancing knowledge and practice in health promotion, health education, and health-related behavior across diverse populations and settings. JHPB takes a multidisciplinary approach to understanding the complex interplay of psychological, social, cultural, behavioral, and policy-level factors that influence health outcomes. The journal welcomes contributions from fields such as psychology, sociology, anthropology, communication, education, nursing, public health, and allied health professions, particularly as they relate to the prevention of illness, promotion of well-being, and transformation of health behaviors. The journal aims to provide evidence-based insights and practical strategies for improving population health through behavior change, policy reform, and community-based interventions. It seeks to deepen understanding of health behaviors and their determinants at individual, community, and societal levels. JHPB encourages submissions from researchers worldwide and places a strong emphasis on supporting high-quality research from low- and middle-income countries (LMICs), especially work that addresses pressing local health issues with potential global relevance. Areas of interest include, but are not limited to: Health behavior theories and applications Health promotion and disease prevention strategies Behavioral epidemiology and lifestyle research Health education methodologies and outcomes Cultural and social influences on health behavior Community health interventions and participatory approaches Health communication and information dissemination Policy and environmental influences on public health behavior Evaluation of health programs and health systems JHPB is officially accredited by the Ministry of Research, Technology, and Higher Education, Government of Indonesia, under Decree No. 10/C/C3/DT.05.00/2025. The journal holds SINTA 2 status, effective from April 16, 2022, to July 16, 2027. Through the dissemination of rigorous and impactful research, the Journal of Health Promotion and Behavior strives to advance global health equity, foster innovation in public health practice, and support the development of effective health promotion strategies tailored to diverse populations.
Masters Program in Public Health, Sebelas Maret University
Effect of Breast Milk Donor Education Program in Increasing Breastfeeding Mothers’ Participation: A Scoping Review
Background: Breast milk donation is one of the solutions recommended by WHO in fulfilling nutritional intake for infants who cannot receive it directly from their mothers. However, the participation rate of breastfeeding mothers in breast milk donor programs remains low in many countries. This study aims to explore effectiveness of breast milk donor education programmes in increasing breastfeeding mothers’ participation. Subjects and Method: This study employed a scoping review guided by the Arkey and O'Malley framework approach. The population in this study consists of breastfeeding mothers who are potential donors or recipients of breast milk donation. The article search used 4 databases namely Pubmed, Sciencedirect, ProQuest and Wiley according to the inclusion criteria, namely articles published in the last 10 years (2016-2025) with keywords. Filtering articles using PRISMA Flowchart. There were 10 articles obtained and further analysis was carried out based on the Joanna Briggs Institute (JBI). Results: Based on the review of 10 articles, it can be concluded that breast milk donor education programs have a significant influence in increasing breastfeeding mothers' participation, especially through behavioural theory-based approaches and digital technology interventions used to promote and serve as recruitment platforms. However, the success of educational programmes is highly dependent on adaptation to cultural and social factors in each region. Conclusion: Breast milk donation education effectively inreases breastfeeding participation, especially when it digital, behavior-based and contextual. Therefore, future educational approaches need to be comprehensive and contextually adaptive in order to strengthen sustainable breast milk donation practices.
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Perception-Driven Prevention: A Health Belief Model Implementation to Dengue Fever Control in Jepara, Central Java, Indonesia
Background: Dengue fever is an infectious disease caused by the dengue virus and transmitted through the bites of Aedes aegypti and Aedes albopictus mosquitoes. The disease continues to pose a major public health challenge, particularly in tropical and subtropical regions, including Indonesia. This study aims to examine the Health Belief Model in relation to dengue prevention behaviors and the incidence of dengue fever in Jepara District, Central Java. Subjects and Method: This was a cross-sectional study conducted in Jepara District, Central Java, in January 2025. A sample of 200 respondents was selected using the fixed disease sampling method, all of whom were residents of Jepara District. The dependent variable was dengue prevention behavior. Independent variables included perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. The data were collected using a questionnaire and analyzed using multiple linear analysis. Results: Dengue prevention behavior increased with higher perceived susceptibility (b = 0.21; 95% CI = 0.00 to 0.43; p = 0.049), perceived severity (b = 0.29; 95% CI = 0.01 to 0.57; p = 0.044), perceived benefits (b= 0.33; 95% CI= 0.03 to 0.63; p = 0.030), cues to action (b = 0.19; 95% CI = 0.01 to 0.37; p = 0.042), and self-efficacy (b= 0.33; 95% CI = 0.01 to 0.65; p = 0.045), while lower perceived barriers were associated with improved prevention behavior (b = –0.18; 95% CI = –0.36 to –0.01; p = 0.045). Conclusion: The results of this study show that higher levels of perceived susceptibility, perceived severity, perceived benefits, cues to action, and self-efficacy, as well as lower perceived barriers, enhance dengue prevention behaviors.
Health Behaviors Associated with Overweight among University Students: The Roles of Ultra-Processed Food Consumption and Physical Activity
Background: Overweight and obesity among university students are influenced by dietary behavior, physical activity, socioeconomic characteristics, and family predisposition. This study aimed to analyze factors associated with overweight/obesity among university students, focusing on ultra-processed food consumption and physical activity while controlling for potential confounders. Subjects and Method: This case-control study involving 201 active university students, comprising 77 overweight/obesity cases and 124 normal controls. Participants were selected using purposive sampling with matching by sex and age. Data were collected using a semi-quantitative food frequency questionnaire (SQ-FFQ), International Physical Activity Questionnaire-Short Form (IPAQ-SF), Pittsburgh Sleep Quality Index (PSQI), and anthropometric measurements. Data were analyzed using multiple logistic regression with SPSS version 29. Results: family history of obesity was significantly associated with higher odds of overweight/ obesity. Students with a family history of obesity had approximately three times higher odds of being overweight/obese than those without a family history (aOR= 2.96; 95% CI=1.10 to 7.93; p= 0.031). Students enrolled in the Nutrition study program had lower odds of overweight/obesity than those in the Hospital Administration program (aOR=0.35; 95% CI=0.13 to 0.95; p= 0.040). Weekly allowance >IDR 700,000 showed a borderline association with higher odds of overweight/ obesity (aOR= 6.59; 95% CI=0.89 to 48.95; p=0.065). Vigorous physical activity ≤10 minutes also showed a borderline association with lower odds (aOR=0.33; 95% CI=0.11 to 1.01; p=0.053), whereas vigorous physical activity of 11–20 minutes was not significantly associated with over­weight/ obesity (aOR= 0.89; 95% CI=0.32 to 2.45; p=0.820). Frequent snack and soft drink consumption were not significantly associated with overweight/obesity after adjustment. Conclusion: Family history of obesity and study program were significantly associated with overweight/obesity, whereas ultra-processed food consumption and physical activity were not independently associated after adjustment. These findings highlight the importance of familia predisposition and nutrition-related educational environments in campus-based prevention strategies.
Correlations between Knowledge, Attitude, Personal Values, Traumatic Experiences, and Risky Sexual Behavior among Indonesian Adolescents
Background: Sexually transmitted infections (STIs) remain a major public health concern among adolescents, with risky sexual behavior contributing to ongoing transmission and adverse sexual and reproductive health outcomes. Although knowledge, attitudes, personal values, and traumatic experiences have been identified as factors related to adolescent sexual behavior, evidence examining these factors simultaneously among Indonesian adolescents remains limited. This study aimed to examine the associations of knowledge, attitudes, personal values, and traumatic experiences with risky sexual behavior among Indonesian adolescents. Subjects and Method: A cross-sectional study was conducted among 189 adolescents. Participants were recruited using multistage probability sampling technique. The dependent variable was risky sexual behavior. The independent variables were knowledge of STIs, attitudes toward reproductive health, personal values, and traumatic experiences. Data were collected using a structured self-administered questionnaire. Responses were categorized based on Rasch model analysis. Correlation between variables were analyzed using the Product Moment Pearson are test, and multivariat analysis used multiple regression linier. Statistical significance was set at p<0.05. Results: A total of 189 adolescents participated in the study, and 55.1% were classified as having risky sexual behavior. Multiple linear regression analysis showed that traumatic experience was positively associated with sexual behavior (b= 0.15; 95% CI= 0.01 to 0.29; p= 0.049). No significant associations were found between knowledge (b= 0.10; 95% CI= −0.04 to 0.24; p= 0.162), attitude (b = −0.03; 95% CI = −0.40 to 0.34; p = 0.882), personal value (b= 0.07; 95% CI= −0.50 to 0.65; p = 0.803), and sexual behavior. Conclusion: Attitudes toward reproductive health, personal values, and traumatic experiences were significantly associated with risky sexual behavior among Indonesian adolescents, whereas knowledge of STIs was not. These findings indicate that psychosocial factors should be considered alongside knowledge in understanding risky sexual behavior among adolescents.
Psychosocial Work Factors and Academic Performance among Working Professionals: A Public Health Perspective
Background: Long working hours and high job demands are recognized psychosocial risk factors in occupational health. Professionals who pursue graduate education while maintaining full time employment may experience dual role strain, which can affect cognitive functioning and academic performance. This study examined the association between psychosocial work factors and academic performance among occupational health professionals enrolled in graduate education. Subjects and Method: A cross-sectional quantitative study was conducted among 95 occupa­tional health professionals enrolled in the Master of Applied Occupational Health and Safety program. Variables included weekly working hours, weekly study time, perceived workplace support, family support, resilience, and grade point average (GPA). Data were analyzed using a multiple linear regression. Results: Participants reported high levels of work exposure, with some experiencing extreme workloads. Workplace support was significantly associated with lower GPA (b= −0.08, 95% CI −0.16 to −0.01, p = 0.028), whereas weekly study time showed a positive association with GPA (b= 0.01, 95% CI 0.01–0.01, p = 0.050). Resilience (b= −0.01, 95% CI −0.01 to 0.01, p = 0.449), weekly working hours (b= −0.01, 95% CI −0.01 to 0.01, p = 0.523), and family support (b= −0.01, 95% CI −0.03 to 0.02, p= 0.736) were not significantly associated with GPA. Conclusion: The findings suggest that workplace support without meaningful workload adjustment may function as a latent psychosocial risk factor rather than a protective mechanism. Academic performance among working professionals appears to depend more on structural time availability than on perceived support alone. From a public health perspective, alignment between institutional encouragement and actual workload management is essential to safeguard cognitive functioning and academic success.
Unveiling Maternal Behavior in Stunting Prevention and Control: A Cross-Sectional Study of the Health Promotion Model in Surakarta, Indonesia
Background: Child stunting is a major public health problem and a key indicator of child well-being. Indonesia aims to reduce stunting prevalence to below 14% through behavior change communication and health promotion. Guided by the Health Belief Model, Social Cognitive Theory, and the Social Support Model, this study aimed to develop a health promotion model of maternal behavior for stunting prevention and control in Surakarta City. Subjects and Method: This study used cross-sectional research approach. The research location was Surakarta City, Central Java, Indonesia; conducted for 3 (three) months from June 2024 to August 2024. The target population of this study comprised mothers who were members of the Village-Level Stunting Reduction Acceleration Team (TPPS) in Surakarta City. The sampling technique used quota sampling technique; the sample size was 143 respondents. Data collection techniques used questionnaires; data analysis consisted of univariate, bivariate, and multivariate analysis. Multivariate analysis was performed with multiple logistic regression. Results: The results showed that maternal behavior in stunting prevention and control was not associated with perceived threat (aOR=1.04; 95% CI=0.96 to 1.12; p=0.328), knowledge (aOR=0.87; 95% CI=0.71 to 1.05; p=0.146), outcome expectation (aOR=0.99; 95% CI=0.76 to 1.27; p=0.907), situational perception (aOR=1.03; 95% CI=0.85 to 1.26; p=0.746), self-efficacy (aOR=0.97; 95% CI=0.81 to 1.16; p=0.721), cues to action (aOR=1.02; 95% CI=0.94 to 1.12; p=0.623), or social support (aOR=1.01; 95% CI=0.92 to 1.10; p=0.831). Mothers with longer TPPS involvement had 2.94 times higher odds of demonstrating positive stunting prevention and control behaviors than those with shorter involvement (aOR=2.94; 95% CI=1.31 to 6.61; p=0.009). Conversely, each one-unit increase in perceived expectations was associated with a 6% lower odds of positive maternal behavior (aOR=0.94; 95% CI=0.88 to 1.00; p=0.032). Conclusion: Duration of TPPS involvement and perceived expectations were significant factors associated with maternal behavior in stunting prevention and control.
Anak Agung Alit Kirti Estuti Narendra Putri
Application of the Health Belief Model to Non-Alcohol Drinking Behavior Among Adolescents in Surakarta, Central Java, Indonesia
Background: Alcohol consumption among adolescents is an important public health concern due to its adverse physical, psychological, and social consequences. The Health Belief Model (HBM) provides a theoretical framework for understanding health-related behaviors based on individual perceptions and beliefs. This study aimed to analyze the relationships among HBM constructs and non-alcohol consumption behavior among adolescents. Subjects and Method: A case control study was conducted in Surakarta, Central Java, Indone­sia, from May to June 2025. A total of 200 adolescents aged 15–19 years were recruited, consisting of 100 adolescents who had consumed alcohol and 100 who had never consumed alcohol. Parti­cipants were selected using fixed disease sampling. Data were collected using a structured question­naire measuring perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and alcohol consumption behavior. Data were analyzed using path analysis. Results: Non-alcohol drinker behavior was negatively associated with high perceived suscepti­bility (β= −0.02; 95% CI= −0.05 to −0.01; p= 0.044). It was positively associated with strong self-efficacy (β= 0.98; 95% CI= 0.94 to 1.02; p<0.001). Non-alcohol drinker behavior was positively associated with strong cues to action, but it was statistically non-significant (β= 0.03; 95% CI= −0.01 to 0.07; p= 0.190). Self-efficacy decreased with high perceived severity (β= −0.08; 95% CI= −0.13 to −0.03; p= 0.002) but increased with high perceived barrier (β= 0.5; 95% CI= 0.93 to 0.96; p<0.001). Non-alcohol drinker behavior was indirectly associated with self-efficacy through cues to action (β= 0.98; 95% CI= 0.83 to 1.13; p<0.001). Conclusion: Strong self-efficacy was an important factor associated with non-alcohol drinker behavior among adolescents. Strengthening adolescents’ confidence to refuse alcohol and increasing awareness of alcohol-related risks may support alcohol prevention efforts.
Health Belief Model and Hypertension-Related Actions Among Posyandu Community Health Workers in Langgudu District, Bima Regency, West Nusa Tenggara, Indonesia
Background: Hypertension is one of the most prevalent non-communicable diseases and remains a major public health concern worldwide. Effective hypertension control requires not only formal healthcare services but also active community participation through community health workers who play a crucial role in health promotion and disease prevention. Community health workers’ actions in hypertension control may be influenced by psychological factors described in the Health Belief Model (HBM). This study aimed to analyze the association between HBM constructs and hypertension-related actions among Posyandu community health workers. Subjects and Method: A cross-sectional study was conducted among 86 integrated community health (posyandu) workers. Sample was selected using purposive sampling. The dependent variable was hypertension-related actions. The independent variables were perceived susceptibility, perceived severity, perceived benefit, perceived barrier, and cues to action. Data were collected using a structured questionnaire and analyzed using a multiple logistic regression. Results: Integrated community health workers with high perceived severity were 3.69 times more likely to perform good hypertension-related actions than those with low perceived severity (OR= 3.69, 95% CI= 1.11 to 12.27, p= 0.033). Community health workers with high perceived barrier were 4.80 times more likely to demonstrate good hypertension-related actions (OR= 4.80, 95% CI= 1.37 to 16.83, p = 0.014). Perceived susceptibility (OR = 1.49, 95% CI= 0.44 to 5.13, p = 0.522), perceived benefits (OR= 0.42, 95% CI= 0.10 to 1.91, p = 0.263), and cues to action (OR= 4.18, 95% CI = 0.97 to 18.02, p = 0.055) were not significantly associated with hypertension-related actions. Conclusion: The study concludes that perceived severity and perceived barriers are the most influential HBM constructs affecting hypertension-related actions among community health workers.
Associations Between Social Support, Health Belief Model Constructs, and Smoking Cessation Among Patients Attending a Smoking Cessation Clinic in Surakarta, Central Java, Indonesia
Background: Smoking behaviour is a major health problem in Indonesia, with a high prevalence rate. The decision to quit smoking is influenced by various factors, including social support and components of the Health Belief Model (HBM). However, the direct and indirect mechanisms through which social support and HBM components influence smoking behaviour remain incompletely understood, particularly among patients attending smoking cessation clinics. Understanding these factors is crucial for improving the success of smoking cessation programmes. Subjects and Method: This analytical observational study employed a case-control design involving patients at the Surakarta Smoking Cessation Clinic from September 2025 to November 2025. Data were collected using structured questionnaires and analysed using logistic regression and generalized structural equation modeling (GSEM) to evaluate the direct and indirect effects between variables. Results: Self-efficacy had a positive effect on smoking cessation (b = 1.23; 95% CI = 0.60 to 1.85; p < 0.001). Perceived susceptibility (b = 0.66; 95% CI = 0.05 to 1.27; p = 0.034) and perceived benefit (b = 0.63; 95% CI = 0.001 to 1.26; p = 0.050) have a positive effect on smoking cessation, whilst perceived barriers have a negative effect on smoking cessation (b = −0.70; 95% CI = −1.30 to −0.09; p = 0.025). Cues to action had a positive effect on self-efficacy (b = 0.73; 95% CI = 0.16 to 1.31; p = 0.013). Social support positively influenced cues to action (b = 1.85; 95% CI = 1.21 to 2.49; p < 0.001) and perceived benefits (b = 1.00; 95% CI = 0.42 to 1.59; p = 0.001). Social support influences smoking cessation indirectly through cues to action, perceived benefits, and self-efficacy. Conclusion: Smoking cessation is influenced by the interaction between social support and the components of the Health Belief Model, with self-efficacy being the most dominant factor. Social support plays an indirect role by increasing cues to action, perceived benefits, and self-efficacy; therefore, strengthening these factors is important in improving the success of smoking cessation.
Transforming Dengue Prevention: Community Knowledge and Health Promotion as Keys to Reducing Mortality in Surakarta, Central Java, Indonesia
Background: Dengue Haemorrhagic Fever (DHF) remains a major public health threat in tropical regions like Surakarta, Indonesia. While conventional mosquito control methods such as fogging are widely implemented, their long-term effectiveness is limited. This study investigates how gaps in community knowledge regarding dengue symptoms and warning signs contribute to treatment delays and increased mortality rates. Subjects and Method: The study employed a quantitative-method approach focusing on the year 2024. Due to fieldwork challenges, a total sampling of 11 families who lost members to DHF was conducted using proxies, including relatives, neighborhood heads, and health cadres. Data were collected through semi-structured interviews and analyzed using SPSS for descriptive and inferential statistics, including multiple linear regression and ANOVA analysis. Results: DHF fatalities in Surakarta rose by over 150%, from 4 deaths in 2023 to 11 in 2024, with the 5–14 age group being most vulnerable. Statistical analysis revealed that all 11 families lacked sufficient knowledge of dengue symptoms. While most variables were not statistically significant, family recognition of experienced symptoms was a critical factor in identifying the disease. The high R-square value (91.4%) indicates that knowledge gaps and information access strongly influence DHF awareness. Conclusion: The primary driver of DHF mortality in Surakarta is a critical lack of knowledge among families, leading to fatal delays in seeking medical care. Traditional reactive strategies like fogging are insufficient. Reducing mortality requires a paradigm shift toward inclusive, knowledge-based community empowerment and early warning health education.
Effect of Social Capital on Tertiary Preventive Behavior among Older Adults with Type 2 Diabetes Mellitus: A Structural Equation Modeling Approach
Background: Diabetes Mellitus (DM), known as the “silent killer,” continues to show an increasing number of cases. It has emerged as one of the most serious and common chronic diseases, leading to life-threatening complications, disability, and reduced life expectancy. The persistently high prevalence of diabetes in Karanganyar Regency, along with the interaction among multiple determinants, underlies the objective of this study, which is to analyze the influence of structural, cognitive, and relational social capital models on tertiary preventive behavior among elderly individuals with Type 2 Diabetes Mellitus. Subjects and Method: This study employed a cross-sectional design. It was conducted in Karanganyar Regency (Jatipuro, Jatiyoso, and Karanganyar sub-districts), Central Java, from January to March 2025. A total of 210 elderly participants were selected using certified random sampling. Data were collected using a structured questionnaire. The analyses included univariate, bivariate, and multivariate analyses using a structural equation model (SEM). The dependent variable was tertiary preventive behavior among elderly individuals with Type 2 Diabetes Mellitus. The independent variables were social capital, comprising structural social capital, cognitive social capital, and relational social capital. Results: Structural social capital had a positive and statistically significant effect on tertiary preventive behavior (b= 0.32; 95% CI= 0.13 to 0.52; p= 0.001). Relational social capital also showed a positive and significant effect on tertiary preventive behavior (b= 0.37; 95% CI= 0.15 to 0.59; p= 0.001). Age demonstrated a negative and statistically significant effect on tertiary preventive behavior (b= -0.09; 95% CI= -0.16 to -0.03; p= 0.003). Conclusion: The findings of this study indicate that elderly individuals with Type 2 Diabetes Mellitus who have higher levels of social capital—comprising structural, cognitive, and relational dimensions—are more likely to engage in tertiary preventive behaviors.
The Influence of the Health Belief Model on Reproductive Health Behavior among Adolescents in Surakarta, Indonesia
Background: Adolescents are vulnerable to reproductive health problems. Globally, approximately 1.7 million adolescents are living with HIV, and 12 million births occur among those aged 15–19 years. In Surakarta, 224 cases have been reported, highlighting the need for a Health Belief Model (HBM)-based approach. This study aimed to analyze the influence of HBM constructs on adolescent reproductive health behavior in Surakarta, both directly and indirectly. Subject and method: This was a quantitative study with a cross-sectional design conducted among 200 respondents selected through multistage random sampling from five secondary schools. Data were collected using a structured questionnaire and analyzed using simple logistic regression and path analysis. Results: Bivariate analysis showed that perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy were significantly associated with reproductive health behavior (p < 0.05). In multivariate analysis, self-efficacy had a positive and significant effect (b = 0.08; p = 0.015), perceived barriers had a negative and significant effect (b = -0.03; p = 0.034), and cues to action had a positive and significant effect (b = 0.19; p < 0.001). In addition, several HBM components had indirect effects on reproductive health behavior through self-efficacy as a mediating variable. The model demonstrated a good fit to the data (p = 0.441; RMSEA = 0.000; CFI = 1.000; TLI = 1.003; SRMR = 0.016). Conclusion: The components of the Health Belief Model significantly influence adolescent reproductive health behavior, both directly and indirectly through self-efficacy. Reproductive health interventions should emphasize improving self-efficacy and strengthening behavioral enabling factors.
Application of Social Cognitive Theory on the Determinants of Tertiary Prevention Behavior and Its Impact on Blood Pressure among Elderly Individuals with Hypertension in Surakarta, Indonesia
Background: Hypertension is a noncommunicable disease that commonly affects older adults and may lead to serious complications. Effective hypertension control also depends on tertiary preventive behaviors. This study aimed to examine the reduction of hypertension through tertiary preventive behaviors and to analyze the direct and indirect effects of Social Cognitive Theory constructs on tertiary preventive behaviors and systolic blood pressure among older adults with hypertension. Subjects and Method: This cross-sectional study was conducted in Surakarta, Indonesia. A multistage random sampling technique was employed, resulting in the selection of seven community health centers (Puskesmas) and a total sample of 211 respondents. Data were collected using questionnaires that had been tested for validity and reliability. Multivariate data analysis was performed using path analysis. Results: Tertiary preventive behavior was directly and significantly influenced by behavioral skills (b= 0.26; 95% CI= 0.11 to 0.40; p = 0.001), reinforcement (b = 0.23; 95% CI = 0.10 to 0.36; p = 0.001), self-regulation (b = 0.16; 95% CI = 0.02 to 0.30; p = 0.021), observational learning (b = 0.18; 95% CI = 0.06 to 0.30; p = 0.003), and female sex (b= 0.12; 95% CI= 0.02 to 0.21; p = 0.013). Systolic blood pressure was directly and significantly associated with tertiary preventive behavior in a negative direction (b= −0.14; 95% CI= −0.27 to −0.02; p= 0.027), indicating that better tertiary preventive behavior was associated with lower systolic blood pressure. In contrast, body mass index (b= 0.19; 95% CI = 0.06 to 0.32; p = 0.003) and age (b= 0.21; 95% CI= 0.08 to 0.34; p= 0.001) showed positive associations with systolic blood pressure. Sex was not significantly associated with systolic blood pressure. Outcome expectations indirectly influenced tertiary preventive behavior through self-efficacy and subsequently through behavioral skills. Conclusion: Tertiary preventive behavior is influenced by key constructs of Social Cognitive Theory and plays an important role in reducing systolic blood pressure among older adults with hypertension.
Socioeconomic Factors, Parenting Styles, Bullying, and Adolescent Mental Health in Surakarta, Central Java, Indonesia
Background: According to the World Health Organization (WHO) in 2018, approximately 970 million people worldwide live with mental disorders, with anxiety and depression being the most prevalent. In Indonesia, mental health problems are particularly common among adolescents; the 2022 Indonesian Adolescent Mental Health Survey (I-NAMHS) reported that 34.9% experienced mental health issues in the past year. In Surakarta, 597 cases of mental health problems were recorded between January and June 2024, with adolescents aged over 15 years accounting for 5.51% of cases. This study examined the direct and indirect effects of socioeconomic status, parenting styles, and bullying on adolescent mental health in Surakarta. Subjects and Method: A quantitative cross-sectional study was conducted on 200 respondents selected through multistage random sampling in three secondary schools. The independent variables were socioeconomic status, parenting styles, and bullying. The dependent variable was mental health. Data were collected using questionnaires and analyzed using simple logistic regression and path analysis. Results: The risk of mental health problems decreased with higher socioeconomic status (b= −1.59; 95% CI= −2.63 to −0.55; p = 0.003), positive parenting practices (b= −0.87; 95% CI= −1.68 to −0.61; p= 0.035), and a lower frequency of bullying (b = 1.77; 95% CI = 1.02 to 2.51; p < 0.001). Conclusion: This study concludes that mental health disorders decrease if adolescents have high socioeconomic status and good parenting patterns applied by their parents. Mental health disorders increase if adolescents experience high frequency of bullying. And this path analysis model shows good fit
Implementation of the Health Belief Model to Explore Elderly Health Post Service Utilization in Jaten, Karanganyar District, Central Java, Indonesia
Background: The utilization of elderly integrated health post (posyandu) visits remains a significant issue affecting the health status of older adults. Elderly health post service serves as a community-based health service platform designed to cater to the needs of the elderly population. However, the utilization of elderly health post service visits is still very low. This study aims to analyze the factors associated with the utilization of elderly health post service services based on the Health Belief Model (HBM). Subjects and Method: The study employed a cross-sectional design and was conducted in Jaten District, Karanganyar, Central Java, Indonesia, from March to April 2025. Sampling was carried out using a multistage sampling method, involving 210 elderly individuals from 30 existing elderly health post service centers. The dependent variable was the utilization of elderly health post service. The independent variables were perceived susceptibility, perceived severity, perceived benefit, perceived barrier, cues to action, and self-efficacy. Data were collected using a questionnaire. Path analysis was employed for data analysis. Results: The utilization of elderly health post service was significantly influenced by perceived susceptibility (b= 0.22; 95% CI= 0.09 to 0.35; p= 0.001), perceived barrier (b= -0.29; 95% CI= 0.42 to -0.15; p <0.001), and self-efficacy (b= 0.13; 95% CI= 0.01 to 0.26; p= 0.038). It was indirectly affected by perceived benefits, perceived susceptibility, perceived severity, and cues to action. Conclusion: The utilization of elderly health post service services is directly influenced by perceived susceptibility, perceived barriers, and self-efficacy. Indirectly, the utilization of elderly health post service visits is affected by perceived barriers, perceived benefits, perceived susceptibility, perceived severity, and cues to action.
The Role of the Health Belief Model in Antenatal Care Visits among Pregnant Women at Sentru Saude Komunitaria, Baucau Municipality, Timor Leste
Background: Antenatal Care (ANC) visits are an essential intervention for reducing the risk of maternal morbidity and mortality. However, ANC coverage in several regions of Timor-Leste, including Baucau Municipality, remains below the national target. This study aimed to analyze factors influencing pregnant women’s compliance with recommended ANC visits according to timing and guidelines using the Health Belief Model (HBM) Subjects and Method: This cross-sectional study involved 200 pregnant women registered at healthcare facilities in Baucau Municipality, Timor-Leste. Data were collected using a question-naire based on HBM constructs that had been tested for validity and reliability. Data were analyzed using path analysis with STATA version 13 to identify direct and indirect effects among variables associated with ANC visits. Results: The results showed that cues to action had a direct and positive effect on ANC visits (b= 0.12; 95% CI= 0.03 to 0.20; p= 0.005). Gestational age had a significant positive effect on ANC visits (b= 0.24; 95% CI= 0.16 to 0.32; p< 0.001). In contrast, distance to healthcare facilities had a significant negative effect (b= -0.70; 95% CI= -0.75 to -0.64; p< 0.001), while parity had a negative but non-significant effect (b= -0.05; 95% CI= -0.14 to 0.03; p= 0.175). Self-efficacy had an indirect effect on ANC visits through perceived benefits (b= 0.15; 95% CI= 0.01 to 0.29; p= 0.040) and perceived benefits also had a significant indirect effect (b= 0.22; 95% CI= 0.08 to 0.37; p= 0.002). Perceived severity indirectly influenced ANC visits as well (b= -0.14; 95% CI= -0.26 to -0.01; p= 0.035). Conclusion: ANC visits increased with stronger cues to action and advancing gestational age. Conversely, ANC visits decreased with greater parity and longer distance to healthcare facilities. ANC visits were indirectly influenced by perceived susceptibility, perceived severity, perceived barriers, perceived benefits, and self-efficacy.
Cervical Cancer Patients’ Perceptions of Treatment Experiences at Dr. Moewardi Regional General Hospital, Surakarta, Central Java, Indonesia
Background: Cervical cancer is one of the most common cancers affecting women and ranks fourth worldwide. During the course of treatment, cervical cancer patients in Indonesia often face various challenges that may affect their quality of life and treatment outcomes. Some of the main challenges experienced by cervical cancer patients include physical, psychological, social, and economic aspects. This study aimed to explore the experiences of cervical cancer patients while undergoing treatment. Subjects and Method: This was a qualitative study with a phenomenological approach. The study was conducted at Dr. Moewardi Regional General Hospital, Surakarta, Central Java, parti-cular¬ly in the Obstetrics and Gynecology Outpatient Clinic. A total of 20 informants, consist¬ing of 1 key informant, 10 main informants, and 9 supporting informants, were selected using purposive sampling. Data were collected through interviews, observations, and documen¬tation. Data were analyzed using the Miles and Huberman approach. Results: The study identified five themes: (1) the emotional journey of cervical cancer patients during treatment, (2) physical challenges experienced during cervical cancer treatment, (3) socio-economic barriers to undergoing cervical cancer treatment, (4) the role of social and spiritual support in patient resilience, and (5) the benefits of and expectations toward cervical cancer treatment. Conclusion: The perceptions of cervical cancer patients during treatment were not limited to medical aspects alone but also encompassed emotional, social, spiritual, and economic dimensions. Addressing these aspects is essential for improving patients’ quality of life and enhancing adherence to cervical cancer treatment.
Application of Social Cognitive Theory in Promoting Tertiary Prevention Behavior among Hypertensive Patients in Tulungagung, East Java, Indonesia
Background: Hypertension is a non-communicable disease that can affect individuals across all age groups, including the productive age population, largely due to changes in lifestyle. The implementation of tertiary prevention behaviors is essential to prevent disease complications such as coronary heart disease, stroke, kidney failure, and liver disease. This study aimed to analyze the application of Social Cognitive Theory in relation to tertiary prevention behaviors among patients with hypertension. Subjects and Method: This analytic observational study employed a cross-sectional design. The study subjects were patients with hypertension of productive age (15–64 years) in Tulungagung Regency, selected using a non-proportional random sampling technique, with a total sample of 220 participants. Data were collected using a research questionnaire that had been tested for validity and reliability. Multivariate data analysis was conducted using path analysis to examine both direct and indirect effects among variables. Results: There were direct and statistically significant effects of observational learning (b = 0.13; 95% CI = 0.01 to 0.24; p = 0.028), self-efficacy (b = 0.20; 95% CI = 0.05 to 0.35; p = 0.008), and attitude (b = 0.31; 95% CI= 0.17 to 0.45; p < 0.001) on tertiary prevention behaviors. Education was not significantly associated with tertiary prevention behaviors. Age (b = 0.17; 95% CI= 0.05 to 0.29; p = 0.005) and tertiary prevention behaviors (b= −0.38; 95% CI = −0.49 to −0.27; p < 0.001) showed direct and significant effects on blood pressure. Sex was not significantly associated with blood pressure. Social support, outcome expectations, and age had indirect effects on tertiary prevention behaviors through self-efficacy. Conclusion: There are direct effects of observational learning, attitude, and self-efficacy on tertiary prevention behaviors, as well as indirect effects of social support, outcome expectations, age, and education on tertiary prevention behaviors. In addition, age, sex, and tertiary prevention behaviors have direct effects on blood pressure.
Social Support, Depression, and Anxiety as Predictors of Suicidal Ideation in People Living with HIV/AIDS: A Meta-Analysis
Background: Acquired Immune Deficiency Syndrome (AIDS) is a disease caused by the Human Immunodeficiency Virus (HIV). People living with HIV/AIDS (PLWHA) are 7 to 36 times more likely to experience suicidal ideation compared to the general population. Suicidal ideation among PLWHA is closely correlated with depression and anxiety. Social support plays a crucial role in helping individuals cope with HIV, serving as a direct protective factor for psychosocial health. This meta-analysis aims to examine the relationship between social support, depression, and anxiety with suicidal ideation among people living with HIV/AIDS (PLWHA) Subjects and Method: The meta-analysis was conducted using the PICO framework. Population: people living with HIV/AIDS (PLWHA). Intervention: high social support, presence of depression, and anxiety. Comparison: low social support, absence of depression, and absence of anxiety. Outcome: suicidal ideation. Research data were obtained from the Google Scholar, PubMed, and ScienceDirect databases. The keywords used were “social support” OR “depression” OR “anxiety” AND “suicidal ideation” AND “HIV/AIDS” OR “PLWHA.” The inclusion criteria included cross-sectional studies published between 2014 and 2024. Data analysis was performed using RevMan version 5.4. Results: The meta-analysis included 19 primary studies conducted in Indonesia, South Korea, China, Ethiopia, Uganda, Nigeria, South Africa, and the United States, with a total sample size of 11,166 participants. PLWHA residing in communities with high social support had 0.65 times lower odds of suicidal ideation compared to those with low social support (aOR= 0.65; 95% CI= 0.57 to 0.74; p<0.001). PLWHA experiencing depression had a 3.21 times higher risk of suicidal ideation compared to those without depression (aOR= 3.21; 95% CI= 2.07 to 4.99; p <0.001). PLWHA with anxiety were 1.67 times more likely to experience suicidal ideation than those without anxiety (aOR= 1.67; 95% CI= 1.29 to 2.18; p= 0.001). Conclusion: Depression and anxiety increase the risk of suicidal ideation, whereas high social support reduces the risk of suicidal ideation among people living with HIV/AIDS.
Path Analysis: Health Belief Model Application on Predicting Oral Hygiene Behavior of Junior High School Students in Surakarta, Central Java, Indonesia
Background: The high prevalence of orodental diseases, accompanied by low prevalence of appropriate behavior in maintaining orodental health, shows the urgency of health institutions to understand the determinants influencing such behaviors in Indonesia. The aims of this study was to analyze the effect of applying the health belief model on orodental health behavior among middle school students in Surakarta. Subjects and Method: This study was a cross-sectional observational analytical quantitative study, which was conducted in 14 public Junior High Schools in Surakarta, Central Java, Indonesia from January to March 2025. The independent variables were perceived susceptibility, perceived severity, perceived benefit, perceived barrier, self-efficacy, and cues to action. Orodental health behavior acts as the dependent variable. Subjects were determined using a multistage random sampling method with a total of 210 students. The data were collected through a researcher-made questionnaire, which included questions about demographic characteristics and the six HBM constructs. Data analysis was conducted using path analysis by StataMP 13. Results: Orodental health behavior in middle school students was directly influenced by perceived benefit (OR= 0.36; CI 95%= 0.26 to 0.45; p<0.001), perceived susceptibility (OR= 0.47; CI 95%= 0.38 to 0.55; p<0.001), and self-efficacy (OR= 0.20; CI 95%= 0.10 to 0.30; p<0.001). Orodental health behavior was also indirectly influenced by perceived susceptibility and cues-to-action. Conclusion: Perceived benefit, perceived susceptibility, and self-efficacy significantly improved orodental health behavior in students.