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
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.
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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.
Implementation of the Health Belief Model to Predict Acupuncture Therapy Adherence in Patients with Hernia Nucleus Pulposus
Background: Hernia Nucleus Pulposus is one of the causes of low back pain that can interfere with activity and quality of life. Acupuncture therapy is one of the effective non-pharmacological treatment alternatives in reducing pain due to Hernia Nucleus Pulposus. However, patient adherence to undergoing acupuncture therapy is still a challenge. This study aims to analyze the factors within the framework of the Health Belief Model that affect adherence to acupuncture therapy in patients with Hernia Nucleus Pulposus. Subjects and Method: This study was a cross-sectional study conducted in Surakarta, from January to March 2025. A total of 200 patients were selected randomly. The depen­dent variable was adherence to acupuncture therapy in Hernia Nucleus Pulposus. Independent variables were perceived susceptibility, perceived severity, perceived benefits, perception of barriers, self-efficacy, and cues to action. The data were analyzed using Linear Regression. Results: Adherence to acupuncture therapy patients with hernia nucleus pulposus increased with high perceived susceptibility (b=0.14; 95% CI= 0.01 to 0.27; p= 0.040), high perceived severity (b= 0.30; 95% CI= 0.02 to 0.59; p=0.038), high perceived benefits (b= 0.16; 95% CI= 0.01 to 0.31; p=0.042), high cues to action (b=0.19; 95% CI= 0.02 to 0.36; p= 0.032), high self-efficacy (b=0.19; 95% CI= 0.02 to 0.38; p= 0.022). Adherence to acupuncture therapy decreased with high perceived barrier (b= -0.10; 95% CI= -0.21 to -0.01; p= 0.046). Conclusion: There was a positive relationship between perceived susceptibility, perceived severity, perceived benefits, cues to action, and self-efficacy on adherence to acupuncture therapy. Perceived barriers decrease adherence to acupuncture therapy in hernia nucleus pulposus.
The Role of Social Media, Health Literacy, and Parental Communication in Risky Sexual Behavior among Adolescentsin Surakarta, Central Java, Indonesia
Background: Risk-taking sexual behavior among adolescents continues to increase, especially in Indonesia, and causes serious health problems such as unwanted pregnancies and sexually transmitted diseases. In 2023, there were 402 cases of HIV in Surakarta, Central Java, Indonesia, with 2.91% of them being adolescents. This study aims to examine the relationship between the role of social media, health literacy, and parental communication with risky sexual behavior among adolescents, both directly and indirectly. Subjects and Method: A cross-sectional study conducted from August to September 2025 on 200 high school/vocational school students in Surakarta, selected using multistage random sampling. The independent variables included the role of social media, health literacy, and parental communication; the dependent variable was risky sexual behavior. Data were collected through a structured questionnaire and analyzed univariate, bivariate (chi-square), and multivariate using path analysis. Results: The results of the analysis show that negative social media use can increase risky sexual behavior (b= 0.87; 95% CI=0.24 to 1.51; p=0.007), high health literacy can reduce risky sexual behavior (b=−1.70; 95% CI=−2.38 to −1.02; p<0.001), and good parental communication can reduce risky sexual behavior (b=−0.76; 95% CI=−1.34 to −0.19; p=0.009). The path analysis model shows good fit (AIC= 502.38, BIC= 522.17). Conclusion: The role of social media increases the risk of risky sexual behavior in adolescents, while health literacy and parental communication act as protective factors. This study shows that strengthening health literacy and parental involvement has important implications for efforts to prevent risky sexual behavior in adolescents.
Effects of Social Norms and Social Networks on Non-Smoking Behavior among Junior High School Adolescents in Boyolali, Central Java, Indonesia
Background: Smoking behavior among adolescents remains a public health problem that may lead to long-term health consequences. Junior high school students are a vulnerable population at risk of engaging in smoking behavior due to social environmental influences, particularly from peers and family members. Social norms and social networks play an important role in shaping adolescents’ ability to maintain non-smoking behavior. This study aimed to analyze the effects of social norms and social networks on non-smoking behavior among junior high school students in Boyolali Regency. Subjects and Method: This study employed a quantitative research method with a cross-sectio­nal design. The population consisted of 33,700 junior high school adolescents in Boyolali Regency. A total of 240 respondents were included in this study, and the data were collected using a stratified random sampling technique. The samples were obtained from eight junior high schools in Boyolali Regency, comprising four public junior high schools and four private junior high schools. Results: Based on Table 4, social norms had a significant effect on non-smoking behavior. Respondents with high social norms were 7.34 times more likely to engage in non-smoking behavior than those with low social norms (AOR = 7.34; 95% CI = 3.48 to 15.49; p = 0.001). Social networks also had a significant effect on non-smoking behavior. Respondents with high social networks were 7.78 times more likely to engage in non-smoking behavior than those with low social networks (AOR= 7.78; 95% CI= 3.68 to 16.43; p= 0.001). Gender was significantly associated with non-smoking behavior. Female respondents were 2.52 times more likely to engage in non-smoking behavior than male respondents (AOR = 2.52; 95% CI = 1.22 to 5.21; p = 0.012). Conclusion: Social norms and social networks significantly influenced non-smoking behavior among junior high school adolescents in Boyolali Regency.
Theory of Planned Behavior Constructs in Predicting Iron Supplement Consumption Adherence among Female Adolescents in Kudus, Central Java, Indonesia
Background: Anemia among female adolescents remains a significant public health problem in Indonesia. One of the main strategies to prevent anemia is the routine provision of iron supple­mentation tablets (TTD) for female adolescents. However, compliance to iron tablet consumption remains suboptimal. This study aimed to analyze the influence of the constructs of the Theory of Planned Behavior, on adherence to iron tablet consumption among female adolescents. Subjects and Method: This study employed a quantitative research design with a cross-sectional approach. The study was conducted among 275 female adolescents attending senior high schools at Ngembal Kulon and Jekulo sub districts, Kudus, Central Java, Indonesia. Participants were selected using proportional sampling. Data were collected using structured questionnaires and analyzed using logistic regression to determine the influence of attitude, subjective norms, perceived behavioral control, and intention on adherence to iron tablet consumption. Results: The results showed that attitude (OR=0.78; 95% CI=0.45–1.37; p=0.397) and intention (OR=0.82; 95% CI=0.44–1.51; p=0.520) was not significantly associated with compliance to iron tablet consumption. In contrast, subjective norms (OR=1.80; 95% CI=1.03–3.15; p=0.040) and perceived behavioral control (OR=4.67; 95% CI=2.40–9.10; p<0.001) were significantly associated with adherence to iron tablet consumption. Among these variables, perceived behavioral control was identified as the strongest determinant.in non-smoking behavior than male respondents (AOR = 2.52; 95% CI = 1.22 to 5.21; p = 0.012). Conclusion: Subjective norms and perceived behavioral control significantly influence adherence to iron tablet consumption among female adolescents.
Ageing, Education, and Protein Intake Shape Nutritional Status in Indonesian Older Adults: A Population-Based Study
Background: The elderly population in Indonesia has increased rapidly, accompanied by health challenges such as malnutrition, which can lead to sarcopenia and physical weakness. Body weight is one indicator of nutritional status, which can be influenced by characteristics and nutrient intake, such as protein. This study aims to analyze the influence of age, gender, education and protein intake on nutritional status in the elderly in Indonesia. Subjects and Method: A cross-sectional study of the Indonesian Family Life Survey (IFLS-5) involved 2,908 individuals aged 60 and above. Sociodemographic variables (age, gender, education level, and marital status) were measured using a questionnaire, while protein intake was measured using a Food Frequency Questionnaire (FFQ). Bivariate data analysis was used to determine the relationship between age, gender, and protein intake and nutritional status and logistic regression analysis was used to evaluate factors influencing poor nutritional status. Results: Age ≥ 71 years (aOR= 2.14; 95%CI= 0.56 to 0.96; p<0.001), male (aOR=1.43; 95%CI= 0.16 to 0.55; p= 0.003) increase the risk of poor nutritional status, while education > Senior High School (aOR=0.22; 95%CI= -0.22 to -0.77; p<0.001), and high protein intake (aOR= 0.80; 95%CI= -0.42 to -0.02; p =0.033) are protective factors for poor nutritional status in the elderly. Conclusion: Age over 70 years and being male increases the risk of poor nutritional status, while high levels of education and protein intake reduce the risk of poor nutritional status in the elderly in Indonesia.
Visual Inspection with Acetic Acid Screening Participation among Women of Childbearing Age in Tulungagung, East Java, Indonesia : A Health Belief Model Approach
Background: Visual inspection with acetic acid (VIA) is a screening test that aims to detect precancerous cervical lesions and early cervical cancer in women who appear normal and asymptomatic. However, VIA coverage in various regions in Indonesia is very low and far from the national target. This study aims to analyze the application of the Health Belief Model on the participation of women of childbearing age in VIA examinations. Subjects and Method: A quantitative cross-sectional study design was used. The subjects were married women of childbearing age in Tulungagung Regency, selected using a multistage random sampling method, totaling 210 individuals. The instrument used was a research questionnaire that had undergone validity and reliability testing. Data analysis used multivariate path analysis to examine the direct and indirect effects between variables. Results: There was a direct and significant effect of cues to action (OR= 5.26; CI 95% 1.58 to 17.48; p=0.007) and self-efficacy (OR= 4.01; 95% CI 1.19 to 13.39; p=0.025) towards participation in VIA screening among women of childbearing age. Perceived susceptibility (OR= 4.11; 95% CI 1.61 to 10.49; p=0.003), perceived severity (OR= 0.11; 95% CI 0.02 to 0.51; p=0.005), perceived barriers (OR= 0.08; 95% CI 0.03 to 0.21; p<0.001), perceived benefits (OR= 17.55; 95% CI 4.58 to 67.19; p<0.001), and cues to action (OR= 8.02; 95% CI 3.16 to 20.31; p<0.001) had an indirect effect on the participation of women of childbearing age in VIA screening through self-efficacy. Conclusion: There is a direct effect of cues to action and self-efficacy on the participation of women of childbearing age in VIA screening. There is an indirect effect of perceived vulnerability, perceived seriousness, perceived barriers, perceived benefits, and cues to action on the participation of women of childbearing age in VIA screening through self-efficacy.
Understanding Utilization of Basic Oral Health Services Through the Health Belief Model: A Population-Based Study in Kediri, East Java, Indonesia
Background: The utilization of basic oral and dental health services remains suboptimal despite the availability of services within primary healthcare systems. This gap suggests that service utilization is influenced not only by access but also by individual health beliefs and perceptions. The Health Belief Model provides a theoretical framework to explain how cognitive and behavioral factors shape health-seeking behavior. This study aimed to examine determinants of basic oral health service utilization in Kediri Regency, Indonesia, using the Health Belief Model framework. Subjects and Method: A cross-sectional study was conducted among 363 residents of Kediri Regency selected through multistage sampling. The dependent variable was the utilization of basic oral and dental health services. Independent variables included perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action. Data were collected using structured questionnaires and analyzed using multiple logistic regression with a significance level of p < 0.005. Results: Perceived benefits showed a positive and significant association (OR = 1.30; 95% CI: 0.71 to 2.44; p = 0.037), cues to action demonstrated a significant negative association (OR = 0.59; 95% CI: 0.31 to 1.13; p = 0.012), perceived susceptibility (OR = 2.42; 95% CI: 0.90 to 6.48; p = 0.074), perceived severity (OR = 0.84; 95% CI: 0.41–1.72; p = 0.062), perceived barriers (OR = 0.71; 95% CI: −0.41 to 1.22; p = 0.228), and self-efficacy (OR = 1.86; 95% CI: −0.82 to 4.37; p = 0.146) were not statistically significant predictors of dental service utilization. Conclusion: Utilization of basic oral health services was primarily influenced by perceived benefits and cues to action. Strengthening public awareness of the benefits of dental care and enhancing behavioral triggers may improve the utilization of oral health services in the community.
Gaps in Maternal Behavior, Family Support, and Early Childhood Education Participation in the Development of Children Under Five Years: A Stratified Analysis of Urban vs. Rural Settings
Background: The intensity and quality of developmental stimulation provided by mothers, families, and the early childhood education environment determine the developmental outcomes of children under five years of age. Place of residence influences the cultural practices surrounding child-rearing, access to healthcare services, and the availability of facilities that support child development. This study aims to examine maternal stimulation behaviors, family support, and participation in early childhood education on child development based on place of residence (urban vs. rural). Subjects and Method: A cross-sectional study was conducted involving 200 respondents in urban areas and 200 in rural areas. Respondents consisted of mother-child pairs with children under five years of age, selected according to predetermined criteria. Data were measured using questionnaires and observation sheets (DDST II). Stratified tests were performed using STATA 13 software. Results: In the rural group, positive maternal behavior and family support were significantly associated with improved developmental outcomes for children under five years of age (RR 1.94; 95%CI 1.31 to 2.87; p = 0.001 and RR 1.47; 95%CI 1.17 to 1.867; p = 0.001), while non-significant associations were found in the urban group (p = 0.256 and p = 0.069). In the urban group, children's participation in early childhood education programs was significantly associated with more optimal developmental outcomes (RR 1.59; 95%CI 1.04 to 2.43; p = 0.033), whereas a non-significant association was observed in the rural group (p = 0.546). Conclusion: The factor of place of residence determines differences in maternal behavior, family support, and participation in early childhood education regarding child development. Health promotion intervention research aimed at enhancing maternal behavior and family support for child development needs to be designed with different methodologies based on the residential area.
Applying the Health Belief Model to Examine Obesity Prevention Behaviors Among Female Adolescents in Sukoharjo, Central Java, Indonesia
Background: Obesity is a growing global health problem, especially among adolescent girls. The increasing prevalence of obesity in Indonesia, including in Sukoharjo Regency, is a serious concern because obesity contributes to various non-communicable diseases. This study aims to analyze the influence of the Health Belief Model (HBM) application on obesity prevention behavior among female adolescents at PPTQ Al Rasyid Kartasura, Sukoharjo, Central Java. Subjects and Method: This study used a cross-sectional Study design. The study was carried out from February to March 2025 at PPTQ Al Rasyid Junior and Senior High School Kartasura, Suko¬harjo. The study sample was 210 students who were selected by an exhaustive sampling technique. The data collection instrument was in the form of a structured questionnaire that measured the HBM constructs, namely perceived susceptibility, perceived severity, perceived benefit, perceived barriers, cues to action, and self-efficacy. Data analysis was conducted using multiple linear regression. The dependent variable was obesity prevention behavior. Results: Obesity prevention behaviors increased with high perceived susceptibility (b= 0.17; 95% CI= 0.01 to 0.34; p= 0.022), perceived severity (b= 0.17; 95% CI= 0.01 to 0.34; p = 0.022), perceived benefits (b= 0.31; 95% CI= 0.03 to 0.59; p= 0.028), cues to action (b= 0.25; 95% CI= 0.02 to 0.49; p= 0.033), self-efficacy (b = 0.19; 95% CI= 0.01 to 0.37; p= 0.045), and decreased with the high perceived barriers (b = -0.18; 95% CI= -0.35 to -0.01; p= 0.046). Conclusion: High perceived susceptibility, perceived severity, perceived benefit, cues to action, and self-efficacy, as well as low perceived barriers, contribute to improving obesity prevention behaviors among female adolescents.