Application of the Health Belief Model to Predict Iron Supplementation Compliance Among Adolescent Girls in Bantul, Indonesia
Keywords:
Adolescent girls, Anemia, Consumption of iron supplementsAbstract
Anemia remains a major public health problem among adolescent girls in low-income countries, leading to long-term consequences such as decreased academic performance and increased risks during future pregnancies. Although iron supplementation programs have been widely implemented in schools, adherence among adolescent girls remains low. This study aimed to identify factors associated with compliance with iron supplementation among teenage girls using the Health Belief Model (HBM) framework. A cross-sectional study was conducted from February to June 2024 in Bantul Regency, Yogyakarta Special Region, Indonesia. Data were collected from 230 adolescent girls using a structured questionnaire. Bivariate analysis was performed using the Chi-square test, followed by multivariate logistic regression to identify independent predictors of compliance. The 230 participants, only 49.5% adhered to iron supplementation. Most respondents reported low perceived benefits (62.6%) and low perceived health threats (66.7%). Bivariate analysis showed significant associations between perceived benefits, perceived health threats, and perceived barriers with compliance (p<0.001). However, multivariate analysis identified perceived health threats (p=0.004; AOR = 3.52; 95% CI: 1.48–8.38) and perceived barriers (p<0.001; AOR = 7.11; 95% CI: 3.26–15.51) as independent predictors of compliance. Compliance with iron supplementation among adolescent girls is significantly influenced by perceived health threats related to anemia and perceived barriers to tablet consumption. Interventions should focus on increasing risk awareness and reducing perceived barriers through targeted education, supportive school environments, and multisectoral engagement to enhance anemia prevention efforts.
Downloads
References
Mirza FG, Abdul-Kadir R, Breymann C, Fraser IS, Taher A. Impact and management of iron deficiency and iron deficiency anemia in women’s health. Vol. 11, Expert Review of Hematology. Taylor and Francis Ltd; 2018. p. 727–36.
Thomas D, Chandra J, Sharma S, Jain A, Pemde HK. Determinants of Nutritional Anemia in Adolescents. Vol. 867, INDIAN PEDIATRICS. 2015.
Wiafe MA, Ayenu J, Eli-Cophie D. A Review of the Risk Factors for Iron Deficiency Anaemia among Adolescents in Developing Countries. Vol. 2023, Anemia. Hindawi Limited; 2023.
Taufiqurrahman T, Hafid F, Mujayanto M, Nuswantari A, Ratno R, Rahayuningtyas R, et al. Iron Supplement Adherence, Dietary Intake, and Anemia Risk among Adolescent Girls in Madiun Regency, Indonesia. Journal of Health and Nutrition Research [Internet]. 2025 Dec 1 [cited 2025 Dec 31];4(3):1354–63. Available from: https://journalmpci.com/index.php/jhnr/article/view/723
Ma J, Huang J, Zeng C, Zhong X, Zhang W, Zhang B, et al. Dietary Patterns and Association with Anemia in Children Aged 9–16 Years in Guangzhou, China: A Cross-Sectional Study. Nutrients. 2023 Oct 1;15(19).
Stubbendorff A, Borgström Bolmsjö B, Bejersten T, Warensjö Lemming E, Calling S, Wolff M. Iron insight: exploring dietary patterns and iron deficiency among teenage girls in Sweden. Eur J Nutr [Internet]. 2025 Mar 4;64(3):107. Available from: http://www.ncbi.nlm.nih.gov/pubmed/40035857
Grantham-Mcgregor S, Ani C. Iron-Deficiency Anemia: Reexamining the Nature and Magnitude of the Public Health Problem A Review of Studies on the Effect of Iron Deficiency on Cognitive Development in Children 1,2. 2001; Available from: https://academic.oup.com/jn/article-abstract/131/2/649S/4686855
Benson CS, Shah A, Stanworth SJ, Frise CJ, Spiby H, Lax SJ, et al. The effect of iron deficiency and anaemia on women’s health. Vol. 76, Anaesthesia. Blackwell Publishing Ltd; 2021. p. 84–95.
World Health Organization. World Health Organization. 2023 [cited 2023 Jun 20]. Anemia. Available from: https://www.who.int/health-topics/anaemia#tab=tab_1
Kementerian Kesehatan Republik Indonesia. Laporan Nasional Riskesdas 2018 [Internet]. Jakarta; 2019 [cited 2024 Oct 3]. Available from: https://repository.badankebijakan.kemkes.go.id/id/eprint/3514/1/Laporan%20Riskesdas%202018%20Nasional.pdf
Dinas Kesehatan Daerah Istimewa Yogyakarta. Anemia Dan Risiko KEK Pada Remaja Putri di DIY [Internet]. Yogyakarta; 2018 Nov [cited 2024 Oct 3]. Available from: https://dinkes.jogjaprov.go.id/berita/detail/anemia-dan-risiko-kek-pada-remaja-putri-di-diy--anemia-dan-risiko-kek-pada-remaja-putri-di-diy-
Juffrie M, Helmyati S, Hakimi M. Nutritional anemia in Indonesia children and adolescents: Diagnostic reliability for appropriate management. Asia Pac J Clin Nutr. 2020;29:18–31.
Kementerian Kesehatan Republik Indonesia. Buku Pedoman Pencegahan dan Penanggulangan Anemia pada Rematri dan Wanita Usia Subur [Internet]. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018 [cited 2024 Oct 3]. Available from: https://ayosehat.kemkes.go.id/buku-pedoman-pencegahan-dan-penanggulangan-anemia-pada-remaja-putri-dan-wanita-usia-subur
Dubik SD, Amegah KE, Alhassan A, Mornah LN, Fiagbe L. Compliance with Weekly Iron and Folic Acid Supplementation and Its Associated Factors among Adolescent Girls in Tamale Metropolis of Ghana. J Nutr Metab. 2019;2019.
Thifal F, Noviasty R, Ulfa UM, Farahita L, Utari A, Kurniawati ER, et al. Factors related to the compliance to consuming iron-folic acid in young women in East Kalimantan, Indonesia. AcTion: Aceh Nutrition Journal. 2023;8(2):260–9.
Silitonga HTH, Salim LA, Nurmala I, Wartiningsih M. Compliance of Iron Supplementation and Determinants among Adolescent Girls: A Systematic Review. Iran J Public Health [Internet]. 2023 [cited 2025 Dec 13];52(1):37. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9941429/
Gillespie B, Katageri G, Salam S, Ramadurg U, Patil S, Mhetri J, et al. Attention for and awareness of anemia in adolescents in Karnataka, India: A qualitative study. PLoS One. 2023 Apr 1;18(4 April).
Apriani M, Syafiq A. Adolescent compliance on iron tablet consumption: a systematic review. Adv Sci Lett. 2018;24(9):6371–5.
Glanz K RBVK. Health Behavior Theory, Research and Practice. 5th ed. United States of America: Jossey-Bass; 2015.
Lestari P, Mulyani S, Tinggi Ilmu Kesehatan Alma Ata Yogyakarta Jalan Ringroad Barat Daya No S. Konsumsi Tablet Fe saat Menstruasi pada Remaja Putri di SMAN 2 Banguntapan Bantul 145. Jurnal Ners dan kebidanan Indonesia. 2015 Sep 27;3(3).
Setyorini RH, Revika E. Using the Theory of Planned Behavior to Explore Factors Associated with the Behavior of Consuming Blood Booster Tablets Among Adolescent Girls in Bantul Regency. Jurnal Promkes: The Indonesian Journal of Health Promotion and Health Education. 2024;12(2):208–17.
Janz NK, Becker MH. The Health Belief Model: A Decade Later. Health Educ Q [Internet]. 1984 Mar 4 [cited 2019 Feb 2];11(1):1–47. Available from: http://journals.sagepub.com/doi/10.1177/109019818401100101
Aprianti R, Sari GM, Kusumaningrum T. Factors Correlated with the Intention of Iron Tablet Consumption among Female Adolescents. Jurnal Ners. 2018 Apr 1;13(1):122–7.
Acharya AS, Prakash A, Saxena P, Nigam A. Sampling: why and how of it? Indian Journal of Medical Specialities. 2013 Jul 7;4(2).
Iacobucci D, Posavac SS, Kardes FR, Schneider MJ, Popovich DL. The median split: Robust, refined, and revived. Journal of Consumer Psychology. 2015 Oct 1;25(4):690–704.
Kementerian kesehatan Indonesia. Pedoman Pencegahan dan Penanggulangan Anemia Pada Remaja Putri dan Wanita Usia Subur (WUS). 2016.
World Health Organization. Health for the World’s Adolescents A second chance in the second decade [Internet]. 2014. Available from: www.who.int/adolescent/second-decade
Silitonga HTH, Salim LA, Nurmala I, Hargono R, Notobroto HB, Hartini N, et al. The role of social support and interpersonal trust to improve compliance of iron supplementation amongst adolescent girls: A qualitative approach. Niger Postgrad Med J [Internet]. 2023 Jan 1 [cited 2025 Nov 18];30(1):75–80. Available from: https://journals.lww.com/npmj/fulltext/2023/30010/the_role_of_social_support_and_interpersonal_trust.11.aspx
Amir N, Djokosujono K. Faktor-Faktor yang Berhubungan dengan Konsumsi Tablet Tambah Darah (TTD) pada Remaja Putri di Indonesia: Literatur Review. Kedokteran dan Kesehatan [Internet]. 2019 Jun;15(2):119. Available from: https://jurnal.umj.ac.id/index.php/JKK
Green EC, Murphy EM, Gryboski K. History of the Health Belief Model The Health Belief Model. 2021.
Nechitilo M, Nguyen P, Webb-Girard A, Gonzalez-Casanova I, Martorell R, DiGirolamo A, et al. A Qualitative Study of Factors Influencing Initiation and Adherence to Micronutrient Supplementation among Women of Reproductive Age in Vietnam. Food Nutr Bull. 2016 Dec 1;37(4):461–74.
Sawyer SM, Azzopardi PS, Wickremarathne D, Patton GC. The age of adolescence. Lancet Child Adolesc Health [Internet]. 2018;2(3):223–8. Available from: https://www.sciencedirect.com/science/article/pii/S2352464218300221
Sawyer SM, Afifi RA, Bearinger LH, Blakemore SJ, Dick B, Ezeh AC, et al. Adolescence: A foundation for future health. The Lancet [Internet]. 2012 [cited 2025 Dec 19];379(9826):1630–40. Available from: https://pubmed.ncbi.nlm.nih.gov/22538178/
Nutbeam D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot Int [Internet]. 2000 Sep 1;15(3):259–67. Available from: https://doi.org/10.1093/heapro/15.3.259
World Health Organization. Prevention of iron deficiency anaemia in adolescents [Internet]. WHO Regional Office for South-East Asia; 2011 [cited 2025 Dec 19]. Available from: https://iris.who.int/handle/10665/205656
Ajzen I. The Theory of Planned Behavior. 1991.
Glanz K, Rimer BK, Viswanath K. Health Behavior And Health Education. Theory, Research, and Practice [Internet]. 4TH Editio. Foreword by.C.Tracy Orleans, editor. San Francisco: Jossey-Bass; 2008 [cited 2019 Jan 31]. Available from: http://fhc.sums.ac.ir/files/salamat/health_education.pdf
WHO. Daily Iron Supplementation in adult women and adolescent girls. 2016.
Viyanti R, Aisah S, Pranata S. The Influence of Whatsapp, Teacher Support and Attitude of Adolescent Girls Towards Compliance In Taking Iron Supplement Tablets: Systematic Review. Indonesian Journal of Global Health Research [Internet]. 2025 Apr 1 [cited 2025 Dec 17];7(2):637–50. Available from: https://jurnal.globalhealthsciencegroup.com/index.php/IJGHR/article/view/5724
Ramdhani NL, Dwiriani CM, Khomsan A. Determinants of Iron Supplementation Compliance Among Adolescent Girls in Kuningan Regency, Indonesia. Journal of Health and Nutrition Research [Internet]. 2025 Dec 1 [cited 2025 Dec 31];4(3):1274–86. Available from: https://journalmpci.com/index.php/jhnr/article/view/685
Lotfipur Rafsanjani SS, Masoomi M, Askari F, Abdolkarimi M. Consumption of Iron Supplements, based on the Structures of the Health Belief Model, in Children Aged 6 to 24 Months in the Southeast of Iran. Universitas Médica. 2024 Feb 19;65.
Jafari A, Hosseini Z, Tehrani H, Alami A. Evaluation of the barriers and facilitators of iron supplementation program among adolescent females. Clin Nutr ESPEN [Internet]. 2023;56:36–42. Available from: https://www.sciencedirect.com/science/article/pii/S2405457723001171
Raihani AD, Utami RP, Sari RA. The Effectiveness of Educational Media on Knowledge, Dietary Patterns and Compliance with Iron Supplement Consumption in Anemic Adolescent Girls. Journal of Health and Nutrition Research [Internet]. 2024 Apr 9 [cited 2025 Dec 31];3(1):53–61. Available from: https://journalmpci.com/index.php/jhnr/article/view/197
Published
How to Cite
Issue
Section
Copyright (c) 2026 Retno Heru Setyorini, Thami Septiariyani , Teguh Budi Prasetya

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Similar Articles
- Nur Laily Ramdhani, Cesilia Meti Dwiriani, Ali Khomsan , Determinants of Iron Supplementation Compliance Among Adolescent Girls in Kuningan Regency, Indonesia , Journal of Health and Nutrition Research: Vol. 4 No. 3 (2025)
- Nasrul Nasrul, Fahmi Hafid, Taqwin Taqwin, Hikmah, Risma, Atika Nuswantari, Sarina Sariman, Iron Supplement Consumption, Dietary Intake, Nutritional Status, and Anemia Among Adolescent Girls in Banawa, Donggala Regency , Journal of Health and Nutrition Research: Vol. 4 No. 2 (2025)
You may also start an advanced similarity search for this article.









