DOI: https://doi.org/10.14710/jphtcr.v8i3.26914

Application of the Health Belief Model in Adherence to Iron Supplement Consumption Among Female Students at Universitas Diponegoro

Department of Health Promotion and Behavioral Sciences, Faculty of Public Health, Universitas Diponegoro, Semarang, Jawa Tengah , Indonesia

Received: 8 May 2025; Published: 30 Dec 2025.
Open Access Copyright (c) 2025 The authors. Published by Faculty of Public Health, Universitas Diponegoro
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Abstract

Introduction: Anemia, a deficiency of red blood cells, is common in adolescent girls. The Indonesian government has an iron supplement program targeting school-aged girls. Female university students are not included. Consequently, iron supplement intake depends on individual choices. This study aimed to identify the factors associated with adherence to iron supplement consumption as a preventive measure against anemia among female students at Universitas Diponegoro.

Methods: This was a quantitative study with a cross-sectional approach using interviews and questionnaires. The sample of this study was 384 respondents from 33,156 female students of Universitas Diponegoro in 11 faculties and one vocational school using the proportional sampling method, with the inclusion criteria being active diploma/undergraduate students who consented. This study employed univariate and bivariate analyses using chi-square tests.

Results: The results indicated a significant relationship between iron supplement adherence and knowledge of anemia (p=0.001), knowledge of iron tablet consumption (p=0.001), perceived susceptibility (p=0.001), perceived severity (p=0.001), perceived benefits (p=0.001), perceived barriers (p=0.001), self-efficacy (p=0.001), and cues to action (p=0.001). However, no significant relationships were found between iron supplement adherence and age (p=0.570), level of study (p=0.127), allowance (p=0.958), or place of residence (p=0.793).

Conclusion: Knowledge of anemia, knowledge of iron tablet consumption, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action are associated with iron supplement adherence among female students at Universitas Diponegoro in Semarang.

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Keywords: anemia, iron supplement, perceived, adherence, female students.

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  1. World Health Organization. World Health Organization. 2023 [cited 2024 Jan 17]. Anaemia. Available from: https://www.who.int/news-room/fact-sheets/detail/anaemia
  2. World Health Organization. World Health Statistics 2022: Monitoring Health for The SDGs [Internet]. World Health Organization. Geneva: World Health Organization; 2022. 131 p. Available from: http://apps.who.int/bookorders
  3. World Health Organization. World Health Statistics 2023: Monitoring Health for The SDGs [Internet]. Vol. 27, World Health Organization. Geneva: World Health Organization; 2023. 136 p. Available from: https://www.who.int/publications/book-orders
  4. Haile B, Oumer A, Negese T, Temesgen M, Kebede A, Abdurahman D, et al. Factors Associated with Compliance with Weekly Iron and Folic Acid Supplementation among School Adolescent Girls in Debub Achefer District, Northwest Ethiopia: School-based Cross-sectional Study. Sci Rep [Internet]. 2024;14(1):1–9. Available from: https://doi.org/10.1038/s41598-024-60800-5
  5. Kementerian Kesehatan Republik Indonesia. Pedoman Pemberian Tablet Tambah Darah (TTD) Bagi Remaja Putri pada Masa Pandemi Covid-19. Jakarta: Direktorat Jenderal Kesehatan Masyarakat; 2020. 25 p
  6. Kementerian Kesehatan Republik Indonesia. Profil Kesehatan Indonesia 2021. Kementerian Kesehatan Republik Indonesia. Jakarta: Kementerian Kesehatan RI; 2022. 538 p
  7. Kementerian Kesehatan Republik Indonesia. Hasil Utama RISKESDAS 2018. Kementerian Kesehatan Republik Indonesia. Jakarta; 2018. 220 p
  8. Badan Penelitian dan Pengembangan Kesehatan. Riset Kesehatan Dasar (RISKESDAS) 2007. Departemen Kesehatan RI. Jakarta: Kementerian Kesehatan RI; 2007. 384 p
  9. Tim Riskesdas 2013. Riset Kesehatan Dasar (RISKESDAS) 2013. Kemenkes RI. Jakarta: Kementerian Kesehatan RI; 2013. 306 p
  10. Tim Riskesdas 2018. Laporan Nasional Riskesdas 2018. Kemenkes RI. Jakarta; 2019. 674 p
  11. Munira SL, Trihono, Thaha RA, Musadad P, Kusnanto H, Sugihantono A. Laporan Survei Kesehatan Indonesia 2023 dalam Angka. Kementerian Kesehatan Republik Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia; 2018. 1–68 p
  12. Paramita GV. Studi Kasus Perbedaan Karakteristik Mahasiswa di Universitas ‘X’-Indonesia dengan Universitas ‘Y’-Australia. Humaniora. 2010;1(2):629–35
  13. Al Amin M, Juniati D. Klasifikasi Kelompok Umur Manusia Berdasarkan Analisis Dimensi Fraktal Box Counting dari Citra Wajah dengan Deteksi Tepi Canny. J Ilm Mat. 2017;2(6):1–10
  14. Anggraeni N. Badan Perencanaan Pembangunan Nasional (BAPPENAS). 2021 [cited 2023 Mar 16]. Potret Anemia pada Remaja Indonesia. Available from: https://cegahstunting.id/berita/potret-anemia-pada-remaja-indonesia/
  15. WHO. Nutrition in Adolescence Issues and Challenges for [Internet]. Geneva: WHO Press; 2005. 123 p. Available from: http://whqlibdoc.who.int/publications/2005/
  16. Aryani R, Tim Penulis Politeknik Kesehatan Departemen Kesehatan Jakarta. Kesehatan Remaja Problem dan Solusinya. Jakarta: Salemba Medika; 2010. 156 p
  17. Sulistyawati N, Nurjanah AS. Pengetahuan Remaja Putri tentang Anemia Studi Kasus pada Siswa Putri SMAN 1 Piyungan Bantul. J Kesehat Samodra Ilmu [Internet]. 2018;9(2):214–20. Available from: https://stikes-yogyakarta.e-journal.id/JKSI/article/view/107
  18. Kementerian Kesehatan Republik Indonesia. Pedoman Pencegahan dan Penanggulangan Anemia pada Remaja Putri dan Wanita Usia Subur (WUS) [Internet]. Jakarta; 2018. 92 p. Available from: http://journal.um-surabaya.ac.id/index.php/JKM/article/view/2203
  19. Septiana KS, Adnani QES, Susiarno H, Tarawan VM, Arya IFD, Anwar R. The Influence of Anemia Education Media on Increasing Self-Awareness and Compliance in Consuming Iron Supplements in Adolescent Girls: A Systematic Review. Int J Womens Health. 2025;17:2277–89
  20. UGM, Kemenkes RI. Kampus Sehat: Strategi Perguruan Tinggi Mengadopsi Health Promoting University. Universitas Gadjah Mada. Yogyakarta; 2021
  21. Kementerian Kesehatan Republik Indonesia. X. 2019 [cited 2025 Apr 24]. Indikator Poin Penilaian Kampus Sehat. Available from: https://x.com/kemenkesri/status/1190565821262643206
  22. Purwanto B. Kementrian Kesehatan Republik Indonesia. 2021 [cited 2025 Apr 24]. Kementerian Kesehatan RI Kembangkan Kampus Sehat di 23 Perguruan Tinggi. Available from: https://ayosehat.kemkes.go.id/kementerian-kesehatan-ri-kembangkan-kampus-sehat-di-23-perguruan-tinggi
  23. Admin K3L. UPT Keselamatan Kesehatan Kerja dan Lingkungan. 2022 [cited 2024 May 11]. Penerapan Program Kampus Sehat di Unit Fakultas Universitas Diponegoro. Available from: https://uptk3l.undip.ac.id/2022/06/03/penerapan-program-kampus-sehat-di-unit-fakultas-universitas-diponegoro/
  24. Rosenstock IM, Strecher VJ, Becker MH. Social Learning Theory and The Health Belief Model. Health Educ Q. 1988;15(2):175–83
  25. Glanz K, Rimer B k., Viswanath K. Health Behavior Theory, Research, and Practice. 5th ed. Wiley, editor. San Francisco: Jossey-Bass; 2015. 571 p
  26. Kementerian Pendidikan dan Kebudayaan. Kamus Besar Bahasa Indonesia. 5th ed. Jakarta: Badan Pengembangan dan Pembinaan Bahasa; 2018. 19964 p
  27. Hulukati W, Djibran MR. Analisis Tugas Perkembangan Mahasiswa Fakultas Ilmu Pendidikan Universitas Negeri Gorontalo. Bikotetik (Bimbingan dan Konseling Teor dan Prakt. 2018;2(1):73–114
  28. Hall GS. Adolescence and Its Psychology and Its Relations to Physiology, Anthropology, Sociology, Sex, Crime, Religion and Education [Internet]. Vol. 1, Appleton and Company. New York: Appleton and Company; 1904. 630 p. Available from: http://scioteca.caf.com/bitstream/handle/123456789/1091/RED2017-Eng-8ene.pdf?sequence=12&isAllowed=y%0Ahttp://dx.doi.org/10.1016/j.regsciurbeco.2008.06.005%0Ahttps://www.researchgate.net/publication/305320484_SISTEM_PEMBETUNGAN_TERPUSAT_STRATEGI_MELESTARI
  29. Rahayuningtyas D, Indraswari R, Musthofa SB. Faktor-faktor yang Berhubungan dengan Praktik Konsumsi Tablet Tambah Darah (TTD) Remaja Putri di Wilayah Kerja Puskesmas Gilingan Kota Surakarta. J Kesehat Masy. 2021;9(3):310–8
  30. Noviazahra D. Faktor-faktor Yang Memengaruhi Konsumsi Tablet Tambah Darah Dalam Program Sekolah Peduli Kasus Anemia Pada Siswi Sma Negeri Di Kabupaten Bantul Tahun 2017 Dhina. Politeknik Kesehatan Kemenkes Yogyakarta. Politeknik Kesehatan Kemenkes Yogyakarta; 2017
  31. Gebrezgi M, Haile F, Zereabruk K. Prevalence of Anemia and Its Associated Factors among Female College Students in Eritrea: a Cross-Sectional Study. BMC Public Health. 2019;19(1146)
  32. Notoatmodjo S. Promosi Kesehatan dan Ilmu Perilaku. Jakarta: Penerbit Rineka Cipta; 2007
  33. Wartisa F, Triveni T. Hubungan Umur dan Pendidikan dengan Kosumsi Tablet Fe pada Ibu di Puskesmas Padang Lua. J Kesehat Perintis (Perintis’s Helath Journal) [Internet]. 2017;4(1):44–7. Available from: https://jurnal.upertis.ac.id/index.php/JKP/issue/view/17
  34. Aminin F, Dewi U. Kepatuhan Ibu Hamil Mengkonsumsi Tablet Fe di Kota Tanjungpinang Tahun 2017. J Ners dan Kebidanan (Journal Ners Midwifery). 2020;7(2):285–92
  35. Compaore A, Gies S, Brabin B, Tinto H, Brabin L. “There is iron and iron...” Burkinabè Women’s Perceptions of Iron Supplementation: A Qualitative Study. Matern Child Health J. 2014;18(8):1976–84
  36. Dzati YI, Ningtyias FW, Rohmawati N. Determinan Perilaku Konsumsi Tablet Tambah Darah pada Mahasiswi Jurusan Kesehatan dan Non Kesehatan Universitas Jember. J Gizi Klin Indones. 2024;20(3):95–104
  37. Titaley C, Dibley M, Agho K, Roberts C, Hall J. Determinants of Iron Supplementation among Pregnant Women in Indonesia: a Cross-Sectional Study. BMC Public Health. 2010;10(144)
  38. Rismayanti T, Oktapiani S. Pengaruh Uang Saku dan Gaya Hidup terhadap Perilaku Konsumtif Mahasiswa Fakultas Ekonomi dan Bisnis Universitas Teknologi Sumbawa. Nusant Joural Econ. 2020;2(2):31–7
  39. Samsiah. Pola Pemberian Uang Saku/Bekal bagi SMP Negeri 7 Kelurahan Purnama Kecamatan Dumai Barat Kota Dumai. Jom Fisip. 2017;4(2):1–15
  40. Rahmah N, Hargono R, Raharjo B. Dukungan Orang Tua terhadap Kepatuhan Konsumsi Tablet Tambah Darah pada Remaja Putri. Mediaa Gizi Indones. 2024;19(1):45–51
  41. Estiyani A. Hubungan Dukungan Keluarga terhadap Konsumsi Tablet Tambah Darah (TTD) dengan Kejadian Anemia pada Remaja Putri. J Kebidanan Mutiara Mahakam. 2020;8(1):71–6
  42. Friedman M, Bowden V, Jones E. Family Nursing: Research, Theory, and Practice. 5th editio. Norwalk, CT: Appleton & Lange; 2003
  43. McCubbin M, McCubbin H. Family Coping with Illness: The Resiliency Model of Family Stress, Adjustment, and Adaptation. In: Danielson C, Hamel-Bissel B, Winstead-Fry P, editors. Families, Health and Illness: Perspectives on Coping and Intervention. St. Louis, MO: CV Mosby; 1993
  44. Savitry NSD, Arifin S, Asnawati. Hubungan Dukungan Keluarga dengan Niat Konsumsi Tablet Tambah Darah pada Remaja Puteri. Berk Kedokt [Internet]. 2017;13(1):113–8. Available from: https://ppjp.ulm.ac.id/journal/index.php/jbk/article/view/3447/2992
  45. Irianto PEA. Pengaruh Asal Daerah, Uang Saku, Lifestyle terhadap Perilaku Konsumtif Selama Pandemi Covid-19 (Studi Kasus Mahasiswa Jurusan Ekonomi Pembangunan Universitas Islam Indonesia). Universitas Islam Indonesia. Universitas Islam Indonesia; 2022
  46. Notoatmodjo S. Metodologi Penelitian Kesehatan. 3rd ed. Jakarta: Rineka Cipta; 2018
  47. Pamangin LOM. Perilaku Konsumsi Tablet Tambah Darah (TTD) pada Remaja Putri. J Promot Prev [Internet]. 2023;6(2):311–7. Available from: http://journal.unpacti.ac.id/index.php/JPP/article/view/746/432
  48. Kaur, S., P. R. Deshmukh and BSG. Epidemiological Correlates of Nutritional Anemia in Adolescent Girls of Rural Wardha. Indian J Community Med. 2006;31(4):7–19
  49. Van Haalen H, Jackson J, Spinowitz B, Milligan G, Moon R. Impact of Chronic Kidney Disease and Anemia on Health-related Quality of Life and Work Productivity: Analysis of Multinational Real-World Data. BMC Nephrol. 2020;21(88):1–15
  50. Nasir Y, Masithah S, Yusuf K, Nurcahyani ID, Syafruddin. Hubungan Pengetahuan Anemia dengan Kepatuhan Mengkonsumsi Tablet Tambah Darah pada Remaja Putri di Wilayah Kerja Puskesmas Turikale. Ghidza J Gizi dan Kesehat. 2024;8(1):93–100
  51. Riana NWM. Hubungan Pengetahuan Remaja Putri tentang Anemia dan Tablet Tambah Darah (TTD) dengan Kepatuhan Mengkonsumsi TTD di SMAN 1 Gianyar Tahun 2018. Politeknik Kesehatan Kemenkes Denpasar; 2018
  52. Tirthawati S, Rosidi A, Sulistyowati E, Ayuningtyas RA. Pengetahuan, Sikap Remaja Putri dan Dukungan Petugas Kesehatan terhadap Konsumsi Tablet Besi Folat SMKN 1 Bangsri Jepara: Sebuah Studi Cross Sectional. J Gizi Unimus. 2020;9(2):201–14
  53. Dimas-Benedicto C, Albasanz L, Bermejo LM, Alejandro S, Mart M, Mart RM. Impact of Iron Intake and Reserves on Cognitive Function in Young University Students. Nutriens. 2024;16(2808):1–26
  54. Nutbeam D. Health Literacy as A Public Health Goal: A Challenge for Contemporary Health Education and Communication Strategies into The 21st Century. Heal Promot Internnational [Internet]. 2000;15(3):259–67. Available from: https://academic.oup.com/heapro/article-abstract/15/3/259/551108?redirectedFrom=fulltext
  55. Andani Y, Esmianti F, Haryani S. Hubungan Pengetahuan dan Sikap Remaja Putri terhadap Konsumsi Tablet Tambah Darah (TTD) di SMP Negeri 1 Kepahiang. J Kebidanan Besurek [Internet]. 2020;5(2):55–62. Available from: http://jurnal.fk.unand.ac.id/index.php/jka/article/download/744/600
  56. Rosenstock IM. The Health Belief Model and Preventive Health Behavior. Health Educ Monogr [Internet]. 1974;2(4):354–86. Available from: https://journals.sagepub.com/doi/10.1177/109019817400200405
  57. Lismiana H, Indarjo S. Pengetahuan dan Persepsi Remaja Putri terhadap Kepatuhan Konsumsi Tablet Tambah Darah. Indones J Public Heal Nutr. 2021;1(1):22–30
  58. Bintang MK br, Widjanarko B, Prabamurti PN. Gambaran Perilaku Pencegahan Pengemudi Ojek Online Selama Pandemi Covid-19 di Kelurahan Tembalang Kota Semarang Tahun 2020. Media Kesehat Masy Indones. 2022;21(1):36–45
  59. Rahayu S, Said MSM, Sansuwito T Bin. Factors Affecting Adherence to Consumption of Fe Tablets in The Prevention of Anemia in High School Students: A Literature Review. Int J Health Sci (Qassim). 2023;1(4):724–39
  60. Nasichah A, Sulistyowati M. Hubungan Keyakinan Remaja Putri dengan Kepatuhan Konsumsi Tablet Tambah Darah Berdasarkan Teori HBM : Literature Review. J Kesehat Tambusai. 2023;4(2):459–69
  61. Aprianti R, Meinar G, Kusumaningrum T. Factors Correlated with The Intention of Iron Tableet Consumption among Female Adolescents. J Ners [Internet]. 2018;13(1):122–7. Available from: https://e-journal.unair.ac.id/JNERS/article/view/8368/pdf
  62. Janz N, Marshall Becker. The Health Belief Model: A Decade Later. Health Educ Q. 1984;11(1):1–47
  63. Chusna FF, Sulistiawati, Irwanto. Hubungan Persepsi Hambatan dan Kemampuan Diri dengan Intensitas Konsumsi Tablet Fe pada Remaja Putri. J Kebidanan. 2021;10(2):82–8
  64. Kurniawati KD, Kusumawati A, Prabamurti PN. Hubungan Pengetahuan, Persepsi Keseriusan, Persepsi Hambatan dan Efikasi Diri dengan Partisipasi Remaja dalam Mengikuti Posyandu Remaja. J Kesehat Masy. 2020;8(3):406–9
  65. Bandura A. Self-efficacy: Toward a Unifying Theory of Behavioral Change. Psychol Rev. 1977;84(2):191–215
  66. Novita H, Nurlina N, Suratmi S. The Obedience Factors of Teenage Girls to Consume Iron Tablet at SMK Negeri 1 Kedawung, Cirebon. J Kebidanan. 2021;11(1):23–33
  67. Bandura A. Self-efficacy The Exercise of Control. New York: W.H. Freeman; 1997. 604 p
  68. Rachmawati WC. Promosi Kesehatan dan Ilmu Perilaku. Malang: Penerbit Wineka Media; 2019. 62 p
  69. Fatimah J, Wulandari R. Faktor yang Mempengaruhi Kepatuhan Konsumsi Tablet Tambah Darah Remaja Puteri. J Kebidanan dan Keperawatan Aisyiyah. 2022;18(2):124–9
  70. Nurjanah A, Azinar M. Kepatuhan Konsumsi Tablet Tambah Darah Remaja Putri pada Sekolah Percontohan Kesehatan Reproduksi dan Seksualitas. HIGEIA (Journal Public Heal Res Dev. 2023;7(2):244–54
  71. Fatmawati A, Subagja CA. Analysis of Compliance Factors Consuming Iron Tablets in Adolescent Girls. J Keperawatan [Internet]. 2020;12(3). Available from: https://journal.stikeskendal.ac.id/index.php/Keperawatan/article/view/772
  72. Mulugeta A, Tessema M, H/sellasie K, Seid O, Kidane G, Kebede A. Examining Means of Reaching Adolescent Girls for Iron Supplementation in Tigray, Northern Ethiopia. Nutrients. 2015;7(11):9033–45
  73. Us H, Fitriani A, Fatiyani. Faktor yang Mempengaruhi Konsumsi Fe pada Remaja. J Ris Kesehat Nas. 2023;7(2):167–76
  74. Apriningsih, Madanijah S, Dwiriani CM, Kolopaking R. Peranan Orang Tua dalam Meningkatkan Kepatuhan Siswi Minum Tablet Zat Besi Folat di Kota Depok. Gizi Indones. 2019;42(2):71–82
  75. Anugerah DT, Rusli D. Pengaruh Dukungan Teman Sebaya terhadap Resiliensi Remaja Pesantren Modern Nurul Ikhlas. J Ris Psikol [Internet]. 2020;1(1):1–12. Available from: https://jurnal.unismabekasi.ac.id/index.ph%0A p/soul/article/view/631
  76. Wahyuni F, A F, S M, N U. Hubungan Peran Keluarga dan Teman Sebaya dengan Perilaku Seksual Remaja Putra di SMA Negeri 5 Kota Lhokseumawe Tahun 2018. J Kebidanan Khatulistiwa. 2021;7(2):98–106
  77. Muthia Adila A, Ramadhan N, Mufida Z, Surury I, Riptifah Handari S. Hubungan Pengetahuan dan Dukungan Teman Sebaya terhadap Upaya Pencegahan Anemia Saat Menstruasi pada Remaja. J Kesehat Reproduksi. 2022;13(1):39–46
  78. Sab’ngatun, Riawati D. Hubungan Pengetahuan dengan Konsumsi Tablet Tambah Darah pada Remaja Putri. Avicenna J Heal Res. 2021;4(2):83–90

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