The Influence of the Health Belief Model on Reproductive Health Behavior among Adolescents in Surakarta, Indonesia
DOI:
https://doi.org/10.26911/Abstract
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.
Keywords:
adolescents, health belief model, self-efficacy, reproductive health behavior
How to Cite
References
Abdurahman C, Oljira L, Hailu S, Mengesha MM (2022). Sexual And Reproductive Health Services Utilization And Asso¬ciated Factors Among Adolescents Attending Secondary Schools. Reprod Health, 19(1). 19(1):1-12. doi:10.1186/¬s12978-022-01468-w
Adaralegbe AA, Oluwatomi A, Stephanie CO, Obiageri EE, Nnenna AU (2021). Sexual Behaviors and HIV Status: A Population-Based Study among Youths and Adults in Tanzania. J Infect Dis Epidemiol. 7(8):1-7. Doi:10.23937/24-74-3658/1510224
Anokye TBP, Charles-Unadike VO, Anaman-Torgbor JA, Tarkang EE (2022). Predictors of Risky Sexual Behavior Among Atudents Aged 15 to 24 Years in The Suhum Municipality, Eastern Region of Ghana. J HIV AIDS Soc Serv. 21(1): 27–47. doi:10.1080/-15381501.2021.2007197
Appau R, Aboagye RG, Nyahe M, Khuzwayo N, Tarkang EE (2024). Predictive Abi-lity of The Health Belief Model in HIV Testing and Counselling Uptake Among Youth Aged 15–24 in La-Nkwantanang-Madina Municipality, Ghana. BMC Public Health, 24(1): 1–15. doi:10.1186¬/s12889-024-19362-4
Aprilia M, Handayani S, Mulyanti S (2025). Adolescents’ reproductive health know¬ledge and risky sexual behavior: A correlational study. Interest: J Ilmu Kesehat. 12: 92–98. Doi:10.37341/inte¬rest.v12i2.718
Decker MJ, Atyam TV, Zárate CG, Bayer AM, Bautista C, Saphir M (2021). Ado-lescents’ perceived barriers to Access-ing Sexual and Reproductive Health Services in California: a Cross-sectional Survey. BMC Health Serv Res, 21(1), 1–12. Doi:10.1186/s12913-021-07278-3
Dungga EF, Ihsan M (2023). Reproductive health education among adolescents. (in Indonesian Language). Jurnal Pengabdian Masyarakat Farmasi: Pharmacare Society. https://api.se-manticscholar.org/CorpusID:265775109.
Fatkhiyah N, Masturoh M, Atmoko D (2020). Adolescent reproductive health education. J Abdimas Mahakam. 4(1): 84–89. Doi:10.24903/jam.v4i1.776
Gebreyesus H, Teweldemedhin M, Mamo A (2019). Determinants of Reproductive Health Services Utilization Among Rural Female Adolescents in Asgede-Tsimbla District Northern Ethiopia: A Community Based Cross-Sectional Study. Reprod Health. 16(1): doi:10.11-86/s12978-019-0664-2
Glanz KKB, Rimer, Viswanath K (2015). Health Behavior Theory, Research, and Practice 5th ed. San Francisco Jossey-Bass.
IDHS. (2017). Indonesia demographic and health survey 2017: adolescent book. Jakarta: National Population and Family Planning Board.
Joorbonyan H, Ghaffari M, Rakhshanderou S (2022). Peer-led theoretically desinged HIV/AIDS prevention inter-vention among students: A case of health belief model. BMC Public Health. 22(1):1-11. Doi:10.1186/s128-89-021-12445-6
Katirayi L, Akuno J, Kulukulu B, Masaba R (2021). “When You Have a High Life, and You Like Sex, You Will be Afraid”: a Qualitative Evaluation of Adolescents’ Decision to Test for HIV in Zambia and Kenya Using The Health Belief Model. BMC Public Health. 21(1):1-11 doi:10.1¬186/s12889-021-10391-x
Khatirpasha S, Farahani-Nia M, Nikpour S, Haghani H (2019). Puberty Health Education and Female Students’ Self-efficacy. J Client Cent Nurs Care, 5(4): 231–238. doi:10.32598/JCCNC.5.4.9-3.12
Kustin, Handayani Y (2024). Health Belief Model as an effort to prevent free sex behavior among adolescents. 5(3).
Kusumawardani DA, Ayu EJ (2021). Appli-cation of the Health Belief Model on the Reproductive Health Services Uptake in Adolescents: A Meta-Analysis. J Health Promot Behav: 6(4): 318–326. doi:10.26911/thejhpb.2021.06.04.06
Langat EC, Mohiddin A, Kidere F, Omar A, Akuno J, Naanyu V, Temmerman M (2024). Challenges and opportunities for improving access to adolescent and youth sexual and reproductive health services and information in the coastal counties of Kenya: a qualitative study. BMC Public Health. 24(1):1-14. Doi:10.¬1186/s12889-024-17999-9
Leekuan P, Kane R, Sukwong P, Kulnitichai W (2022). Understanding sexual and reproductive health from the perspec-tive of late adolescents in Northern Thailand: a Phenomenological Study. Reprod Health. 19(1): 1–17. Doi:10.11-86/s12978-022-01528-1
Liang M, Simelane S, Fortuny FG, Chalasani S, Weny K, Salazar CP, Jenkins L, et al. (2019). The State of Adolescent Sexual and Reproductive Health. In J Adoles Health. 65(6):S3-S15. doi:10.1016/j.ja-dohealth.2019.09.015
Limbu YB, Gautam RK (2023). How Well the Constructs of Health Belief Model Predict Vaccination Intention: A Syste-matic Review on COVID-19 Primary Series and Booster Vaccines. Vaccines (Basel). 11(4):816. Doi:10.3390/vacci-nes11040816.
Murti B (2018). Principles and methods of epidemiological research. Surakarta: Universitas Sebelas Maret.
Ngoma-Hazemba A, Chavula MP, Sichula N, Silumbwe A, Mweemba O, Mweemba M, Simpungwe MK, et al. (2024). Exploring the barriers, facilitators, and opportunities to enhance uptake of sexual and reproductive health, hiv and gbv services among adolescent girls and young women in Zambia: a Qualitative Study. BMC Public Health, 24(1):1-15. Doi:10.1186/s12889-024-19663-8
Prabandari FH, Rahayu TB (2016). Rela-tionship between adolescents’ repro-ductive health knowledge and free sex behavior among 11th grade students of SMA Negeri 6 Surakarta. J Health. 3(1): 45–51. Doi:10.30590/vol3-no1-p45-51
Rajapakshe W, Wickramasurendra AK, Amarasinghe RR, Wijerathne SLMKA, Wijesinghe ND, Madhavika N (2024). Application of the Health Belief Model (HBM) to Explore the Quality of Sexual and Reproductive Health (SRH) Edu¬cation in Sri Lanka. Int J Environ Res and Public Health. 21(12). Doi:10.339¬0/ijerph21121703
Rohmah SA (2025). Relationship between reproductive health knowledge and risky sexual behavior among female high school adolescents in Central Java [thesis]. Semarang: Universitas Islam Sultan Agung.
Surakarta Health Office. (2024). Commu-nity health centers with the highest reproductive health cases in Surakarta.
Taba M, Allen TB, Caldwell PHY, Skinner SR, Kang M, McCaffery K, Scott KM (2022). Adolescents’ self-efficacy and digital health literacy: A cross-sectional mixed methods study. BMC Public Health, 22(1):1-13. doi:10.1186/s1288¬9-022-13599-7
Tadesse T, Dangisso MH, Abebo TA (2020). Sexual and reproductive health rights knowledge and reproductive health services utilization among rural repro¬ductive age women in Aleta Wondo District, Sidama Zone, Ethiopia: Com¬munity Based Cross-Sectional Study. BMC Int Health Hum Rights. 20(1):1-9. Doi:10.1186/s12914-020-00223-1
Thongmixay S, Essink DR, De Greeuw T, Vongxay V, Sychareun V, Broerse JEW (2019). Perceived Barriers in Accessing Sexual and Reproductive Health Ser-vices for Youth in Lao People’s Demo-cratic Republic. PLoS ONE, 14(10): e0218296. Doi:10.1371/journal.pone.-0218296
Tilahun T, Bekuma TT, Getachew M, Seme A (2021). Assessment of access and utilization of adolescent and youth sexual and reproductive health services in Western Ethiopia. Reprod Health, 18(1). Doi:10.1186/s12978-021-01136-5
UNFPA. (2023). Adolescent Sexual and Reproductive Health. United Nations Population Fund. Available from: https://www.unfpa.org/resources/adolescent-sexual-and-reproductive-health
WHO (2022). Reproductive health. Geneva: World Health Organization. Available from: https://www.who.int/western-pacific/health-topics/reproductive-health
WHO. (2024a). Adolescent Health. Geneva: World Health Organization. Available from: https://www.who.int/health-topics/adolescent-health/#tab=tab_1
WHO (2024b). Transforming adolescent health: WHO’s comprehensive report on global progress and gaps. Geneva: World Health Organization. Available from: https://www.who.int/indonesia-/news/detail/01-11-2024-transform-ing-adolescent-health--who-s-comprehensive-report-on-global-progress-and-gaps
Wulandari YA, Suryani N, Poncorini E (2016). Health Belief Model: Health Preventive Behavior of Sexually Trans-mitted Infection in Female Sex Workers in Surakarta. J Health Promot Behav. 1(2): 70–78. Doi:10.26911/thejhpb.20¬16.01.02.02
Yakubu I, Garmaroudi G, Sadeghi R, Tol A, Yekaninejad MS, Yidana A (2019). Assessing the impact of an educa¬tional intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a Cluster Randomised Control Trial. Reprod Health. 16(1):1-11. Doi:10.1186/s12978-019-0784-8.
