Associations Between Social Support, Health Belief Model Constructs, and Smoking Cessation Among Patients Attending a Smoking Cessation Clinic in Surakarta, Central Java, Indonesia
DOI:
https://doi.org/10.26911/thejhpb.2026.11.03.01Abstract
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.
Keywords:
smoking cessation, social support, Health Belief Model, Generalized Structural Equation ModelHow to Cite
References
Aderita NI, Ningsih S, Yuliyanti T (2023). Hubungan antara sikap, norma sub-jektif, dan persepsi terhadap intensi berhenti merokok pada remaja putra sekolah menengah atas. Jurnal Ilmiah Permas: Jurnal Ilmiah STIKES Kendal. 13(3): 751–760. https://doi.-org/10.32583/pskm.v13i3.585.
Ayuningtyas D, Tuinman M, Prabandari YS, Hagedoorn M (2021). Smoking-rela-ted social control in Indonesian si-ngle-smoker couples. Int J Behav Med. 28(4): 455–465. https://doi.-org/10.1007/s12529-020-09935-z
Becker MH (1978). The Health Belief Model and personal health behavior. Thorofare, NJ: Charles B. Slack.
Fitriani F, Harlivasari AD, Susanto AD (2024). Pedoman diagnosis dan penatalaksanaan berhenti merokok di Indonesia (Guidelines for the diag-nosis and management of smoking cessation in Indonesia). In: Susanto AD (ed.). Upaya berhenti merokok. Jakarta: EGC.
Global Smoking and Tobacco Harm Reduction Database (2025). Tobacco smoking in Indonesia. Retrieved from https://gsthr.org/countries/profile/idn/cigarettes/.
Green LW, Kreuter MW (2005). Health program planning: An educational and ecological approach. 4th ed. New York: McGraw-Hill.
Gwaltney CJ, Metrik J, Kahler CW, Shiffman S (2009). Self-efficacy and smoking cessation: A meta-analysis. Psychol Addict Behav. 23(1): 56–66. https://doi.org/10.1037/a0013529.
Hong Q, Liao Y, Zhang N (2024). Implicit theories of smoking and intention to quit: A serial mediation model. Nicotine Tob Res. 26(5): 621–628. https://doi.org/10.1093/ntr/ntad213.
Hopkins PD, Spears CA, Hoover DS, Li L, Cambron C, Potter LN, Cinciripini PM, et al. (2022). Trajectories of motivation and self-efficacy during a smoking quit attempt: An ecological momentary assessment study. Psychol Addict Behav. 36(1): 78–89. https://doi.org/10.1037/adb0000734
King BA, Creamer MLR, Harrell M, Kelder S, Norman L, Perry CL (2018). Sur-geon General's reports on tobacco: A continued legacy of unbiased and rigorous synthesis of the scientific evidence. Nicotine Tob Res. 20(8): 1033–1036. https://doi.org/10.1093/-ntr/ntx266.
Lepore SJ, Collins BN, Sosnowski DW (2019). Self-efficacy as a pathway to long-term smoking cessation among low-income parents in the multilevel Kids Safe and Smokefree intervention. Drug Alcohol Depend. 204: 107594. https://doi.org/10.1016/j.drugalcdep.2019.05.027.
Nisriina ZN (2024). Active smokers Health Belief Model: Health Belief Model pada perokok aktif. J Kesehat Masy Mulawarman. 6(1): 1–10. https://doi.-org/10.30872/jkmm.v6i1.13346.
Pribadi ET, Devy SR (2020). Application of the Health Belief Model on the inten-tion to stop smoking behavior among young adult women. J Public Health Res. 9(2): 121–124. https://doi.org/-10.4081/jphr.2020.1817.
Rohadatul DS, Surjaningrum ER (2021). Health Belief Model pada perilaku merokok menurut tingkat pendapat-an. Buletin Riset Psikologi Dan Kese-hatan Mental. 1(1): 638–648. https:-//doi.org/10.20473/brpkm.v1i1.26803.
Rosenstock IM (1974). The Health Belief Model and preventive health beha-vior. Health Educ Monogr. 2(4): 354–386. https://doi.org/10.1177/109019-8174002004002.
Saudi ANA, Bintang RS, Loloallo VL, Zai-nuddin NI (2024). Multidimensional Scale of Perceived Social Support (M-SPSS): Uji validitas konstruk dengan confirmatory factor analysis (CFA). Edukatif: Jurnal Ilmu Pendidikan. 6(4): 4266–4275. https://doi.org/10.-31004/edukatif.v6i4.7492
Strecher VJ, McEvoy DeVellis B, Becker MH, Rosenstock IM (1986). The role of self-efficacy in achieving health behavior change. Health Educ Q. 13(1): 73–92. https://doi.org/10.1177-/109019818601300108
United States Public Health Service Office of the Surgeon General; National Center for Chronic Disease Prevention and Health Promotion (US) Office on Smoking and Health (2020). Smoking Cessation: A Report of the Surgeon General [Internet]. Washington (DC): US Department of Health and Human Services. Chapter 6, Interventions for Smoking Cessation and Treatments for Nicotine Dependence. Retrieved from https://www.ncbi.nlm.nih.gov/-books/NBK555596/.
Vanfrank B, Presley-Cantrell L (2021). A comprehensive approach to increase adult tobacco cessation. JAMA. 325(3): 232–233. https://doi.org/10.-1001/jama.2020.23608.
World Health Organization (2023). WHO report on the global tobacco epidemic 2023: : protect people from tobacco smoke. Geneva: World Health Orga-nization. Retrieved from https://-www.who.int/publications/i/item/9789240077164.


