Development of Self-Regulation Model Based on Health Promotion Model on Anemia Prevention Behavior in Pregnant Women
Main Article Content
Abstract
Background: Anemia prevention in pregnant women is essential to reduce health risks for both mother and fetus. This study aimed to develop a self-regulation model for anemia prevention behavior based on the Health Promotion Model.
Methods: An explanatory design with a cross-sectional approach was applied to 115 pregnant women attending health centers in Surabaya, selected through cluster sampling. Data were collected using a structured questionnaire and analyzed using SEM-PLS.
Results: The findings showed that anemia prevention behavior was significantly influenced by behavioral self-regulation (T=2.945) through personal regulation (T=5.932), which was shaped by environmental self-regulation (T=8.611) and individual characteristics (T=3.302). Commitment did not directly affect anemia prevention behavior (T=0.144; p=0.886). The model demonstrated substantial explanatory power, with R² values of 71.9% for behavioral self-regulation and 43.1% for anemia prevention behavior. Predictive relevance (Q² > 0) confirmed the model’s robustness across different contexts.
Conclusion: This study highlights the pivotal role of self-regulation processes in shaping anemia prevention behavior. The model can serve as a framework for nursing interventions to strengthen self-regulation among pregnant women and improve maternal and fetal health outcomes.
Article Details
References
Arifah, I., Pambarep, T. S. A., Khoiriyah, L., Kusumaningrum, T. A. I., Werdani, K. E., & Ngadiyono, N. P. (2023). Effectiveness of daily educational message on pregnancy anemia prevention behavior and knowledge: A pilot randomized controlled trial. Journal of Education and Health Promotion, 12(1). https://doi.org/10.4103/jehp.jehp_108_23
Balcha, W. F., Eteffa, T., Arega Tesfu, A., & Abeje Alemayehu, B. (2023). Maternal knowledge of anemia and adherence to its prevention strategies: A health facility-based cross-sectional study design. Inquiry (United States), 60. https://doi.org/10.1177/00469580231167731
Bayrami, R., Masudi, S., Didarloo, A., & Nournezhad, H. (2024). Determining the predictors of preventive behaviors adopted by pregnant women against COVID-19 based on the Health Belief Model constructs: A cross sectional study. BMC Women’s Health, 24(1), 528. https://doi.org/10.1186/s12905-024-03305-7
Beressa, G., Whiting, S. J., & Belachew, T. (2024). Effect of nutrition education integrating the health belief model and theory of planned behavior on dietary diversity of pregnant women in Southeast Ethiopia: A cluster randomized controlled trial. Nutrition Journal, 23(1), 3. https://doi.org/10.1186/s12937-023-00907-z
Chen, H.-H., & Hsieh, P.-L. (2021). Applying the Pender’s Health Promotion Model to identify the factors related to older adults’ participation in community-based health promotion activities. International Journal of Environmental Research and Public Health, 18(19), 9985. https://doi.org/10.3390/ijerph18199985
Conner, M., Wilding, S., Wright, C. E., & Sheeran, P. (2023). How Does self-control promote health behaviors? A multi-behavior test of five potential pathways. Annals of Behavioral Medicine, 57(4), 313–322. https://doi.org/10.1093/abm/kaac053
Dahlan, S. (2021). Statistik untuk kedokteran dan kesehatan (6th Ed.). Epidemiologi Indonesia.
Delil, R., Tamiru, D., & Zinab, B. (2018). Dietary diversity and its association with anemia among pregnant women attending public health facilities in South Ethiopia. Ethiopian Journal of Health Sciences, 28(5). https://doi.org/10.4314/ejhs.v28i5.14
Devinia, N. (2020). Hubungan pola makan dan status sosial ekonomi dengan kejadian anemia pada ibu hamil systematic review. Tugas Akhir. Politeknik Kesehatan Kalimantan Timur.
Edelson, P. K., Cao, D., James, K. E., Ngonzi, J., Roberts, D. J., Bebell, L. M., & Boatin, A. A. (2023). Maternal anemia is associated with adverse maternal and neonatal outcomes in Mbarara, Uganda. The Journal of Maternal-Fetal & Neonatal Medicine : The Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians, 36(1), 2190834. https://doi.org/10.1080/14767058.2023.2190834
Ghozali, I. (2021). Partial least squares konsep teknik dan aplikasi menggunakan program smartpls 3.2.9 untuk penelitian empiris. Badan Penerbit Universitas Diponegoro, (3rd ed).
Goodarzi-Khoigani, M., Ardakani, T. S., Aram, F. A., Khoshhali, M., Mardanian, F., & Ardian, N. (2024). The effect of Internet-based nutrition education according to Pender’s health promotion model on gestational weight gain: Study protocol for a randomized controlled clinical trial. Journal of Education and Health Promotion, 13(1). https://doi.org/10.4103/jehp.jehp_926_23
Handajani, D. O. (2021). Hubungan dukungan keluarga dengan tingkat kecemasan pada ibu hamil primigravida trimester III dalam menghadapi persalinan. IJMT : Indonesian Journal of Midwifery Today, 1(1), 27. https://doi.org/10.30587/ijmt.v1i1.3321
Handayani, S. (2021). Self efficacy ibu hamil dengan anemia. Profesi (Profesional Islam), 19(1), 30–37. https://journals.itspku.ac.id/index.php/profesi/article/view/82
Hennessy, E. A., Johnson, B. T., Acabchuk, R. L., McCloskey, K., & Stewart-James, J. (2020). Self-regulation mechanisms in health behavior change: A systematic meta-review of meta-analyses, 2006-2017. Health Psychology Review, 14(1), 6–42. https://doi.org/10.1080/17437199.2019.1679654
Heshmati, R., Alizadeh, M., Javadpour, S., & Alizada, N. (2020). Psychosocial determinants of self-care behavior in outpatients with heart failure: A test of Penderʼs health promotion model. Iranian Red Crescent Medical Journal, 22(12), 18–24. https://doi.org/10.32592/ircmj.2020.22.12.141
Hidayanty, H., Nurzakiah, N., Irmayanti, I., Yuliana, Y., Helmizar, H., & Yahya, Y. (2025). Perceived barriers and enablers for taking iron–folic acid supplementation regularly among adolescent girls in Indonesia: A pilot study. International Journal of Environmental Research and Public Health, 22(2), 209. https://doi.org/10.3390/ijerph22020209
Kebaabetswe, P., Diseko, M., Zash, R., Mayondi, G., Mabuta, J., Mmalane, M., Makhema, J., Lockman, S., Moeng, L., Lowenthal, E., Shapiro, R., & Caniglia, E. C. (2024). A qualitative assessment of barriers to iron and folic acid supplementation among pregnant women in Botswana. BMC Public Health, 24(1), 3369. https://doi.org/10.1186/s12889-024-20685-5
Kemenkes RI. (2020a). Pedoman pelayanan antenatal terpadu (3rd ed.). Kementerian Kesehatan RI.
Kemenkes RI. (2020b). Pedoman Pemberian Tablet Tambah Darah (TTD) bagi ibu hamil. Kementerian Kesehatan Republik Indonesia.
Kemenkes RI. (2022a). Anemia dalam kehamilan. Accessed September 22, 2024 from https://yankes.kemkes.go.id/view_artikel/1132/anemia-dalam-kehamilan#:~:text=Berdasarkan WHO%2C anemia pada kehamilan,g%2FdL pada pasca persalinan.
Kemenkes RI. (2022b). Laporan Akuntabilitas Kinerja Instansi Pemerintah (LAKIP) Direktorat Gizi dan Kesehatan Ibu dan Anak Tahun Anggaran 2022. Accessed September 22, 2024 from https://ppid.kemkes.go.id/docs/informasi-publik-berkala/k-laporan-akuntabilitas-kinerja-lakip/laporan-akuntabilitas-kinerja-lakip/
Khani Jeihooni, A., Hoshyar, S., Afzali Harsini, P., & Rakhshani, T. (2021). The effect of nutrition education based on PRECEDE model on iron deficiency anemia among female students. BMC Women’s Health, 21(1), 1–9. https://doi.org/10.1186/s12905-021-01394-2
Li, X., Gao, Q., Sun, L., & Gao, W. (2022). Effect of self-control on health promotion behavior in patients with coronary heart disease: Mediating effect of ego-depletion. Psychology, Health and Medicine, 27(6), 1268–1276. https://doi.org/10.1080/13548506.2020.1867316
Lo, S. L., Gearhardt, A. N., Fredericks, E. M., Katz, B., Sturza, J., Kaciroti, N., Gonzalez, R., Hunter, C. M., Sonneville, K., Chaudhry, K., Lumeng, J. C., & Miller, A. L. (2021). Targeted self-regulation interventions in low-income children: Clinical trial results and implications for health behavior change. Journal of Experimental Child Psychology, 208, 105157. https://doi.org/10.1016/j.jecp.2021.105157
Pender, N., Murdaugh, C., & Parsons, M. A. (2015). Health promotion in nursing practice. In Nursing standard (Royal College of Nursing (Great Britain) : 1987) (Vol. 5, Issue 23). Julie Levin Alexander. https://doi.org/10.7748/ns.5.23.37.s49
Queen Mary University of London. (2018). Risk of maternal death doubled in pregnant women with anemia. ScienceDaily. Access September 22, 2024 from https://www.sciencedaily.com/releases/2018/03/180321092634.htm
Risyati, L., Al-Tadom, N., & Kiah, F. K. (2024). Self management ibu hamil dengan anemia. Jurnal Kreativitas Pengabdian Kepada Masyarakat (PKM), 7(1), 162–170. https://doi.org/10.33024/jkpm.v7i1.12522
Santi, M., Dewi, C. N. T., & Purnamaningrum, Y. E. (2023). Dukungan Sosial dan Tingkat Kecemasan Ibu Hamil pada Masa Pandemi COVID-19. Window of Health : Jurnal Kesehatan, SE-Articles, 365–377. https://doi.org/10.33096/woh.vi.228
Sedlander, E., Long, M. W., Mohanty, S., Munjral, A., Bingenheimer, J. B., Yilma, H., & Rimal, R. N. (2020). Moving beyond individual barriers and identifying multi-level strategies to reduce anemia in Odisha India. BMC Public Health, 20(1), 1–16. https://doi.org/10.1186/s12889-020-08574-z
Sharma, D. (2020). Achieving sustainable development nutrition targets: The challenge for South Asia. Journal of Global Health, 10(1), 10303. https://doi.org/10.7189/jogh.10.010303
Sunuwar, D. R., Singh, D. R., Chaudhary, N. K., Pradhan, P. M. S., Rai, P., & Tiwari, K. (2020). Prevalence and factors associated with anemia among women of reproductive age in seven South and Southeast Asian countries: Evidence from nationally representative surveys. PLOS ONE, 15(8), e0236449. https://doi.org/10.1371/journal.pone.0236449
Torkan, N., Kazemi, A., Paknahad, Z., & Bahadoran, P. (2018). Relationship of social cognitive theory concepts to dietary habits of pregnant women. Iranian Journal of Nursing and Midwifery Research, 23(2), 125–130. https://doi.org/10.4103/ijnmr.IJNMR_157_16
Triharini, M., Nursalam, Sulistyono, A., Adriani, M., Armini, N. K. A., & Nastiti, A. A. (2018). Adherence to iron supplementation amongst pregnant mothers in Surabaya, Indonesia: Perceived benefits, barriers and family support. International Journal of Nursing Sciences, 5(3), 243–248. https://doi.org/10.1016/j.ijnss.2018.07.002
UNFPA. (2023). Strengthening data to reduce maternal deaths in Indonesia. September 22, 2024 from https://indonesia.unfpa.org/en/news/strengthening-data-reduce-maternal-deaths-indonesia
Utami, T. A., Suprapti, F., & Supardu, S. (2020). Aplikasi promosi kesehatan melalui “booklet patuh ARV” (A. Baidhowi (ed.)). Pilar Utama Mandiri. September 22, 2024 from http://repository.stik-sintcarolus.ac.id/1153/1/Aplikasi promosi kesehatan.pdf
Wakwoya, E. B., Belachew, T., & Girma, T. (2023). Effects of intensive nutrition education and counseling on nutritional status of pregnant women in East Shoa Zone, Ethiopia. Frontiers in Nutrition, 10. https://doi.org/10.3389/fnut.2023.1144709
WHO. (2019). The global health observatory: Anaemia in pregnant women. September 22, 2024 from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/prevalence-of-anaemia-in-pregnant-women-(-)
WHO. (2023). Anaemia. September 22, 2024 from https://www.who.int/news-room/fact-sheets/detail/anaemia#:~:text=During pregnancy%2C anaemia has been,%2C families%2C communities and countries.
Young, M. F. (2018). Maternal anaemia and risk of mortality: A call for action. The Lancet Global Health, 6(5), e479–e480. https://doi.org/10.1016/S2214-109X(18)30185-2
Zhang, J., Li, Q., Song, Y., Fang, L., Huang, L., & Sun, Y. (2022). Nutritional factors for anemia in pregnancy: A systematic review with meta-analysis. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.1041136