Enhancing nutritional literacy and improving dietary patterns in obese adolescents through e-booklets

Afifah Bektiningrum; Almira Sitasari; Muhammad Primiaji Rialihanto; Nurhidayat Nurhidayat; Waluyo Waluyo; Isti Suryani; Nurul Ain Azizan; Tri Siswati

doi:10.21927/ijnd.2025.0(0).%p

Enhancing nutritional literacy and improving dietary patterns in obese adolescents through e-booklets

Afifah Bektiningrum, Almira Sitasari, Muhammad Primiaji Rialihanto, Nurhidayat Nurhidayat, Waluyo Waluyo, Isti Suryani, Nurul Ain Azizan, Tri Siswati

Abstract

ABSTRAK

Latar Belakang: Obesitas merupakan masalah kesehatan masyarakat dengan peningkatan prevalensi di semua kelompok usia di dunia. Salah satu faktor yang berkontribusi terhadap obesitas pada remaja adalah rendahnya literasi gizi dan pola makan yang tidak sehat.

Tujuan: untuk mengetahui dampak intervensi edukasi dengan media e-booklet terhadap pengetahuan dan asupan makanan.

Metode: single group pre-posttest intervention pada remaja di SMA di Kabupaten Kulon Progo, Yogyakarta, Indonesia. Sampel ditentukan dengan kriteria inklusi siswa SMAN 1 Sentolo, kelas X dan XI, bersedia menjadi responden, hadir saat pengumpulan data dan mempunyai skor IMT/U > 1 SD, sehingga berjumlah 46 orang. Intervensi edukasi diberikan dengan media e-booklet melalui grup WhatsApp sedangkan data pengetahuan dan asupan makanan diobservasi pada saat pre-test, posttest-1 dan posttest-2. Data pengetahuan dikumpulkan dengan kuesioner dan data asupan makanan dikumpulkan dengan food recall 2 x 24 jam lalu dianalisis dengan t-test dan Wilcoxon.

Hasil: Skor pengetahuan siswa pre, posttest-1 dan posttest-2 masing-masing adalah 56,3; 94,5; dan 98,5. Terdapat perbedaan pengetahuan yang signifikan baik pada posttest-1 maupun posttest-2. Tingkat asupan energi, protein, karbohidrat dan lemak pada pengukuran pre, posttest-1 dan posttest-2. Asupan energi menurun dari 126%, 110% dan 91%; asupan protein menurun dari 163%, 156% dan 106%; asupan lemak menurun dari 153%, 137% dan 106%; asupan karbohidrat menurun dari 100%, 91%, 76%. Hasil analisis menyatakan ada perbaikan asupan yang signifikan baik pada posttest-1 maupun posttest-2 kecuali asupan karbohidrat pada posttest-1.

Kesimpulan: Edukasi gizi dengan media e-booklet berdampak pada peningkatan pengetahuan tentang obesitas dan memperbaiki asupan makanan pada remaja yang mengalami overweight dan obesitas.

KATA KUNCI: asupan;edukasi; e-booklet; pengetahuan; protein; remaja.

ABSTRACT

Background: Obesity is a public health problem with increasing prevalence in all age groups in the world. One of the factors that contribute to obesity in adolescents is low nutritional literacy and unhealthy diets.

Objective: To determine the impact of educational interventions with e-booklet to knowledge and food intake

Method: A single group pre-posttest intervention study was conducted on adolescents in senior high school Sentolo 1 (SMAN 1 Sentolo), Kulon Progo, Yogyakarta, Indonesia. The sample was chosen by criteria for grades X and XI, willing to be responders, present during data collection, and had BMI-for-age-score >1 SD, as many as 46 participants included this study. Educational interventions were provided with e-booklet was shared through WhatsApp groups, while knowledge and food intake were observed during the pre-test, post-test 1, and post-test 2. Knowledge was collected by questionnaire, and food intake was collected by food recall 2x24 hours. We apply t-test and Wilcoxon to analyze the data.

Results: The knowledge scores significantly improved from 56.3 (pre-test) to 94.5 (post-test 1) and 98.5 (post-test 2) (p< 0.05). Significant reductions were observed in energy, protein, carbohydrate, and fat intake between pre-test, post-test 1, and post-test 2, demonstrating the intervention's effectiveness in improving dietary habits among adolescents.

Conclusion: Nutrition education using e-booklet has an impact on increasing knowledge about obesity and improving food intake in adolescents who are overweight and obese.

KEYWORDS: adolescent; education; e-booklet; intake; knowledge; protein.

Article submitted on January 19, 2025; Articles revised on February 17, 2025; Articles received on July 25, 2025; Articles available online on November 28, 2025

Keywords

asupan;edukasi; e-booklet; pengetahuan; protein; remaja; adolescent; education; e-booklet; intake; knowledge; protein

References

WHO. Obesity [Internet]. 2024. Available from: https://www.who.int/health-topics/obesity/#tab=tab_1, accessed on 23th March 2025

Kemenkes RI. Laporan Nasional Riskesdas 2018. Jakarta, Indonesia; 2018.

Kemenkes RI. Laporan Provinsi DI Yogyakarta Riskesdas 2018. Jakarta, Indonesia; 2019.

Siswati T, Astria B, Primiaji M, Paramashanti BA, Rialihanto MP, Waris L. Epidemiological Transition in Indonesia and Its Prevention: A Narrative Review. J Complement Altern Med Res. 2022;18(May):50–60. Available from: https://doi.org/10.9734/jocamr/2022/v18i130345.

Pressler M, Devinsky J, Duster M, Lee JH, Glick CS, Wiener S, et al. Dietary Transitions and Health Outcomes in Four Populations – Systematic Review. Front Nutr. 2022;9(February). Available from: https://doi.org/10.3389/fnut.2022.748305.

Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev. 2022;23(1):1–18. Available from: doi: https://doi.org/10.1111/obr.13366.

Mistry SK, Puthussery S. Risk factors of overweight and obesity in childhood and adolescence in South Asian countries: a systematic review of the evidence. Public Health. 2015 Mar;129(3):200–9. Available from: https://doi.org/10.1016/j.puhe.2014.12.004

Sudargo T, Pertiwi S, Alexander RA, Siswati T, Ernawati Y. The relationship between fried food consumption and physical activity with diabetes mellitus in Yogyakarta, Indonesia. Int J Community Med Public Heal. 2016;4(1):38–44. Available from: https://doi.org/10.18203/2394-6040.ijcmph20164709.

Mizwar M, Astiti D, Aji AS, Siswati T. Transportation Mode Choice and Obesity: a Cross-Sectional Study At Senior High School Female Student in Yogyakarta, Indonesia. J Nutr Coll. 2022;11(2):114–9. Available from: https://doi.org/10.14710/jnc.v11i2.33158.

Bhana N, Utter J, Eyles H. Knowledge, Attitudes and Behaviours Related to Dietary Salt Intake in High-Income Countries: a Systematic Review. Curr Nutr Rep. 2018;7(4):183–97. Available from: https://doi.org/10.1007/s13668-018-0239-9.

Canavan CR, Fawzi WW. Addressing Knowledge Gaps in Adolescent Nutrition: Toward Advancing Public Health and Sustainable Development. Curr Dev Nutr. 2019 Jul 1;3(7):nzz062. Available from: 10.1093/cdn/nzz062.

Barbati C, Maranesi E, Giammarchi C, Lenge M, Bonciani M, Barbi E, et al. Effectiveness of eHealth literacy interventions: a systematic review and meta-analysis of experimental studies. BMC Public Health. 2025;25(1):288. Available from: https://doi.org/10.1186/s12889-025-21354-x.

WHO. Adolescent health and development. 2020; Available from: https://www.who.int/philippines/news/q-a-detail/adolescent-health-and-development

WHO. Adolescent Health [Internet]. [cited 2022 Sep 30]. Available from: https://www.who.int/health-topics/adolescent-health#tab=tab_1

Salam. Adolescent Health Interventions: Conclusions, Evidence Gaps, and Research Priorities.

Ernawati E, Baso YS, Hidayanty H, Syarif S, Aminuddin A, Bahar B. The Effects of Anemia Education Using Web-based She Smart to Improve Knowledge, Attitudes, and Practice in Adolescent Girls. Int J Heal Med Sci. 2022;5(1):44–9. Available from: https://doi.org/10.21744/ijhms.v5n1.1831.

Hidayah ER, Hidayat N, Siswati T. Efektivitas Penyuluhan Gizi melalui Roda Putar dan Leaflet terhadap Pengetahuan dan Sikap Gizi Seimbang pada Siswa Sekolah Dasar. J Nutr. 2021;23(1):22–31. Available from: https://doi.org/10.29238/jnutri.v23i1.206.

Siswati, Tri; Olfah, Yustiana; Kasjono, Heru Subaris; Paramashanti BA. Improving Adolescent Knowledge and Attitude toward the Intergenerational Cycle of Undernutrition through Audiovisual Education: Findings from RESEPIN Study in Yogyakarta, Indonesia. Indian J community Med. 2022;47(2):196–207. Available from: https://doi.org/10.4103/ijcm.ijcm_1229_21.

Pinandari AW, Kågesten AE, Li M, Moreau C, van Reeuwijk M, Wilopo SA. Short-Term Effects of a School-Based Comprehensive Sexuality Education Intervention Among Very Young Adolescents in Three Urban Indonesian Settings: A Quasi-Experimental Study. J Adolesc Heal. 2023;73(1, Supplement):S21–32. Available from: https://doi.org/10.1016/j.jadohealth.2023.01.030.

Galmarini E, Marciano L, Schulz PJ. The effectiveness of visual-based interventions on health literacy in health care: a systematic review and meta-analysis. BMC Health Serv Res. 2024;24(1):718. Available from: https://doi.org/10.1186/s12913-024-11138-1.

Permenkes RI. Permenkes RI No 2 tahun 2020 tentang Standar Antropometri Anak [Internet]. 2020 [cited 2021 Sep 23]. Available from: https://peraturan.bpk.go.id/Home/Details/152505/permenkes-no-2-tahun-2020.

Dorn LD, Hostinar CE, Susman EJ, Pervanidou P. Conceptualizing Puberty as a Window of Opportunity for Impacting Health and Well-Being Across the Life Span. J Res Adolesc. 2019;29(1):155–76. Available from: https://doi.org/10.1111/jora.12431.

Gato-Moreno M, Martos-Lirio MF, Leiva-Gea I, Bernal-López MR, Vegas-Toro F, Fernández-Tenreiro MC, et al. Early nutritional education in the prevention of childhood obesity. Int J Environ Res Public Health. 2021;18(12). Available from: https://doi.org/10.3390/ijerph18126569.

Djalalinia S, Qorbani M, Peykari N, Kelishadi R. Health Impacts of Obesity - Obesity Canada. Pak J Med Sci. 2015;31(1):239–42. Available from: https://doi.org/10.12669/pjms.311.7033.

Ryabov I. Childhood obesity and academic outcomes in young adulthood. Children. 2018;5(11). Available from: https://doi.org/10.3390/children5110150.

Fowler LA, Kracht CL, Denstel KD, Stewart TM, Staiano AE. Bullying experiences, body esteem, body dissatisfaction, and the moderating role of weight status among adolescents. J Adolesc. 2021;91:59–70. Available from: https://doi.org/10.1016/j.adolescence.2021.07.006.

Ercan TMF, Özcebe LH. Relations of self-esteem, obesity and peer bullying among middle school students in Turkey. Eur J Public Health. 2020 Sep 1;30(Supplement_5):ckaa166.936. Available from: https://doi.org/10.1093/eurpub/ckaa166.936.

Cheng S, Kaminga AC, Liu Q, Wu F, Wang Z, Wang X, et al. Association between weight status and bullying experiences among children and adolescents in schools: An updated meta-analysis. Child Abuse Negl. 2022;134:105833. Available from: https://doi.org/10.1016/j.chiabu.2022.105833.

Siswati T, Iskandar S, Pramestuti N, Raharjo J. Effect of a Short Course on Improving the Cadres ’ Knowledge in the Context of Reducing Stunting through Home Visits in Yogyakarta , Indonesia. IJERPH. 2022;19(16)(9843):1–10. Available from: https://doi.org/10.3390/ijerph19169843.

Siswati T, Iskandar S, Pramestuti N, Raharjo J, Rubaya AK, Wiratama BS. Impact of an Integrative Nutrition Package through Home Visit on Maternal and Children Outcome: Finding from Locus Stunting in Yogyakarta, Indonesia. Nutrients. 2022;14(16):3448. Available from: https://doi.org/10.3390/nu14163448.

Kao KT, Denker M, Zacharin M, Wong SC. Pubertal abnormalities in adolescents with chronic disease. Best Pract Res Clin Endocrinol Metab.2019;33(3):101275. Available from: https://doi.org/10.1016/j.beem.2019.04.009.

Lilik Laras Shinta, Toto Sudargo TS. Supplementary Feeding in The Form of Biscuits Improving Student Achievement in Elementary School. In: The Proceeding of International Nutrition and Health Symposium (INHESION). Yogyakarta: UGM, Yogyakarta; 2017.

Andriastuti M, Ilmana G, Nawangwulan SA, Kosasih KA. Prevalence of anemia and iron profile among children and adolescent with low socio-economic status. Int J Pediatr Adolesc Med. 2020;7(2):88–92. Available from: https://doi.org/10.1016/j.ijpam.2019.11.001.

Sahoo J. Research Trends in Nutrition and Food Science (Volume - 1). 2022.

Coffey AB, Alai NL, Gray VB, Cotter JA, Barrack MT. Nutrition Education Curriculum Promotes Adolescent Runners’ Self-Efficacy, Knowledge, and Intake of Nutrient-Rich Carbohydrate Foods. J Am Nutr Assoc.2023;42(2):178–86. Available from: https://doi.org/10.1080/07315724.2021.2019139.

Espinosa-Curiel IE, Pozas-Bogarin EE, Lozano-Salas JL, Martínez-Miranda J, Delgado-Pérez EE, Estrada-Zamarron LS. Nutritional Education and Promotion of Healthy Eating Behaviors Among Mexican Children Through Video Games: Design and Pilot Test of FoodRateMaster. JMIR Serious Games. 2020;8(2):e16431. Available from: http://games.jmir.org/2020/2/e16431/.

Norris SA, Frongillo EA, Black MM, Dong Y, Fall C, Lampl M, et al. Nutrition in adolescent growth and development. Lancet. 2022 Jan 8;399(10320):172–84. Available from: https://doi.org/10.1016/S0140-6736(21)01590-7.

Rachmi CN, Li M, Alison Baur L. Overweight and obesity in Indonesia: prevalence and risk factors—a literature review. Public Health. 2017;147:20–9. Available from: https://doi.org/10.1016/j.puhe.2017.02.002.

Yu X, Li L, Xue J, Wang J, Song G, Zhang Y, et al. Effect of air-frying conditions on the quality attributes and lipidomic characteristics of surimi during processing. Innov Food Sci Emerg Technol. 2020;60:102305. Available from: https://doi.org/10.1016/j.ifset.2020.102305.

Mohammadbeigi A, Asgarian A, Moshir E, Heidari H, Afrashteh S, Khazaei S, et al. Fast food consumption and overweight/obesity prevalence in students and its association with general and abdominal obesity. J Prev Med Hyg. 2018;59(3):E236–40. Available from: https://doi.org/10.15167/2421-4248/jpmh2018.59.3.830.

Chung A, Backholer K, Zorbas C, Hanna L, Peeters A. Factors influencing sweet drink consumption among preschool-age children: A qualitative analysis. Heal Promot J Aust. 2021 Jan 1;32(1):96–106. Available from: https://doi.org/10.1002/hpja.306.

DOI: http://dx.doi.org/10.21927/ijnd.2025.0(0).%25p