Information exposure, anemia perceptions, and parental roles in iron consumption compliance among adolescent girls
Abstract
Background: Iron deficiency anemia remains a common public health problem among adolescent girls, negatively impacting physical development, cognitive performance, and productivity. Although iron supplementation programs have been widely implemented, compliance with iron tablet consumption is still suboptimal.
Objective: This study aims to identify factors associated with compliance with iron consumption among adolescent girls, including knowledge of anemia symptoms, exposure to information about anemia, exposure to information about iron tablets, adolescent girls' perceptions of the impact of anemia on pregnancy and childbirth, acceptance of iron tablets, and parental awareness of the iron tablet program, and parental support for adolescent girls.
Methods: This study is a cross-sectional survey study conducted from June to August 2024 in Bantul Regency, Special Region of Yogyakarta, involving 384 adolescent girls selected using stratified random sampling. Data were collected through a structured questionnaire and analyzed using the chi-square test and logistic regression.
Results: Bivariate analysis showed a significant association between adherence and acceptance of iron consumption (p = 0.000), parental awareness (p = 0.020), perception of the impact of anemia (p = 0.014), exposure to information about anemia (p = 0.040), and iron tablets (p = 0.029). Logistic regression revealed that the main predictors of adherence included acceptance of iron supplements (OR = 3.911; 95% CI: 1.938–8.218), parental awareness (OR = 1.925; 95% CI: 1.068–3.471), perception of the impact of anemia (OR = 1.742; 95% CI: 1.138–2.669), and exposure to information about iron tablets (OR = 1.633; 95% CI: 1.062-2.510).
Conclusion: Although exposure to information was not statistically significant in multivariate analysis, it showed a positive trend. These findings highlight the importance of increasing adolescent acceptance, improving perception of the consequences of anemia, and increasing parental involvement to support iron supplementation adherence.
References
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33. Handayani D, Sumiati S, Risnawati R, Meihartati T. The Effect Of Anemia Education Videos On Compliance Take Blood Booster Tablets. JKM (Jurnal Kebidanan Malahayati). 2024 Jun 26;10(6):597–606.
34. Hertz U. A cognitive approach to learning, monitoring, and shifting social norms. Current opinion in psychology. 2024 Sep 25;60:101917–101917.
35. Lajnef K. The effect of social media influencers’ on teenagers Behavior: an empirical study using cognitive map technique. Current Psychology. 2023;42(22):19364–77.
36. Velazquez E, Garthe RC, Barinas J, Rodriguez M, Loggins J. Parental practices and adolescent health. Encyclopedia of Child and Adolescent Health, First Edition. 2023 Jan 1;2:635–46.
37. Sedlander E, Long MW, Bingenheimer JB, Rimal RN. Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project. PLoS ONE. 2021 May 1;16(5):e0249646.
38. Jyotish SK, Shokandha S, Milton A. Prevalence of Anemia, Knowledge, Attitude and Compliance Related to Weekly Iron Folic Acid Supplementation Programme among the Adolescents in Selected School of South East Delhi. International Journal of Advanced Research in Science, Communication and Technology. 2023 Aug 17;404–21.
39. Baharzadeh K, Marashi T, Saki A, Zare A, Araban M. Using of health belief model to promote preventive behaviors against iron deficiency anemia among pregnant women. Journal of Research & Health. 2016;
40. Diamond-Smith N, Holton AE, Francis S, Bernard D. Addressing anemia among women in India-an informed intervention using Facebook Ad Manager. mHealth. 2020 Oct 5;6:39–39.
41. Huang HY. Message Tailoring. The International Encyclopedia of Health Communication. 2022 Nov 10;1–7.
42. Mancone S, Corrado S, Tosti B, Spica G, Diotaiuti P. Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review. Frontiers in Public Health. 2024 Oct 9;12:1387874.
43. Freeman JL, Caldwell PHY, Scott KM. How Adolescents Trust Health Information on Social Media: A Systematic Review. Academic Pediatrics. 2023 May 1;23(4):703–19.
44. Glanz K RBVK. Health Behavior Theory, Research and Practice. 5th ed. United States of America: Jossey-Bass; 2015.
45. Wardani DSSJ. Tinjauan Literatur: Faktor-Faktor yang Berhubungan dengan Kepatuhan Konsumsi Tablet Tambah Darah pada Remaja Putri di Indonesia. Media Gizi Kesmas [Internet]. 2024 Dec 12;13(2):878–97. Available from: https://e-journal.unair.ac.id/MGK/article/view/59684
2. Nadiyah N, Sitoayu L, Dewanti LP. Remaja putri pedesaan di indonesia berisiko anemia dua kali lebih tinggi. Gizi Indonesia. 2022 Apr 11;45(1):35–46.
3. Global Health Metrics. Lancet. 2019 [cited 2025 May 2]. Anemia - Level 1 impairment. Available from: https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets/2021-anemia-level-1-impairment
4. Behera MsG, Balakrishnamony DrB. Iron deficiency anemia among adolescent girls – a review. The Genesis. 2021 Sep 15;8(3):105–8.
5. Sonawane S V., Todkar SS, Mulaje S. Prevalence of anemia and factors affecting anemia among adolescent girls under field practice area of rural health training centre of western Maharashtra. Int J Community Med Public Health. 2024 Dec 30;12(1):226–30.
6. Kumari R, Lenka AK, Kumar S, Lodhi M. Prevalence of anaemia among adolescent girls: a community-based study in delhi, india. J Adv Sci Res. 2023 Nov 30;14(10):5–12.
7. BKPK Kemenkes RI. Survei Kesehatan Indonesias 2023 dalam Angka. Jakarta; 2023.
8. Helmyati S, Syarifa CA, Rizana NA, Sitorus NL, Pratiwi D. Acceptance of Iron Supplementation Program among Adolescent Girls in Indonesia: A Literature Review. Amerta Nutrition. 2023;7(3SP):50–61.
9. Sudarti F, Bahriyah F, Putri M. The Relationship Between Consumption of Blood Supplemental Tablets to the Incidence of Anemia in Adolescent Women. INCH : Journal of Infant and Child Healthcare. 2023 Jul 21;2(1):40–4.
10. Daba DD, Bidu KT, Heyi SK, Garoma D, Assegu YB. Compliance with weekly iron folic acid supplementation and associated factors among secondary school adolescent girls, in Jimma Arjo District, West Ethiopia, 2022: A mixed method cross-sectional Study. World Journal of Biology Pharmacy and Health Sciences. 2024 Oct 20;20(1):394–408.
11. Silitonga HTH, Salim LA, Nurmala I, Wartiningsih M. Compliance of Iron Supplementation and Determinants among Adolescent Girls: A Systematic Review. Iranian journal of public health. 2023 Jan 1;52(1):37–48.
12. Pramono AY. Harian Jogja. 2023 [cited 2025 May 6]. Ratusan Remaja Putri di Bantul Menderita Anemia. Available from: https://jogjapolitan.harianjogja.com/read/2023/03/04/511/1128146/ratusan-remaja-putri-di-bantul-menderita-anemia
13. Silitonga HTH, Salim LA, Nurmala I, Hargono R, Purwandini S. Knowledge, attitude, intention, and program implementation of iron supplementation among adolescent girls in Sidoarjo, Indonesia. J Public Health Afr. 2023 May 25;14(S2).
14. Isnaini YS, Pihahey PJ, Bahra, Mintaningtyas SI, Simanjuntak MK, Fabanjo IJ. Knowledge, attitude, practice and compliance to weekly iron supplementation among female public junior high school students in West Papua. Public Health of Indonesia. 2024 Dec 25;10(4):38–48.
15. Biswas B, Gautam A, Jahnavi G, Gupta P, Varshney S. Barriers, Facilitators of Iron and Folic Acid Supplementation, and Deworming Program among School-Going Adolescents of Deoghar, Jharkhand, India: A Mixed-Methods Study. Korean J Fam Med. 2024;2–10.
16. Chen X, Hay JL, Waters EA, Kiviniemi MT, Biddle C, Schofield E, et al. Health Literacy and Use and Trust in Health Information. J Health Commun. 2018 Aug 3;23(8):724.
17. Alyafei A, Easton-Carr R. The Health Belief Model of Behavior Change. StatPearls. 2024 May 19;
18. Green EC, Murphy E. Health Belief Model. The Wiley Blackwell Encyclopedia of Health, Illness, Behavior, and Society. 2014 Feb 21;766–9.
19. Kington RS, Arnesen S, Chou WYS, Curry SJ, Lazer D, Villarruel AM. Clinical Practice Guidelines We Can Trust. Clinical Practice Guidelines We Can Trust. 2021 Jun 16;
20. Institute of Medicine, National Research Council Committee on the Science of Adolescence. The Science of Adolescent Risk-Taking: Workshop Report. Washington, D.C.: National Academies Press (US); 2011.
21. Lewis CC, Taba M, Allen TB, Caldwell PHY, Skinner SR, Kang M, et al. Developing an Educational Resource Aimed at Improving Adolescent Digital Health Literacy: Using Co-Design as Research Methodology. J Med Internet Res. 2024 Aug 7;26:e49453–e49453.
22. Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Methode Approach. United States od America Library: SAGE Publication, Inc; 2013.
23. Viner RM, Allen NB, Patton GC. Puberty, Developmental Processes, and Health Interventions. In: Disease Control Priorities, Third Edition (Volume 8): Child and Adolescent Health and Development. Washington D.C.: The International Bank for Reconstruction and Development / The World Bank; 2017. p. 107–18.
24. Bonnie RJ, Backes EP. The Promise of Adolescence: Realizing Opportunity for All Youth. The Promise of Adolescence. Washington, DC: The National Academies Press.; 2019.
25. De Buhr E, Tannen A. Parental health literacy and health knowledge, behaviours and outcomes in children: A cross-sectional survey. BMC Public Health. 2020 Jul 13;20(1):1–9.
26. Van Zyl C, Badenhorst M, Hanekom S, Heine M. Unravelling ‘low-resource settings’: a systematic scoping review with qualitative content analysis. BMJ Global Health. 2021 Jun 3;6(6):5190.
27. Kuntz B, Waldhauer J, Zeiher J, Finger JD, Lampert T. Socioeconomic differences in the health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study. Journal of Health Monitoring. 2018 Jul 3;3(2).
28. Marttila-Tornio K, Männikkö N, Ruotsalainen H, Miettunen J, Kääriäinen M. Lower parental socioeconomic status in childhood and adolescence predicts unhealthy health behaviour patterns in adolescence in Northern Finland. Scandinavian Journal of Caring Sciences. 2021 Sep 1;35(3):742–52.
29. Masfufah M, Kandarina I, Padmawati RS. Penerimaan remaja putri terhadap tablet tambah darah di Kota Yogyakarta. Jurnal gizi klinik Indonesia. 2022 Jan 30;18(3):145.
30. Sineke J, Pascoa ME, Saud F, Ranti IN, Paruntu OL. Factors Related To Compliance With The Consumption Of Iron Tablets In Adolescent Females. IOSR Journal of Nursing and health Science. 2024 Oct 1;13(5):35–40.
31. Feriyanti A, atus Sintya Deviatin N, Nurmala I, Widati S, Raditya Atmaka D, Kesehatan P, et al. Determinant of Adherence to iron supplementation in Adolescent Girl In Spesific Intervention For Stunting Prevention: Systematic Review. Media Gizi Indonesia. 2022 Dec 15;17(1SP):90–6.
32. Raihani AD, Utami RP, Sari RA. The Effectiveness of Educational Media on Knowledge, Dietary Patterns and Compliance with Iron Supplement Consumption in Anemic Adolescent Girls. Journal of Health and Nutrition Research. 2024 Apr 9;3(1):53–61.
33. Handayani D, Sumiati S, Risnawati R, Meihartati T. The Effect Of Anemia Education Videos On Compliance Take Blood Booster Tablets. JKM (Jurnal Kebidanan Malahayati). 2024 Jun 26;10(6):597–606.
34. Hertz U. A cognitive approach to learning, monitoring, and shifting social norms. Current opinion in psychology. 2024 Sep 25;60:101917–101917.
35. Lajnef K. The effect of social media influencers’ on teenagers Behavior: an empirical study using cognitive map technique. Current Psychology. 2023;42(22):19364–77.
36. Velazquez E, Garthe RC, Barinas J, Rodriguez M, Loggins J. Parental practices and adolescent health. Encyclopedia of Child and Adolescent Health, First Edition. 2023 Jan 1;2:635–46.
37. Sedlander E, Long MW, Bingenheimer JB, Rimal RN. Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project. PLoS ONE. 2021 May 1;16(5):e0249646.
38. Jyotish SK, Shokandha S, Milton A. Prevalence of Anemia, Knowledge, Attitude and Compliance Related to Weekly Iron Folic Acid Supplementation Programme among the Adolescents in Selected School of South East Delhi. International Journal of Advanced Research in Science, Communication and Technology. 2023 Aug 17;404–21.
39. Baharzadeh K, Marashi T, Saki A, Zare A, Araban M. Using of health belief model to promote preventive behaviors against iron deficiency anemia among pregnant women. Journal of Research & Health. 2016;
40. Diamond-Smith N, Holton AE, Francis S, Bernard D. Addressing anemia among women in India-an informed intervention using Facebook Ad Manager. mHealth. 2020 Oct 5;6:39–39.
41. Huang HY. Message Tailoring. The International Encyclopedia of Health Communication. 2022 Nov 10;1–7.
42. Mancone S, Corrado S, Tosti B, Spica G, Diotaiuti P. Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review. Frontiers in Public Health. 2024 Oct 9;12:1387874.
43. Freeman JL, Caldwell PHY, Scott KM. How Adolescents Trust Health Information on Social Media: A Systematic Review. Academic Pediatrics. 2023 May 1;23(4):703–19.
44. Glanz K RBVK. Health Behavior Theory, Research and Practice. 5th ed. United States of America: Jossey-Bass; 2015.
45. Wardani DSSJ. Tinjauan Literatur: Faktor-Faktor yang Berhubungan dengan Kepatuhan Konsumsi Tablet Tambah Darah pada Remaja Putri di Indonesia. Media Gizi Kesmas [Internet]. 2024 Dec 12;13(2):878–97. Available from: https://e-journal.unair.ac.id/MGK/article/view/59684
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