Perceptions and beliefs of adolescent girls regarding adherence to iron supplementation: An analysis using the health belief model
DOI:
https://doi.org/10.53713/nhsj.v5i3.570Keywords:
adolescent girls, anemia, iron and folic acid tablets, adherence, health belief modelAbstract
Iron deficiency anemia in adolescent girls is a significant public health issue with a high prevalence. Despite the government's launch of the Nutritious Action Program to tackle this problem, its effectiveness is still hindered by low adherence to Iron and Folic Acid (IFA) tablet consumption among adolescents. This qualitative study aims to analyze the factors influencing adherence to IFA tablet consumption in adolescent girls from the Health Belief Model (HBM) perspective. Using a case study design, this research collected data through in-depth interviews with four adolescent girls, one parent, and an expert from IAKMI Kudus. Data analysis was conducted interactively by identifying key themes relevant to the HBM components. The results show that adherence is influenced by the complex interaction of the six HBM components. Adolescents have a good perception of their susceptibility to and the severity of anemia, but this is not enough to overcome the perceived barriers. Physical barriers, such as side effects like nausea, dizziness, and unpleasant taste, are the strongest predictors of non-adherence. Adherence is highly dependent on external cues, such as supervision from teachers and parents, with behavioral differences observed between students living in boarding schools and those who are not. This study concludes that successful interventions must go beyond merely providing IFA tablets. A comprehensive strategy is needed to strengthen adolescents' self-efficacy to overcome barriers and ensure continuous social support from schools and families to achieve sustainable dietary behavior changes.
References
Abu-Baker, N. N., Eyadat, A. M., & Khamaiseh, A. M. (2021). The impact of nutrition education on knowledge, attitude, and practice regarding iron deficiency anemia among female adolescent students in Jordan. Heliyon, 7(2), e06348. https://doi.org/10.1016/j.heliyon.2021.e06348
Agustina, S., Rasyid, R., & Kasra, K. (2025). Determinants of Adolescent Female Behavior for Consumption ff Fe Tablets in the Working Area of the Nan Balimo Public Health Center. Journal La Medihealtico, 6(4), 1007-1027. https://doi.org/10.37899/journallamedihealtico.v6i4.2473
Atinga, E., Henyo, A., Ayamga, C., Mensah, M. I., Gyan, B., Sarfo, H. M., Kwakye, D., & Kuupiel, D. (2025). Facilitators and barriers to the implementation of the Girls' Iron Folate Tablet Supplementation program among adolescent girls in the Bono Region: A cross-sectional survey. The Pan African Medical Journal, 50, 57. https://doi.org/10.11604/pamj.2025.50.57.44319
Bathla, S., & Arora, S. (2021). Prevalence and approaches to manage iron deficiency anemia (IDA). Critical Reviews in Food Science and Nutrition, 62(32), 8815–8828. https://doi.org/10.1080/10408398.2021.1935442
Conrad, A., Burns, J., Sherburne, L., Kaled, M. D., Souley, H., & Nielsen, J. (2024). Understanding behavioural drivers of iron and folic acid supplementation and vitamin A- and iron-rich food consumption among women and adolescent girls in Niger. Public health nutrition, 27, e249. https://doi.org/10.1017/S1368980024002192
Haile, B., Oumer, A., Negese, T., Temesgen, M., Kebede, A., Abdurahman, D., Motuma, A., & Roba, K. T. (2024). Factors associated with compliance with weekly iron and folic acid supplementation among school adolescent girls in Debub Achefer district, northwest Ethiopia: School-based cross-sectional study. Scientific Reports, 14(1), 1-9. https://doi.org/10.1038/s41598-024-60800-5
Hargreaves, D., Mates, E., Menon, P., Alderman, H., Devakumar, D., Fawzi, W., Greenfield, G., Hammoudeh, W., He, S., Lahiri, A., Liu, Z., Nguyen, P. H., Sethi, V., Wang, H., Neufeld, L. M., & Patton, G. C. (2022). Strategies and interventions for healthy adolescent growth, nutrition, and development. The Lancet, 399(10320), 198-210. https://doi.org/10.1016/S0140-6736(21)01593-2
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
Janah, R. M., & Trimawartinah, T. (2025). Determinants Of Adherence to Blood Supplementation Tablet Consumption Among Adolescent Girls in Class X And XI in Tangerang High School. Jurnal Bahana Kesehatan Masyarakat (Bahana of Journal Public Health), 9(1), 33–39. https://doi.org/10.35910/jbkm.v9i1.811
Klankhajhon, S., Pansuwan, K., Klayjan, K., & Nensat, N. (2021). Perspectives of Pregnant Women Regarding Iron Deficiency Anemia. Jurnal Ners, 16(2), 119–127. https://doi.org/10.20473/jn.v16i2.27418
Kshatri, J. S., Satpathy, P., Sharma, S., Bhoi, T., Mishra, S. P., & Sahoo, S. S. (2022). Health Research In The State Of Odisha, India: A Decadal Bibliometric Analysis (2011‑2020). Journal of Family Medicine and Primary Care, 11(7), 169–170. https://doi.org/10.4103/jfmpc.jfmpc_2192_21
Kumar, S. B., Arnipalli, S. R., Mehta, P., Carrau, S., & Ziouzenkova, O. (2021). Iron Deficiency Anemia: Efficacy and Limitations of Nutritional and Comprehensive Mitigation Strategies. Nutrients, 14(14), 2976. https://doi.org/10.3390/nu14142976
Mekonnen, A., Alemnew, W., Abebe, Z., & Demissie, G. D. (2021). Adherence to Iron with Folic Acid Supplementation Among Pregnant Women Attending Antenatal Care in Public Health Centers in Simada District, Northwest Ethiopia: Using Health Belief Model Perspective. Patient Preference and Adherence, 15, 843–851. https://doi.org/10.2147/PPA.S299294
Munro, M. G., Mast, A. E., Powers, J. M., Kouides, P. A., O’Brien, S. H., Richards, T., Lavin, M., & Levy, B. S. (2023). The relationship between heavy menstrual bleeding, iron deficiency, and iron deficiency anemia. American Journal of Obstetrics and Gynecology, 229(1), 1-9. https://doi.org/10.1016/j.ajog.2023.01.017
Novelia, S., & Sari, I. P. (2022). Analysis of Factors Associated with Anemia Among Adolescent Girls. Nursing and Health Sciences Journal, 2(3), 266–273. https://doi.org/10.53713/nhs.v2i3.142
Obeagu, G. U., Altraide, B. O., & Obeagu, E. I. (2025). Iron deficiency anemia in pregnancy and related complications with specific insight in Rivers State, Nigeria: a narrative review. Annals of medicine and surgery (2012), 87(6), 3435–3444. https://doi.org/10.1097/MS9.0000000000003224
Ramachandran, R., Dash, M., Adaikaladorai, F. C., Aridass, J., Zachariah, B., & Manoharan, B. (2023). Effect of individual nutrition education on perceptions of nutritional iron supplementation, adherence to iron - folic acid intake and Hb levels among a cohort of anemic South Indian pregnant women. The Journal of Maternal-Fetal & Neonatal Medicine, 36(1). https://doi.org/10.1080/14767058.2023.2183749
Salim, L. A., Silitonga, H. T. H., Nurmala, I., Muthmainnah, M., Devi, Y. P., Salsabila, A. C., & Restuti, D. Y. (2025). The Effect of Self Identity on Increasing Iron Tablet Adherence Among High School Adolescent Girls Through Health Belief Model as Mediator Variables. Journal of Multidisciplinary Healthcare, 18, 4173–4183. https://doi.org/10.2147/JMDH.S527641
Samson, K. L., Fischer, J. A., & Roche, M. L. (2021). Iron Status, Anemia, and Iron Interventions and Their Associations with Cognitive and Academic Performance in Adolescents: A Systematic Review. Nutrients, 14(1), 224. https://doi.org/10.3390/nu14010224
Sanghvi, T. G., Nguyen, P. H., Forissier, T., Ghosh, S., Zafimanjaka, M., Walissa, T., Mahmud, Z., & Kim, S. (2023). Comprehensive Approach for Improving Adherence to Prenatal Iron and Folic Acid Supplements Based on Intervention Studies in Bangladesh, Burkina Faso, Ethiopia, and India. Food and Nutrition Bulletin. https://doi.org/10.1177/03795721231179570
Sari, P., Herawati, D. M., Dhamayanti, M., & Hilmanto, D. (2021). Fundamental Aspects of the Development of a Model of an Integrated Health Care System for the Prevention of Iron Deficiency Anemia among Adolescent Girls: A Qualitative Study. International Journal of Environmental Research and Public Health, 19(21), 13811. https://doi.org/10.3390/ijerph192113811
Saville, N. M., Kharel, C., Morrison, J., Harris-Fry, H., James, P., Copas, A., ... & Hillman, S. (2022). Comprehensive Anaemia Programme and Personalized Therapies (CAPPT): protocol for a cluster-randomised controlled trial testing the effect women’s groups, home counselling and iron supplementation on haemoglobin in pregnancy in southern Nepal. Trials, 23(1), 183. https://doi.org/10.1186/s13063-022-06043-z
Sawudatu, Z. A., Omeife, H., Moran, V. L., Godfred, E., Seth, A. A., Lowe, N. M., & Aryeetey, R. (2024). Anaemia prevention among pregnant women: Views and experiences of pregnant women and antenatal care providers in Accra, Ghana. World Nutrition, 15(2), 87-101. https://doi.org/10.26596/wn.202415287-101
Sedlander, E., Long, M. W., Bingenheimer, J. B., & Rimal, R. N. (2021). Examining intentions to take iron supplements to inform a behavioral intervention: The Reduction in Anemia through Normative Innovations (RANI) project. PLOS ONE, 16(5), e0249646. https://doi.org/10.1371/journal.pone.0249646
Yanniarti, S., Nurhaliza, S., Baska, D. Y., Widiyanti, D., & Savitri, W. (2023). Compliance with consuming blood supplement tablets can reduce the incidence of anemia in young women in Bengkulu City. JNKI (Jurnal Ners dan Kebidanan Indonesia)(Indonesian Journal of Nursing and Midwifery), 11(4), 416-429. http://dx.doi.org/10.21927/jnki.2023.11(4).416-429














