Dewi Sri Sumardilah, Kadek Dwi Ratna Kemala, Gading Quinta Wangi

Faktor Determinan Kepatuhan Konsumsi Tablet Tambah Darah pada Siswi SMP Berdasarkan Teori Perilaku Terencana

Introduction

Faktor determinan kepatuhan konsumsi tablet tambah darah pada siswi smp berdasarkan teori perilaku terencana. Faktor kepatuhan siswi SMP minum TTD untuk cegah anemia (Teori Perilaku Terencana). Sikap, norma subjektif, kontrol perilaku sangat berpengaruh. Tingkatkan kepatuhan lewat intervensi sekolah.

Abstract

ABSTRACT Iron deficiency anemia remains a major nutritional problem among adolescent girls, caused by low dietary iron intake and monthly menstrual blood loss. To prevent anemia, the Indonesian government has implemented a weekly iron supplementation program (Tablet Tambah Darah, TTD) for school-aged girls since 2014. However, adherence to TTD remains low, limiting program effectiveness. Adherence is influenced by students’ attitudes, support from parents or teachers, and perceived behavioral control. This study aimed to examine the relationship between attitudes, subjective norms, and perceived behavioral control with TTD adherence among adolescent girls. A cross-sectional study was conducted at SMP Kartika II-2 Bandar Lampung, including the total population of seventh- and eighth-grade female students (n = 73). The dependent variable was TTD adherence, measured using the Morisky Medication Adherence Scale-8 (MMAS-8), while independent variables included attitude, subjective norms, and perceived behavioral control. Data were analyzed using the chi-square test. Results showed that 65.8% of students were non-adherent to TTD. Significant associations were found between attitude (p = 0.044; OR = 1.8), subjective norms (p = 0.010; OR = 2.3), and perceived behavioral control (p = 0.000; OR = 3.6) with adherence. It is recommended that schools, through teachers and school health staff, implement a structured weekly TTD schedule and enhance supervision to improve adherence among students ABSTRAK Anemia defisiensi besi masih menjadi masalah gizi pada remaja putri, disebabkan rendahnya asupan zat besi dari makanan sehari-hari dan kehilangan darah bulanan akibat menstruasi. Untuk mencegah anemia, pemerintah Indonesia telah menjalankan program suplementasi zat besi melalui Tablet Tambah Darah (TTD) mingguan bagi siswi sejak 2014. Namun, kepatuhan minum TTD masih rendah sehingga efektivitas program belum optimal. Kepatuhan dipengaruhi oleh sikap, dukungan orang tua atau guru, dan kontrol perilaku yang dimiliki remaja. Penelitian ini bertujuan mengetahui hubungan antara sikap, norma subjektif, dan kontrol perilaku dengan kepatuhan minum TTD pada remaja putri. Penelitian ini menggunakan pendekatan cross-sectional di SMP Kartika II-2 Bandar Lampung dengan total populasi siswi kelas VII dan VIII sebanyak 73 orang. Variabel dependen adalah kepatuhan minum TTD, diukur menggunakan Morisky Medication Adherence Scale-8 (MMAS-8), sedangkan variabel independen adalah sikap, norma subjektif, dan kontrol perilaku. Analisis data menggunakan uji chi-square. Hasil menunjukkan 65,8% siswi tidak patuh minum TTD. Terdapat hubungan bermakna antara sikap (p = 0,044; OR = 1,8), norma subjektif (p = 0,010; OR = 2,3), dan kontrol perilaku (p = 0,000; OR = 3,6) dengan kepatuhan. Disarankan agar sekolah, melalui guru dan petugas UKS, menyusun jadwal pemberian TTD mingguan dan meningkatkan pengawasan untuk meningkatkan kepatuhan siswi.

Review

This study adeptly addresses a critical public health issue: the low adherence to iron supplementation (TTD) among adolescent girls in Indonesia, a key factor undermining the effectiveness of national anemia prevention programs. By applying the well-established Theory of Planned Behavior (TPB), the research systematically investigates the influence of attitudes, subjective norms, and perceived behavioral control on TTD adherence. The findings are significant, revealing that over two-thirds of the participants were non-adherent and that all three TPB constructs are significantly associated with adherence, with perceived behavioral control showing the strongest relationship. These results provide a valuable theoretical framework and practical insights for understanding and tackling this persistent challenge. While the study offers important contributions, certain methodological aspects warrant consideration. The cross-sectional design, while suitable for identifying associations, precludes the establishment of causality. Furthermore, the relatively small sample size (n=73) drawn from a single school in Bandar Lampung limits the generalizability of the findings to the broader population of Indonesian adolescent girls. The reliance on self-reported data for adherence via the MMAS-8, and presumably for the TPB constructs, may also introduce social desirability bias. Future research could benefit from exploring more objective measures or triangulating data with qualitative methods to provide a deeper understanding of underlying reasons for non-adherence. Despite these limitations, the study's conclusions offer clear, actionable recommendations. The emphasis on schools, teachers, and school health staff implementing structured TTD schedules and enhancing supervision directly targets the identified determinants, particularly perceived behavioral control and subjective norms. To build upon this work, future studies should consider longitudinal designs to track changes in adherence and their determinants over time, employ larger and more diverse samples to enhance generalizability, and potentially integrate interventional studies to evaluate the effectiveness of school-based strategies designed around TPB principles. Exploring additional factors beyond TPB, such as socio-economic status or specific knowledge gaps, could also enrich the understanding of this complex public health issue.

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