The Role of Teachers and Structural Barriers in Adolescent  Anemia Education in Surabaya Schools

Alma Feriyanti; Ira Nurmala; Sri Widati; Muthmainnah Muthmainnah; Hari Basuki Notobroto

doi:10.14710/jpki.20.4.%p

DOI: https://doi.org/10.14710/jpki.20.4.%25p

The Role of Teachers and Structural Barriers in Adolescent Anemia Education in Surabaya Schools

*Alma Feriyanti

- Health Promotion, Faculty of Public Health, Universitas Mulawarman, Indonesia

Ira Nurmala

- Division of Health Promotion and Behaviour Science, Universitas Airlangga, Indonesia

Sri Widati

- Division of Health Promotion and Behaviour Science, Universitas Airlangga, Indonesia

Muthmainnah Muthmainnah

- Division of Health Promotion and Behaviour Science, Universitas Airlangga, Indonesia

Hari Basuki Notobroto

- Division of Biostatistics and Demography,Universitas Airlangga, Indonesia

BibTex Citation Data :

@article{JPKI74287,
    author = {Alma Feriyanti and Ira Nurmala and Sri Widati and Muthmainnah Muthmainnah and Hari Basuki Notobroto},
    title = {The Role of Teachers and Structural Barriers in Adolescent  Anemia Education in Surabaya Schools},
    journal = {Jurnal Promosi Kesehatan Indonesia},
  volume = {20},
    number = {4},
    year = {2025},
    keywords = {Teacher intention ; Health education ; Anemia prevention ; Structural barriers ; Adolescent health},
    abstract = {   Background : Anemia in adolescents, particularly young women, remains a significant public health concern in Indonesia, with low adherence to iron supplementation being a key contributing factor. While previous interventions have focused primarily on individual compliance, the role of teachers as health educators in schools is often overlooked. This study aimed to analyze the determinants of teachers’ intention to provide health education on anemia prevention in Surabaya high schools.    Method : A cross-sectional survey was conducted among 119 high school and vocational school teachers within the working area of Tanah Kali Kedinding Health Center, selected through simple random sampling from a total population of 170 teachers. Data were collected using structured questionnaires and analyzed using multiple logistic regressions to assess the influence of attitudes, subjective norms, and perceived behavioral control on teachers' intention to deliver health education.    Result  : The analysis indicated that teacher' attitudes, subjective norms, and perceived behavioral control did not significantly influence their intention to deliver health education on iron supplementation. This indicates that structural and institutional factors, rather than individual psychological characteristics, primarily influence teachers' involvement in health education delivery.of the risks of e cigarettes. Efforts to enhance adolescent anemia prevention should address structural barriers within the educational system. Policy support from schools and educational authorities is critical to institutionalizing health education as part of the teachers' formal responsibilities.  },
   issn = {2620-4053},   pages = {291--302}  doi = {10.14710/jpki.20.4.%p},
    url = {https://ejournal.undip.ac.id/index.php/jpki/article/view/74287}
}

Citation Format:

Abstract

Background: Anemia in adolescents, particularly young women, remains a significant public health concern in Indonesia, with low adherence to iron supplementation being a key contributing factor. While previous interventions have focused primarily on individual compliance, the role of teachers as health educators in schools is often overlooked. This study aimed to analyze the determinants of teachers’ intention to provide health education on anemia prevention in Surabaya high schools.
Method: A cross-sectional survey was conducted among 119 high school and vocational school teachers within the working area of Tanah Kali Kedinding Health Center, selected through simple random sampling from a total population of 170 teachers. Data were collected using structured questionnaires and analyzed using multiple logistic regressions to assess the influence of attitudes, subjective norms, and perceived behavioral control on teachers' intention to deliver health education.
Result : The analysis indicated that teacher' attitudes, subjective norms, and perceived behavioral control did not significantly influence their intention to deliver health education on iron supplementation. This indicates that structural and institutional factors, rather than individual psychological characteristics, primarily influence teachers' involvement in health education delivery.of the risks of e cigarettes. Efforts to enhance adolescent anemia prevention should address structural barriers within the educational system. Policy support from schools and educational authorities is critical to institutionalizing health education as part of the teachers' formal responsibilities.

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Keywords: Teacher intention ; Health education ; Anemia prevention ; Structural barriers ; Adolescent health

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Section: Research Article

Language : EN

In Vol 20 No 4: October 2025

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Figueiredo ACMG, Gomes-Filho IS, Silva RB, Pereira PPS, Da Mata FAF, Lyrio AO, et al. Maternal anemia and low birth weight: A systematic review and meta-analysis. Nutrients. 2018;10(5):1–17
Kemenkes RI. Hasil Riset Kesehatan Dasar Tahun 2018. Kementrian Kesehat RI. 2018;53(9):1689–99
Stevens GA, Paciorek CJ, Flores-Urrutia MC, Borghi E, Namaste S, Wirth JP, et al. National, regional, and global estimates of anaemia by severity in women and children for 2000–19: a pooled analysis of population-representative data. Lancet Glob Heal. 2022;10(5):e627–39
WHO. Anaemia in Women and Children [Internet]. World Health Organization. 2021 [cited 2022 Nov 22]. Available from: https://www.who.int/data/gho/data/themes/topics/anaemia_in_women_and_children. https://
Balitbangkes RI. Riset Kesehatan Dasar Tahun 2018. 2018
Badan Kebijakan Pembangunan Kesehatan. Survei Kesehatan Indonesia (SKI) Dalam Angka. BKPK. 2023
Engidaw MT, Wassie MM, Teferra AS. Anemia and associated factors among adolescent girls living in Aw-Barre refugee camp, Somali regional state, Southeast Ethiopia. PLoS One. 2018;13(10):1–12
Sari P, Herawati DMD, Dhamayanti M, Hilmanto D. Anemia among Adolescent Girls in West Java, Indonesia: Related Factors and Consequences on the Quality of Life. Nutrients. 2022;14(18):1–13
Suandana IA, Capri M, Satya N, Setyowati L, Sari DK, Renamastika SN. Literature Review : Analisis Faktor yang Berhubungan dengan Kejadian Anemia Pada Remaja Putri. Arteri. 2022;4(1)
Savitri MK, Tupitu ND, Iswah SA, Safitri A. Hubungan Kepatuhan Konsumsi Tablet Tambah Darah Dengan Kejadian Anemia Pada Remaja Putri: a Systematic Review. J Kesehat Tambusai. 2021;2(2):43–9
Musfira M, Hadju V. Nutrition and Dietary Intake of Adolescent Girls in Indonesia: A Systematic Review. Scr Medica (Banja Luka). 2024;55(4):473–87
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Alfiah E, Briawan D, Khomsan A, Dewi M, Ekayanti I, Mardewi, et al. Coverage and adherence of weekly iron folic acid supplementation among school going adolescent girls in indonesia. J Nutr Sci Vitaminol (Tokyo). 2020;66:S118–21
Silitonga HTH, Salim LA, Nurmala I, Hargono R, Notobroto HB, Hartini N, et al. The Role of Social Support and Interpersonal Trust to Improve Compliance of Iron Supplementation amongst Adolescent Girls: A Qualitative Approach. Niger Postgrad Med J. 2023;(1):30
Wangaskar SA, Sahu SK, Majella MG, Rajaa S. Prevalence of Anaemia and Compliance to Weekly Iron ‑ Folic Acid Supplementation Programme amongst Adolescents in Selected Schools of Urban Puducherry , India. Niger Postgrad Med J |. 2021;44–50
Sudfeld CR, Rai RK, Barik A, Valadez JJ, Fawzi WW. Population-level effective coverage of adolescent weekly iron and folic acid supplementation is low in rural West Bengal, India. Public Health Nutr. 2020;23(15):2819–23
Yidana A, Azongo TB, Mohammed A. Iron and Folic Acid Supplementation Compliance among Adolescent Girls in Karaga District , Ghana. Public Heal Res. 2020;10(5):133–42
Lai H-R, Wu D-M, Lee P-H, Jhang Y-S. Health Literacy Teaching Beliefs , Attitudes , Efficacy , and Intentions of Middle School. J Sch Heal. 2018;88(5)
Burak LJ. predicting elementary school teachers’ intentions to teach health education: An application of the theory of planned behavior. Am J Heal Educ. 2016;33(1):4–9
Febrianti S, Purwanti M. Gambaran Intensi Guru dalam Menerapkan Pendidikan Seksualitas pada Siswa Kelas IV-VI SD N di Jakarta. Provitae J Psikol Pendidik. 2018;11(1):63–83
Ates H. Elementary school teachers’ behavioral intentions for healthy nutrition: Extending theory of planned behavior. Health Educ. 2019;119(2):133–49
Yang E, Yoon B. Exploring factors of nutrition teachers’ intentions for sustainable dietary education in South Korea: an application of the theory of planned behavior. Korean J Community Nutr. 2024;29(2):114–28
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Betschart S, Sandmeier A, Skedsmo G, Hascher T, Okan O, Dadaczynski K. The Importance of School Leaders’ Attitudes and Health Literacy to the Implementation of a Health-Promoting Schools Approach. Int J Environ Res Public Health. 2022;19(22)
Garrido-Fernández A, García-Padilla FM, Ramos-Pichardo JD, Romero-Martín M, Sosa-Cordobés E, Sánchez-Alcón M. Attitude towards the Promotion of Healthy Eating among Secondary School Teachers—Construction and Validation of a Questionnaire. Nutrients. 2022 May 28;14(11):2271
Mashau T. The role of the teacher as a promoter of health in schools: conceptualisation and practical implications TI. the North West University; 2019
Nuradhiani A, Briawan D, Dwiriani CM. Dukungan guru meningkatkan kepatuhan konsumsi tablet tambah darah pada remaja putri di Kota Bogor. J Gizi dan Pangan. 2017;12(3):153–60
Ramdhani N. Penyusunan Alat Pengukur Berbasis Theory of Planned Behavior. Bul Psikol [Internet]. 2016;19(2):55–69
Sabrifha E, Darmawati D. The importance of teacher interpersonal communication as an effort to maintain students’ mental health: a study of lerature review. J Educ J Pendidik Indones. 2022;8(2):236
Muthmainnah, Nurmala I, Siswantara P, Rachmayanti RD, Devi YP. Implementation of adolescent health programs at public schools and religion-based schools in Indonesia. J Public health Res. 2021;10(4):625–32
Setijanto RD, Bramantoro T, Palupi R, Hanani A. The role of attitude, subjective norm, and perceived behavioral control (PBC) of mothers on teaching toothbrushing to preschool children - Based on the Theory of Planned Behavior: A cross-sectional study. Fam Med Prim Care Rev. 2019;21(1):53–7
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