skip to main content

Self-Efficacy as the Strongest Predictor of Adolescent Reproductive Health Behavior: A Health Belief Model Study among Vocational Students in Rural East Java

*Kustin Kustin orcid scopus  -  Fakultas Ilmu Kesehatan Universitas dr. Soebandi, Indonesia
Lailatul Rahmawati  -  Faculty of Public Health, Universitas Bakti Indonesia, Indonesia, Indonesia
Firda Ayu Anugrah  -  Nursing Professional Program, STIKES Bhakti Al-Qodiri, Indonesia, Indonesia
Open Access Copyright (c) 2026 Authors
Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Citation Format:
Abstract

Background: Adolescents enrolled in vocational high schools, especially in rural areas, are particularly susceptible to reproductive health risks due to limited knowledge, low perception of risk, and restricted access to reliable information. The health belief model presents a comprehensive theoretical framework to explain these behavioural determinants. This study explores the factors influencing reproductive health behaviour among vocational high school students in rural areas of East Java, Indonesia

Method: A school-based cross-sectional study design was used, with 150 students chosen through random sampling. Data were obtained through a structured questionnaire and subsequently analysed using Chi-square tests and multivariate logistic regression.

Result: The findings indicated that all constructs of the Health Belief Model—perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy—were significantly related to reproductive health behaviour (p < 0.05). Students with higher perceived susceptibility and perceived benefits, lower perceived barriers, and greater self-efficacy were more likely to engage in positive behaviours. In the adjusted analysis, self-efficacy emerged as the most dominant predictor (OR = 3.85; 95% CI: 2.01–7.39; p < 0.001). Perceived susceptibility, perceived benefits, perceived barriers, and cues to action remained independently associated, whereas perceived severity showed a relatively weaker effect. These findings highlight the critical role of cognitive and perceptual factors in shaping adolescents’ reproductive health behaviour within vocational school settings. Interventions based on the Health Belief Model—particularly those aimed at enhancing self-efficacy and reducing perceived barriers—are essential for enhancing reproductive health outcomes among adolescents in underserved rural area.

 

Keywords: Adolescent reproductive health. Health belief model, Health behavior, Secondary school students

Keywords: Adolescent reproductive health. Health belief model, Health behavior, Secondary school students

Article Metrics:

  1. Kustin K, Handayani Y. Konseling teman tentang keterampilan reproduksi kesehatan remaja. J Kesehat Komunitas. 2024;10(1):96–103
  2. Kustin K, Handayani Y. Health Belief Model sebagai upaya pencegahan perilaku seks bebas pada remaja. Arteri J Ilmu Kesehat. 2024;5(3):40–7
  3. Santoso LH, Sulistyowati M. Determinan perilaku seks pranikah remaja berdasarkan teori Health Belief Model (HBM). J Kesehat Masy. 2024;8(2):810–5
  4. World Health Organization. Adolescent health. Geneva: World Health Organization; 2023
  5. United Nations Population Fund. Adolescent pregnancy. New York: UNFPA; 2023
  6. Badan Kependudukan dan Keluarga Berencana Nasional. Evaluasi program keluarga berencana di Indonesia. Jakarta: BKKBN; 2022
  7. Kementerian Kesehatan RI. Profil kesehatan Indonesia 2023. Jakarta: Kemenkes RI; 2023
  8. Kustin K. Efektifitas pembentukan kader PKPR terhadap perilaku kesehatan pada santri di Pondok Pesantren Shofa Marwa. J Kesehat. 2021;9(2):100–8
  9. Violita F, Hadi EN. Determinants of adolescent reproductive health service utilization by senior high school students in Makassar, Indonesia. BMC Public Health. 2019;19(1):1–7
  10. Virgia V, Program M, Program N. Effectiveness of reproductive health education using the Health Belief Model (HBM) approach to increasing reproductive health knowledge of adolescents. J Ilm Kesehat. 2024;16(2):163–77
  11. Alhafids MS, Azizah AN, Syehabuddin AZ. Determinants of premarital sex prevention behavior among adolescents at SMAS Budi Mulia Utama Jakarta in 2023 according to the HBM (Health Belief Model) theory. J Health Stud. 2024;1(1):1–17
  12. Kustin K, Dermawan FAA, Dewi SNC. Improving the quality of Z generation regarding knowledge of reproductive health for junior high school girls. Blambangan J Community Serv. 2023;1(1):1–7
  13. Kustin K, Handayani Y. Peer counseling on adolescent health reproductive skills. J Kesehat Komunitas. 2024;10(1):96–103
  14. Ullah F, Ragazzoni L, Hubloue I, Barone-Adesi F, Valente M. The use of the health belief model in the context of heatwaves research: a rapid review. Disaster Med Public Health Prep. 2024;18:e45
  15. Harahap NH, Hadi AJ, Ahmad H. Efektifitas pendidikan kesehatan menggunakan pendekatan Health Belief Model (HBM) terhadap peningkatan pengetahuan kesehatan reproduksi remaja di MTSN 3 Padangsidimpuan. Media Publikasi Promosi Kesehatan Indonesia. 2024;7(2):463–71
  16. Yanti TM, Aris G. Peran efikasi diri dalam membentuk perilaku seksual pranikah remaja. Aisyah Med. 2024;9(2):406–15
  17. Birrulwalidaini B, Suyono H, Tentama F. Dinamika psikologis efikasi diri terhadap intensi perilaku seks pranikah pada remaja. J Psikol Terap Pendidik. 2019;1(1):45–52
  18. Nisariati N, Kusumaningrum TAI. Hubungan pengetahuan, sikap dan self efficacy dengan sexual abstinence pada remaja. J Kesehat. 2022;15(2):214–23
  19. Rajapakshe W, Wickramasurendra AK, Amarasinghe RR, Kohilawatta Arachchige Wijerathne SLM, Wijesinghe ND, Madhavika N. Application of the Health Belief Model (HBM) to explore the quality of Sexual and Reproductive Health (SRH) education in Sri Lanka. Int J Environ Res Public Health. 2024;21(12):1–25
  20. Wulansari B, Istiono W, Prawitasari S. The effect of reproductive health counseling to the perception on prevention behavior of leucorrhea in female students at SMAN 1 Temon (based on the Health Belief Model/HBM theory). Rev Prim Care Pract Educ. 2018;1(3):116–22
  21. Alpiani D, Kosim EW. Persepsi remaja tentang seks pranikah di sekolah menengah atas. J Keperawatan Jiwa. 2021;9(1):161–70
  22. Kustin K, Handayani Y. Psiko-Sosio-Edukasi sebagai upaya optimalisasi peran remaja dalam pencegahan seks bebas. J ABDIMAS-HIP Pengabdian Kepada Masyarakat. 2024;5(1):42–9
  23. Kusumawardani DA, Ayu EJ. Application of the health belief model on the reproductive health services uptake in adolescents: a meta-analysis. J Health Promot Behav. 2021;6(4):318–26
  24. Anuar HASH. Usage of health belief model (HBM) in health behavior: a systematic review. Mal J Med Health Sci. 2025;16(11):88–95
  25. Setyaningsih W, Yudianti I, Mansur H. Perceived susceptibility, barriers, and cues to action as determinant factors of reproductive health behavior. Int J Public Health Sci. 2022;11(3):884–92
  26. Sutriyanti Y, Haryani S. Determinants of menstrual health in young women living in Darussalam Islamic Boarding School. J Kebidanan Besurek. 2022;7(2):35–41
  27. Widiarta MBO, Megaputri PS, Armayanti LY. Akses informasi melalui orang tua dapat meningkatkan pengetahuan remaja tentang kesehatan reproduksi. J Ilm Permas: J Ilm STIKES Kendal. 2023;13(1):307–14
  28. Saparini S, Simbolon D, Ningsih L. Knowledge and access to adolescent reproductive health information in Indonesia. J Promosi Kesehat Indones. 2023;19(1):1–10
  29. Sulistyorini Y, Mahmudah M, Fitriyah N. Improving reproductive health knowledge and behavior of adolescents with hearing loss. Southeast Asian J Trop Med Public Health. 2022;53(1):45–52
  30. Yakubu I, Garmaroudi G, Sadeghi R, Tol A, Yekaninejad MS, Yidana A. Assessing the impact of an educational intervention program on sexual abstinence based on the health belief model amongst adolescent girls in Northern Ghana, a cluster randomised control trial. Reprod Health. 2019;16(1):1–12
  31. Rizqi YNK, Nafisah L, Aryani AA. Service implementation analysis of adolescent reproductive health toward adolescents’ expectations and needs. J Kesehat Masy. 2022;17(2):269–78
  32. Eghbal SB, Kenari ZA, Ashouri A, Rouhani-Tonekaboni N, Kasmaei P, Mehrabian F, et al. The effectiveness of educational program based on health belief model on promotion of puberty health concepts among teen girls: a cross-sectional study in north of Iran. BMC Womens Health. 2023;23(1):1–9
  33. Octamelia M, Sabrin G, Ratnanengsih R, Susanti S, Febrianti S. Effect self efficacy, emotional support, and informational support on sexual behavior adolescents. Int J Nurs Health Serv. 2023;6(2):96–103
  34. Setyaningsih W, Yudianti I, Mansur H. Perceived susceptibility, barriers, and cues to action as determinant factors of reproductive health behavior. Int J Public Health Sci. 2022;11(3):884–92
  35. Nikmah JN, Kustin K. Hubungan self efficacy dengan self care menstruasi hygiene pada remaja putri. J Pendidik Kesehat. 2025;14(2):120–8

Last update:

No citation recorded.

Last update: 2026-07-23 17:18:20

No citation recorded.