When Knowledge Is Not Enough: The Role of Attitude in Anemia Preventive Behavior Among Adolescents

Authors

DOI:

https://doi.org/10.35816/jiksh.v15i1.238

Keywords:

Adolescent, Anemia, Attitude, KAP

Abstract

Introduction: Adolescent anemia remains a significant public health concern affecting physical growth, cognitive performance, and long-term productivity. Despite ongoing school-based iron supplementation programs, preventive behaviors remain suboptimal. Behavioral determinants, particularly within the Knowledge Attitude Practice (KAP) framework, may explain this gap. This study aimed to identify factors associated with anemia preventive behavior among adolescents and to determine which behavioral determinant independently predicts preventive practice.

Research Methodology: A quantitative cross-sectional study was conducted among 84 12th-grade students in West Kalimantan, Indonesia. Data were collected using a validated 15-item KAP questionnaire adapted from FAO guidelines. Descriptive statistics were applied, followed by Chi-square and Fisher’s Exact tests. Binary logistic regression was performed to identify independent predictors, with p < 0.05 as the threshold for statistical significance.

Results: Most respondents demonstrated good knowledge (89.3%), positive attitudes (91.7%), and good preventive practices (70.2%). Bivariate analysis showed that attitude was significantly associated with preventive practice (p = 0.012), whereas knowledge was not (p = 0.293). Multivariate analysis confirmed that attitude remained the only independent predictor (OR = 6.624; p = 0.033). Adolescents with positive attitudes were 6.6 times more likely to demonstrate good preventive behavior.

Conclusion: Attitude was independently associated with anemia-preventive behavior, whereas knowledge alone did not significantly influence practice. These findings imply that school-based and nursing interventions should prioritize strengthening positive attitudes and motivational engagement to promote sustainable anemia prevention behaviors.

References

Agustina, R., Wirawan, F., Sadariskar, A. A., Setianingsing, A. A., Nadiya, K., Prafiantini, E., Asri, E. K., Purwanti, T. S., Kusyuniati, S., Karyadi, E., & Raut, M. K. (2021). Associations of Knowledge, Attitude, and Practices toward Anemia with Anemia Prevalence and Height-for-Age Z-Score among Indonesian Adolescent Girls. Food and Nutrition Bulletin, 42(1_suppl), S92–S108. https://doi.org/10.1177/03795721211011136

Cliffer, I. R., Millogo, O., Barry, Y., Kouanda, I., Compaore, G., Wang, D., Sie, A., & Fawzi, W. (2023). School-based supplementation with iron-folic acid or multiple micronutrient tablets to address anemia among adolescents in Burkina Faso: a cluster-randomized trial. The American Journal of Clinical Nutrition, 118(5), 977–988. https://doi.org/10.1016/j.ajcnut.2023.09.004

Cohen, C. T., & Powers, J. M. (2024). Nutritional Strategies for Managing Iron Deficiency in Adolescents: Approaches to a Challenging but Common Problem. Advances in Nutrition, 15(5), 100215. https://doi.org/10.1016/j.advnut.2024.100215

Darmawan, A. D., & Sulastri. (2026). The role of knowledge and attitude as determinants of adolescent girls’ compliance with iron tablet consumption. Indonesian Journal of Global Health Research, 8(3), 423–430. https://doi.org/10.37287/ijghr.v8i3.842

Gardner, W. M., Razo, C., McHugh, T. A., Hagins, H., Vilchis-Tella, V. M., Hennessy, C., Taylor, H. J., Perumal, N., Fuller, K., Cercy, K. M., Zoeckler, L. Z., Chen, C. S., Lim, S. S., Aali, A., Abate, K. H., Abd-Elsalam, S., Abdurehman, A. M., Abebe, G., Abidi, H., … Kassebaum, N. J. (2023a). Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the Global Burden of Disease Study 2021. The Lancet Haematology, 10(9), e713–e734. https://doi.org/10.1016/S2352-3026(23)00160-6

Mithra, P., Khatib, M. N., Sinha, A. P., Kumar, N., Holla, R., Unnikrishnan, B., Vijayamma, R., Nair, N. S., Gaidhane, A., & Quazi Zahiruddin, S. (2021). Interventions for Addressing Anemia Among Children and Adolescents: An Overview of Systematic Reviews. Frontiers in Pediatrics, 8(February), 1–23. https://doi.org/10.3389/fped.2020.549549

Munira, L., & Viwattanakulvanid, P. (2024). Knowledge, attitude, and practice towards anemia prevention among female students in Indonesia: a mixed method study. International Journal of Evaluation and Research in Education (IJERE), 13(1), 371. https://doi.org/10.11591/ijere.v13i1.25750

Naim, R., Rosmiati, & Saputri, E. (2025). The relationship of knowledge, attitude, behavior, and nutritional status with anemia incidence among adolescent girls. Nusantara Hasana Journal, 5(2), 295–304. https://doi.org/10.59003/nhj.v5i2.1542

Ningrum, D., Sediapermana, E., Ardiwinata, J. S., & Sardin, S. (2026). Family Nutrition Education in Preventing Anemia in Adolescent Girls a Literature Review. Jurnal Keperawatan Respati Yogyakarta, 13(January), 21–33. https://doi.org/10.35842/jkry.v13i1.921

Nisrina, M. Y., & Sinaga, E. S. (2025). Determinant Associated with Anemia in Adolescent Girls : A School-Based Cross-Sectional Study. Journal of Health Sciences and Epidemiology, 3(3), 97–106. https://doi.org/10.62404/nnawge92

Niza, A. W. C., Buanasita, A., Mujayanto, Nugroho, R. F., Hafid, F., & Ishak, S. I. Z. S. (2024). The Relationship Between Knowledge and Attitude About Anemia with Compliance to Consume Iron Supplement Tablets in Female Adolescents of Grade X at State Senior High School 13 Surabaya. Journal of Nutrition Explorations, 2(3), 405–414. https://doi.org/10.36568/jone.v2i3.370

Pertiwi, W. O. E., Sabilu, Y., & Hikmawati, Z. (2025). Perbedaan pengetahuan, sikap, dan tindakan sebelum dan sesudah diberikan penyuluhan kesehatan tentang anemia dengan media kartu kuartet anemia pada remaja putri di SMP Negeri 11 Kendari tahun 2025. Indonesian Journal of Health Science, 5(2), 217–230. https://doi.org/10.54957/ijhs.v5i2.1407

Puspitasari, E., Zaman, C., Harokan, A., & Suryani, D. (2025). Analysis of factors affecting the incidence of anemia in adolescent girls at Nawangsasi Health Center: A cross-sectional study. Lentera Perawat, 6(3), 411–418. https://doi.org/10.52235/lp.v6i3.485

Putri, H. P., & Fauziyah, A. (2023). Knowledge about Anemia and Physical Activity with the Incidence of Anemia Among Adolescent Girls. Jurnal Ilmiah Kesehatan (JIKA), 5(2), 260–266. https://doi.org/10.36590/jika.v5i2.520

Rahman, M. J., Rahman, M. M., Sarker, M. H. R., Matsuyama, R., Kakehashi, M., Tsunematsu, M., Ali, M., Ahmed, A., Hawlader, M. D. H., Kawasaki, H., & Shimpuku, Y. (2025). Impact of mobile health-based nutritional education on hemoglobin levels in anemic adolescent girls in rural Bangladesh: a randomized controlled trial. BMC Public Health, 25(1), 2567. https://doi.org/10.1186/s12889-025-23687-z

Riswanto, M. F. R., Rahma, A., & Ariestiningsih, E. S. (2024). Education Effectivity in Increasing Adolescent’s Female Awareness in Preventing Anemia. Indonesian Journal of Global Health Research, 6(S6), 733–744. https://doi.org/10.37287/ijghr.v6iS6.5009

Sari, P., Herawati, D. M. D., Dhamayanti, M., & Hilmanto, D. (2022). Anemia among Adolescent Girls in West Java, Indonesia: Related Factors and Consequences on the Quality of Life. Nutrients, 14(18), 3777. https://doi.org/10.3390/nu14183777

Silitonga, H. T. H., Salim, L. A., & Nurmala, I. (2024). A systematic review of iron supplementation’s effects on adolescent girls. Jurnal Gizi Indonesia (The Indonesian Journal of Nutrition), 12(2), 60–69. https://doi.org/10.14710/jgi.12.2.60-69

Situmeang, A. M. N., Apriningsih, A., Makkiyah, F. A., & Wahyuningtyas, W. (2022). Hubungan Pengetahuan, Sikap, dan Sosioekonomi dengan Perilaku Pencegahan Anemia pada Remaja Putri di Desa Sirnagalih, Bogor. Jurnal Kesehatan Komunitas, 8(1), 32–39. https://doi.org/10.25311/keskom.Vol8.Iss1.1126

Subba, S. S., & Araveti, S. (2025). Knowledge, attitudes, and practices related to iron deficiency anemia and probiotics among adolescent girls in Anantapur, India: A QIDAP-guided cross-sectional study. Food and Humanity, 4, 100551. https://doi.org/10.1016/j.foohum.2025.100551

Suprapti, E., Hadju, V., Ibrahim, E., Indriasari, R., Erika, K. A., & Balqis, B. (2025). Anemia: Etiology, Pathophysiology, Impact, and Prevention: A Review. Iranian Journal of Public Health, 54(3), 509–520. https://doi.org/10.18502/ijph.v54i3.18244

Wisnuwardani, R. W., Wulandari, S., & Kartika, A. D. (2023). Health education to prevent anemia among adolescents in Samarinda, Indonesia. Abdimas: Jurnal Pengabdian Masyarakat Universitas Merdeka Malang, 8(2), 288–296. https://doi.org/10.26905/abdimas.v8i2.9224

Zakiah, S., Toaha, A., Abri, N., & Wahyutri, E. (2023). The Effect of Nutrition Education on Knowledge, Attitudes, and Iron Intake in Adolescent Girls. Journal of Health and Nutrition Research, 2(3), 131–139. https://doi.org/10.56303/jhnresearch.v2i3.174

Downloads

Published

2026-03-28

How to Cite

Ledy Ervita, Wulida Litaqia, Devi Harmita, Yusriani Saleh Baso, & Hanafi. (2026). When Knowledge Is Not Enough: The Role of Attitude in Anemia Preventive Behavior Among Adolescents. Jurnal Ilmiah Kesehatan Sandi Husada, 15(1), 211–219. https://doi.org/10.35816/jiksh.v15i1.238

Most read articles by the same author(s)

Similar Articles

1 2 > >> 

You may also start an advanced similarity search for this article.