Effects of Iron Supplementation and Nutrition Education on Adolescent Girls' Knowledge, Adherence, and Hemoglobin Levels

Authors

DOI:

https://doi.org/10.36568/jone.v4i3.752

Keywords:

Adolescent girls, Anemia, Hemoglobin, iron supplementation, nutrition education

Abstract

Anemia remains a major public health problem among adolescent girls in Indonesia. The effectiveness of iron supplementation programs is often constrained by inadequate knowledge and poor adherence to iron tablet consumption. This study analyzed the effects of iron supplementation integrated with nutrition education on knowledge, adherence, and hemoglobin (Hb) levels among adolescent girls. A quasi-experimental pretest-posttest control group design was conducted among 56 adolescent girls from four senior high schools in Maros Regency, Indonesia, using multistage cluster random sampling, with two schools allocated to an intervention group (n = 27, iron supplementation plus nutrition education) and two schools to a control group (n = 29, iron supplementation only). Baseline knowledge scores did not differ significantly between groups (p = 0.115); adherence was not assessed at baseline, as it was a prospective outcome measured throughout the intervention using the DOS method. Data were analyzed using the Wilcoxon, Mann-Whitney, paired t-test, and ANCOVA, with baseline hemoglobin, dietary intake, nutritional status, and menstrual cycle as covariates. Knowledge increased significantly in the intervention group (p < 0.001), with significant between-group differences in knowledge (p < 0.001) and adherence (92.6% vs. 44.8%; p = 0.002). Mean Hb rose significantly in the intervention group, from 13.12 ± 1.78 to 14.15 ± 1.35 g/dL (p = 0.011). Adjusted Hb remained significantly higher in the intervention than control (13.86 vs. 12.90 g/dL; F = 6.065; p = 0.017). Integrating nutrition education into iron supplementation programs improved knowledge, adherence, and Hb levels, supporting incorporation into school-based anemia prevention efforts.

References

World Health Organization. Anaemia [Internet]. Geneva: World Health Organization; 2022 [cited 2026 Jun 17]. Available from: https://www.who.int/health-topics/anaemia

United Nations Children's Fund. Undernourished and Overlooked: A Global Nutrition Crisis in Adolescent Girls and Women [Internet]. New York: UNICEF; 2023 [cited 2026 Jun 17]. Available from: https://www.unicef.org/reports/undernourished-overlooked-nutrition-crisis

Kementerian Kesehatan Republik Indonesia. Survei Kesehatan Indonesia Tahun 2023. Jakarta: Badan Kebijakan Pembangunan Kesehatan; 2023.

Kementerian Kesehatan Republik Indonesia. Petunjuk Teknis Pelaksanaan Pemberian Tablet Tambah Darah di Sekolah melalui UKS. Jakarta: Direktorat Jenderal Kesehatan Masyarakat; 2020.

Helmyati S, Syarifa CA, Rizana NA, Sitorus NL, Pratiwi D. Penerimaan program tablet tambah darah pada remaja putri di Indonesia. Amerta Nutr. 2023;7(3 Suppl):50-61.

Bahtiar H, Yusriani, Idris FP. Compliance with blood adding tablet consumption based on theory of planned behavior. J Kesehat. 2023;14(3):135-41.

Febrianti KD, Ayu WC, Anidha Y, Mahmudiono T. Efektivitas edukasi gizi pada pengetahuan terkait anemia dan kadar hemoglobin remaja putri usia 12-19 tahun: tinjauan sistematis dan meta analisis. Amerta Nutr. 2023;7(3):478-86.

Rusdin R, Abdullah AZ, Wahiduddin, Ansariadi, Suriah, Hidayanty H. Educational model of PAKEM in compliance with Fe tablet consumption of adolescent girls. Open Access Maced J Med Sci. 2021;9:710-6.

Adhi KT, Asmin MLP. Determinan kejadian anemia pada remaja putri usia 15-24 tahun pada daerah pedesaan di Indonesia (Analisis data Riskesdas 2018). Arch Community Health. 2024;11(1):17-28. doi:10.24843/ACH.2024.v11.i01.p02

Herwandar FR, Heryanto ML, Juita SR. Hubungan kadar hemoglobin dengan siklus menstruasi pada remaja putri. J Ilmu Kesehat Bhakti Husada. 2023;14(1):99-106. doi:10.34305/jikbh.v14i01.724

Chairiyah R. Hubungan lama menstruasi, konsumsi zat besi dan status gizi dengan kejadian anemia pada remaja putri. J Kesehat Masy Indones. 2022;17(2):33-7. doi:10.26714/jkmi.17.2.2022.33-37

Vagha K, Choudhari S, Taksande A, Tembhurne J, Vagha J, Vagha S. Implementation of a spaced-repetition approach to enhance undergraduate learning and engagement in paediatrics. Front Med. 2025;12:1601614. doi:10.3389/fmed.2025.1601614

Hall JE, Guyton AC. Guyton and Hall Textbook of Medical Physiology. 14th ed. Philadelphia: Elsevier; 2021.

Green LW, Kreuter MW. Health Program Planning: An Educational and Ecological Approach. 4th ed. New York: McGraw-Hill; 2005.

Nuradhiani A, Briawan D, Dwiriani CM. Dukungan guru meningkatkan kepatuhan konsumsi tablet tambah darah pada remaja putri di Kota Bogor. J Gizi Pangan. 2017;12(3):153-60. doi:10.25182/jgp.2017.12.3.153-160

Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Educ Q. 1988;15(2):175-83. doi:10.1177/109019818801500203

Damayanti F, Kusharisupeni K, Adawiyah AR, Hymawati H. Determinan kepatuhan mengonsumsi tablet tambah darah (TTD) pada remaja putri di SMAN 02 Gunung Putri Kabupaten Bogor. J Untuk Masy Sehat. 2025;9(1):15-31. doi:10.52643/jukmas.v9i1.4891

Lismiana H, Indarjo S. Pengetahuan dan persepsi remaja putri terhadap kepatuhan konsumsi tablet tambah darah. Indones J Public Health Nutr. 2021;1(1):22-30. doi:10.15294/ijphn.v1i1.45146

Rehman T, Agrawal R, Ahamed F, Das S, Mitra S, Kumar D, et al. Optimal dose and duration of iron supplementation for treating iron deficiency anaemia in children and adolescents: a systematic review and meta-analysis. PLoS One. 2025;20(2):e0319068. doi:10.1371/journal.pone.0319068

Okam MM, Koch TA, Tran MH. Iron supplementation, response in iron-deficiency anemia: analysis of five trials. Am J Med. 2017;130(8):991.e1-991.e8. doi:10.1016/j.amjmed.2017.03.045

Rusmiati D, Ama PGB, Wahyuni D. Efektivitas suplementasi tablet tambah darah dalam meningkatkan kadar hemoglobin remaja putri. J Ilm Kesehat. 2025;17(2):85-95. doi:10.37012/jik.v17i2.2975

Field AP. Discovering Statistics Using IBM SPSS Statistics. 5th ed. London: SAGE Publications Ltd; 2018.

Nasir Y, Masithah S, Yusuf K, Nurcahyani ID, Syafruddin. Hubungan pengetahuan anemia dengan kepatuhan mengkonsumsi tablet tambah darah pada remaja putri di wilayah kerja Puskesmas Turikale. Ghidza J Gizi Kesehat. 2024;8(1):93-100. doi:10.22487/ghidza.v8i1.1158

Sweller J, van Merriënboer JJG, Paas F. Cognitive architecture and instructional design: 20 years later. Educ Psychol Rev. 2019;31:261-92. doi:10.1007/s10648-019-09465-5

Pratiwi VA. Hubungan pengetahuan dan sikap mengenai anemia dengan asupan zat besi remaja putri di SMA Negeri 9 Depok [skripsi]. Jakarta: Universitas Binawan; 2022.

Terry PE. Health promotion planning and an interview with Dr. Lawrence Green. Am J Health Promot. 2021;35(6):760-5. doi:10.1177/08901171211022560.

Downloads

Published

2026-07-15

How to Cite

Fatmawati, St. Masithah, Siti Uswatun Hasanah, & Andi Rahmaniar MB. (2026). Effects of Iron Supplementation and Nutrition Education on Adolescent Girls’ Knowledge, Adherence, and Hemoglobin Levels. Journal of Nutrition Explorations, 4(3), 345–360. https://doi.org/10.36568/jone.v4i3.752

Issue

Section

Articles