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Niken A. Utami
Division of Fetomaternal, Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Banda Aceh, Indonesia; Division of Fetomaternal, Department of Obstetrics and Gynecology, Dr. Zainoel Abidin Hospital, Banda Aceh, Indone

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Determinants of intrauterine device use among reproductive-age women in a province implementing Islamic Sharia law in Indonesia: An application of the theory of planned behavior Dean R. Purnama; Tgk. Puspa Dewi; Rusnaidi Rusnaidi; Niken A. Utami; Rizka Aditya; Rachmad Suhanda
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3025

Abstract

The utilization of the intrauterine device (IUD) in Indonesia remains low at 3.9%, despite its high effectiveness (99.4%) and designation as a national family planning priority, suggesting the presence of psychosocial barriers influencing contraceptive behavior among women of reproductive age. This study aimed to analyze psychosocial factors influencing IUD use behavior based on the theory of planned behavior, including attitudes, subjective norms, perceived behavioral control, actual behavioral control, and intention, in Banda Aceh—the only province in Indonesia implementing holistic Sharia law. A quantitative cross-sectional study was conducted among women of reproductive age from six urban public health centers using cluster random sampling. Data were collected through face-to-face interviews using a structured TPB-based questionnaire validated for reliability. Statistical analyses included linear regression and binary logistic regression with a significance level set at p<0.05. A total of 442 women were included in the final analysis. Attitude toward IUD use, subjective norms, and perceived behavioral control were all significantly associated with intention to use an IUD, all had p<0.001. Attitudes toward IUD use (B=0.410; p<0.001; R²=0.213), subjective norms (B=0.552; p<0.001; R²=0.413), perceived behavioral control (B=0.273; p<0.001; R²=0.255), and actual behavioral control (B=0.273; p<0.001; R²=0.255) were all significantly associated with IUD use behavior. Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.780; p<0.001; R²=0.566). Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.78; p<0.001; R²=0.56). This study highlights that all intention was shaped by positive attitudes, strong subjective norms, and a high level of behavioral control. Efforts to increase IUD use should therefore focus on educational interventions, strengthening partner and social support, and improving the accessibility and quality of long-acting contraceptive services.
Associations of self-efficacy, outcome expectancies, and socio-structural factors with teenage pregnancy in remote areas of Indonesia: An application of Social Cognitive Theory framework Liza Muknisa; Tgk. Puspa Dewi; Munizar Munizar; Niken A. Utami; Rusnaidi Rusnaidi; Rachmad Suhanda
Narra J Vol. 6 No. 3 (2026): December 2026 (In Press)
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i3.3133

Abstract

Teenage pregnancy remains a major public health challenge in Indonesia, particularly in remote settings where sociocultural norms strongly influence adolescent behavior. In Gayo Lues Regency, Aceh Province, Indonesia, adolescent pregnancy continues to occur within a context of early marriage, limited reproductive health access, and strong community norms. The aim of this study was to examine the associations of self-efficacy, outcome expectancies, and socio-structural factors with teenage pregnancy within the framework of Social Cognitive Theory. A quantitative cross-sectional study was conducted among female adolescents aged 10 to 19 years registered across four community health centers (Puskesmas) in Gayo Lues. Participants were selected using cluster random sampling. Data were collected through structured face-to-face interviews using a validated questionnaire. The associations were analyzed using simple and multiple binary logistic regression. A history of teenage pregnancy was reported by 29.5% of participants. Bivariate analysis showed that self-efficacy, outcome expectancies, and socio-structural factors were significantly associated with the history of teenage pregnancy. In the multivariate model, higher outcome expectancies were most strongly associated with lower odds of teenage pregnancy history (odds ratio (OR): 0.424; p<0.001), followed by higher self-efficacy (OR: 0.628; p=0.027), whereas socio-structural factors were not independently associated (OR: 0.810; p=0.318). These findings suggest that personal cognitive factors play a stronger role than socio-structural factors in this setting. Interventions to prevent teenage pregnancy should prioritize strengthening adolescents’ self-efficacy and shaping positive outcome expectancies through comprehensive reproductive health education and supportive social environments.