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Meta-Analysis: Bullying's Effects on Anxiety and Depression in Adolescents Amin Nur Hanida; Bhisma Murti; Didik Gunawan Tamtomo
Journal of Health Promotion and Behavior Vol. 10 No. 1 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.01.06

Background: Bullying is a major problem worldwide. Bullying itself is defined as a condition in the form of negative and repetitive behavior, carried out by a person or group of people, the treatment is carried out deliberately and intensely with the aim of hurting physically and mentally. This study aims to analyze and estimate the magnitude of the influence of bullying on anxiety and depression in adolescents. Subject and Method: The meta-analysis was performed according to the flow of the PRISMA diagram and the PICO model. P: Adolescents, I: Bullying, C: No bullying, O: Anxiety and depression. The search for articles in this study is through databases that include PubMed, Google Scholar, Science Direct and Scopus. With keywords including: "bullying" AND "anxiety" AND "depression" AND "adolescent". Full paper article with cross-sectional study, the subject of the study was adolescents, the measure of the relationship used was adjusted Odds Ratio,   the outcome of the study was anxiety and depression. Analysis was done with Revman 5.3 Results: There were 10 articles with cross-sectional designs from the United States, Africa, China, Saudi Arabia, Malaysia, and Australia with a total of 282,799 research samples. A meta-analysis of 10 cross-sectional studies concluded that adolescents who experienced bullying had a 1.98 times greater risk of anxiety than those without bullying (aOR = 1.98; CI 95%= 1.54 to 2.53; A meta-analysis of 8 cross-sectional studies concluded that adolescents who experienced bullying had a 1.85 times greater risk of depression compared to no bullying (aOR= 1.85; CI 95%= 1.37 to 2.50; p<0.001). Conclusion: Bullying increases the risk of anxiety and depression in adolescents

Analysis Multilevel: Application of Health Belief Model on Tertiary Prevention Behavior in Kaur District, Bengkulu Province, Indonesia Betriza; Hanung Prasetya; Bhisma Murti
Journal of Health Promotion and Behavior Vol. 10 No. 1 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.01.02

Background: Uncontrolled hypertension can cause complications, so efforts to prevent and control hypertension can be carried out by applying the Health Belief Model health promotion theory. This study aimed to determine the influence of the Health Belief Model construct on tertiary prevention behavior in hypertensive patients. Subjects and Method: This was a cross-sectional study conducted in 16 health centers in Kaur district, Bengkulu, from November to December 2023. A total of 208 hypertension patients were selected by simple random sampling. The dependent variable is tertiary prevention behavior. Independent variables are a number of constructs in the Health Belief Model theory including perceived susceptibility, stimulus to act, and self-efficacy. Data collection was carried out using questionnaires and data were analyzed using a multilevel double linear regression analysis model. Results: There was a positive association between perception of vulnerability (b= 0.11; CI 95%= 0.01 to 0.22; p= 0.065), signal to act (b= 0.20; CI 95%= 0.03 to 0.38; p= 0.022), self-efficacy (b= 0.16; CI 95%= -0.01 to 0.32; p= 0.059) on hypertension tertiary prevention behavior. Public health center have less contextual influence on tertiary prevention behavior in hypertensive patients (ICC= 6.68%). Conclusion: Perception of vulnerability, cues to act, and self-efficacy are predictors of hypertension tertiary prevention behaviors.

Imlementation of Health Belief Model to Predict Adherence toward Acupuncture Services in Low Back Pain Patients Nurcahyo aji legowo; Bhisma Murti; Sumardiyono Sumardiyono
Journal of Health Promotion and Behavior Vol. 10 No. 1 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.01.09

Background Adherence in using acupuncture services can reduce the risk of developing more severe low back pain. Low back pain patients who do not receive regular treatment will experience a high risk of injury. This study aims to determine the relationship between the construct of the health belief model and adherence in using acupuncture services. Subjects and Method: This was a cross-sectional study carried at the Surakarta acupuncture clinic in December-March 2024. A sample of 200 low back pain patients was selected using random sampling. The dependent variable was low back pain patients. The independent variables were perceived vulnerability, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Data were analyzed using a multiple logistic regression. Results: Adherence to acupuncture therapy in LBP patients increased with high perceived vulnerability (OR= 2.46; 95% CI= 1.09 to 5.07; p = 0.028), high perceived severity (OR= 4.07; CI 95%= 1.84 to 8.99; p = 0.001), high perceived benefit (OR= 2.57; 95% CI= 1.12 to 5.84; p = 0.024), had cues to action (OR= 2.24; 95% CI= 1.03 to 4.90; p = 0.042), and high self-efficacy (OR= 2.27; 95% CI= 1.03 to 5.00; p = 0.042). It was decreased by high perceived barriers (OR= -0.35; 95% CI= -0.15 to -0.80; p = 0.014). Conclusion: Adherence to acupuncture therapy in LBP patients increases with high perceived vulnerability, high perceived severity, high perceived benefit, had cues to action, and high self-efficacy. It is decreased by high perceived barriers

Application of Information Motivation Behavior Skill on Tertiary Preventive Behavior of Type 2 Diabetes Mellitus Patients at Blora Health Center Jihan Nabilla; Didik Gunawan Tamtomo; Bhisma Murti
Journal of Health Promotion and Behavior Vol. 10 No. 1 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.01.12

Background: Diabetes mellitus (DM) is a priority disease that not only requires control efforts but is also important for prevention efforts. Complications that occur in type II DM patients can be prevented with tertiary preventive behavior. This tertiary preventive behavior can be done by applying the Information Motivation Behavior (IMB) skill model. The purpose of this study is to explore the influence of the application based on the IMB model on tertiary prevention behavior in type II DM patients. Subjects and Method: This study is cross sectional from April-May 2024. The sample used was 200 type 2 DM patients aged >18 years and selected by random sampling technique at the Blora Health Center, Central Java. The dependent variable was the tertiary preventive behavior of type 2 DM patients. The independent variables were information, motivation and behavioral skills. Data collection using questionnaires and data analysis using path analysis with Stata 13. Results: Tertiary preventive behavior of patients with type 2 diabetes mellitus was directly influenced by behavioral skills (b= 5.80; CI 95%= 4.73 to 6.87; p <0.001), information (b= 1.25; CI 95%= 0.01 to 2.50; p= 0.047) and gender (b= -1.60; CI 95%= -0.60 to -2.59; p= 0.002). Tertiary preventive behavior of type 2 DM patients through behavioral skills is indirectly influenced by information, motivation, age and education. Information is indirectly influenced by motivation and education. There was no significant effect on gender on behavioral skills. Conclusion: Tertiary preventive behavior is directly influenced by behavioral skills, information and gender. Tertiary preventive behavior is indirectly influenced by information, motivation, age, and education through behavioral skills. Tertiary preventive behavior is indirectly influenced by gender and education through information.

Application of Social Cognitive Theory for Tertiary Preventive Behavior in Elderly with Hypertension: A Multilevel Analysis in Cirebon, West Java Sita Rahayu Sanusi; Bhisma Murti; Argyo Demartoto
Journal of Health Promotion and Behavior Vol. 10 No. 1 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.01.11

Background: Hypertension is the first non-communicable disease diagnosed in various health facilities up to 185,857 cases. Hypertension is one of the main causes of mortality and morbidity in Indonesia, so the management of this disease is a very common intervention carried out at various levels of health facilities, especially in the elderly. This study aims to analyze the influence of the application of social cognitive theory on the preventive behavior of the elderly tertiary with hypertension in Cirebon Regency. Subjects and Method: The study was conducted with a cross-sectional study design involving as many as 200 research subjects, including 102 positive tertiary preventive behavior research subjects and 93 negative tertiary preventive behavior research subjects. This research was conducted in 25 elderly posyandu in Cirebon Regency, West Java. This research was conducted in March-April 2024. The sample was selected using simple random sampling to select elderly research subjects with hypertension and stratified random sampling to select the type of Posyandu. The dependent variable is tertiary preventive behavior behavior in the elderly with hypertension. The independent variables were knowledge, expectations, self-regulation, self-efficacy, reinforcement and observational learning. Data collection was carried out using questionnaires and data were analyzed using a multilevel analysis model.. Results: Tertiary preventive behavior in older age with hypertension was influenced by knowledge (b = 1.89; 95% CI = 1.54 to 2.23; p <0.001), expectations (b = 0.15; 95% CI = 0.01 to 0.29; p = 0.031), self-regulation (b = 0.15; 95% CI = 0.01 to 0.29; p = 0.035), self-efficacy (b = 0.14; 95% CI = 0.00 to 0.29; p = 0.042), reinforcement (b = 0.15; 95% CI = 0.00 to 0.29; p = 0.042), reinforcement (b = 0.36; 95% CI = 0.22 to 0.50; p <0.001), and observational (b = 0.22; 95% CI = 0.07 to 0.38; p = 0.004). Posyandu has a contextual influence on tertiary preventive behavior in the elderly with hypertension with ICC = 40%. Conclusion: Tertiary preventive behavior in the elderly with hypertension is influenced by knowledge, expectations, self-regulation, self-efficacy, reinforcement and positive outcomes of observational learning. Thus, social cognitive theory can be used to explain and predict tertiary preventive behavior in the elderly with hypertension. Variations at the Posyandu level have a strong contextual effect on tertiary preventive behavior in the elderly with hypertension.

Application of Health Belief Model of Tertiary Prevention Behavior in Elderly People with Hypertension: A Multilevel Analysis Hallisa’tu Zahro; Argyo Demartoto; Bhisma Murti
Journal of Health Promotion and Behavior Vol. 10 No. 2 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.02.03

Background: The health of the elderly is influenced by various risk factors and changes from within themselves and their environment. These various conditions can affect health problems, functional status, level of independence and quality of life of the elderly. Deterioration of health in the elderly can manifest in a variety of diseases, including hypertension. Efforts to control the incidence of hypertension can be done through the provision of health education about hypertension, which aims to raise awareness of hypertensives about the concept of hypertension, complications, and how to overcome. This study aims to examine the application of the Health Belief Model (HBM) as a predictor by taking into account the contextual effects of the Elderly Integrated Healthcare Posts in Kepanjen, Malang, East Java, Indonesia. Subjects and Method: This study was an observational analytical study with a cross-sectional approach using a multilevel analysis model. The population in this study was all elderly people with hypertension at the Elderly Integrated Healthcare Posts in the working area of Kepanjen Community Health Center, Malang, East Java, Indonesia. The sample in this study was 200 elderly with hypertension at the Elderly Integrated Healthcare Posts in the Kepanjen Community Health Center Working Area, Malang, East Java, Indonesia. The study used the Stratified Sampling technique at the healthcare level (Elderly Integrated Healthcare Posts), and Stratified Random Sampling in the selection of the elderly. Results: Tertiary prevention behavior among elderly with hypertension increased with high self-efficacy (b= 0.57; CI 95%= 0.39 to 0.73; p<0.001), cues to action (b= 0.27; CI 95%= 0.35 to 1.71; p<0.001), female gender (b= 0.76; CI 95%= 0.10 to 0.42; p<0.001), age 70-90 years (b= 0.37; CI 95%= -0.01 to 0.75; p= 0.060). Integrated health posts for elderly on the tertiary prevention behavior of hypertension. The Integrated Healthcare Posts had contextual effect on tertiary prevention behavior (ICC=29.87%; p<0.001). Conclusion: Tertiary prevention behavior of hypertension in the elderly increases with high self-efficacy, cues to action, female gender, age 70-90 years.

Application of Social Cognitive Theory to Promote Healthy Behavior Among the Elderly at Integrated Health Post for Elderly Agil Rafi’ah Afandi; Argyo Demartoto; Bhisma Murti
Journal of Health Promotion and Behavior Vol. 10 No. 2 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.02.04

Background: The results of a survey by the Central Statistics Agency in 2021 reported that as many as 42.22% of the elderly population in Indonesia experience health problems. One of the factors that determines healthy behavior in the elderly is implementing healthy behavior. This study aims to examine the application of social cognitive theory as a determinant of healthy behavior of the elderly in Sukoharjo Regency, Central Java. Subjects and Method: This was a cross-sectional study carried out at integrated health post (posyandu) in Grogol, Sukoharjo Regency, Central Java, in June-July 2024. A sample of 200 elderly was selected purposively. Five villages were randomly selected. From each village, 6 primary strata Posyandu, 6 intermediate strata Posyandu, 6 purnama strata Posyandu, and 7 independent Posyandu were chosen. Then, from each selected Posyandu, 8 elderly individuals were randomly selected. The dependent variable is healthy behavior in the elderly. The independent variables are a number of constructs in social cognitive theory, namely observational learning, outcome expectation, outcome expectancy, reinforcement, and self-efficacy. Data were analyzed by multiple linear regression. Results: Healthy behaviors increased with observational learning (b= 0.17; 95% CI= 0.12 to 0.43; p= 0.001), outcome expectation (b=0.24; 95% CI= 0.02 to 0.473; p= 0.036), outcome expectancy (b= 0.36; 95% CI= 0.05 to 0.68; p= 0.025), reinforcement (b= 0.36; 95% CI= 0.10 to 0.84; p= 0.013), and self efficacy (b= 0.55; 95% CI= 0.19 to 0.91; p= 0.003). Conclusion: Healthy behavior in the elderly is positively associated with observational learning, outcome expectation, outcome expectancy, reinforcement, and self efficacy.

Application of the Information-Motivation-Behavioral Skills Model to Tertiary Preventive Behavior in Osteoarthritis Nisrina Nafisa; Setyo Sri Rahardjo; Bhisma Murti; Hanung Prasetya; Sumardiyono; Revi Gama Hatta Novika
Journal of Health Promotion and Behavior Vol. 10 No. 2 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2025.10.02.12

Background: Osteoarthritis (OA) is a type of degenerative disease in which chronic joint inflammation occurs that can occur in the elderly. People with osteoarthritis will feel pain and experience functional limitations. Physiotherapy helps prevent and minimize further joint damage. The success of the rehabilitation program depends on the patient's skills in doing exercises, lifestyle changes, such as maintaining weight and avoiding activities that improve the joints. This study aims to analyze the influence of the Application of the Information Motivation Behavioral Skills Model (IMB) on the tertiary preventive behavior in osteoarthritis patients. Subjects and Method: This was a cross sectional study conducted at a physiotherapy clinic in Surakarta, in January 2025. A sample of 210 osteoarthritis patients was selected using the fixed diseases sampling. The dependent variable was the tertiary preventive behavior. Independent variables were information, motivation, and behavioral skill. The data were collected using questionnaire and analyzed using a path analysis. Results: Tertiary preventive behaviors in OA patients increased with behavioral skills (b= 0.45; 95% CI= 0.34 to 0.55; p<0.001) and motivation (b= 0.44; 95% CI= 0.34 to 0.53; p<0.001). Behavioral skill increased with information (b= 0.47; 95% CI= 0.37 to 0.57; p<0.001) and motivation (b= 0.35; 95% CI= 0.25 to 0.46; p<0.001). The goodness of fit indices were p= 0.285; RMSEA= 0.026 (<0.050); CFI= 1.0 (≥0.90); TLI= 0.99 (≥0.90); and SRMR= 0.01 (<0.050). Conclusion: Tertiary preventive behaviors in OA patients increases with behavioral skill and motivation. Behavioral skill increases with information and motivation.

Effect of Social Capital on Tertiary Preventive Behavior among Older Adults with Type 2 Diabetes Mellitus: A Structural Equation Modeling Approach Anna Nugrahani; Bhisma Murti; Setyo Sri Rahardjo; Argyo Demartoto; Revi Gama Hatta Novika
Journal of Health Promotion and Behavior Vol. 10 No. 4 (2025)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/

Background: Diabetes Mellitus (DM), known as the “silent killer,” continues to show an increasing number of cases. It has emerged as one of the most serious and common chronic diseases, leading to life-threatening complications, disability, and reduced life expectancy. The persistently high prevalence of diabetes in Karanganyar Regency, along with the interaction among multiple determinants, underlies the objective of this study, which is to analyze the influence of structural, cognitive, and relational social capital models on tertiary preventive behavior among elderly individuals with Type 2 Diabetes Mellitus. Subjects and Method: This study employed a cross-sectional design. It was conducted in Karanganyar Regency (Jatipuro, Jatiyoso, and Karanganyar sub-districts), Central Java, from January to March 2025. A total of 210 elderly participants were selected using certified random sampling. Data were collected using a structured questionnaire. The analyses included univariate, bivariate, and multivariate analyses using a structural equation model (SEM). The dependent variable was tertiary preventive behavior among elderly individuals with Type 2 Diabetes Mellitus. The independent variables were social capital, comprising structural social capital, cognitive social capital, and relational social capital. Results: Structural social capital had a positive and statistically significant effect on tertiary preventive behavior (b= 0.32; 95% CI= 0.13 to 0.52; p= 0.001). Relational social capital also showed a positive and significant effect on tertiary preventive behavior (b= 0.37; 95% CI= 0.15 to 0.59; p= 0.001). Age demonstrated a negative and statistically significant effect on tertiary preventive behavior (b= -0.09; 95% CI= -0.16 to -0.03; p= 0.003). Conclusion: The findings of this study indicate that elderly individuals with Type 2 Diabetes Mellitus who have higher levels of social capital—comprising structural, cognitive, and relational dimensions—are more likely to engage in tertiary preventive behaviors.

Associations Between Social Support, Health Belief Model Constructs, and Smoking Cessation Among Patients Attending a Smoking Cessation Clinic in Surakarta, Central Java, Indonesia Seindy Arya Kusuma Timoer; Hendrastutik Apriningsih; Bhisma Murti; Jatu Aphridasari; Ana Rima Setijadi
Journal of Health Promotion and Behavior Vol. 11 No. 3 (2026)
Publisher : Masters Program in Public Health, Sebelas Maret University

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.26911/thejhpb.2026.11.03.01

Background: Smoking behaviour is a major health problem in Indonesia, with a high prevalence rate. The decision to quit smoking is influenced by various factors, including social support and components of the Health Belief Model (HBM). However, the direct and indirect mechanisms through which social support and HBM components influence smoking behaviour remain incompletely understood, particularly among patients attending smoking cessation clinics. Understanding these factors is crucial for improving the success of smoking cessation programmes. Subjects and Method: This analytical observational study employed a case-control design involving patients at the Surakarta Smoking Cessation Clinic from September 2025 to November 2025. Data were collected using structured questionnaires and analysed using logistic regression and generalized structural equation modeling (GSEM) to evaluate the direct and indirect effects between variables. Results: Self-efficacy had a positive effect on smoking cessation (b = 1.23; 95% CI = 0.60 to 1.85; p < 0.001). Perceived susceptibility (b = 0.66; 95% CI = 0.05 to 1.27; p = 0.034) and perceived benefit (b = 0.63; 95% CI = 0.001 to 1.26; p = 0.050) have a positive effect on smoking cessation, whilst perceived barriers have a negative effect on smoking cessation (b = −0.70; 95% CI = −1.30 to −0.09; p = 0.025). Cues to action had a positive effect on self-efficacy (b = 0.73; 95% CI = 0.16 to 1.31; p = 0.013). Social support positively influenced cues to action (b = 1.85; 95% CI = 1.21 to 2.49; p < 0.001) and perceived benefits (b = 1.00; 95% CI = 0.42 to 1.59; p = 0.001). Social support influences smoking cessation indirectly through cues to action, perceived benefits, and self-efficacy. Conclusion: Smoking cessation is influenced by the interaction between social support and the components of the Health Belief Model, with self-efficacy being the most dominant factor. Social support plays an indirect role by increasing cues to action, perceived benefits, and self-efficacy; therefore, strengthening these factors is important in improving the success of smoking cessation.

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