Development A Behavioral Model of Family Planning Participation Among Women Of Reproductive Age Based On Lawrence Green’s Precede–Proceed Framework in Medan City, Indonesia

Nopita Yanti Sitorus (Sekolah Tinggi Ilmu Kesehatan Flora, Jl. Rajawali No.24, Sei Kambing, Medan Sunggal, Kota Medan, Sumatera Utara)
Helfrida Situmorang (Sekolah Tinggi Ilmu Kesehatan Flora, Jl. Rajawali No.24, Sei Kambing, Medan Sunggal, Kota Medan, Sumatera Utara)
Sri Dewi Br Siregar (Sekolah Tinggi Ilmu Kesehatan Flora, Jl. Rajawali No.24, Sei Kambing, Medan Sunggal, Kota Medan, Sumatera Utara)
Desi Handayani Lubis (Sekolah Tinggi Ilmu Kesehatan Flora, Jl. Rajawali No.24, Sei Kambing, Medan Sunggal, Kota Medan, Sumatera Utara)
Yulia Safitri

Contagion: Scientific Periodical Journal of Public Health and Coastal Health
Vol 8, No 3 (2026): Contagion

Participation of women of reproductive age (WRA) in the family planning (FP) programme in Medan City is only 42.2%, far below the national contraceptive prevalence rate of 59.4%. Existing programmes have not been guided by a locally validated behavioural model.  To develop a behavioural model of FP participation among WRA using Lawrence Green’s PRECEDE–PROCEED framework.  An analytical cross-sectional study was conducted in 2025 among 260 WRA attending 10 maternity clinics and 3 community health centres (puskesmas) in Medan City, selected by stratified random sampling with proportional allocation. Data were collected with a structured questionnaire measuring predisposing (education, knowledge, attitude, information-seeking behaviour, parity), enabling (income, access to health services, media exposure) and reinforcing (husband’s support, health-worker support) factors. Bivariate analysis used the chi-square test with prevalence ratios (PR) and 95% confidence intervals (CI); variables with p < 0.25 entered a multiple logistic regression (forward stepwise Wald). Forty-two respondents (16.2%) did not participate in the FP programme. Eight of ten variables qualified for multivariable modelling. Four determinants remained significant in the final model: knowledge (AOR = 31.37; 95% CI 12.29–80.06), education (AOR = 17.66; 95% CI 8.03–38.85), husband’s support (AOR = 9.52; 95% CI 4.42–20.50) and income (AOR = 2.83; 95% CI 1.20–6.66). Knowledge was the dominant predictor. A woman with poor knowledge, low education, an unsupportive husband and low income had a predicted probability of non-participation of 99.8%, compared with 0.9% for a woman with none of these characteristics. FP participation in Medan is determined by the interaction of predisposing, enabling and reinforcing factors. Interventions should combine contraceptive literacy education, couple-based counselling and economic empowerment of low-income households Keywords: Contraceptive Behaviour; Family Planning; Logistic Regression; PRECEDE–PROCEED Model; Women of Reproductive Age