Effect of health promotion and Whatsapp reminder to self-efficacy of the consumption of Fe tablets adherence among pregnant women


  • Dyah Tri Kusuma Dewi Universitas 'Aisyiyah Yogyakarta
  • Wiwik Kusumawati Universitas Muhammadiyah Yogyakarta
  • Ismarwati Ismarwati Universitas ‘Aisyiyah Yogyakarta


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Health Promotion, WhatsApp Reminder, Self-efficacy


Maternal Mortality Rate (MMR) as an indicator of maternal health during pregnancy, childbirth, and childbirth. Anemia contributes 20% to the incidence of maternal deaths caused by bleeding during labor. The government prevents anemia by giving iron tablets at least 90 tablets for pregnant women. However, the prevalence of anemia remains high, because of the low adherence in consuming Fe tablets every day. Self-efficacy adherence is a predictor of health behavior and adherence to treatment.To improve adherence with self-efficacy in consuming Fe tablets in pregnant women with health promotion and WhatsApp reminder in Yogyakarta City Health Center.This study used a quasi-experiment method with a pre-test post-test non-equivalent control group design. The sample amounted to 59, the sampling technique used was consecutive sampling which was taken by random sampling technique in which samples were taken alternately to determine the intervention group and the control group.There were significant differences in the self efficacy score between the intervention groups (Mean = 6.30, SD = 8.11) and the control group (Mean = 0.89, SD = 7.83) with t-test = 2.60 and Ï = 0.012.There is a significant difference in self-efficacy adherence with consuming Fe tablets in pregnant women before and after being given health promotion and WhatsApp reminder intervention and control groups. Health service agencies can consider the combined service between health promotion and WhatsApp reminder to improve self-efficacy in adhering to consuming Fe tablets in increasing Hb levels in anemic pregnant women.


Abel, E., & Painter, L. (2003). Factors That Influence Adherence To HIV Medications: Perceptions Of Women And Health Care Providers. Journal of the Association of Nurses in AIDS Care, 14(4), 61–69. https://doi.org/10.1177/1055329003252879

Adefolalu, A., Nkosi, Z., Olorunju, S., & Masemola, P. (2014). Self-Efficacy, Medication Beliefs And Adherence To Antiretroviral Therapy By Patients Attending A Health Facility In Pretoria. South African Family Practice, 56(5), 281–285. https://doi.org/10.1080/20786190.2014.975476

Archiopoli, A., Ginossar, T., Wilcox, B., Avila, M., Hill, R., & Oetzel, J. (2016). Factors of interpersonal communication and behavioral health on medication self-efficacy and medication adherence. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 28(12), 1607–1614. https://doi.org/10.1080/09540121.2016.1192577.

Arora, S., Peters, A. L., Agy, C., & Menchine, M. (2012). A Mobile Health Intervention for Inner City Patients with Poorly Controlled Diabetes: Proof-of-Concept of the TExT-MED Program. Diabetes Technology & Therapeutics, 14(6), 492–496. https://doi.org/10.1089/dia.2011.0252.

Bandura, A. (1977). Self Efficacy Toward A Unifying Theory Of Behavioural Change Bandura 1977 PR.pdf, 84(2).

Bandura, A. (1998). Self-Efficacy, 4(1994), 71–81.

Bin, N., Alam, A., Aurangzeb, B., & Dibley, M. (2014). Perception Of Antenatal Iron- Folic Acid Supplement In Urban And Rural Pakistan: A Qualitative Study. BMC Pregnancy Childbirth, 14, 1–12.

Boulos, M. N. K., Giustini, D. M., & Wheeler, S. (2016). Instagram And Whatsapp In Health And Healthcare: An Overview. Future Internet, 8(3), 1–14. https://doi.org/10.3390/fi8030037

Cameron, K. A., Ross, E. L., Clayman, M. L., Bergeron, A. R., Federman, A. D., Bailey, S. C., … Wolf, M. S. (2010). Measuring Patients’ Self-Efficacy In Understanding And Using Prescription Medication. Patient Education and Counseling, 80(3), 372–376. https://doi.org/10.1016/j.pec.2010.06.029

Chen, K.-J., Chang, Y.-L., Chang, H., Su, S.-Y., Peng, H.-H., Chang, S.-D., & Chao, A.-S. (2017). Long-Term Outcome Of Pregnancy Complicating With Severe Aplastic Anemia Under Supportive Care. Taiwanese Journal of Obstetrics & Gynecology, 56(5), 632–635. https://doi.org/10.1016/j.tjog.2017.08.010

Chrispinus Siteti, M. (2014). Anaemia in Pregnancy: Prevalence and Possible Risk Factors in Kakamega County, Kenya. Science Journal of Public Health, 2(3), 216. https://doi.org/10.11648/j.sjph.20140203.23

Criswell, T. J., Weber, C. A., & Xu, Y. (2014). Effect of Self-Efficacy and Social Support on Adherence to Antihypertensive Drugs, 30(5), 432–441. https://doi.org/10.1592/phco.30.5.432.Effect

Davey, D. J., NHWOTO, J. A., Augusto, O., & Ponce, W. (2018). SMSaude:Evaluating Mobile Phone Text Reminders To Improve Retention In HIV Care For Patients On Antiretroviral Therapy In Mozambique, 73(2), 1–17. https://doi.org/10.1097/QAI.0000000000001115.SMSa

Dinas Kesehatan. (2015). ( Data Tahun 2014 ). Profil Kesehatan Tahun 2015 Kota Yogyakarta, (56).

Gao, L. ling, Sun, K., & Chan, S. W. chi. (2014). Social Support And Parenting Self-Efficacy Among Chinese Women In The Perinatal Period. Midwifery, 30(5), 532–538. https://doi.org/10.1016/j.midw.2013.06.007

Gebreamlak, B., Dadi, A. F., & Atnafu, A. (2017). High Adherence To Iron/Folic Acid Supplementation During Pregnancy Time Among Antenatal And Postnatal Care Attendant Mothers In Governmental Health Centers In Akaki Kality Sub City, Addis Ababa, Ethiopia: Hierarchical Negative Binomial Poisson Regression. PLoS ONE, 12(1), 1–11. https://doi.org/10.1371/journal.pone.0169415

Gentles, S. J., Lokker, C., & McKibbon, K. A. (2010). Health Information Technology To Facilitate Communication Involving Health Care Providers, Caregivers, And Pediatric Patients: A Scoping Review. Journal of Medical Internet Research, 12(2). https://doi.org/10.2196/jmir.1390.

Hacking, D., Haricharan, H. J., Brittain, K., Lau, Y. K., Cassidy, T., & Heap, M. (2016). Hypertension Health Promotion via Text Messaging at a Community Health Center in South Africa: A Mixed Methods Study. JMIR mHealth and uHealth, 4(1), e22. https://doi.org/10.2196/mhealth.4569

Handayani, L. (2013). Peran Petugas Kesehatan Dan Kepatuhan Ibu Hamil Mengkonsumsi Tablet Besi, 7(2), 83–88.

Haynes, R. B., Ackloo, E., Sahota, N., Mcdonald, H. P., & Yao, X. (2008). Interventions For Enhancing Medication Adherence ( Review ) Interventions For Enhancing Medication Adherence, (2), 2–4. https://doi.org/10.1002/14651858.CD000011.pub3.Copyright

Huang, H.-L., Li, Y.-C. J., Chou, Y.-C., Hsieh, Y.-W., Kuo, F., Tsai, W.-C., … Chuang, C.-J. (2013). Effects Of And Satisfaction With Short Message Service Reminders For Patient Medication Adherence: A Randomized Controlled Study. BMC Medical Informatics And Decision Making, 13(1), 127. https://doi.org/10.1186/1472-6947-13-127

International Nutritional Anemia Consultative Group (INACG), World Health Organization (WHO), & United Nations Childrens Fund (UNICEF). (1998). Guidelines For The Use Of Iron Supplements To Prevent And Treat Iron Deficiency Anemia. Retrieved from http://wwwlive.who.int/entity/nutrition/publications/micronutrients/guidelines_for_Iron_supplementation.pdf

Izadirad, H., Niknami, S., Zareban, I., & Hidarnia, A. (2017). Effects of Social Support and Self-Efficacy on Maternal Prenatal Cares Among the First-Time Pregnant Women, Iranshahr, Iran. Journal of Family & Reproductive Health, 11(2), 67–73. https://doi.org/10.2967/jnumed.108.058362

Jasemzadeh, M., Khafaie, M. A., Jaafarzadeh, N., & Araban, M. (2018). Effectiveness Of A Theory-Based Mobile Phone Text Message Intervention For Improving Protective Behaviors Of Pregnant Women Against Air Pollution: A Randomized Controlled Trial. Environmental Science and Pollution Research, 25(7), 6648–6655. https://doi.org/10.1007/s11356-017-1034-7

Jo, H., Lee, S., Ahn, M. O., & Jung, S. H. (2003). Structural Relationship Of Factors Affecting Health Promotion Behaviors Of Korean Urban Residents. Health Promotion International, 18(3), 229–236. https://doi.org/10.1093/heapro/dag018

Johnson, K. B., Patterson, B. L., Ho, Y. X., Chen, Q., Nian, H., Davison, C. L., … Mulvaney, S. A. (2016). The feasibility of text reminders to improve medication adherence in adolescents with asthma. Journal of the American Medical Informatics Association, 23(3), 449–455. https://doi.org/10.1093/jamia/ocv158

Kefiyalew, F., Zemene, E., Asres, Y., & Gedefaw, L. (2014). Anemia Among Pregnant Women In Southeast Ethiopia : Prevalence , Severity And Associated Risk Factors,BMC Research Notes 2014, 7:771 http://www.biomedcentral.com/1756-0500/7/771. BMC Research Notes, 7(771), 1–8.

Mercer, R. T. (2006). Nursing Support Of The Process Of Becoming A Mother. JOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35(5), 649–651. https://doi.org/10.1111/j.1552-6909.2006.00086.x

Montag, C., Kannen, C., Lachmann, B., Sariyska, R., Duke, É., Reuter, M., & Markowetz, A. (2015). The Importance Of Analogue Zeitgebers To Reduce Digital Addictive Tendencies In The 21st Century. Addictive Behaviors Reports, 2, 23–27. https://doi.org/10.1016/j.abrep.2015.04.002

Náfrádi, L., Nakamoto, K., & Schulz, P. J. (2017). Is Patient Empowerment The Key To Promote Adherence? A Systematic Review Of The Relationship Between Self-Efficacy, Health Locus Of Control And Medication Adherence. PLoS ONE, 12(10), 1–23. https://doi.org/10.1371/journal.pone.0186458.

Piaseu, N., Schepp, K., & Belza, B. (2002). Causal Analysis Of Exercise And Calcium Intake Behaviors For Osteoporosis Prevention Among Young Women In Thailand. Health Care For Woman International, 23(4), 364–376. https://doi.org/10.1080/0739933029008937.

Quilici, J., Fugon, L., Beguin, S., Morange, P. E., Bonnet, J. L., Alessi, M. C., … Cuisset, T. (2013). Effect Of Motivational Mobile Phone Short Message Service On Aspirin Adherence After Coronary Stenting For Acute Coronary Syndrome. International Journal of Cardiology, 168(1), 568–569. https://doi.org/10.1016/j.ijcard.2013.01.252.

Rahman, M., Abe, S. K., Rahman, S., Kanda, M., Narita, S., Bilano, V., … Shibuya, K. (2016). Maternal Anemia And Risk Of Adverse Birth And Health Outcomes In Low- And Middle-Income Countries : Systematic Review And Meta-Analysis. The American Journal of Clinical Nutrition, 103, 495–504. https://doi.org/10.3945/ajcn.115.107896.Am.

Republic of Indonesia Ministry of Health. (2016). Indonesian Health Profile. 7(771), 1–8. Retrieved from: https://doi.org/10.1111/evo.12990.

Republic of Indonesia Ministry of Health. (2014). Infodatin-Mother. Data and Information Center. Pdf.

Rimer, D. B. K., & Glanz, D. K. (2005). Theory at a Glance. AGuide For Health Promotion Practice. Rochon, D., Ross, M. W., Looney, C., Nepal, V. P., Price, A. J., & Giordano, T. P. (2011). Communication Strategies To Improve HIV Treatment Adherence. Health Communication, 26(5), 461–467. https://doi.org/10.1080/10410236.2011.554168.

Sharma, A., Adiga, S., & Ashok, M. (2014). Knowledge, attitude and practices related to dietary supplements and micronutrients in health sciences students. Journal of Clinical and Diagnostic Research, 8(8), 8–11. https://doi.org/10.7860/JCDR/2014/9329.4683.

Sulaeman, E. S. (2016). Learning Model and Health Behavior Theory Concepts and Applications. Surakarta: UNS Press. Edisi 1, Maret 2016.

Taye, B., Abeje, G., & Mekonen, A. (2015). Factors Associated With Adherence Of Prenatal Iron Folate Supplementation Among Women In Mecha District, Western Amhara: A Cross-Sectional Study. Pan African Medical Journal, 20, 1–7. https://doi.org/10.11604/pamj.2015.20.43.4894.

Tsegaye, A., & Tesfaye, G. (2014). Prevalence Of Anemia Among Pregnant Women In Ethiopia And Its Management: A Review. International Research Journal of Pharmacy, 5(10), 737–750. https://doi.org/10.7897/2230-8407.0510151.

Warren-Findlow, J., Seymour, R. B., & Shenk, D. (2011). Intergenerational Transmission Of Chronic Illness Self-Care: Results From The Caring For Hypertension In African American Families Study. Gerontologist, 51(1), 64–75. https://doi.org/10.1093/geront/gnq077.

World health Organization. (2003). A D H E R E N C E TO LO N G - T E R M T H E R A P I E S World Health Organization 2003.

WHO. (2011). The Global Prevalence Of Anaemia in 2011.

WHO. (2015). Health in 2015 from MDGs to SDGs. World Health Organization, ISBN 978 9. Retrieved from: https://www.who.int/gho/publications/mdgs-sdgs/en/.

Wolf, M. S., Davis, T. C., Osborn, C. Y., Skripkauskas, S., Bennett, C. L., & Makoul, G. (2007). Literacy, self-efficacy, and HIV medication adherence. Patient Education and Counseling, 65(2), 253–260. https://doi.org/10.1016/j.pec.2006.08.006


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Dewi, D. T. K., Kusumawati, W., & Ismarwati, I. (2019). Effect of health promotion and Whatsapp reminder to self-efficacy of the consumption of Fe tablets adherence among pregnant women. Journal of Health Technology Assessment in Midwifery, 2(1), 23–32. https://doi.org/10.31101/jhtam.683