Currently submitted to: JMIR Public Health and Surveillance
Date Submitted: Mar 27, 2025
Open Peer Review Period: Mar 27, 2025 - May 22, 2025
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Determinants of Health-Promoting Behaviors Among Indonesian Adolescents Living in Child Welfare Institutions: A Structural Equation Modeling Study
ABSTRACT
Background:
Adolescents in child welfare institutions often experience challenges in adopting health-promoting behaviors (HPB), which leads to significant health vulnerabilities.
Objective:
This study aimed to identify the HPB of adolescents in child welfare institutions and the determinants influencing them, using the Health Promotion Model.
Methods:
A cross-sectional design was employed. A total of 276 adolescents from 17 child welfare institutions in East Java Province, Indonesia, participated in this study. Structural equation modeling was utilized to examine the relationships among the determinants.
Results:
HPB had a positive correlation with health literacy (r=0.13, P<.05), self-esteem (r=0.31, P<.001), perceived self-efficacy (r=0.66, P<.01) and social support (r=0.53, P<.01), and a negative correlation with perceived barriers to action (r=-0.15, P<.05). In the final model, both perceived self-efficacy and social support accounted for 47.9% of HPB. In addition, perceived barriers to action were influenced by health literacy (β=-0.234, P<.001), self-esteem (β=-0.194, P<.01), and perceived self-efficacy (β=-0.185, P<.01). Self-esteem indirectly affected HPB through perceived self-efficacy (β= 0.099, P<.01) and social support (β= 0.078, P<.001).
Conclusions:
To improve the HPB of adolescents in these institutions, their self-esteem needs to be increased in order to further enhance their self-efficacy and social support. Careful attention and monitoring of HPB among these adolescents may lead to better health outcomes and support their transition from child welfare institutions to the broader community.
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