Effectiveness of Game Health Education Anemia (GHEA) Guided by the Health Belief Model on Improving Knowledge and Attitudes Toward Iron-Deficiency Anemia Prevention Among Adolescent Girls: A Quasi-Experimental Study
DOI:
https://doi.org/10.55018/janh.v7i3.448Keywords:
Adolescent, Anemia, Iron-Deficiency, Health Knowledge, Attitudes, Practice, Health Education, GamesAbstract
Background: Iron-deficiency anemia (IDA) remains a significant health problem among adolescent girls, affecting growth, academic achievement, and reproductive health. Traditional education methods like lectures and booklets are often less engaging and ineffective in changing behavior. Few studies have tested gamified, theory-based health education for anemia prevention in Indonesian adolescents. This study evaluated the effectiveness of the Game Health Education Anemia (GHEA) compared with a Digital Pocket Book in improving knowledge and attitudes toward IDA prevention among adolescent girls.
Methods: A quasi-experimental study, guided by the Health Belief Model (HBM) and reported according to the TREND checklist, was conducted at SMP Islam Ma’arif 02 Malang, Indonesia, in June 2025. Sixty female adolescents were selected through purposive sampling based on power analysis (effect size = 1.12, α = 0.05, power = 0.95). Inclusion criteria were female students aged 12–18 years, healthy, and owning a digital device; exclusion criteria were prior exposure to digital anemia education or incomplete participation. Participants were equally assigned to an intervention group (GHEA) and a control group (the Digital Pocket Book). Data were collected using a validated questionnaire and analyzed with Wilcoxon signed-rank, paired t-, and Mann–Whitney U tests at a 0.05 significance level.
Results: The mean age of participants was 14 years (range 13–15). The GHEA group showed significant improvements in knowledge (Z = -4.847, p < 0.001) and attitudes (Z = -4.275, p < 0.001), while the control group showed smaller yet significant gains. Between-group analysis revealed higher post-test scores in the intervention group for both knowledge (Z = -5.284, p < 0.001) and attitudes (Z = -3.081, p = 0.002).
Conclusion: The GHEA intervention was more effective than the Digital Pocket Book in improving adolescents’ knowledge and attitudes toward IDA prevention, indicating that gamification-based education can serve as an engaging and effective tool for school-based health promotion
Downloads
References
Abu-Baker, N. N., Eyadat, A. M., & Khamaiseh, A. M. (2021). The impact of nutrition education on knowledge, attitude, and practice regarding iron deficiency anemia among female adolescent students in Jordan. Heliyon, 7(2). https://doi.org/10.1016/j.heliyon.2021.e06348
Adhi, K. T., & Asmin, M. L. P. (2024). Determinan kejadian anemia pada remaja putri usia 15-24 tahun pada daerah pedesaan di indonesia (Analisis Data Riskesdas 2018). Archive of Community Health, 11(1), 17. https://doi.org/10.24843/ach.2024.v11.i01.p02
Adiati, C. C., Firdaus, R., & Nurwahidin, M. (2023). Efektivitas video animasi terhadap hasil belajar siswa. Akademika, 12(01), 69–81. https://doi.org/10.34005/akademika.v12i01.2663
Adipat, S., Laksana, K., Busayanon, K., Ausawasowan, A., & Adipat, B. (2021). Engaging students in the learning process with game-based learning: the fundamental concepts. International Journal of Technology in Education, 4(3), 542–552. https://doi.org/10.46328/ijte.169
Aggrawal, S., & Boowuo, H. (2023). Enhancing teamwork through games: a systematic literature review. 2023 IEEE Frontiers in Education Conference (FIE), 1–9. https://doi.org/10.1109/FIE58773.2023.10343284
Allifah Vakhroh, D., Bayu, A., & Nandiyanto, D. (2022). Open global scientific journal education regarding the importance of maintaining mental health and immune in generation z through digital-based learning media. 01(May), 14–20.
Aloi, M. A., Caldwell, P. H. Y., Taba, M., Kang, M., Skinner, S. R., Bray, L., & Scott, K. M. (2025). Co-designing an online educational resource to help adolescents improve their digital health literacy. BMC Public Health, 25(1), 1870. https://doi.org/10.1186/s12889-025-22949-0
Alzghoul, B. (2024). The effectiveness of gamification in changing health-related behaviors: a systematic review and meta-analysis. The Open Public Health Journal, 17(1). https://doi.org/10.2174/0118749445234806240206094335
Andani, S. V. I., Mahmudiono, T., & Adhela, Y. D. (2021). Health belief application model: knowledge and patterns of iron source food consumption as a preventive effort foanemia events. The Indonesian Journal of Public Health, 16(3), 461–471. https://doi.org/10.20473/ijph.v16i3.2021.461-471
Aschentrup, L., Steimer, P. A., Dadaczynski, K., Mc Call, T., Fischer, F., & Wrona, K. J. (2024). Effectiveness of gamified digital interventions in mental health prevention and health promotion among adults: a scoping review. BMC Public Health, 24(1), 69. https://doi.org/10.1186/s12889-023-17517-3
Febrianti, K. D., Ayu, W. C., Anidha, Y., & Mahmudiono, T. (2023). Effectiveness of nutrition education on knowledge of anemia and hemoglobin level in female adolescents aged 12-19 years: a systematic reviews and meta-analysis. Amerta Nutrition, 7(3), 478–486. https://doi.org/10.20473/amnt.v7i3.2023.478-486
Gardner, W. M., Razo, C., McHugh, T. A., Hagins, H., Vilchis-Tella, V. M., Hennessy, C., Taylor, H. J., Perumal, N., Fuller, K., Cercy, K. M., Zoeckler, L. Z., Chen, C. S., Lim, S. S., Aali, A., Abate, K. H., Abd-Elsalam, S., Abdurehman, A. M., Abebe, G., Abidi, H., … Kassebaum, N. J. (2023). Prevalence, years lived with disability, and trends in anaemia burden by severity and cause, 1990–2021: findings from the global burden of disease study 2021. The Lancet Haematology, 10(9), e713–e734. https://doi.org/10.1016/S2352-3026(23)00160-6
Ghadam, O. S., Sohrabi, Z., Mehrabi, M., Fararouei, M., Shahraki, M., Hejazi, N., Clark, C. C. T., Mehrabani, S., Gerami, S., & Nouri, M. (2023). Evaluating the effect of digital game‐based nutrition education on anemia indicators in adolescent girls: a randomized clinical trial. Food Science & Nutrition, 11(2), 863–871. https://doi.org/10.1002/fsn3.3120
Gkintoni, E., Vantaraki, F., Skoulidi, C., Anastassopoulos, P., & Vantarakis, A. (2024). Promoting physical and mental health among children and adolescents via gamification—a conceptual systematic review. Behavioral Sciences, 14(2), 102. https://doi.org/https://doi.org/10.3390/bs14020102
Glass, S., & Galati, A. (2025). Advancements and challenges in methodological approaches for game-based health interventions: a scoping review. Frontiers in Digital Health, 7(March), 1–19. https://doi.org/10.3389/fdgth.2025.1561422
Helmyati, S., Syarifa, C. A., Rizana, N. A., Sitorus, N. L., & Pratiwi, D. (2024). Acceptance of iron supplementation program among adolescent girls in indonesia: a literature review. Amerta Nutrition, 7(3SP), 50–61. https://doi.org/10.20473/amnt.v7i3SP.2023.50-61
Hidayanty, H., Nurzakiah, N., Irmayanti, I., Yuliana, Y., Helmizar, H., & Yahya, Y. (2025). Perceived barriers and enablers for taking iron–folic acid supplementation regularly among adolescent girls in indonesia: a pilot study. International Journal of Environmental Research and Public Health, 22(2), 209. https://doi.org/10.3390/ijerph22020209
Huang, J., Zou, Y., Huang, W., Zhou, Y., Lin, S., Chen, J., & Lan, Y. (2020). Factors associated with physical activity in elderly nursing home residents: a path analysis. BMC Geriatrics, 20(1), 274. https://doi.org/10.1186/s12877-020-01676-8
IDN Research Institute. (2025). Indonesia Millennial and Gen Z Report 2025. https://doi.org/10.18356/d60ac2d9-en
Indriasari, R., Mansur, M. A., Srifitayani, N. R., & Tasya, A. (2022). Pengetahuan, sikap, dan tindakan terkait pencegahan anemia pada remaja berlatarbelakang sosial-ekonomi menengah ke bawah di makassar. Amerta Nutrition, 6(3), 256–261. https://doi.org/10.20473/amnt.v6i3.2022.256-261
Jayanti, C., & Anggraeni, O. A. (2025). The role of social support in iron folic acid supplement adherence among adolescent girls in a public junior high school in jakarta. Contagion: Scientific Periodical Journal of Public Health and Coastal Health, 7(1), 186. https://doi.org/10.30829/contagion.v7i1.24085
Kolarš, B., Mijatović Jovin, V., Živanović, N., Minaković, I., Gvozdenović, N., Dickov Kokeza, I., & Lesjak, M. (2025). Iron deficiency and iron deficiency anemia: a comprehensive overview of established and emerging concepts. Pharmaceuticals, 18(8), 1104. https://doi.org/10.3390/ph18081104
Loury Priskila, Hendi Wicaksono, Mikha Jhonatan, Emmanuel Vito Pandya Arkananta, Mahanani Yekti Putri Sion Warsito, Giovanno Surya Honesto, Benediktus Satria, & Daniel Christian. (2025). Anemia pada remaja: kajian pustaka. MEDICINUS, 38(5), 19–28. https://doi.org/10.56951/vyn29h03
Mancone, S., Corrado, S., Tosti, B., Spica, G., & Diotaiuti, P. (2024). Integrating digital and interactive approaches in adolescent health literacy: a comprehensive review. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1387874
Muzayyana, A., & Aini, Q. (2024). Bibliometric analysis of the health belief model in healthcare workers: trends, insights, and future directions. Journal of Angiotherapy, 8(5). https://doi.org/10.25163/angiotherapy.859698
Nurbavliyev, O., Kaymak, S., & Sydykov, B. (2022). The effect of active learning method on students’ academic success, motivation and attitude towards mathematics. Journal of Language and Linguistic Studies, 18(2), 701–713. www.jlls.org
Nuryana, H., Rachmawati, E., Khusun, H., Mulyawati, D. A., & Lestari, H. (2025). Efektifitas buku saku digital untuk transformasi pengetahuan dan sikap remaja putri tentang pencegahan anemia. Amerta Nutrition, 9(1), 161–168. https://doi.org/10.20473/amnt.v9i1.2025.161-168
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328–335. http://www.jstor.org/stable/45240621
Sailer, M., & Homner, L. (2020). The gamification of learning: a meta-analysis. Educational Psychology Review, 32(1), 77–112. https://doi.org/10.1007/s10648-019-09498-w
Samson, K. L. I., Fischer, J. A. J., & Roche, M. L. (2022). Iron status, anemia, and iron interventions and their associations with cognitive and academic performance in adolescents: a systematic review. Nutrients, 14(1), 224. https://doi.org/10.3390/nu14010224
Sari, P., Herawati, D. M. D., Dhamayanti, M., Ma’ruf, T. L. H., & Hilmanto, D. (2022). The effect of mobile health (m-health) education based on wanter application on knowledge, attitude, and practice (kap) regarding anemia among female students in a rural area of indonesia. Healthcare, 10(10), 1933. https://doi.org/10.3390/healthcare10101933
Shofiyyah, N. A., Asep Muharam, Illa Susanti, & Anne Nurdiana. (2024). Exploring the power of storytelling: enhancing engagement and learning outcomes among adolescents. Indo-MathEdu Intellectuals Journal, 5(1), 990–1006. https://doi.org/10.54373/imeij.v5i1.847
Triantafyllou, S. A., Georgiadis, C., & Sapounidis, T. (2025). Gamification in education and training: a literature review. International Review of Education, 71(3), 483–517. https://doi.org/10.1007/s11159-024-10111-8
UNICEF. (2023). Adolescent nutrition programme aksi bergizi: from district pilot to national scale-up. In Unicef Indonesia. https://www.unicef.org/
van Gaalen, A. E. J., Brouwer, J., Schönrock-Adema, J., Bouwkamp-Timmer, T., Jaarsma, A. D. C., & Georgiadis, J. R. (2021). Gamification of health professions education: a systematic review. Advances in Health Sciences Education, 26(2), 683–711. https://doi.org/10.1007/s10459-020-10000-3
Wang, A. I., & Tahir, R. (2020). The effect of using kahoot! for learning – a literature review. Computers & Education, 149, 103818. https://doi.org/10.1016/j.compedu.2020.103818
Wang, L., Liang, D., Huangfu, H., Shi, X., Liu, S., Zhong, P., Luo, Z., Ke, C., & Lai, Y. (2024). Iron deficiency: global trends and projections from 1990 to 2050. Nutrients, 16(20), 3434. https://doi.org/10.3390/nu16203434
WHO. (2023). Anemia. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/ANAEMIA
Zewdie, A., Mose, A., Sahle, T., Bedewi, J., Gashu, M., Kebede, N., & Yimer, A. (2022). The health belief model’s ability to predict covid-19 preventive behavior: a systematic review. SAGE Open Medicine, 10. https://doi.org/10.1177/20503121221113668
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Imam Nur Fauzi, Kumboyono Kumboyono, Fransiska Imavike Fevriasanty
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
