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

Authors

  • 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

DOI:

https://doi.org/10.30829/contagion.v8i3.28425

Abstract

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

References

Akande, T. M., Olumide, A. O., Adeniran, A. S., & Oyetunde, O. (2025). Male support for family planning and contraceptive use by their partners during the COVID-19 pandemic in selected states in Nigeria : a qualitative explorative study. Reproductive Health, 22, 1–13. https://doi.org/https://doi.org/10.1186/s12978-025-02230-8

Anik, A. I., Islam, R., & Rahman, S. (2022). Association between socioeconomic factors and unmet need for modern contraception among the young married women: A comparative study across the low- and lower-middle-income countries of Asia and Sub-Saharan Africa. PLOS Global Public Health, 23(1), 1–14. https://doi.org/10.1371/journal.pgph.0000731

Aventin, Á., Robinson, M., Hanratty, J., Keenan, C., Hamilton, J., Ruane, E., Mark, M., Clarke, M., Bonell, C., & Lohan, M. (2023). Involving men and boys in family planning : A systematic review of the effective components and characteristics of complex interventions in low ‐ and middle ‐ income countries. Campbell Systematic Reviews, 19, 1–45. https://doi.org/10.1002/cl2.1296

Badan Kependudukan dan Keluarga Berencana Nasional. (2023). Laporan kinerja program keluarga berencana nasional tahun 2023.

Belachew, T. B., Negash, W. D., Bitew, D. A., & Asmamaw, D. B. (2023). Modern contraceptive utilisation and its associated factors among reproductive age women in high fertility regions of Ethiopia : a multilevel analysis of Ethiopia Demographic and Health Survey. BMJ Open, 13(2), 9–11. https://doi.org/10.1136/bmjopen-2022-066432

Dinas Kesehatan Kota Medan. (2023). Profil kesehatan Kota Medan tahun 2023.

Dwomoh, D., Amuasi, S. A., Amoah, E. M., Gborgbortsi, W., & Tetteh, J. (2022). Exposure to family planning messages and contraceptive use among women of reproductive age in sub ‑ Saharan Africa : a cross ‑ sectional program impact evaluation study. Scientific Reports, 12, 1–11. https://doi.org/10.1038/s41598-022-22525-1

Fahlevie, R., Anggraini, H., & Turiyani, T. (2022). Hubungan Umur, Paritas, dan Tingkat Pendidikan Terhadap Penggunaan Metode Kontrasepsi Jangka Panjang (MKJP) di Rumkitban Muara Enim Tahun 2020. Jurnal Ilmiah Universitas Batanghari Jambi, 22(2), 706. https://doi.org/10.33087/jiubj.v22i2.1679

Gebremeskel, F., Estifanous, W., Gizachew, Y., Jemal, S., Atnafu, N., & Nuriye, K. (2020). Utilization of Family Planning Methods and Associated Factors Among Reproductive-Age Women with Disability in Arba Minch Town ,. Open Access Journal of Contraception, 11, 25–32. https://doi.org/https://doi.org/10.2147/OAJC.S240817

Gusman, A. P., Magdalena, M., Duka, T., Manek, B. D., & Ilma, N. N. (2025). Hubungan Dukungan Suami dan Peran Petugas Kesehatan Terhadap Pemilihan Alat Kontrasepsi Jangka Panjang pada Wanita Usia Subur di Polindes Kefa Utara Sekolah Tinggi Ilmu Kesehatan Maranatha Kupang , Indonesia Politeknik Kesehatan Kemenkes Kupang , Indonesi. Quantum Wellness : Jurnal Ilmu Kesehatan, 2(2), 1–9. https://doi.org/https://doi.org/10.62383/quwell.v2i2.2051

Harnanto, A. M., Sunarto, S., & Sumardino, S. (2023). Application of the PRECEDE-PROCEED Model in the Development of Community-Based Daily Emergency First Aid Management Training. Jurnal Keperawatan Global, 8(2), 126–136. https://doi.org/https://doi.org/10.37341/jkg.v8i2.799

Keogh, S. C., Otupiri, E., Castillo, P. W., Li, N. W., Apenkwa, J., & Polis, C. B. (2021). Contraceptive and abortion practices of young Ghanaian women aged 15 – 24 : evidence from a nationally representative survey. Reproductive Health, 18(1), 1–18. https://doi.org/10.1186/s12978-021-01189-6

Makumbi, F. E., Nabukeera, S., Tumwesigye, N. M., Namanda, C., Atuyambe, L., Mukose, A., Ssali, S., Ssenyonga, R., Tweheyo, R., Gidudu, A., Sekimpi, C., Hashim, C. V., Nicholson, M., & Ddungu, P. (2023). Socio ‑ economic and education related inequities in use of modern contraceptive in seven sub ‑ regions in Uganda. BMC Health Services Research, 23, 1–16. https://doi.org/10.1186/s12913-023-09150-y

Negash, W. D., Eshetu, H. B., & Asmamaw, D. B. (2022). Predictors of modern contraceptive use among reproductive age women in high fertility countries in sub ‑ Saharan Africa : evidence from demographic and health surveys. BMC Women’s Health, 1–10. https://doi.org/10.1186/s12905-022-02121-1

Population Reference Bureau. (2024). Percent of married women ages 15–49 using contraception (modern methods). https://www.prb.org/international/indicator/fp-all/

Poudel, S., Dobbins, T., Razee, H., & Akombi-inyang, B. (2023). Adolescent Pregnancy in South Asia : A Pooled Analysis of Demographic and Health Surveys. International Journal of Environmental Research and Public Health (IJERPH), 20, 1–14. https://doi.org/https://doi.org/10.3390/ijerph20126099

Rahmawani, R., & Musniati, N. (2025). Program Studi Kesehatan Masyarakat , Fakultas Ilmu-Ilmu Kesehatan , Universitas Muhammadiyah Prof . DR . HAMKA PENDAHULUAN Jumlah penduduk Indonesia pada November 2024 tercatat sebanyak 281 , 6 jiwa pada tahun 2022 ( BPS , 2024 ). Kondisi ini menyebabkan. Jurnal Pendidikan Kesehatan, 5(2), 195–202. https://doi.org/https://doi.org/10.64931/jks.v5i2.165

Rizkianti, A., Kistiana, S., Fajarningtiyas, D. N., Hutasoit, E. F., Baskoro, A. A., Maryani, H., Titisari, A. S., Sari, D. P., Naibaho, M. M. P., Melissa, M., & Muthmainnah, M. (2024). Understanding the association between family planning and fertility reduction in Southeast Asia : a scoping review. BMJ Open, 14(6), 1–10. https://doi.org/10.1136/bmjopen-2023-083241

Sari, S. N., Sirait, S. E., & Tarigan, I. (2024). Hubungan Sosial Ekonomi dengan Penggunaan Alat Kontrasepsi Jangka Panjang (MKJP) di Puskesmas Labuhan Deli Kabupaten Deli Sedang. Jurnal Sadewa : Publikasi Ilmu Pendidikan, Pembelajaran Dan Ilmu Sosial, 2(4), 1–7. https://doi.org/https://doi.org/10.61132/sadewa.v2i3.1263

Tampah-naah, A. M., Yendaw, E., & Sumankuuro, J. (2023). Residential status and household wealth disparities in modern contraceptives use among women in Ghana : a cross-sectional analysis. BMC Women’s Health, 23, 1–11. https://doi.org/https://doi.org/10.1186/s12905-023-02684-7

Tesema, Z. T., Tesema, G. A., & Boke, M. M. (2022). Determinants of modern contraceptive utilization among married women in sub ‑ Saharan Africa : multilevel analysis using recent demographic and health survey. BMC Women’s Health, 22, 1–11. https://doi.org/https://doi.org/10.1186/s12905-022-01769-z

United Nations, Department of Economic and Social Affairs, P. D. (2025). World Urbanization Prospects 2025 (Summary of). United Nations. https://population.un.org/wpp/

United Nations Population Fund. (2024). State of world population report 2024.

World Health Organizations. (2024). Family planning: Global database on contraceptive use and unmet need. https://www.who.int/data/gho

Yadassa, F., Tura, G., & Birhanu, Z. (2026). A community-based contraceptive education intervention study on inter-spousal communication , approval , and support for contraceptive use among married couples in selected districts of Jimma zone , southwest. Journal of Health, Population and Nutrition, 45, 1–15. https://doi.org/https://doi.org/10.1186/s41043-026-01305-x

Yulihah, Y., Ginting, A. S. br, & Istiana, I. (2023). Pengaruh Pengetahuan Dan Dukungan Suami Dengan Penggunaan Alat Kontrasepsi Dalam Rahim (AKDR) Pada Pasangan Usia Subur (Pus) Di Upt Puskesmas Mancak Tahun 2022. SENTRI: Jurnal Riset Ilmiah, 2(4), 1234–1242. https://doi.org/https://doi.org/10.55681/sentri.v2i4.729

Downloads

Published

2026-08-01

Issue

Vol. 8 No. 3 (2026): Contagion

Section

Articles

License

COPYRIGHT

Authors who publish with this journal agree to the following terms:

  1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-ShareAlike 4.0 International License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
  2. Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
  3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges as well as earlier and greater citation of published work (see The Effect of Open Access).
LICENSE

CONTAGION (Scientific Periodical Journal of Public Health and Coastal Health) is published under the terms of the Creative Commons Attribution-ShareAlike 4.0 International License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.