8 Suryaningrum et al.

, Media Gizi Indonesia (National Nutrition Journal)

Special Issue: The 3rd Bengkulu International Conference on Health (B-ICON 2023) 2024.19(1SP): 8–19
[Link]

THE EFFECT OF PROVIDING NUTRITIONAL COUNSELING ON

THE LEVEL OF KNOWLEDGE, ATTITUDES, AND COMPLIANCE
WITH FE TABLETS CONSUMPTION FOR PREGNANT WOMEN
WITH ANEMIA IN THE GROGOL COMMUNITY HEALTH CENTER
AREA
Aprilia Suryaningrum1, Firmansyah1*, Luluk Ria Rakhma1, Elida Soviana1
1 Department of Nutritional Sciences, Universitas Muhammadiyah Surakarta, Indonesia
*E-mail: fir790@[Link]

ABSTRACT
Anemia contributes to maternal mortality during pregnancy, with a 2021 prevalence of 5.02% in Grogol. Non-
compliance with Fe tablet consumption is a key factor. Nutritional counseling can effectively improve mothers’
knowledge, attitudes, and compliance with Fe tablet intake. This study examines the impact of nutritional counseling
on knowledge, attitudes, and compliance with Fe tablet consumption among anemic pregnant women at Grogol
Community Health Center. Using a pre-experimental one-group pre-post-test design, 35 anemic pregnant women
in their second and third trimesters were randomly sampled from clinic records. They received 15-20 minutes of
counseling with leaflets. Knowledge and attitudes were assessed via interviews and questionnaires, while compliance
was measured using the pill count formula. The Wilcoxon Signed Rank Test evaluated changes from baseline to post-
counseling. Nutritional counseling increased knowledge (28.60%), attitudes (17.10%), and compliance (22.80%).
Significant improvements were found in knowledge (p=0.001), attitude (p=0.001), and Fe tablet compliance (p=0.002).
Nutritional counseling at the Grogol Community Health Center should be provided periodically to carry out promotive
and preventive functions in the incidence of anemia in pregnant women.

Keywords: Anemic pregnant women, compliance, nutrition counseling, knowledge, attitude, fe tablets

INTRODUCTION Anemia that occurs during pregnancy can

Nowadays, anemia during pregnancy is still a increase the risk of maternal and child death, the
health problem which is a contributing factor to the emergence of infectious diseases, premature birth
high maternal mortality rate which is often referred of the baby, and disruption of the growth and
to as “Potential Danger to Mother and Child”. development process of the fetus, either when
According to the World Health Organization the baby is still in the womb or after it is born
(2017), the incidence of anemia in pregnant women (Ministry of Health of the Republic of Indonesia,
in 2016 had a prevalence of around 40% globally, 2021). One preventive measure to reduce the
while in 2019 the global prevalence rate of anemia incidence of anemia in pregnant women that can be
in pregnant women was around 36.5% (WHO, done is by administering red blood cell supplement
2021). This shows that the incidence of anemia tablets (TTD) during pregnancy in a minimum
in pregnant women is still quite high worldwide. quantity of 90 TTD, where one tablet contains iron
The results of Basic Health Research (Riskesdas) (ferrous fumarate which is equivalent to 60 mg of
in 2018 showed that the 2018 prevalence rate of elemental iron) and 0.4 mg of folic acid (Ministry
pregnant women with anemia in Indonesia was of Health of the Republic of Indonesia, 2021).
48.9%. The rate experienced a quite high increase The prevalence of administering 90 TTD in
compared to that of 2013 with a prevalence of the Grogol Community Health Center area in 2021
37.1% (Ministry of Health of the Republic of is 92.23%. This prevalence has met the target when
Indonesia, 2018). The prevalence of anemia in it is compared with the achievement in Sukoharjo
pregnant women in 2021 in the Grogol Community Regency, namely > 90%. However, several villages
Health Center area was 5.02% (Grogol Community such as Telukan Village with a percentage of
Health Center, 2021). 88.76%, Parangjoro 70.71%, Pondok 78.37%,

©2024. The formal legal provisions for access to digital articles of this electronic journal are subject to the terms of the Creative Commons-
Attribution-NonCommercial-ShareAlike license (CC BY-NC-SA 4.0). Received 23-12-2023, Accepted 20-06-2024, Published online 30-06-2024.
Suryaningrum et al., Media Gizi Indonesia (National Nutrition Journal) 9
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Langenharjo 68.41%, and Gedangan with a Community Health Center II area also shows that
percentage of 87.70% still have a prevalence below there is an influence of nutritional counseling on
90% (unfulfilled) (Grogol Health Center, 2021). the consumption of Fe tablets with a percentage of
This shows that the provision of 90 Fe tablets for 76.2% in the treatment group after the treatment in
pregnant women in the Grogol Community Health the form of nutritional counseling.
Center area has not been carried out optimally Based on the preliminary survey, researchers
because those villages have not reached the 90% interviewed 10 anemic pregnant women. The
target. results showed that 70% of the respondents stated
Nutritional counseling can be an effective way that they did not regularly consume Fe tablets and
to increase maternal knowledge which is expected in one week only consumed Fe tablets < 3 times/
to have a positive influence on awareness and week. Then, 50% of the respondents stated that
compliance with the consumption of Fe tablets in the reason for not routinely consuming them was
pregnant women so that anemia during pregnancy that they felt they had only consumed the vitamins
can be prevented and treated before delivery. Djati, given by the obstetrician and ignored the Fe tablets
et al (2017) stated that the occurrence of two- from the health center. This shows that one of the
way communication in counseling between the factors causing anemia is that pregnant women are
counselor and the client means that mothers have not compliant with consuming Fe tablets during
more opportunities to ask questions so that the pregnancy.
information they need is more precise and meets This study aimed to determine the effect of
their needs. In addition, mothers’ motivation can nutritional counseling on the level of knowledge,
be strengthened through counseling causing an attitudes, and compliance with the consumption of
increase in compliance with the consumption of Fe tablets among pregnant women with anemia in
Fe tablets during pregnancy. Besides, individuals’ the Grogol Community Health Center area.
inner perceptions can be more convincing in
providing an action plan through counseling. METHODS
According to the health belief model theory
proposed by Strecher & Rosenstock (1997), the This study utilized pre-experimental with a
presence of good or bad perceptions originating group pretest and posttest design in which there
from knowledge, experience, or information can was no control group. This research was carried
provide confidence so that individuals are aware out in the working area of the Grogol Community
to view something. Knowledge plays an important Health Center, Grogol District, Sukoharjo Regency
role in determining the level of consumption of on 16 December 2022 - 28 February 2023. The
Fe tablets because it can influence the attitude of population in this study were all pregnant women
pregnant women. If pregnant women’s knowledge registered in the Grogol Community Health Center
is lacking, it can cause individuals’ less optimal area in 2022 with inclusion criteria including
health behavior to prevent anemia (Shofiana, et al, pregnant women with trimester anemia II and III,
2018). Accordingly, counseling can be a strategy pregnant women who lived in the research area for
for changing social behavior and communication approximately 6 months, pregnant women who did
by influencing actions that can be observed and not work as a health worker, pregnant women who
measured to improve health status (Juma et al, received Fe tablets from the community health
2015). center, the distance between the current pregnancy
Purbowati’s (2016) research result in the and the previous pregnancy was > 2 years. The
working area of the Kedaung Wetan Community exclusion criteria included pregnant women who
Health Center, Tangerang City, shows that there is did not complete all questionnaires and did the
an increase in compliance with the consumption of post-test. The sample used in this research was
Fe tablets after providing nutritional counseling in 35 respondents. Sampling was carried out using a
the treatment group after the nutritional counseling simple random sampling technique.
process with a percentage of 89.7%. Research The independent variable in this research is
conducted by Djati, et al (2017) in the Sumpiuh the provision of nutritional counseling, while the
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dependent variable in this research is the level of meaning of anemia, characteristics of anemia,
knowledge, attitude, and level of compliance with causes of anemia during pregnancy, the impact
the consumption of Fe tablets. Data collection of anemia, steps to prevent anemia, the meaning
in this study was carried out through interviews of Fe tablets, the importance of consuming Fe
and pre-post test questionnaires consisting of 20 tablets during pregnancy, the ways to consume
statements regarding anemia and the importance Fe tablets, kinds of food consumption to limit and
of consuming Fe tablets for the level of knowledge avoid during pregnancy; 6) conducting a question
and 28 statements regarding consuming Fe tablets and answer session with respondents regarding the
for attitudes. The level of compliance was taken respondents’ eating habits, respondent complaints
using the calculation method using the pill count (reasons for non-compliance), how the respondent
formula and the use of a checklist instrument consumes Fe tablets, and repeating questions
in the KIA book containing a table of Fe tablet regarding counseling material; 7) expressing
consumption schedules. The level of knowledge gratitude for the respondents’ availability in
was scored using the Guttman scale. If the answer attending counseling sessions.
is correct, the score is 1. If it is incorrect, the score In this study, univariate analysis consisted
is 0. The total score obtained was divided by the of maternal age, gestational age, educational
number of questions, then multiplied by 100 to background, employment, maternal anemia status,
obtain a result in the form of a percent value. knowledge, attitudes, and compliance of pregnant
The knowledge category can be said to be good mothers in consuming Fe tablets in the form of
if the respondents can answer 15-20 statements a frequency and percentage distribution table for
correctly. It is considered sufficient if they answer each variable in the SPSS program. Analysis of the
8-14 statements correctly, and considered poor influence and differences in levels of knowledge,
if they answer 0-7 statements correctly. Attitude attitudes, and compliance to consuming Fe tablets
scoring was done using a Likert scale with five at the beginning and the end using the Wilcoxon
answer categories. The score of positive statements Signed Rank Test. Analysis of the relationship
(favorable) with the answer “Strongly Agree” is between variables used the Spearman Correlation
5, “Agree” is 4, “Undecided” is 3, “Disagree” Test. This research has received approval from
is 2, and “Strongly Disagree” is 1. The score for the Health Research Ethics Commission (KEPK)
negative statements (unfavorable) with the answers Faculty of Medicine, Muhammadiyah University
“Strongly Agree” is 1, “Agree” is 2, “Undecided” of Surakarta with ethical clearance No. 4744/B.1/
is 3, “Disagree” is 4, and “Strongly Disagree” KEPK-FKUMS/I/2023.
is 5. Attitude can be said to be positive if the
respondents’ T > T mean. It can be considered RESULTS AND DISCUSSION
as a negative attitude if the respondents’ T < T
mean. Compliance level scoring was obtained Table 1 shows a description of the
using the pill count calculation formula, where the characteristics of the respondents. Regarding
number of Fe tablets consumed was divided by the maternal age, the majority of respondents
number of Fe tablets received, then multiplied by experienced pregnancy in the early adulthood
100%. Consumption of Fe tablets can be said to be category, namely 26-35 years (48.60%), 22
compliant if the percentage is 100% in one month, respondents (62.90%) were in the second trimester
if <100% then it is said to be non-compliant. of their pregnancy, and 13 respondents (37.10%)
The steps for conducting nutritional were in the third trimester of their pregnancy. The
counseling are as follows: 1) Greeting and doing a majority of respondents had their highest education
self-introduction to the respondents; 2) explaining at high school or vocational school level (74.30%),
the purpose and benefits of nutritional counseling; did not work or were housewives (68.60%), and
3) asking about the respondents’ availability; had mild levels of anemia, namely Hb levels in the
4) conveying the technical counseling which is range of 10-10.9 g/dl (74.30%).
carried out for 15-20 minutes; 5) explaining the Table 2 shows that there were differences in
material counseling using leaflets regarding the the level of knowledge, attitudes, and compliance
Suryaningrum et al., Media Gizi Indonesia (National Nutrition Journal) 11
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Table 1. Distribution of Characteristics of Pregnant with the consumption of Fe tablets before and after
Women with Anemia the administration of nutritional counseling, with a
Characteristic n % significant percentage increase in the level of good
Maternal age knowledge of 28.60%; positive attitude of 17.10%;
Late adolescents 12 34.30 and compliance with Fe tablet consumption was
Early adulthood 17 48.60 22.80%.
Late adulthood 6 17.10 Table 3 indicates that the average results of
Total 35 100.00 correct answers chosen by respondents before
Gestational age the administration of nutritional counseling on
Second trimester 22 62.90
indicators regarding anemia were <80%, while
Third trimester 13 37.10
on indicators regarding consumption of Fe tablets
Total 35 100.00
>80%. After nutritional counseling administration,
Educational background
respondents experienced an increase in each
Elementary education (Elementary
school [SD], Junior high school [SMP] 8 22.90 indicator, where each indicator had an average of
graduate) > 80%.
High school (Senior high school [SMA],
Vocational high school [SMK])
26 74.30 Table 4 shows that before the nutritional
Tertiary education (S1) 1 2.90
counseling process, the average respondents’
Total 35 100.00 answers, if rounded, had a score of 4 on the
Employment indicator of the importance of consuming Fe
Housewives 24 68.60 tablets and the side effects of consuming Fe tablets.
Labor 3 8.60 The average respondents’ answers on the indicator
Private employees 5 14.30 of how to consume Fe tablets and compliance
Self-employed 3 8.60 with consuming Fe tablets if rounded had a score
Total 35 100.00 of 3. After the nutritional counseling process, the
Anemia status average respondents’ answers to each indicator, if
Mild anemia 26 74.30
rounded, had a score of 4.
Moderate anemia 7 20.00
Table 5 shows the results of the bivariate
Severe anemia 2 5.70
analysis describing that p < 0.05 at the level of
Total 35 100.00
knowledge (p = 0.001); attitude (p = 0.001); and
compliance with Fe tablet consumption (0.002),
Table 2. Description of Level of Knowledge, where these results indicated that there was an
Attitudes, and Compliance with Fe Tablet influence of providing counseling on the level
Consumption of knowledge, attitudes, and compliance with Fe
Nutritional tablet consumption.
counseling Improvement
Table 6 shows that 23 respondents (65.72%)
Variables levels
Before After who had a good level of knowledge tended to
(%)
n % n % have a positive attitude, while 6 other respondents
Level of Knowledge (17.14%) had a negative attitude. A total of 4
Good 19 54.30 29 82.90 respondents (11.43%) who had a sufficient level
Sufficient 15 42.90 6 17.10 of knowledge also had a positive attitude, while
28.60
Poor 1 2.90 0 0.00 the other 2 respondents (5.71%) had a negative
Total 35 100 35 100 attitude. Based on the results of the correlation
Attitudes
analysis, the result was p = 0.516, meaning that
Positive 21 60.00 27 77.10
the level of knowledge had no relationship or
Negative 14 40.00 8 22.90 17.10
connection with the mothers’ attitudes because p
Total 35 100 35 100
> 0.05.
Compliance
Table 7 portrays that 25 respondents (71.43%)
Compliant 22 62.90 30 85.70
who had a good level of knowledge tended to
Non-compliant 13 37.10 5 14.30 22.80
be compliant in consuming Fe tablets during
Total 35 100 35 100
pregnancy, while 4 other respondents (11.43%)
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were not compliant in consuming Fe tablets. adulthood category, namely 26-35 years (48.60%),
A total of 5 respondents (14.28%) who had a where at this age a woman’s reproductive organs
sufficient level of knowledge were also compliant can be said to be mature and physically and
in consuming Fe tablets, while 1 other respondent mentally ready to conceive (Ministry of Health
(2.86%) was not compliant in consuming Fe of the Republic of Indonesia, 2014). However,
tablets. Based on the results of the correlation several respondents experienced pregnancies < 20
analysis, the result was p = 0.860, meaning that years, where if a woman is pregnant at < 20 years,
the level of knowledge had no relationship or the reproductive organs in her body are still in
connection with the level of compliance because the period of development and maturation of the
p > 0.05. reproductive system, so at this age, they tend to
Table 8 illustrates that 27 respondents still need more nutritional supplies compared to
(80.00%) who had a positive attitude tended to be pregnant women aged > 20 years. Apart from that,
compliant in consuming Fe tablets, 3 respondents several respondents also experienced pregnancies
(8.57%) who had a negative attitude were also > 35 years, where at this age the body’s immune
compliant in consuming Fe tablets, and 5 other system tends to decrease and start to enter a
respondents (14.29%) were not compliant degenerative period so that there is a greater risk
in consuming Fe tablets. Based on the results of experiencing health problems during pregnancy,
of the correlation analysis, the result was p = one of which is anemia (Rahmaniah & Linda,
0.001, meaning that the mothers’ attitudes had a 2019).
significant relationship or relationship with the Based on the characteristics of gestational
mothers’ level of compliance because p < 0.05. age, 22 respondents (62.90%) were in the second
trimester of their pregnancy, and 13 respondents
Characteristics of Pregnant Women (37.10%) were in the third trimester of their
Regarding maternal age, the majority of pregnancy. During pregnancy, blood thinning
respondents experienced pregnancy in the early reaches its maximum limit in the second and

Table 3. Percentage of Respondents’ Correct Answers to the Questionnaire of Knowledge

Levels of knowledge
Question Before After Increase levels
Indicators
number Mean Mean Mean (%)
Mean Item (%)
Total (%) Item (%) Total (%)
Side effects of consuming 13 37.14 77.14
Fe tablets 20 40.00 38.57 80.00 78.57 40.00
6 45.71 80.00
Causes of anemia 62.85 87.40 24.55
16 80.00 94.28
7 80.00 85.71
Ways of preventing anemia
12 48.57 64.28 85.71 85.71 21.43
Definition of anemia 17 68.57 68.57 85.71 85.71 17.14
Symptoms of anemia in 9 57.14 65.71
pregnant women 14 51.42 54.28 77.14 71.42 17.14
Impact of anemia during 10 91.42 91.42
pregnancy 18 51.42 71.42 80.00 85.71 14.29
2 85.71 100.00
The importance of
87.14 100.00 12.86
consuming Fe tablets 3 88.57 100.00

Ways of consuming Fe 4 77.14 94.28

tablets 5 80.00 81.90 85.71 91.42 9.52
8 88.57 94.28
Definition of Fe tablets 95.71 98.57 2.86

11 88.57 80.00
Administration of Fe tablets 84.28 85.71 1.43
15 80.00 91.42
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Table 4. Results of Respondents’ Answers to the Questionnaire of Attitudes

Attitudes
Question
Indicators Before After
number
Mean Item Mean Total Mean Item Mean Total
8 3.60 4.29
11 3.57 3.94
Ways of consuming Fe 13 3.91 4.20
4.03
tablets 18 2.43 3.74
3.42
15 3.71 4.00
22 3.31 4.03
4 3.94 4.43
14 4.20 4.34
The importance of 19 4.17 4.46
4.22
consuming Fe tablets 6 3.34 4.11
3.74
23 3.54 4.06
25 3.30 3.94
5 3.94 4.46
24 3.80 3.97
Side effects of consuming
7 3.69 3.86 3.85
Fe tablets
12 3.14 3.60 3.57
21 3.43 3.74
1 3.77 4.29
16 3.63 3.94
20 2.17 3.80
26 3.60 4.14
Compliance with Fe tablet
2 3.71 4.00 3.90
consumption
3 3.51 3.91
3.40
9 3.40 4.11
10 3.54 3.86
17 3.31 3.80

Table 5. Differences in Levels of Knowledge, Attitudes, and Compliance with Fe Tablet Consumption before and after
Nutrition Counseling
Variables Minimum Maximum Mean ± SD p-value
Level of knowledge
Before (%) 5.00 19.00 14.31 ± 3.47 0.001*
After (%) 14.00 20.00 17.46 ± 1.82
Level of Attitudes
Before 15.76 64.10 50.00 ± 10.00 0.001*
After 31.87 65.69 50.00 ± 10.00
Level of compliance
Before (%) 10.00 100.00 75.92 ± 35.07 0.002*
After (%) 16.67 100.00 91.68 ± 21.86

Notes: *Wilcoxon signed rank test

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Table 6. Attitudes of Pregnant Women with Anemia Based on Level of Knowledge After Nutrition Counseling
Attitudes
Total
Level of knowledge Positive Negative
p-value
n % n % n %
Good 23 65.72 6 17.14 29 82.86
Sufficient 4 11.43 2 5.71 6 17.14 0.516*
Total 27 77.15 8 22.85 35 100.00

Description: *Spearman Correlation

Table 7. Compliance Level of Pregnant Women with Anemia Based on Level of Knowledge After Nutrition
Counseling
Level of Attitudes
Total
Level of knowledge Compliant Non-Compliant p-value
n % n % n %
Good 25 71.43 4 11.43 29 82.86
Sufficient 5 14.28 1 2.86 6 17.14 0.860*
Total 30 85.71 5 14.29 35 100.00

Description: *Spearman Correlation

Table 8. Compliance Level of Pregnant Women with Anemia Based on Mothers’ Attitude After Nutrition
Counseling
Level of compliance Total
Attitudes Compliant Non-Compliant p-value
n % n % n %
Positive 27 80.00 0 0.00 27 80.00
Negative 3 8.57 5 14.29 8 20.00 0.001*
Total 30 85.71 5 14.29 35 100.00

Description: *Spearman Correlation

third trimesters or 5-8 months. As the mothers’ unemployed or housewives (68.60%). Employment
gestational age increases, the risk of suffering from is a factor related to economic status and income.
anemia becomes higher if it is not balanced with Pregnant women who do not work are at risk of
a balanced diet and regular consumption of Fe experiencing anemia because they tend to have
tablets (Herawati & Rusmiati, 2018). low incomes so they are less able to buy food
Based on the characteristics of maternal that contains enough iron, while pregnant women
education, the majority of respondents in this study who work tend to have better incomes so they can
had their final education at the high school or improve their health status, such as by consuming
vocational school level (74.30%). Education, most nutritious food more often and visiting health
of which is high school, influences the mothers’ facilities during pregnancy (Aminin & Dewi,
understanding and analytical power in receiving 2020). Families with low incomes also tend to
information (Fitrianingsih, et al, 2019). The higher influence mothers to disobey the consumption
individuals’ education level, the more open their of Fe tablets compared to families with higher
mindset can be in accepting new information so incomes (Agegnehu et al., 2019).
that it can have an impact on positive behavior Based on the characteristics of the anemia
toward fulfilling nutrition during pregnancy status of pregnant women, the majority of
(Herawati & Rusmiati, 2018). respondents experienced mild anemia, namely
Based on the characteristics of mothers’ Hb levels in the range of 10-10.9 g/dl (74.30%).
employment, the majority of respondents were Anemia during pregnancy has several impacts,
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such as increasing the risk of maternal and child counseling, 14.28% of respondents who were still
death, the emergence of infectious diseases, disobedient said they experienced nausea that led
premature birth, abortion (miscarriage), and can to vomiting so respondents did not want to force
affect the growth and development of the fetus, themselves to consume the Fe tablets based on the
both while it is still in the womb and after it is born dose recommended by health workers.
(Ministry of Health of the Republic of Indonesia, The availability of a checklist filled in on the
2021). Fe tablet consumption schedule in the KIA book
for pregnant women can also help them to take
Description of Knowledge, Attitudes, and Fe tablets so that it can help increase compliance.
Compliance of Pregnant Women This is also supported by research conducted by
Differences exist in the level of knowledge, Hadiyani and Yunidha (2019), showing that after
attitudes, and compliance with the consumption observations were made in the form of providing
of Fe tablets between before and after nutritional a checklist sheet for the Fe tablet consumption
counseling, with a significant percentage increase schedule which had to be filled out every day, 71%
in the level of good knowledge of 28.60%; positive of respondents became compliant in consuming Fe
attitude of 17.10%; and compliance with Fe tablet tablets.
consumption was 22.80%. The average results of correct answers chosen
Based on the results of interviews before the by respondents on the questionnaire of knowledge
nutritional counseling, 17.14% of respondents before the nutritional counseling on indicators
reasoned that they did not consume Fe tablets regarding anemia were <80%, while on indicators
because they felt they had routinely consumed regarding consumption of Fe tablets >80%.
vitamins or supplements given by obstetricians This indicated that the majority of respondents
and therefore they ignored the Fe tablets given had received fairly good information about the
by the community health center. This happened importance of consuming Fe tablets during
because respondents had the perception that the pregnancy, but still lacked information about
vitamins or supplements given by obstetricians anemia during pregnancy. After the nutritional
were considered better than the Fe tablets given counseling process, respondents experienced an
by the community health center. One capsule of increase in each indicator, where each indicator
the folamil genio type supplement consumed by had an average of > 80%. This showed that through
several respondents contained 1 mg of folic acid; nutritional counseling, respondents could find out
beta-carotene 10,000 IU; vitamin B1 3 mg; vitamin more information about anemia and the importance
B2 3.4 mg; nicotinamide 20 mg; vitamin B6 2 mg; of consuming Fe tablets during pregnancy.
Ca pantothenate 7.5 mg; Ca carbonate 100 mg; An increase in knowledge can also be
vitamin B12 4 mcg; vitamin D3 400 IU; vitamin influenced by educational factors. Most of the
K1 50 mcg; biotin 30 mcg; copper gluconate 0.1 respondents had their final education at the high
mg; Fe polymaltose complex (IPC) 30 mg; DHA school or vocational school level. Education, most
from algae 40 mg; and 8 mg arachidonic acid, of which is high school, can influence the mothers’
while the Fe tablets given by the community health understanding and analytical power in receiving
center only contain iron (ferrous fumarate which information (Fitrianingsih, et al, 2019). Education
is equivalent to 60 mg elemental iron) and 0.4 is a factor that influences maternal knowledge
mg folic acid (Ministry of Health of the Republic to know and understand appropriate nutritional
of Indonesia, 2021). Apart from that, 14.28% intake to meet the needs of the mother and fetus
of respondents who worked said they did not (Savadogo et al, 2014). The higher individuals’
regularly consume Fe tablets because they felt tired education level, the more open their mindset can
and sleepy at night so they forgot to take Fe tablets. be in accepting new information so that it can have
Another 5.71% of respondents complained of side an impact on positive behavior toward fulfilling
effects in the form of nausea when consuming Fe nutrition during pregnancy (Herawati & Rusmiati,
tablets, so they rarely consumed Fe tablets. Based 2018).
on the results of interviews after the nutritional
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In the questionnaire of attitude, before showing the influence of nutritional counseling

the nutritional counseling process, the average on pregnant women’s knowledge (p = 0.028) and
respondents’ answers, if rounded, had a score of 4 mothers’ attitudes (p = 0.001). Research from
on the indicators of the importance of consuming Kamau et al (2019), stated that during the research
Fe tablets and the side effects of consuming Fe the attitude of pregnant women in the intervention
tablets, showing that the majority of respondents group toward consuming iron-folic acid (IFAS)
already had a fairly positive attitude regarding the resulted in an overall positive change in attitudes.
importance of consuming Fe tablets. However, Research by Djati et al. (2017) also showed the
some respondents are still not compliant enough influence of counseling on compliance with blood
in consuming Fe tablets, where the average supplement tablet consumption (p = 0.002).
respondents’ answers to the indicator of how to This is also supported by research by Purbowati
consume Fe tablets and compliance with Fe tablet (2016), where there was an effect of providing
consumption, if rounded, had a score of 3. After nutritional counseling on compliance with iron
the nutritional counseling, the average respondents’ tablet consumption in the treatment group (p =
answers to each indicator, if rounded, had a score 0.001). Research by Berhane & Belachew (2022)
of 4. This showed that there was a positive increase also stated that providing education through
in the respondents’ attitudes, where the respondents counseling is effective in increasing compliance in
could accept any information provided well during consuming iron-folic acid supplements (IFAS) with
nutritional counseling so that it had an impact on a percentage increase of 42.6% in the intervention
their attitudes of being obedient in consuming Fe group. Providing education through counseling is
tablets. effective in increasing the knowledge of pregnant
By attending nutritional counseling sessions, women, encouraging a diet rich in iron, and
pregnant women become more familiar with the increasing consumption of IFA (iron folic-acid)
causes of problems and understand the nutritional tablets or Fe tablets (Nahrisah et al, 2020).
needs required during pregnancy, the impact Based on the results of the analysis of
of anemia during pregnancy, and the potential respondents’ attitudes, it shows that there was an
to overcome their health problems. If they feel improvement in respondents’ attitudes after the
that the behavior is not appropriate, then the nutritional counseling. In both before and after the
mothers are moved to be selective in choosing nutritional counseling, the majority of respondents
better behavior, which can have an impact on had positive attitudes (T score > 50). Respondents
increasing their attitudes toward consuming Fe were able to accept any information provided
tablets (Khairia, 2017). well, both by health workers before nutritional
counseling, and by researchers during nutritional
Differences in Levels of Knowledge, Attitudes, counseling. This was because health workers
and Compliance Before Fe Tablet Consumption were good enough at providing information about
and After Nutrition Counseling how to consume Fe tablets and the reasons for
Based on the results of bivariate analysis, the importance of consuming Fe tablets during
the results obtained were p < 0.05 at the level of pregnancy. In addition, most respondents were
knowledge (p = 0.001); attitude (p = 0.001); and currently pregnant with their second child, so they
compliance with Fe tablet consumption (0.002), already had experience with previous pregnancies.
where these results indicated that there was an According to Azwar (2013), something that
influence of providing counseling on the level an individual has experienced and is currently
of knowledge, attitudes and compliance with Fe experiencing plays a role in forming attitudes and
tablet consumption. These results were in line influencing appreciation of social stimuli.
with research results conducted by Khairia (2017) Counseling can be a strategy for changing
showing the influence of nutritional counseling social behavior and communication by influencing
on pregnant women’s knowledge (p = 0.000) and actions that can be observed and measured to
mothers’ attitudes (p = 0.000). This is also in line improve health status (Juma et al, 2015). An
with research conducted by Yanti et al. (2018), increase in understanding and knowledge
Suryaningrum et al., Media Gizi Indonesia (National Nutrition Journal) 17
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[Link]

can certainly have an impact on changes in good knowledge still had a low level of compliance
consumption patterns of foods that are nutritious in consuming blood supplement tablets.
and contain high Fe, as well as being more Based on the results of the correlation analysis
compliant in consuming Fe tablets. Through of the level of compliance based on the mothers’
counseling, pregnant women can change their attitude after nutritional counseling, the result was
attitudes and behavior to improve their nutritional p = 0.001, meaning that the mothers’ attitude had
status (Bara et al, 2015). Counseling can strengthen a significant relationship or relationship with the
the women’s motivation which is expected to mothers’ level of compliance because p < 0.05.
increase compliance in consuming Fe tablets This showed that a good understanding and self-
(Djati et al, 2017). If the mothers understand the awareness regarding the importance of consuming
importance of consuming Fe tablets well, then they Fe tablets during pregnancy can have an impact on
tend to try to improve themselves to comply with the mothers’ attitudes in taking action to comply
consuming Fe tablets regularly (Khairia, 2017). with consuming Fe tablets. The implementation
of health behavior was influenced by a positive
Correlation between Knowledge, Attitudes, and attitude to prevent anemia during pregnancy, one
Compliance After Nutrition Counseling of which was obediently consuming Fe tablets.
Based on the results of the correlation According to Notoatmodjo (2014), attitude is one
analysis of the mothers’ attitudes based on the of the factors that can influence health behavior.
level of knowledge after nutritional counseling, This is in line with research conducted by Utari
the result was p = 0.516, meaning that the level and Rahmad (2022) revealing that there was a
of knowledge had no relationship or connection relationship between attitude and compliance
with the mothers’ attitudes because p > 0.05. This with the consumption of Fe tablets in pregnant
could happen because the majority of respondents women with a result of p = 0.018. This is also
already had fairly good knowledge regarding supported by the health belief model theory put
information about the importance of consuming forward by Strecher & Rosenstock (1997), where
Fe tablets during pregnancy, but still lacked the presence of good or bad perceptions originating
information about anemia during pregnancy before from knowledge, experience, or information can
attending nutritional counseling. Apart from that, provide confidence which stimulates individuals
most of the respondents were also experiencing to do something, in this case, being obedient to
their second pregnancy, so respondents had more consuming Fe tablets.
experience with previous pregnancies. According
to Azwar (2013), something that an individual CONCLUSION
has experienced and is currently experiencing
There was a percentage increase in the level
plays a role in forming attitudes and influencing
of knowledge after the administration of nutritional
appreciation of social stimuli.
counseling (28.60%); attitude (17.10%); and
Based on the results of the correlation analysis
compliance with Fe tablet consumption (22.80%).
of the mothers’ level of compliance based on the
There is an effect of providing nutritional
level of knowledge after nutritional counseling,
counseling on the level of knowledge (p = 0.001);
the result was p = 0.860, meaning that the level
attitude (p = 0.001); and compliance with Fe tablet
of knowledge had no relationship or connection
consumption (p = 0.002). Health workers at the
with the level of compliance because p > 0.05.
Grogol Community Health Center are suggested to
This is in line with research conducted by Purwati
conduct nutritional counseling for every pregnant
and Dayani (2022). The research showed that
woman who experiences anemia even though the
there was no significant relationship between
pregnant woman’s Hb level is in the mild anemia
knowledge and compliance with consuming blood
category so that anemia during pregnancy can be
supplement tablets (p = 0.2008). These results are
treated early when the Hb is checked in the first
also supported by research conducted by Adnyana
trimester of pregnancy.
et al. (2020) revealing that respondents who had
18 Suryaningrum et al., Media Gizi Indonesia (National Nutrition Journal)
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[Link]

REFERENCES Hamil. Jurnal Stikes Mitra RIA Husada. 1(1):

Adnyana, G. A. N. W. S., Armini, N. W., dan 1-7.
Suarniti, N. W. 2020. Gambaran Pengetahuan Juma, M., Oiye, S. O., and Konyole, S. O. 2015.
Tentang Anemia dan Kepatuhan Remaja Dalam Predictors of Optimum Antenatal Iron-Folate
Mengkonsumsi Tablet Tambah Darah. Jurnal Supplementation in A Low Resource Rural
Ilmiah Kebidanan. 9(1): 103-109. Set-up in Eastern Kenya. Journal Public Health
Agegnehu, G., Atenafu, A., Dagne, H., and Epidemiol. 7(11): 337-345.
Dagnew, B. 2019. Adherence to Iron and Folic Kamau, M., Mirie, W., Kimani, S., and Mugoya,
Acid Supplement and its Associated Factors I. 2019. Effect of Community-Based Health
Among Antenatal Care Attendant Mothers in Education on Knowledge and Attitude Towards
Lay Armachiho Health Centers, Northwest, Iron and Folic Acid Supplementation Among
Ethiopia, 2017. International Journal of Pregnant Women in Kiambu County, Kenya: A
Reproductive Medicine. 2019(1): 1–9. Quasi-Experimental Study. PLoS ONE. 14(11):
Aminin, F., dan Dewi, U. 2020. Kepatuhan Ibu 1-21.
Hamil Mengkonsumsi Tablet Fe di Kota Kementrian Kesehatan Republik Indonesia. 2018.
Tanjung Pinang Tahun 2017. Jurnal Ners Dan Hasil Utama Riskesdas 2018. Jakarta: Badan
Kebidanan (Journal of Ners and Midwifery). Penelitian dan Pengembangan Kesehatan
7(2): 285–292. Republik Indonesia.
Azwar, S. 2013. Sikap Manusia: Teori dan Kementrian Kesehatan Republik Indonesia. 2021.
Pengukurannya. Yogyakarta: Pustaka Pelajar. Profil Kesehatan Indonesia Tahun 2020. Jakarta:
Bara, F. T., Fanny, L., dan Wijayanegara, H. 2015. Kementrian Kesehatan RI.
Pengaruh Konseling Gizi pada Ibu Hamil Dengan Khairia, N. 2018. Pengaruh Konseling Gizi
Anemia Terhadap Status Gizi di Kecamatan Menggunakan Media Leaflet Terhadap
Minasatene dan Kecamatan Pangkajene Pengetahuan, Sikap, dan Kepatuhan Konsumsi
Kabupaten Pangkajene dan Kepulauan. Jurnal Tablet Tambah Darah Pada Ibu Hamil di
Ilmiah Kesehatan Diagnosis. 6(2): 253-261. Wilayah Kerja Puskesmas Lepo-lepo Kota
Berhane, A., and Belachew, T. 2022. Effect of Kendari. Skripsi. Kendari: Politeknik Kesehatan
Picture-Based Health Education and Counselling Kendari.
on Knowledge and Adherence to Preconception Nahrisah, P., Somrongthong, R., Viriyautsahakul,
Iron-Folic Acid Supplementation Among N., Viwattanakulvanid, P., and Plianbangcang,
Women Planning to be Pregnant in Eastern S. 2020. Effect of Integrated Pictorial Handbook
Ethiopia: A Randomized Controlled Trial. Education and Counselling on Improving
Journal of Nutritional Science. 11(58): 1-11. Anemia Status, Knowledge, Food Intake, and
Djati, T. P., Sulistyowati, E., dan Hendriyani, Iron Tablet Compliance Among Anemic Pregnant
H. 2017. Pengaruh Konseling Gizi Terhadap Woman in Indonesia: A Quasi-Experimental
Konsumsi Tablet Tambah Darah dan Kadar Study. Journal of Multidisciplinary Healthcare.
Hb Ibu Hamil Trimester II dan III di Wilayah 2020(13): 43-52.
Puskesmas II Sumpiuh. Jurnal Riset Gizi. 5(1): Notoatmodjo, S. 2014. Promosi Kesehatan dan
76-85. Perilaku Kesehatan. Jakarta: Rineka Cipta.
Fitrianingsih, W., Suindri, N. N., dan Armini, Purbowati, N. 2016. Pengaruh Konseling
N. W. 2019. Hubungan Antara Pengetahuan, Menggunakan Lembar Balik dan Leaflet
Pendapatan, dan Pekerjaan Ibu Dengan Terhadap Kepatuhan Ibu Hamil Mengkonsumsi
Kehamilan Risiko Tinggi di Puskesmas Tablet Besi. Jurnal 2-TRIK Tunas-tunas Riset
Kecamatan Denpasar Barat Tahun 2018. Jurnal Kesehatan. 6(3): 143-147.
Ilmiah Kebidanan. 7(2): 98-108. Purwati, R., and Dayani, D. N. 2022. Relationship
Hadiyani, W., dan Yunidha, V. 2019. Pengaruh of Knowledge and Attitude of Pregnant Women
Kepatuhan Konsumsi Tablet Fe Terhadap with Compliance Consuming Blood Tablets at
Kadar Haemoglobin Ibu Hamil. Jurnal Ilmiah Puskesmas Koto Baru, Dharmasraya Regency
Keperawatan. 5(1): 7-13. in 2022. Journal of Midwifery and Nursing.
Herawati, Y., dan Rusmiati, D. 2018. Hubungan 4(3): 94-99.
Frekuensi Umur, Tingkat Pendidikan, dan Usia Rahmaniah & Linda, P. S. 2019. Hubungan Umur
Kehamilan Dengan Kejadian Anemia Pada Ibu Ibu dan Paritas Dengan Kejadian Anemia Pada
Ibu Hamil di Wilayah Kerja Puskesmas Totoli.
Suryaningrum et al., Media Gizi Indonesia (National Nutrition Journal) 19
Special Issue: The 3rd Bengkulu International Conference on Health (B-ICON 2023) 2024.19(1SP): 8–19
[Link]

Journal of Health, Education and Literacy. Utari, D., dan Rahmad, A. H. A. 2020. Pengetahuan
1(1): 24-28. dan Sikap Ibu Hamil Dengan Pola Kepatuhan
Savadogo, L., Salimata, O., Tamini, C., Kinda, Mengonsumsi Tablet Tambah Darah di
M., and Donnen, P. 2014. Characteristics of Kabupaten Aceh Timur. Jurnal SAGO Gizi
Severely Anemic Pregnant Women and Perinatal dan Kesehatan, 4(1): 8-13.
Outcomes in Banfora Regional Hospital, World Health Organization. 2021. Anemia in
Burkina Faso: An Epidemiological Study. Open Women and Children. Retrieved from. https://
Journal of Obstetrics and Gynecology. 4(5): [Link]/data/gho/data/themes/topics/
234-238. anaemia_in_women_and_children.
Stretcher, V., and Rosenstock, I. M. 1997. The Yanti, D. A. M., Sulistianingsih, A., dan Anggraeni,
Health Belief Model. In K. Glanz, F.M. Lewis, & S. 2018. Peningkatan Pengetahuan, Sikap, dan
B.K. Rimer (Eds.), Health Behavior and Health Kepatuhan Melalui Konseling Nutrisi Pada Ibu
Education: Theory, Research, and Practice (2nd Hamil Anemia di Kabupaten Pringsewu. Media
ed.). San Fransisco: Jossey Bass. Publikasi Penelitian. 15(2): 52-60.