Health Promotion Using Counseling Cards to Increase Perceived Benefit, Perceived Barrier, and Self-Efficacy for Congenital Hypothyroid Screening

Dede  Gantini; Sariestya  Rismawati; Dita Eka Mardiani; Rahmi Nursyadiah

doi:10.33096/woh.vi.2611

Dede Gantini Departement of Midwifery, Tasikmalaya Ministry of Health Polytechnic, Indonesia
Sariestya Rismawati Departement of Midwifery, Tasikmalaya Ministry of Health Polytechnic, Indonesia
Dita Eka Mardiani Departement of Midwifery, Tasikmalaya Ministry of Health Polytechnic, Indonesia
Rahmi Nursyadiah Departement of Midwifery, Surakarta Ministry of Health Polytechnic, Indonesia

DOI: https://doi.org/10.33096/woh.vi.2611

Keywords: Congenital hypothyroid screening, Counseling Card, Perceived benefit, Perceived barrier, Self-efficacy

Abstract

Congenital hypothyroid screening coverage in Indonesia remains low (2.3%), partly due to limited effective health promotion and inadequate use of educational media, leading to low maternal participation. Strengthening health promotion through appropriate media and optimizing the role of health cadres are essential to improving mothers’ perceived benefits, reducing perceived barriers, and enhancing self-efficacy for screening. This study aimed to analyze the effect of education delivered through counseling cards by health cadres on mothers' perceived benefits, perceived barriers, and self-efficacy in conducting congenital hypothyroid screening. A quasi-experimental pre–post test design was conducted in Tasikmalaya City, involving 41 third-trimester pregnant women selected via quota sampling from 20 primary health center service areas. Trained cadres provided education using counseling cards. Data were collected before and after the intervention using validated questionnaires measuring perceived benefit, perceived barrier, and self-efficacy. Data analysis showed significant improvements in all variables after the intervention (p < 0.05). In conclusion, counseling card–based education is effective in improving mothers’ perceived benefits, perceived barriers, and self-efficacy toward congenital hypothyroid screening. It is recommended that this approach be integrated into routine maternal health promotion and scaled up through community health cadres to enhance screening uptake and support early detection at the population level.

References

Kurniawan LB. Congenital Hypothyroidism : Incidence , Etiology and Laboratory Screening. 2020;26(3):375–80.

Klinis PP, Dokter I, Indonesia A. Diagnosis dan Tata Laksana Hipotiroid Kongenital Diagnosis dan Tata Laksana Hipotiroid Kongenital. 2017;

Pulungan AB, Soesanti F, Utari A, Pritayati N, Julia M, Annisa D, et al. Preliminary Study of Newborn Screening for Congenital Hypothyroidism and Congenital Adrenal Hyperplasia in Indonesia Studi Preliminer Skrining Hipotiroid Kongenital dan Hiperplasia. 2020;8(2).

Kemenkes RI. Peraturan Menteri Kesehatan RI No 78 Tahun 2014 Tentang Skrining Hipotiroid Kongenital.

Marliana L, Kasim F, Purba OH. Optimalisasi Tindakan Skrining Hipotiroid Kongenital ( SHK ) Pada Bayi Baru Lahir Di Ruangan Perinatologi Optimization of Congenital Hypothyroidism Screening ( SHK ) Actions in Newborns in the Perinatology Room. J Kebidanan Kestra [Internet]. 2025;112–20. Available from: https://ejournal.medistra.ac.id/index.php/JKK

Nasution AB, Sirait RA, Ginting DY. Implementasi Program Skrining Hipotiroid Kongenital Di Uptd Puskesmas Implementation of Congenital Hypothyroidism Screening Program at Community Health Center. 2025;(c):262–70.

Direktorat Gizi dan Kesehatan Ibu dan Anak KKRI. Laporan Akuntabilitas Kinerja Instansi Pemerintah (LAKIP) Direktorat Gizi dan Kesehatan Ibu dan Anak Tahun Anggaran 2022. Kemenkes RI; 2022. 1–35 p.

Karunarathna N, Hettiarachchi M. Cost-Effective Analysis of the Congenital Hypothyroidism Screening Program in Sri Lanka. Value Heal Reg Issues [Internet]. 2021;24:181–6. Available from: https://doi.org/10.1016/j.vhri.2021.01.001

Kusniawaty A, Rahmiyati AL, Nugrahaeni DK, Mauliku NE. Determinants of Congenital Hypothyroidism Screening Implementation among Mothers with Newborns. 2025;12(2):194–204.

Care JH, Noflidaputri R, Meilinda V, Kesehatan F, Kock UF De. ANALISIS EVALUASI PELAKSANAAN SKRINING HIPOTEROID. 2021;6(1):75–82.

Putri YR. Implementation of the Congenital Hypothyroid Screening Program at Taman Sidoarjo Health Center [ Implementasi Pelaksanaan Program Skrining Hipotiroid Kongenital di Puskesmas Taman Sidoarjo ]. :1–6.

Fauziah AYUB, Moedjiono AI. The effect of health education in improving the knowledge and attitudes of integrated service post cadres about early detection of high ‑ risk pregnancies in the working area of the Mamajang health center , Makassar city , Indonesia. 2023;

Sakai C, Iguchi K, Tachi T, Noguchi Y, Hisamatsu A, Katsuno S, et al. Effectiveness of distributing pocket cards in improving the behavior , attitude , and knowledge regarding proper medication use among junior high school students in Japan. 2024;(January):1–7.

Friska D, Kekalih A, Runtu F, Rahmawati A. Health cadres empowerment program through smartphone application-based educational videos to promote child growth and development.

Estebsari F, Latifi M, Ghorbanzadeh S, Khalifeh ZR. Health Belief Model in Predicting Screening Behavior among Population at Risk of Colorectal Cancer : A Systematic Review. 2025;54(7):1411–23.

WHO. Care for Child Development Participant Manual. 2019.

Amalia S, Rokhanawati D. The Effectiveness of Video and Leaflet Media on Mothers ’ Knowledge , Attitudes , And Behavior in Stunting Prevention Efforts at Puskesmas Karangmojo II. 2026;7(2):481–92.

Shmueli L. Predicting intention to receive COVID-19 vaccine among the general population using the health belief model and the theory of planned behavior model. 2021;1–13.

Preference P. Willingness to Receive Periodic Health Examination Based on the Health Belief Model Among the Elderly in Rural China : A Cross-Sectional Study. 2021;1347–58.

Adyani K, Safitri OLR, Aisyaroh N. Efektivitas Media Edukasi terhadap Perubahan Pengetahuan dan Perilaku Personal Hygiene Menstruasi pada Remaja Putri: Literature Review. Media Publ Promosi Kesehat Indones. 2024 Mar;

Mbanya VN, Terragni L, Gele AA, Diaz E, Kumar BN. Barriers to access to the Norwegian healthcare system among sub-Saharan African immigrant women exposed to female genital cutting. PLoS One [Internet]. 2020;15(3):1–22. Available from: http://dx.doi.org/10.1371/journal.pone.0229770

Sanaeinasab H, Saffari M, Taghavi H, Zarchi AK, Rahmati F, Zaben F Al, et al. An educational intervention using the health belief model for improvement of oral health behavior in grade ‑ schoolers : a randomized controlled trial. BMC Oral Health [Internet]. 2022;1–11. Available from: https://doi.org/10.1186/s12903-022-02132-2

Sarikhani Y, Najibi SM, Razavi Z. Key barriers to the provision and utilization of maternal health services in low ‑ and lower ‑ middle ‑ income countries ; a scoping review. BMC Womens Health [Internet]. 2024;1–15. Available from: https://doi.org/10.1186/s12905-024-03177-x

Kumar D, Singh T, Vaiyam P, Banjare P, Saini S. Identifying potential community barriers for accessing health care services context to health for all in rural-tribal geographical setting in India : A systematic review. 2022;9(4):169–77.

Izzati AN, Indarwati R. The Relationship of Perceived Benefit , Perceived Barrier , and Knowledge with Vaccine Hesitancy among Anti- and Pro- Vaccine Community. 2021;15(4):41–8.

Wei FC, Huang CH, Huang CY, Yen-Ping Tsai, Jeng C. Effectiveness of health education and counseling on stages of change, decisional balance, and smoking cessation self-efficacy: A prospective self-control study. Patient Educ Couns J. 2024;123.