Determinants of Health-Promoting Behaviors Among Indonesian Adolescents Living in Child Welfare Institutions: Cross-Sectional Survey Study

Abstract

Background: Adolescents in child welfare institutions often face inadequate facility resources, limited caregiver support, and restricted access to health care services. These obstacles impede their physical, mental, and social development during adolescence, resulting in significant health vulnerabilities. Engaging in health-promoting behaviors (HPBs) can enhance their overall health and quality of life, potentially contributing to improved long-term well-being. Objective: This study aimed to identify the HPBs of adolescents in child welfare institutions in Indonesia and explore the determinants influencing these behaviors using the health promotion model. Methods: This study used a cross-sectional survey design. Adolescents living in welfare institutions were recruited from January 14, 2024, to February 3, 2024. After obtaining institutional review board approval, 6 research assistants visited 17 institutions in Malang and collected data from participants who provided their consent using tablet PCs that linked to the questionnaire. The variables studied included HPBs, health literacy, self-esteem, perceived barriers to action, perceived self-efficacy, and social support. Multivariate structural analysis was conducted using SPSS Statistics (version 26.0; IBM Corp) and SPSS Amos (version 26.0; IBM Corp). Results: A total of 276 adolescents participated in this study. Adolescents&apos; HPBs differed significantly based on age group (P=.03), educational level (P=.04), duration of stay in child welfare institutions (P=.03), and the institutions&apos; accreditation level (P=.02). In the final model, perceived self-efficacy (beta=0.538; P<.001) and social support (beta=0.256; P<.001) together accounted for 47.9% of the variance in HPBs. Self-esteem was positively correlated with perceived self-efficacy (beta=0.184; P<.001) and social support (beta=0.303; P<.001) but negatively correlated with perceived barriers to action (beta=-0.194; P<.01). Health literacy was also negatively correlated with perceived barriers to action (beta=-0.234; P<.001). Self-esteem indirectly affected HPBs through perceived self-efficacy (beta=0.099; P<.01) and social support (beta=0.078; P<.001). Conclusions: To improve the HPBs of adolescents living in child welfare institutions, their self-esteem needs to be increased to further enhance their self-efficacy and social support. Careful attention and monitoring of HPBs among these adolescents may lead to better health outcomes and support their transition from child welfare institutions to the broader community.