International Journal of Medical Science and Public Health Research
83
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TYPE
Original Research
PAGE NO.
83-97
DOI
10.37547/ijmsphr/Volume06Issue05-07
OPEN ACCESS
SUBMITED
21 March 2025
ACCEPTED
18 April 2025
PUBLISHED
26 May 2025
VOLUME
Vol.06 Issue 05 2025
CITATION
Dahrul Fakri, Said Usman, Irwan Saputra, M. Yani., & T. Maulana.
(2025). Analysis of Dengue Hemorrhagic Fever (Dhf) Prevention
Behavior Using the Health Belief Model (Hbm) Approach in Banda Aceh
City. International Journal of Medical Science and Public Health
Research, 6(05), 83
–
97.
https://doi.org/10.37547/ijmsphr/Volume06Issue05-07,
COPYRIGHT
© 2025 Original content from this work may be used under the terms
of the creative commons attributes 4.0 License.
Analysis of Dengue
Hemorrhagic Fever (Dhf)
Prevention Behavior Using
the Health Belief Model
(Hbm) Approach in Banda
Aceh City
Dahrul Fakri
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
Said Usman
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
Irwan Saputra
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
M. Yani.
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
T. Maulana
Master of Public Health Study Program Faculty of Medicine, Syiah
Kuala University
Abstract
Dengue is a mosquito-borne viral infection that has
remained a global public health concern for more than
five decades. Commonly referred to as Dengue
Hemorrhagic Fever (DHF) in the community, it continues
to be a significant health issue. In 2024, the number of
DHF cases in Aceh Province reached 3,044. In Banda Aceh
City, the trend has been fluctuating, with 400 reported
cases in 2024
—
the highest in the last five years
—
resulting
in three deaths. This study aimed to analyze the
relationship between dengue fever prevention behaviors
using the Health Belief Model (HBM) approach. This
research employed a quantitative analytic observational
design with a cross-sectional approach. The study
population consisted of heads of households or
housewives across 9 subdistricts in Banda
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Aceh. Data analysis was conducted using Partial Least
Squares (PLS) with the SmartPLS version 4.0 application.
Hypothesis testing revealed that age group was
significantly associated with perceived benefits (p =
0.035 < 0.05) and perceived severity (p = 0.035 < 0.05).
Perceived susceptibility was significantly related to
dengue prevention behavior (p = 0.000 < 0.05), as were
perceived benefits (p = 0.000 < 0.05), perceived barriers
(p = 0.000 < 0.05), and cues to action (p = 0.000 < 0.05).
This study provides recommendations for government
and community stakeholders in formulating effective
dengue prevention policies in Banda Aceh City.
Keywords:
Dengue Prevention Behavior, Health Belief
Model.
Introduction:
Dengue can be defined as a viral infection
disease transmitted through mosquitoes and has
become a health problem in the world. For more than
five decades, dengue or commonly known as dengue
fever has become a public health problem in the world,
not only in Indonesia.(Ministry of Health of the Republic
of Indonesia, 2022).
Until now, dengue disease has not been well controlled,
as evidenced by the significant increase in dengue cases
worldwide and the outbreaks that occur every year in
Indonesia. This raises ongoing public concerns about
dengue infection. Therefore, it is necessary to
strengthen the management of dengue control
programs and strategies.(Ministry of Health, Republic of
Indonesia, 2021).
Dengue infection is one of the infectious diseases that
can cause outbreaks and cause death. Transmission of
dengue infection is caused by the dengue virus through
the bite of the female Aedes aegypti mosquito. The
spread of adult female Aedes aegypti mosquitoes is
influenced by several factors including the availability of
egg-laying sites and blood, but the place is limited to a
distance of 100 meters from the location of
emergence(Ministry of Health of the Republic of
Indonesia, 2022).
Dengue infection is one of the infectious diseases that
still attacks the population in Indonesia and is still one of
the public health problems that cannot be overcome.
Dengue infection has even become endemic in almost all
provinces. In the last 5 (five) years, the number of cases
and affected areas has continued to increase and spread
widely and often causes KLB (Extraordinary Events).
Dengue infection in Indonesia in 2022 has reached
131,265 cases, with the highest number of dengue cases
in the provinces of West Java, East Java and Central
Java(Ministry of Health of the Republic of Indonesia,
2022).
Dengue cases in Indonesia continue to increase, in 2021
there were 73,518 cases with a death toll of 705 people,
in 2022 there were 131,265 cases with a death toll of
1,183 people, in 2023 there were 114,720 cases with a
death toll of 894 people. Dengue fever infections in
Indonesia in 2023 saw an increase in the Incidence Rate
(IR) and a decrease in the Case Facility Rate (CFR).
Meanwhile, the number of dengue fever cases as of
October 2024, there were 203,921 dengue cases with
1,210 deaths originating from 482 regencies/cities in 36
provinces in Indonesia (Ministry of Health of the
Republic of Indonesia, 2024).
Aceh Province with a population of 5,515,839 people
consisting of 2,759,685 men and 2,756,154 women, it is
known that in 2024 DHF infections reached 3,044 cases
spread across 23 districts/cities and was the largest
number of DHF cases in the last five years. In addition,
information obtained by province, it turns out that the
most significant increase in DHF occurred in Banda Aceh
City, namely 400 cases and a death rate of 3 people
compared to 22 other districts/cities (Aceh Health
Office, 2024).
The increasing number of dengue fever cases in Banda
Aceh City with a population of 259,538 people, with
details of 129,400 men and 130,138 women spread
across 9 sub-districts and making Banda Aceh City an
endemic area for dengue fever with the highest number
of cases in Aceh Province from year to year. The trend
of dengue fever cases tends to fluctuate, namely in 2019
there were 344 cases, in 2020 there were 98 cases, in
2021 there were 19 cases, in 2022 there were 366 cases,
in 2023 there were 274 cases and in 2024 there were
400 cases.
The number of DHF cases per sub-district in 2024 in
Banda Aceh City consists of Meuraxa sub-district 66
cases, Jaya Baru sub-district 72 cases, Banda Raya sub-
district 43 cases, Baiturrahman sub-district 30 cases,
Lueng Bata sub-district 26 cases, Kuta Alam sub-district
68 cases, Kuta Raja sub-district 27 cases, Syiah Kuala
sub-district 36 cases, and Ulee Kareng sub-district 32
cases (Banda Aceh City Health Office, 2024).
Dengue Hemorrhagic Fever (DHF) infections in 2024 in
Banda Aceh City amounted to 400 cases, consisting of 49
cases in January, 15 cases in February, 16 cases in
March, 10 cases in April, 10 cases in May, 11 cases in
June, 16 cases in July, 29 cases in August, 27 cases in
September, 69 cases in October, 64 in November and 84
cases in December (Banda Aceh City Health Office,
2024).
All regions in Indonesia are at risk of contracting dengue
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fever, because both the causative virus and the
mosquitoes that transmit it have spread widely in
residential areas and in public places throughout
Indonesia except for places above 100 meters above sea
level. Almost every year there are Extraordinary Events
(KLB) in several areas during the rainy season. This
disease is still a public health problem and is endemic in
some districts/cities in Indonesia. Dengue Fever can
attack all age groups. Until now, Dengue Fever has
attacked more children, but in the last decade there has
been a tendency for an increase in the proportion of
Dengue Fever sufferers in adults.(Sukohar, 2014).
According to Glanz. K, et al, (2008) in(Elvin et al., 2016).
One approach that can predict individual health
behavior towards preventing Dengue Hemorrhagic
Fever (DHF) is the Health Belief Model (HBM) developed
by social psychologists in the United States health
service in the 1950s: Godfrey Hochb, Stephen Kegels,
and Irwin Rosenstock. HBM can provide output on
perception patterns that lead to preventive behavior
towards Dengue Hemorrhagic Fever (DHF) in Banda
Aceh City.
METHOD
The method in this study uses quantitative research with
observational analytical studies with cross-sectional.
This study was conducted in Banda Aceh City which
consists of 9 sub-districts, 90 villages in 9 Public Health
Centers (Puskesmas) consisting of Baiturrahman,
Meuraxa, Kuta Alam, Kopelma Darussalam, Jaya Baru,
Banda Raya, Batoh, Lampaseh Kota and Ulee Kareng
Puskesmas. The selection of this research location is
based on the number of sub-districts in Banda Aceh City.
This research was conducted in 9 sub-districts, 90
villages in the Banda Aceh City Area from December
2024 to February 2025. The population in this study was
all families in 9 sub-districts in Banda Aceh City. The
selection of the population was carried out randomly
based on the number of families, namely 77,515. The
sampling technique used in this study used the
probability sampling method with the stratified random
sampling technique, so that a sample of 398
respondents was selected.
RESULTS
Table 1. Univariate Frequency Distribution
Characteristics
Frequency (f)
Percentage (%)
Gender
Man
Woman
Work
Work
Doesn't work
Education
SENIOR HIGH SCHOOL
Diploma
D4/S1
S2/S3
Age Group
21-30 Years
31-40 Years
41-50 Years
51-60 Years
➢
61 Years
123
275
244
154
158
78
152
10
114
97
115
45
27
30.9
69.1
61.3
38.7
39.7
19.6
38.2
2.5
28.6
24.4
28.9
11.3
6.8
Total
398
100
Based on Table 1.illustrates that the gender of female
respondents is more dominant, namely 275 people
(69.1%) compared to men, namely 123 people (30.9%).
This is because women visit the health center more.
Women are also more at home and are easier to
interview and have a high interest in filling out the
research questionnaire. Based on the employment
status of the respondents, the majority of respondents
in this study were employed, namely 244 people
(61.3%), while those who were unemployed were 154
people (38.7%), namely housewives.
Based on the level of education of respondents in this
study, it shows that the dominant respondents have a
high school education background, namely 158 people
(39.7%) and the lowest education is Masters/Doctorate,
namely 10 people (2.5%).
Furthermore, the respondents in the age group category
41-50 years were 115 people (28.9%) and the age group
21-30 years were 114 people (28.6%) which were very
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dominant in this study. While the category with the least
was the age group >60 years, which was 27 people
(6.8%).
Figure 1 Dengue Fever Case Trend Graph in 5 Years
The highest sub-district analysis of DHF in 2020 in Banda
Aceh City is Jaya Baru (16 cases), in 2021 Banda Raya (6
cases), in 2022 Meuraxa (75 cases), in 2023 Meuraxa (61
cases) and, in 2024 Jaya Baru (72 cases). Jaya Baru and
Meuraxa sub-districts are the areas with the highest DHF
cases in the last five years. This must be a priority for
handling DHF in Jaya Baru and Meuraxa sub-districts due
to the behavior of people who do not maintain
environmental health (inside and outside the home)
properly without ignoring other sub-districts.
Figure 2 Monthly Dengue Fever Case Graph from 2021-2024
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Trend
DHF cases in the last five years in Banda Aceh City,
namely 2020 (98 cases), 2021 (19 cases), 2022 (366
cases), 2023 (269 cases) and, 2024 (400 cases). DHF
began to increase sharply from November to January.
This is closely related to climate change. According to
BMKG Class 1 Sultan Iskandar Muda (SIM) data in 2024,
the intensity of moderate rain in Banda Aceh City started
in September and decreased starting in February, the
decrease occurred due to the change in seasons
influenced by the apparent movement of the sun to the
north. The increase in rainfall is in line with the increase
in DHF cases in Banda Aceh.
Figure 3. Outer Model Graph
Convergent validity
or convergent validity refers to the
principle that the dimensions of a construct must be
highly correlated. Validity testing with Smart PLS
software can be seen in the loading factor value of each
indicator or construct. The rule for evaluating
convergent validity is to see the loading factor value
must be more than 0.7 in the confirmatory study and
between 0.6 - 0.7 in the exploratory study and the
Average Variance Extracted (AVE) must be greater than
0.5. in this study, a loading factor value of 0.7 will be
used.
Table 2. Outer Loading Values
No
Question
Variables
Loading
Factor
Average Variance
Extracted (AVE)
1
2
3
4
X1
X2
X3
X4
Gender
Work
Education
Age Group (X)
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
5
6
7
8
9
Y1.1
Y1.2
Y1.3
Y14
Y1.5
Perceived
Vulnerability
(Y1)
0.806
0.779
0.763
0.862
0.769
0.634
10
11
12
13
14
15
Y2.1
Y2.2
Y2.3
Y2.4
Y2.5
Y2.6
Perceived Severity
(Y2)
0.720
0.791
0.730
0.715
0.726
0.709
0.536
16
17
18
Y3.1
Y3.2
Y3.3
Benefits Felt
(Y3)
0.817
0.846
0.851
0.699
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19
20
Y3.4
Y3.5
0.846
0.819
21
22
23
24
25
26
Y4.1
Y4.2
Y4.3
Y4.4
Y4.5
Y4.6
Perceived
Obstacles
(Y4)
0.812
0.884
0.894
0.864
0.816
0.806
0.717
27
28
29
30
31
Y5.1
Y5.2
Y5.3
Y5.4
Y5.5
Signal To Action
(Y5)
0.715
0.859
0.811
0.853
0.833
0.666
32
33
34
35
36
37
38
39
40
41
42
43
44
45
Z1
Z2
Z3
Z4
Z5
Z6
Z7
Z8
Z9
Z10
Z11
Z12
Z14
Z15
Behavior to
Prevent Dengue
Hemorrhagic
Fever (DHF)
(Z)
0.738
0.720
0.705
0.764
0.772
0.789
0.832
0.760
0.755
0.770
0.829
0.735
0.790
0.709
0.582
From table 4.2 above, it can be seen that the loading
factor value of each construct or indicator exceeds the
limit value of 0.7. Likewise, the AVE value of each
variable has met the requirements of >0.5, thus each
construct with a variable has met convergent validity
because it has a loading factor value of >0.7 for the AVE
value of each variable also meets it, namely >0.5, so it
can be said to be valid and can be continued to carry out
hypothesis testing
.
Table 3. Discriminant Validity Value (Cross Loading)
Variables
Demographics
Vulnerability
Which
Felt
Severity
Which
Felt
Benefits Felt
Obstacle
What is Felt
Signal
For
Act
Dengue Fever
Prevention
Behavior
X1:1,000
X2:1,000
X3:1,000
X4:1,000
Y1.1: 0.806
Y1.2: 0.779
Y1.3: 0.763
Y1.4: 0.862
Y1.5: 0.769
Y2.1: 0.720
Y2.2: 0.791
Y2.3: 0.730
Y2.4: 0.715
Y2.5: 0.726
Y2.6: 0.709
Y3.1: 0.817
Y3.2: 0.846
Y3.3: 0.851
Y3.4: 0.846
Y3.5: 0.819
Y4.1: 0.812
Y4.2: 0.884
Y4.3: 0.894
Y4.4: 0.864
Y4.5: 0.816
Y4.6: 0.806
Y5.1: 0.715
Y5.2: 0.859
Y5.3: 0.811
Y5.4: 0.853
Y5.5: 0.833
Z1: 0.738
Z2: 0.720
Z3: 0.705
Z4: 0.764
Z5: 0.772
Z6: 0.789
Z7: 0.832
Z8: 0.760
Z9: 0.755
Z10: 0.770
Z11: 0.829
Z12: 0.735
Z14: 0.790
Z15: 0.709
Based on table 3. above, it can be seen that all indicators
for the variables forming the demographic construct,
vulnerability, severity, benefits, barriers, cues to action
and dengue prevention behavior have met the cross
loading value> 0.7. Therefore, it can be concluded that
all indicators in the variables above have good
discriminant validity values and it can be said that all
indicators are valid.
Table 4. Composite Reliability and Cronbach Alpha Values
Variables
Composite Reliability
Cronbach Alpha
Gender
Work
Education
Age Group
1,000
1,000
1,000
1,000
1,000
1,000
1,000
1,000
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Perceived Vulnerability
Perceived Severity
Benefits Felt
Perceived Obstacles
Signal To Action
Dengue Fever Prevention Behavior
0.865
0.828
0.894
0.921
0.880
0.945
0.856
0.827
0.892
0.921
0.873
0.944
From table 4. above, it can be seen that all variables
meet the reliability criteria. This can be seen from the
composite reliability value greater than 0.7 and the
cronbach alpha (α) value greater than 0.6 as
recommended. Thus, it can be said that the relationship
between all construct indicators and their variables has
been tested for reliability.
Table 5. R-Square Value
No
Variables
R-Square
1
2
3
4
5
Perceived Vulnerability
Perceived Severity
Benefits Felt
Perceived Obstacles
Dengue Hemorrhagic Fever Prevention Behavior
0.057
0.043
0.036
0.031
0.555
Table 5 shows the R-Square value for perceived
vulnerability of 0.057. This shows that demographic
variables are able to influence the perceived
vulnerability variable by 5.7%, the remaining 94.3% is
influenced by other variables. The R-Square value for the
perceived severity variable is 0.043.
This shows that demographic variables are able to
influence the perceived severity variable by 4.3%, the
remaining 95.7% is influenced by other factors. The R-
Square value for the perceived benefits variable is 0.036
or 3.6%, which means that demographic variables are
able to influence the perceived benefits variable by 2.6%
and the remaining 98.4% is influenced by other factors.
The R-Square value for the perceived barriers variable is
0.031 or 3.1%, which means that demographic factors
are able to influence the perceived barriers variable by
3.1%, the remaining 96.9% is influenced by other
factors.
Meanwhile, the R-Square value of Dengue Hemorrhagic
Fever (DHF) prevention behavior is 0.555, which means
that the perception of the Health Belief Model (HBM)
includes variables of perceived vulnerability, perceived
severity, perceived benefits, perceived barriers and cues
to act that can influence Dengue Hemorrhagic Fever
(DHF) prevention behavior by 55.5% and the remaining
44.5% is influenced by other factors.
Figure 4. Inner Model Graph
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Figure 4. above shows that the demographic variable,
namely gender, is related to the perceived benefits
variable with a t value of 2.165. Age group is related to
the perceived benefits variable with a t value of 2.109,
and age group is also related to the perceived severity
variable with a t value of 2.545. Occupation is related to
the perceived barriers variable with a t value of 2.625,
and occupation is also related to the perceived
vulnerability variable of 2.385. So the variables of
vulnerability, severity, benefits and perceived barriers
are mediator variables that do not play a good role in
mediating the relationship between demographic
factors and Dengue Hemorrhagic Fever (DHF)
prevention behavior in Banda Aceh City.
Next is the variable of perceived vulnerability
significantly related to dengue prevention behavior with
a t value of 4.516. The variable of perceived benefits
significantly related to dengue prevention behavior with
a t value of 6.366. The variable of perceived barriers
significantly related to dengue prevention behavior with
a t value of 4.987, and the variable of cues to act related
to dengue prevention behavior with a t value of 5.361.
The results of this study indicate that demographic
factors, namely gender, are related to perceived benefit
variables, age group is related to perceived benefit
variables, age group is also related to perceived severity
variables, occupation is related to perceived barrier
variables, and occupation is also related to perceived
vulnerability variables. Vulnerability, benefit, perceived
barrier and cues to action variables are significantly
related to dengue prevention behavior with a t table
value > 1.96.
DISCUSSION
Gender
Based on the results of data processing with SPSS
software to see the frequency distribution of
respondents, the results can be seen that the gender of
respondents, namely the female category totaling 275
people (69.1%) is more dominant than the male
category, namely 123 people (30.9%). In the results of
hypothesis testing with Smart PLS software, it shows
that the gender factor has a significant relationship with
the perceived benefits variable with a calculated t value
of 2.165> t table 1.96.
While the gender factor does not have a significant
relationship with the perceived vulnerability perception
variable with a t-value of 1.604 <t table 1.96, the gender
factor with the perceived severity variable with a t-value
of 1.701 <t table 1.96, the gender factor with the
perceived barriers variable with a t-value of 0.706 <t
count 1.96, and indirectly the gender factor does not
have a significant relationship with dengue fever (DHF)
prevention behavior with a t-value of 1.024 <t count
1.96. Gender is the difference between women and men
biologically since birth.
Thus, according to Notoatmodjo, (2014). Gender is a
characteristic that is owned or inherent in men or
women who are included socially or culturally. So far, no
difference in susceptibility to Dengue Hemorrhagic
Fever (DHF) attacks has been found in relation to gender
differences (Baitanu et al., 2022).
According to the World Health Organization, (2021),
gender is a biological characteristic of humans that is
defined as male or female. Research conducted in
Malaysia by Muhammad Azami et al., (2021), that
gender does not affect the incidence of Dengue
Hemorrhagic Fever (DHF)(in Baitanu et al., 2022).
According to the research assumption, female gender
has great potential that can be mobilized for Dengue
Hemorrhagic Fever (DHF) prevention activities in Banda
Aceh City because the role of women in society and
families today is so complex. Women also have an
important role in maintaining the cleanliness of the
house and the environment around the house. The
researcher's experience in various social activities in the
community, women have high participation in every
activity, both those carried out by the government and
Non-Governmental Organizations.
According to researchers, in the future, Banda Aceh City
needs to make a breakthrough where in addition to the
existence of village jumantik cadres, it is also necessary
to mobilize and train One House One Jumantik (G1R1J),
this is very effective for women as housewives to
prevent Dengue Hemorrhagic Fever (DBD). Where in
2024, DBD cases in Banda Aceh City reached 400 cases
with 3 deaths due to DBD (Banda Aceh City Health
Office, 2024).
Work
The results of data processing with SPSS software to see
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the frequency distribution of respondents, in this study
showed that the majority of respondents worked, either
as ASN/TNI/Polri, BUMN/BUMD Employees, Private
Employees, Traders, Farmers/Fishermen and other jobs
totaling 244 people (61.3%), the rest were unemployed
(housewives) as many as 154 people (38.7%). The results
of the hypothesis test using Smart PLS software showed
that the work factor had a significant relationship with
the perceived vulnerability variable, namely with a
calculated t value of 2.385> t table 1.96, the work factor
with the perceived obstacle variable, namely with a
calculated t value of 2.625> t table 1.96.
Meanwhile, those that do not have a significant
relationship are the work factor with the perceived
severity variable with a t-value of 0.729 <t table 1.96, the
work factor with perceived benefits with a t-value of
0.003 t table <1.96, and indirectly the work factor is not
significantly related to Dengue Hemorrhagic Fever (DHF)
prevention behavior with a t-value of 1.674 <t table
1.96. Work is an activity that is carried out routinely and
continuously based on the expertise possessed and
earns income from the results of the hard work carried
out (Ministry of National Education, 2005).
The results of this research have a correlation with
research(Ramadani et al., 2023)at the Haji Hospital in
Medan, showed that work has a significant relationship
with the incidence of Dengue Hemorrhagic Fever (DHF)
with a p value of 0.000 <0.05. Employment status, which
is related to DHF, is the place of work related to the
incidence of DHF (Sujariyakul, 2005) (in Hermansyah,
2022).
According to researchers, Banda Aceh City is the
provincial capital that acts as the center of government,
Banda Aceh City is the center of economic, educational,
health, political and cultural activities, making the
mobility of people from other areas to Banda Aceh City
high, thus increasing the risk of spreading DHF. Banda
Aceh City can also potentially spread DHF to other areas
that are not endemic for DHF through community
mobility if the destination area has many aedes aegypti
mosquitoes that can be a vector for transmission.
Education
The results of data processing with SPSS software to see
the frequency distribution of respondents, in this study
showed that the majority of respondents had a high
school education of 159 people (39.7%) and the least
education was S2/S3 of 10 people (2.5%). While the
results of hypothesis testing with Smart PLS software,
showed that the education factor did not have a
significant relationship with the perception of
vulnerability felt with a t-count value of 1.604 <t-count
1.96, the severity felt with a t-count value of 0.415 <t
table 1.96, the benefits felt with a t-count value of 1.562
<t table, the obstacles felt with a t-count value of 0.353
<t table 1.96.
And indirectly, the education factor does not have a
significant relationship with the behavior of preventing
Dengue Hemorrhagic Fever (DHF) with a t-value of 1.559
<t-value of 1.96. Education is a level or stage of formal
education at school that has been carried out or
completed by someone which can be proven by a
Certificate of Completion of Education (Ministry of
National Education, 2005). The education factor does
not have a direct effect on the occurrence of DHF, but
has an effect on preventing DHF. In terms of efforts to
prevent DHF, individuals with higher education will tend
to behave and act better than those with lower
education (Sutomo, 2003) (in Hermansyah, 2022).
The results of the research above are different from
previous research by(Putra et al., 2023)where the
results obtained are a relationship between Education
and the incidence of Dengue Hemorrhagic Fever (DHF)
in Mayangrejo, Bojonegoro Regency, with a p value of
0.024 <0.05. Research from Utami (2021) states that
there is a significant relationship between education and
the incidence of DHF with a p value = 0.001 <0.05.
The researcher's assumption that in general, education
has a close relationship with DHF because it can increase
awareness efforts for DHF prevention, there are other
factors such as climate change, high rainfall, and
urbanization can increase DHF cases, even in areas with
high levels of education such as Banda Aceh City. Family
knowledge about DHF in Banda Aceh City is good, but
even though someone knows how to prevent DHF, they
do not always apply it. For example, someone can have
good knowledge about DHF but still let water stagnate
in their house because they are busy or lack of concern
for the cleanliness of the surrounding environment.
Age
The results of data processing with SPSS software to see
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the frequency distribution of respondents, based on age
group, in this study showed that the majority of
respondents were aged between 41-50 years, totaling
115 people (28.9%) and the least aged> 61 years,
totaling 27 people (6.8%). Based on the results of
hypothesis testing with Smart PLS software, it shows
that the age factor is significantly related to the
perceived severity variable with a t-value of 2.545> t
table 1.96, and the age factor is related to the perceived
benefits variable with a t-value of 2.109> t table 1.96.
While those that are not significantly related are the age
factor with the perceived vulnerability variable with a t-
value of 1.421 <t table 1.96, the age factor with the
perceived obstacle variable with a t-value of 0.125 <t
table 1.96, and indirectly the age factor does not have a
significant relationship with Dengue Hemorrhagic Fever
(DHF) prevention behavior with a t-value of 1.743 <t
count 1.96. Age is the time span from birth to the
present, which is usually expressed in years (Depdiknas,
2005). The relationship between age and DHF, because
usually children still do not understand about the
transmission and prevention of DHF. In addition,
children's activities who often play in parks or gardens
often cause aedes mosquitoes to bite them(Avidsyah et
al., 2024).
Meanwhile, nowadays a shift has occurred from the
dengue fever epidemic which mainly attacks children to
more cases in adults (Hegazi et al., 2020; Moraes et al.,
2013). Research in Taiwan also stated that out of 136
respondents, the majority of dengue fever cases were
adults and only five cases were children or adolescents
under 18 years of age (Wei et al., 2016). However,
research conducted in Sao Luís, Maranhao Brazil stated
that age has a significant relationship with dengue fever
cases and attacks most children aged <15 years (Dias
Júnior et al., 2017),(in Baitanu et al., 2022).
The results of this study are in line with research
(Ramadani et al., 2023)The results of the correlation test
using the Chi-
Square test with a value of α = 0.005 age
against DHF obtained a p value = 0.000 <0.05, which
means there is a significant relationship between age
and DHF at the Medan Haji Hospital. Different from the
results of the study(Baitanu et al., 2022)research
conducted in Wulauan, Minahasa Regency, stated that
age was not significantly related to the incidence of
Dengue Hemorrhagic Fever (DHF) with a p value of 1,000
> 0.05.
The researcher's opinion is that there has been a shift in
the age group of Dengue Hemorrhagic Fever (DHF)
sufferers today, which was previously most infected in
the group of children aged 5-14 years, now changing,
where the age group most infected is the age group of
15-30 years. The researcher predicts that this is because
the age group of 15-30 years has high activity outside
the home, such as at school, college, at work, and other
public places. Other things can also be influenced by
urbanization and climate change.
Perceived Vulnerability
Most respondents in this study had a high level of
perceived vulnerability. This is based on the results of
hypothesis testing with Smart PLS software showing that
perceived vulnerability is significantly related to Dengue
Hemorrhagic Fever (DHF) prevention behavior in Banda
Aceh City with a t-value of 4.516> t table 1.96. Perceived
vulnerability perceives individuals or families about the
threat posed by a particular disease or condition.
The results of this study are in line with previous
research.(Elvin et al., 2016)that the perceived
susceptibility perception shows that there is a significant
influence between family perceptions of susceptibility
to dengue fever (perceived susceptibility to diseases) on
health tasks in preventing dengue fever with a p value of
0.000 <0.05 in Bandar Raya District, Banda Aceh City. In
contrast to research (Maulidiyah, 2023), where the
research results found that the vulnerability perception
variable was not significantly related to dengue fever
prevention behavior (p=0.805, r=0.024) at the Bolo
Health Center, Bima Regency, NTT.
This is in accordance with what was stated by
Hochbaum, Rosenstock and Kegels (in Jones & Bartlett,
2008), namely that the perception of vulnerability
includes estimates of vulnerability to a disease and one
of the stronger perceptions in promoting individuals to
adopt healthy behaviors. The greater the perceived risk,
the greater the likelihood of engaging in behavior to
reduce the risk of disease.
In relation to the results of this study, researchers found
that families in the city of Banda Aceh are at risk of
contracting Dengue Hemorrhagic Fever (DHF), where
the endemicity of DHF is quite high in 2022 - 2024,
where almost all villages have DHF cases within the
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three-year period. However, village officials have not
maximized their efforts to prevent DHF together, for
example by mobilizing residents to carry out clean
Fridays/Sundays targeting Mosquito Nest Eradication
(PSN) such as water reservoirs (TPA), families have also
not maximized their 3M Plus activities such as draining,
burying, and covering containers that can hold water
both inside the house and in the yard at least once a
week.
Perceived Severity
Hypothesis testing with Smart PLS software for the
perception variable of perceived severity with Dengue
Hemorrhagic Fever (DHF) prevention behavior in Banda
Aceh City, the results showed no significant relationship
between the two with a t-value of 0.578 <t table 1.96.
The proportion of severity perceived by respondents in
this study showed low. Perceived severity refers to the
perception of the seriousness of a particular disease or
health condition.
The results of this study are different from the results of
Attamimy's study, (2017), stating that the relationship
between the independent variable in the form of the
severity perception factor and the dependent variable in
the form of DHF prevention efforts that have been
carried out by the research subjects obtained a
correlation coefficient of 0.406. If the correlation
coefficient is between 0.4 - 0.70 then it is stated as
strong, this study was conducted at the Sukorame
Health Center, Mojoroto District, Kediri City. Different
from the study(Elvin et al., 2016)conducted in Bandar
Raya District, Banda Aceh, stated that there was no
significant influence between family perceptions of the
seriousness of DHF (perceived seriousness of diseases)
and health tasks in preventing DHF with a p value of
0.259 <0.05.
McCormick and Brown (1999 in Jones & Bartlett, 2008)
further stated that the perception of perceived severity
of the disease includes how individuals feel the adverse
consequences of a serious health condition. Severity is
considered an individual's belief about the importance
or magnitude of a health threat. Perceptions of severity
are often based on medical information or knowledge.
In addition, it can also come from the beliefs of someone
who has experienced difficulties caused by the disease
and has an impact on their life in general.
The researcher's assumption, in this study the level of
perception of severity felt by the majority is still low by
the community or family, caused by information about
the dangers of Dengue Hemorrhagic Fever (DHF) has not
been optimally conveyed to the community or family in
Banda Aceh City. It is possible that the community or
family also perceives that the symptoms caused by
DHF/Dengue Fever are not too severe, because it is
possible that some respondents have not been infected
with DHF. For example, a housewife considers fever in
her child as a symptom of a common disease. However,
if a mother finds that her child has a fever and the
laboratory test results show positive for DHF/Dengue
Fever, so she must be treated in hospital. So, her
perception of fever changes into a serious disease with
a high level of severity.
Benefits Felt
The results of hypothesis testing using Smart PLS
software show that the perceived benefits are
significantly related to Dengue Hemorrhagic Fever (DHF)
prevention behavior with a calculated t value of 6.366>
t table 1.96. Perceived benefits are a state of decision
making on a particular health action or behavior that will
benefit in reducing the vulnerability or severity of health
risks in individuals or families.
The results of this study are the same as previous
research by(Elvin et al., 2016)respondents said that the
family's perception of the benefits of DHF prevention
measures (perceived benefits of preventive action) on
the dependent variable, namely family health tasks in
DHF prevention, with a significant value (p value) of
0.000 <005. In contrast to research conducted by
Attamimy, (2017), said that the perceived benefits
factor with DHF prevention efforts was concluded to be
weak. This is because the correlation coefficient shows
0.239. This is based on the category below 0.401 is
considered weak.
The same statement was also put forward by Hayden,
(2009), namely that the action taken by a person to
prevent (cure) a disease is very dependent on the
consideration and evaluation of the perception of
perceived susceptibility to diseases or the perception of
perceived benefits of preventive action. So that
individuals or families will accept the recommended
health action if it is considered beneficial or useful to the
patient.
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Researchers assume that health center officers,
especially health promotion, should routinely conduct
health education related to the dangers of dengue fever
and procedures for preventing dengue fever in the
community and families in Banda Aceh City. Where
families always do 3 M Plus at least once a week, this is
very important for families to do so that they feel they
are getting benefits from preventing dengue fever and
reducing the risk of being infected with dengue fever so
that it can reduce the number of dengue fever cases in
the future.
Perceived Obstacles
Based on the results of the hypothesis test with Smart
PLS software, it shows that the perception of perceived
barriers is significantly related to the behavior of
preventing Dengue Hemorrhagic Fever (DHF) with a t-
value of 4.987> t table 1.96. The majority of respondents
answered that the perceived barriers were low. The
perception of perceived barriers is an obstacle in
carrying out the recommended health behavior. The
higher the barriers felt by individuals or families, the
lower the behavior towards health. Therefore, it is
expected that with low barriers, individuals or families
will carry out the recommended health prevention
better, such as the behavior of preventing Dengue
Hemorrhagic Fever (DHF).
The results of this study differ from previous research by
Attamimy, (2017) which stated that perceptions of
barriers were not significantly related to Dengue
Hemorrhagic Fever (DHF) prevention behavior with a
result (p value) of 0.144> 005. There are several reasons
why the results are not significant, including weather
factors, family economic conditions, and other
environmental factors. First, the weather referred to in
terms of obstacles to taking DHF prevention measures is
the condition of climate change at a certain time, second
is the ability of the intended economic condition is the
state of ownership of resources to buy mosquito
repellent. and third is other environmental factors, such
as lack of support in maintaining shared cleanliness.
It is also different from research(Elvin et al., 2016)with
the result that the barrier variable is not significantly
related to family health tasks in preventing DHF in
Bandar Raya District, Banda Aceh City with a p value of
0.230> 0.05. According to Jones and Bartlett (2008) also
said that to improve community behavior in preventing
DHF, the threat of seriousness/severity of real DHF
disease will motivate the community to take preventive
measures by eradicating mosquito nests and preventing
the development of aedes aegypti mosquito larvae.
Whatever obstacles are felt by the community in
Mosquito Nest Eradication (PSN) can be overcome if the
community feels the seriousness/high severity of DHF
disease.
The researcher's assumption in this study is that the
obstacles felt by the community or family in terms of
preventing DHF in Banda Aceh City are the belief that
DHF only occurs during the rainy season. The community
or family has also not maximized the Eradication of
Mosquito Nests (PSN) both in the house, yard and public
places. The community or family also does not
understand the life cycle of the aedes aegypti mosquito
and how to prevent it. There is also an assumption in the
community that only the government is responsible for
preventing DHF and if there is a case of DHF in their
residential environment, ask for fogging, if the Health
Center or Health Office does not do fogging then it is
considered that the government is not making efforts to
prevent and control DHF.
Signal To Action
Based on the hypothesis test value with Smart PLS
software, it shows that cues to act are very significantly
related to dengue fever prevention behavior with a
calculated t value of 5.361> t table 1.96, with the
proportion of cues to act more dominant than other
latent variables, this refers to the motivation that drives
individuals/families to act in a condition related to the
risk of disease or health. The cues to act can be
motivated by internal factors (for example, a person's
condition must act or the div's condition against
disease) or external factors (due to advice from others,
health campaigns, mass media, newspapers, magazines,
doctor's recommendations, government regulations
and encouragement from family/friends). The cue to act
is the most dominant and effective variable to prevent
dengue fever compared to other variables.
This study is in accordance with previous studies, namely
according to (Aulia Syifa et. al., 2024), that individuals
with positive perceptions of cues to act have a 1,248
times greater chance of carrying out PSN practices well
compared to those with negative perceptions at the
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Kasihan 1 Bantul DIY Health Center. The results of this
study are also in line with the results of the study (Inayah
et. al., 2022), that cues to act have a very strong and
significant correlation (p value = 0.001) with DHF
prevention behavior in Pasangrahan Tangerang Banten.
The researcher's assumption is that the role of the
government starting from the Mayor, DPRK, Bappeda,
Banda Aceh City Health Office and Health Centers is very
much needed in relation to planning and budgeting in
the Disease Prevention and Control Sector program.
Another thing that is needed is to issue a Qanun on
Health which includes a mechanism for preventing and
controlling DHF where the One House One Jumanti
Movement (G1R1J) was formed. At the village level, it is
necessary to re-activate the Clean Friday/Sunday which
aims to Eradicating Mosquito Nests (PSN). It is hoped
that with this activity, all elements of society can be
mobilized which aims to reduce DHF cases in Banda
Aceh City.
Considering the lessons learned from handling the
COVID pandemic and Indonesia as a dengue endemic
country, a coordinated multi-sector approach needs to
be strengthened to improve national and regional
preparedness in dealing with problems and anticipating
the impacts of dengue in the future. In order to achieve
zero dengue deaths in 2030 (Zero Dengue Death 2030)
in Indonesia, all components of the nation should better
understand the values of mutual cooperation and jointly
implement efforts to prevent and control dengue fever.
Researchers also found that families have not
maximized the prevention of dengue fever, from field
observations, water reservoirs (TPA), such as flower
vases, bird drinking places or other containers that can
hold water have not been cleaned once a week due to
being busy at home, taking children to school, and many
women in the city of Banda Aceh besides being
housewives, some of them also work in government or
in the private sector. Researchers have also not found
that public places that are the responsibility of the
village/district, have not been maximized in maintaining
cleanliness, especially during the transition from the dry
season to the rainy season.
Health Center surveillance officers routinely go to the
community to monitor the presence of larvae in
residents' homes/neighborhoods suspected of being
breeding places for Aedes aegypti larvae. As well as the
role of village officials to encourage residents to always
maintain good sanitation in the house, in the yard and in
public places, and routinely carry out clean
Friday/Sunday movements and the source of funding for
these activities is taken from the Village Fund Budget
(ADG).
CONCLUSION
Based on the results of this study regarding the analysis
of Dengue Hemorrhagic Fever (DHF) prevention
behavior using the Health Belief Model (HBM) approach
in Banda Aceh City, it can be concluded that, Hypothesis
testing shows that;
Age group has a significant relationship with perceived
benefits (p=0.035<0.05), age group also has a significant
relationship with perceived severity (p=0.035<0.05),
perceived vulnerability has a significant relationship
with
dengue
prevention
behavior,
namely
(p=0.000<0.05), perceived benefits have a significant
relationship with dengue prevention behavior, namely
(p=0.000<0.05), perceived barriers have a significant
relationship with dengue prevention behavior, namely
(p=0.000<0.05), and cues to act have a significant
relationship with dengue prevention behavior, namely
(p=0.000<0.05).
REFERENCES
Avidsyah, MA, Asrina, A., & Fairus Prihatin Idr. (2024).
Relationship between Age and Residential Density with
the Incidence of Dengue Fever Patients in the
Tamalanrea Health Center Work Area, Makassar City.
Public Health, 5 (2), 321
–
330.
Achmadi, UF (2005). Area-Based Disease Management.
First Edition. Jakarta: Kompas Book Publisher.
Attamimy, HB (2017). Application of Health Belief Model
on Dengue Fever Prevention Behavior: e-journal unair:
FKM-Airlangga Surabaya. Vol 5 No.2 Year 2017: Jurnal
Promkes
.
Ananda, Maulidyah; University of Indonesia. Faculty of
Public Health. Health Education and Behavioral
Sciences. (2024). Factors Related to Dengue Fever (DHF)
Prevention Behavior in the Work Area of Bolo Health
Center, Ka, 1.
Baitanu, JZ, Masihin, L., Rustan, LD, Siregar, D., & Aiba,
S. (2022). Relationship Between Age, Gender, Mobility,
International Journal of Medical Science and Public Health Research
96
https://ijmsphr.com/index.php/ijmsphr
and Knowledge with Incidents. Malahayati Nursing
Journal, 4(5), 1230
–
1241.
Champion, V. A. (2008). Health Behavior and Health
Education. In. BK Karentz. Glan, Health Behavior and
Health Education (P.45). San Francisco: A. Wiley Imprint.
Ministry of Health of the Republic of Indonesia. (2004a).
Management of Dengue Hemorrhagic Fever in
Indonesia. Jakarta: Directorate General of P2MPL
Ministry of Health of the Republic of Indonesia. (2004b).
Technical Guidelines for Eradicating Dengue Fever
Mosquito Nests (PSNDBD) by Larvae Monitoring Officers
(Jumantik). Jakarta: Directorate General of PP & PL.
Ministry of Health of the Republic of Indonesia. (2009).
Report on Dengue Hemorrhagic Fever. Jakarta:
Directorate General of P2MPL
Aceh Health Office. (2024). Aceh Health Profile 2023.
Banda Aceh: P2P Division of Aceh Health Office.
Elvin, SD, Mulyadi, & Kamil, H. (2016). The Family Health
Task In Prevention Of Dengue Hemorrhagic Fever With
Health Belief Model Approach The Family Health Task In
Prevention Of Dengue Hemorrhagic Fever With Health
Belief Model Approach Dengue Hemorrhagic Fever
(DBD) is and which is. Journal of Nursing Science, 4(2),
2338
–
6371.
https://repositori.itekes-bali.ac.id
Fitriani. (2022). Application of Health Belief Model to
Preventive Behavior of Covid-19 in Elderly Group.
Indonesian Journal of Health Promotion and Behavior.
21-27.
Hair, J.F., Hult, G.T.M., Ringle, C.M., Sarstedt, M., Danks,
N.P., Ray, S. (2021). An Introduction to Structural
Equation Modeling. In: Partial Least Squares Structural
Equation Modeling (PLS-SEM) Using R. Classroom
Companion:
Business.
Springer,
Cham.
https://doi.org/10.1007/978-3-030-80519-7_1
Hayden, J. (2009). Introduction to health behavior
theory. USA: Jones & Bartletts Publishers LLC.
Hermansyah. (2022). Dengue Hemorrhagic Fever
Management: Area-Based Ecological Study. First Edition.
Purwokerto: Amerta Media
.
Hiswani. (2003). Prevention and Eradication of Dengue
Fever. Medan: ©Digitized by USU digital library, access
at http://library.usu.ac.id. Accessed June 01, 2024
.
Putra, AASAS, Shintia, AY, Lusno, MFD, Ardyanto w, D.,
Irwanto, BSP, Syafi'i, I., Fadli, RC, & Rokhman, A. (2023).
Analysis of the Relationship Between Education Level
and Risk Behavior with the Incidence of Dengue
Hemorrhagic Fever (DHF) in Mayangrejo Village. Care:
Scientific Journal of Health Sciences, 11(2), 277
–
284.
https://doi.org/10.33366/jc.v11i2.4005
Ramadani, F., Nur Azizah, Mayang Sari Ayu, & Lubis, TT
(2023). Relationship between Characteristics of Dengue
Fever Patients at the Medan Hajj Hospital in the Period
January - June 2022. Ibnu Sina: Journal of Medicine and
Health - Faculty of Medicine, Islamic University of North
Sumatra,
22(2),
189
–
195.
https://doi.org/10.30743/ibnusina.v22i2.498
Inayah, Dian Ayubi, Ella Nurlela Hadi: University of
Indonesia. Faculty of Public Health. Health Education
and Behavioral Sciences. (2022). Factors Related to
Dengue Fever Prevention Behavior in the Community in
Pesanggrahan District in 2022. Depok: FKM-UI.
Jones & Bartlett, (2008). The health belief model. Jones
and Bartlett Publishers.
Ministry of Health of the Republic of Indonesia. (2023).
Mpi, Module and, Bionomics of Disease Vectors, Carrier
Animals; Surveillance and Control Training of Vectors
and Disease Carrier Animals for Health Entomologists at
Health Centers. Directorate of Improving the Quality of
Health Workers.
Ministry of Health of the Republic of Indonesia. (2022).
Opening a New Page. 2022 Annual Report on Dengue
Hemorrhagic Fever, 17-19.
Ministry of Health of the Republic of Indonesia. (2021).
Indonesia. In National Dengue Control Strategy 2021-
2025.
Ministry of Health of the Republic of Indonesia. (2013).
Guidelines for Controlling Dengue Fever in Indonesia.
Directorate General of P2PL
Notoatmodjo S. (2007). Health Behavior Science.
Jakarta: Rineka Cipta
Notoatmodjo S. (2010). Health Behavior Science.
Jakarta: Rineka Cipta.
International Journal of Medical Science and Public Health Research
97
https://ijmsphr.com/index.php/ijmsphr
Pramatama, SDDW Endemic., & Wijayanti, SPM (2020).
Characteristics and Patterns of Spread of Fever Diseases
(September Issue)
Romas, MS (2012). Theoretical Foundation of Health
Education and Health Promotion. United States: Malloy
In
