Podcast Education on Anemia’s Knowledge and Attitude of Female

Adolescent in Central Jakarta

Ra’afi Adlu, Adhila Fayasari

Nutrition Program, Faculty of Health Science and Technology, Binawan University, East Jakarta, Indonesia

Keywords: Education, podcast, knowledge, attitude, anemia

Abstract: Anemia is one of the nutritional problems in Indonesia, and the number is higher in female adolescents.

Anemia was caused by low intake of iron, protein, vitamin C, and low absorption related to high intake of

inhibitors like tea and coffee. Iron tablet supplementation program also one of solution in which government

gave, but there were obstacles like low adherence and pandemic covid-19. Therefore, female adolescents must

be given the education to increase knowledge, and attitudes on anemia prevention. We provide podcast media

as the solution. This study aims to determine the effect of education with audio podcast media about anemia

on knowledge, and attitudes. We conducted a quasi-experimental with a control group design on 68 female

adolescents in SMA Negeri 4, Central Jakarta. We divided subjects into 2 groups, the podcast group as an

intervention group and the flyer group, as a control group. The intervention was conducted in 4 phases in 2

weeks period, pre-test and post-tests were collected using an online questionnaire which is shared in the online

application group. Post-tests were conducted twice, after the intervention and 2 weeks after the intervention.

We analysed data using Wilcoxon and Mann-Whitney with α 0.05. The results showed there was an increase

in knowledge (0,000) and attitude (0,036) score in audio podcast group, but for the flyer group, the significant

increase was only in knowledge score (0,000). The podcast was significantly effective to increase knowledge

(0.007), than flyer, but no for attitudes (0.389).

1 INTRODUCTION

One of the goals of the SDGs is to end all forms of

malnutrition and overcome the nutritional needs of

adolescents, pregnant women, and the elderly (SDGs,

2015). Developing countries are currently still facing

the problem of the Triple Burden of Malnutrition,

namely lack of macronutrients, micronutrients, and

being overweight or obese (UNICEF 2016).

Micronutrients are essential vitamins and minerals

needed in small amounts by the body for proper

growth and development. Micronutrient deficiencies

will cause health effects that are not always acutely

visible, which is referred to as hidden hunger

(Ritchie, 2017).

The World Health Organization estimates that

there are 2 billion people in the world's population

suffering from micronutrient deficiencies, one of

them is iron deficiency anemia which is the most

common among women of reproductive age (WHO,

2011). Globally, the prevalence of anemia is

estimated at 9% in developed countries and 43% in

developing countries (Wijayanti, 2019). Based on

WHO data the prevalence of anemia in women of

reproductive age is 16.8% in the Americas and 41.9%

in the Southeast Asian region (WHO, 2011). Based

on Indonesia’s National Health Survey (2018), the

national prevalence of anemia in women was 23.9%

in 2013 and 27.2% in 2018. The prevalence of anemia

in the 15-24 years of age group was 18.4% in 2013

and increased to 32% in 2018.

The prevalence of anemia in adolescent girls in

DKI Jakarta was 44.6% and most of it is caused by

inadequate iron intake from food (Anggraeni, 2010;

Junengsih, 2017; Tania, 2018). A study stated that a

total of 82% of adolescents in high school in Central

Jakarta had inadequate iron intake which may

increased risk of anemia (Hendarto, 2018).

Inadequate absorption of iron can also affect the low

iron level in the body (Susilowati et al, 2018). Factors

that affect iron absorption are the presence of

inhibitors (tannins, casein, calcium, phytic acid, and

oxalic acid) and enhancers (vitamin C and protein)

(Ems et al, 2020; Sholihah, 2019). According to

Solicha’s study (2019), there was a significant

association between protein and vitamin C intake on

Adlu, R. and Fayasari, A.

Podcast Education on Anemia’s Knowledge and Attitude of Female Adolescent in Central Jakarta.

DOI: 10.5220/0010757800003235

In Proceedings of the 3rd International Conference on Social Determinants of Health (ICSDH 2021), pages 279-286

ISBN: 978-989-758-542-5

279

hemoglobin levels in SMA 1 Manyar Gresik.

Inadequate intake of protein and vitamin C, hence

leading to low hemoglobin levels.

To prevent anemia, the Indonesian Government

has been trying to overcome anemia since 1997

through the provision of iron and folic acid

supplementation to junior and senior high school girl

groups (Permatasari et al, 2018).

In March 2020, Indonesia was faced with a

Pandemic of COVID-19. This situation has urged the

Indonesian Government to issue a policy of Large-

Scale Social Restrictions (PSBB) which has an

impact on social activities. This condition has

affected health programs in schools such as the

provision of iron supplementation for adolescent girls

has become restricted (Kemenkes RI, 2020).

Adolescents who do not take iron supplements

have a 2,047 times higher risk of anemia compared to

female adolescents who consume iron supplements

(Listiana, 2016). Another attempt to overcome

anemia in adolescents is to increase the intake of food

sources of iron (Marfuah, 2016). Efforts to increase

dietary iron intake can be done through education or

nutrition counseling to adolescents. Nutrition

education or counseling is an educational approach to

produce individual behavior that can improve food

improvement and nutritional status (Fadila, 2018). In

addition, nutrition education or counseling can

increase knowledge and change attitudes in terms of

food consumption. Knowledge is a very important

domain for the formation of someone's behavior

(Fitriani et al, 2019).

The study conducted by Ardianti (2019) regarding

the relationship between knowledge and personal

hygiene behavior during menstruation in adolescents

found that 55.8% of respondents had a good level of

knowledge supported by positive personal hygiene

behavior. Amany (2015) states that the better

knowledge provided, the better behavior that will be

carried out so that it will prevent a disease.

In the era of the industrial revolution 4.0,

Indonesia is still in a demographic bonus period

where the dominant generation is the youth group.

The generation of teenagers aged 16-18 years was

born when the use of digital technology began to

grow rapidly, so this generation was familiar with its

use. This is evidenced by the highest percentage of

computer and internet use at the age of 16-18 years

compared to other groups of age. They utilize digital

technology for the teaching and learning process,

seeking information and socialization (Badan Pusat

Statistik, 2019).

In 2020, many digital educational media

innovations are being developed to be used as

nutrition education or counseling for adolescents.

One of the digital educational media that is currently

developing among teenagers is podcasts. Podcasts are

an interesting technological medium because in

podcasts anyone can get involved, exchange ideas,

and express anything. Podcasts can also be used

easily and can be accessed by teenagers online

(Meisyanti, 2020). Based on data from the Pew

Research Center 2019 reported by Baer et al. (2020)

stated that 32% of the United States population aged

12 years and over, listen to at least one podcast every

month. Based on DailySocial survey data (2018), in

Indonesia, 67.97% of respondents are familiar with

podcasts and most of them are still in the millennial

age, namely 16 to 35 years.

The current use of podcasts has touched the realm

of education as a learning medium because it can

improve learning outcomes and adolescent learning

motivation (Mayangsari, 2019). The study of

Rockhill (2019) in the United States for college

students aged 22-36 showed that the use of podcasts

resulted in positive learning and got good learning

outcomes. Another study in Indonesia in 2019, there

was a significant effect on the use of podcasts for

learning English listening in high school students.

This is due to the influence of podcasts which can

stimulate students to be more imaginative and build a

picture of what they hear (Widodo, 2019).

Therefore, this study aimed to determine the effect

of education with audio podcast media about anemia

on knowledge and attitudes in female adolescent in

Central Jakarta.

2 MATERIALS AND METHODS

A quasi-experimental with control group design was

conducted in female adolescents of SMA Negeri 4,

Central Jakarta. The inclusion criteria of subjects of

this study were female adolescents aged between 15

– 18 years and using smartphone device. Exclusion

criteria were students who were hospitalized or

unable to carry out normal activities and withdrew or

missed one of the intervention processes. Subjects

received an overview of the background, objective,

and benefits of the study. All participants were

informed of the purpose of the study and received

their written consent to participate voluntarily. The

subjects under 20 received permission from their

legal guardian before enrolment. This study was

approved by University Prof Dr. Hamka’s Health

Research Ethics Commission with number

03/21.03/0875. Consent was also obtained from the

selected school principals, parents, and also subjects.

ICSDH 2021 - International Conference on Social Determinants of Health

280

The sample was calculated following study

Widodo, 2019 with a confidence level of 95%, beta

5%, expected different 0.05 points, and 10% loss to

follow up. The minimum sample in each group was

34 samples or 68 subjects in total.

Stratified random sampling was conducted. All

students in SMA Negeri 4 are stratified into X and XI

classes. Each class was taken randomly and then

divided into two intervention groups.

The intervention consisted of two treatments, the

podcast group as an intervention group and the flyer

group as a control group. Initial data collection was

conducted by google form, and it included the socio-

demographic data, knowledge, and attitude about

anemia.

The intervention was conducted in 4 phases in 2

weeks period in both groups. In the podcast group,

subjects were given education through audio

podcasts, named podcast BINCANGIZI which can be

accessed through Spotify. The podcast was given to

the subject is about 6-12 minutes long. Subjects can

access and listen to podcasts through the application

on their smartphones. The topics presented include

general information about anemia, a balanced diet,

iron-rich foods, and iron supplementation. We use

media flyers taken from the Indonesian Ministry of

Health’s website with the same topic. The subject

who had accessed the media have to list their name in

the WhatsApp group.

The podcast development step begins with

determining the theme and ends with an audio

podcasts acceptance test using Questionnaire for

Assessing Educational Podcasts (QAEP) (Postigo,

2020). The chosen theme refers to materials to

improve the problem of anemia in adolescents. The

QAEP included access and use, design and structure,

content adequacy, and value as an aid to learning.

Pre-test and post-tests were collected using online

questionnaire which was shared through WhatsApp

group. The questionnaire was modified from previous

studies (Sembiring, 2015; Runkat, 2019; and Aditian,

2009). Questionnaires were validated through face

validity by the panel of experts, and quantitative

validity using spearman correlation analysis.

Knowledge questionnaires is consisted of 25

questions with multiple choice options with validity

21 of 25 questions and reliability Cronbach alpha

0.733. Each question is scored 10 points, and for total

250 points, then we categorized of total point with

good (76-100%), sufficient (56-75%) and poor (0-

55%).

Attitude questionnaires is consisted of 10

questions with Likert scale ranging 1-5 with validity

10 of 10 questions and reliability cronbach alpha

0.802. Each question is scored 1 representing

“strongly disagree” to 5 representing “strongly agree”

for the positive question and vice versa for the

negative question, and for total 50 points, then we

categorized of total point with positive (61-100%),

neutral (41-60%), and negative (0-40%).

Post-tests were conducted twice, in the end of the

intervention and 2 weeks after the intervention.

Before selecting the test on bivariate analysis, the

normality of data was checked using Kolmogorov-

Smirnov test. All of the data are not normally

distributed. Data were analyzed using Wilcoxon for

difference mean before and after intervention; and

Mann-Whitney for difference mean between two

group, with significance level of 95%.

3 RESULT

The distribution of demographic information on the

subject is presented in Table 1. No significant

difference of characteristic between podcast and flyer

group (p>0,05). A total of 68 subjects have been

enrolled, the majority of subjects aged 15 - 16 years

in both groups.

Table 1. Demographics information.

Variable

Podcast Fl

p-value

n% n %

15 – 16 years

–

ears

64.7

35.3

58.8

41.2

0.618

Grade

47.1

52.9

50.0

0.808

Allowance/month

(

.000

)

< Rp. 500

Rp. 500 – Rp.

1.000

. 1000

70.6

17.6

11.8

70.6

20.6

8.8

0.896

Father’s Education

Low

Middle

11.8

58.8

29.4

14.7

38.2

47.1

0.225

Father’s Occupation

Government

employees

Private

employees

Entrepreneur

Retired

Etc.

5.9

55.9

17.6

5.9

14.7

5.9

58.8

29.4

2.9

0.403

Father’s Income (.000)

< Rp. 1,000

Rp. 1,000 –

. 3,000

32.4

38.2

20.6

35.3

0.381

Podcast Education on Anemia’s Knowledge and Attitude of Female Adolescent in Central Jakarta

281

Variable

Podcast Fl

p-value

n % n %

> Rp. 3,000 10 29.4 15 44.1

Mother’s Education

Low

Middle

High

14.7

55.9

29.4

26.5

35.3

38.2

0.211

Mother’s Occu

ation

Employed

Unem

23.5

76.5

32.4

67.6

0.417

Mother’s Income (,000)

< Rp. 1,000

Rp. 1,000 –

Rp. 3,000

> Rp. 3,000

79.4

11.8

8.8

61.8

17.6

20.6

0.253

osed Information Related to Anemia

Yes

85.3

14.7

85.3

14.7

1.000

Information Source

Books

Parents

Social Media

Health

workers

Web

6.9

44.8

20.7

10.3

55.2

17.2

0.611

Note: Chi-Square analyzed with p-value < 0.05

The flyer group had a balanced proportion

between subjects in grade X and XI (50%), while

subjects in grade XI were more in the podcast group

(52.9%). Most subjects (70.6%) in both groups had a

lower monthly allowance. Based on subject family’s

characteristic, the father's education in both groups

were most in secondary education. The father’s

occupation was dominated by working as private

employees. The father's income in both groups were

in the middle-upper class. Most mothers had

secondary education than higher education.

Unemployed mothers were more dominant in both

groups than employed and had income in the low

class. A total of 85.3% of subjects in both groups got

information related to anemia before and mostly got

information through social media.

The first part of the acceptance test included the

statements related to access and usage of audio

podcasts. The mean statistic for the access and usage

statement ranged from 3.73 to 3.85 which all

statements are closer to strongly agree. The lowest-

rated statement was “I was able to view the podcasts

in different places” (m=3.73). The highest-rated

statement was “It was easy to access the podcasts”

(m= 3.85) and “The podcasts were easy to find

online” (m= 3.85). The second part of the acceptance

test included the statement related to the design and

structure of the development audio podcast. The

mean statistic for the design and structure statement

ranged from 3.27 to 3.81 which the statements are

closer to agreeing and strongly agreeing. The lowest-

rated statement was “The design of the podcasts is

attractive” (m= 3.27) dan “The length of the podcasts

is appropriate for understanding their content” (m=

3.46). The highest-rated statement was “The audio of

the podcasts is clear” (m= 3.81).

The third part of the acceptance test included the

statements related to the content adequacy of audio

podcasts as a learning tool. The mean statistic for the

content adequacy statement ranged from 3.62 to 3.73

which all statements are closer to strongly agree. The

lowest-rated statement was “The terminology used in

the podcasts is appropriate” (m= 3.62). The highest-

rated statement was “The podcasts provide a good

summary of the topic being addressed” (m= 3.73) and

“The content of the podcasts is relevant to the

subject” (m= 3.73). The fourth part of the acceptance

test included the statements related to audio podcast

value as an aid to learning for the students. The mean

statistic for the value as an aid to learning statement

ranged from 3.38 to 3.58 which statements are closer

to agreeing than strongly agreeing. The lowest-rated

statement was “The podcasts encourage independent

learning by students” (m= 3.38) and “I’m satisfied

with the podcasts as a learning tool for this subject”

(m= 3.42). The highest-rated statement was “The

podcasts were a good aid to learning about the

subject” (m= 3.58), “The podcasts reinforced my

understanding of the subject” (m= 3.58), and “The

podcasts gave me a better understanding of the

subject content” (m= 3.58).

3.1 Effect Education on Knowledge

Table 2 shows the results of knowledge measurement

before and after intervention in each group. Based on

the table, most pretests in both groups showed good

results, but the proportion in the podcast group was

higher (58.8%) than the flyer group (47.1%). On

posttest result, it showed an increased knowledge

score in both groups. In the podcast group, subjects

who had good scores increased to 28 subjects

(82.4%), still higher than the flyer group which

increased to 23 subjects (67.6%).

Table 4 shows the effect of education on

knowledge in the podcast and flyer groups. There was

a significant increase in knowledge after the

intervention. In the podcast group, the mean

difference of pretest-posttest score was 11.77. In the

flyer group, the mean difference of pretest-posttest

score was 8.59. The statistical results using the

Wilcoxon test showed that there was a significant

difference (p-value 0.000) between the knowledge of

ICSDH 2021 - International Conference on Social Determinants of Health

282

adolescents before and after education with audio

podcast media and flyers.

The statistical results between the podcast and

flyer groups using the Mann-Whitney test showed

that there was a significant difference between

knowledge in the group that was educated using audio

podcasts and flyers (p-value 0.007).

Table 2. The result of knowledge measurement before and

after the intervention.

Variable Category

Podcast Flye

n % n %

Pretest Good

Sufficient

Poo

58,8

38,2

2,9

47,1

38,2

15,7

Posttest Good

Sufficient

Poo

82,4

17,6

67,6

26,5

5,9

3.2 Effect Education on Attitude

Table 3 shows the results of knowledge measurement

before and after intervention in each group. Based on

the table, most pretests in both groups showed

positive results, but the proportion in the podcast

group was higher (100%) than the flyer group

(97.1%). On the posttest result, there’s no change on

attitude in the podcast group, but in the flyer group,

there was a decreased in positive attitude (91.2%) and

increased in negative attitude (2.9%).

Table 5 shows the results of attitudes towards

anemia in the podcast and flyer groups. The table

shows a change in the average score after being given

education. In the podcast group, the mean difference

of pretest-posttest score was 2.88. In the flyer group,

the mean difference of pretest-posttest score was -

0.42. The statistical results using the Wilcoxon test

in both groups showed there was a significant

difference between the attitudes of adolescents before

and after education with audio podcast media (p-

value 0.036), while there was no significant

difference between the attitudes of adolescents before

and after education with media flyers (p-value 0.472).

The statistical results between the podcasts and

flyers groups using the Mann-Whitney test showed

that there was no significant difference (p-value

0.389) between the attitudes of adolescents in the

group that was educated using podcast audio and

flyer.

Table 3. The result of attitude measurement before and after

the intervention.

Variable Category

Podcast Fl

n % n %

Pretest Positive

Neutral

Negative

100

97,1

2,9

Posttest Positive

Neutral

ative

100

91,2

5,9

2,9

Table 4. Effect education with the podcast on knowledge.

Variable

Pretest Posttest

∆𝑥

p-value

Min-Max Mean±SD Min-Max Mean±SD

Podcast 48 – 96 76.94±12.497 56 – 100 88.71±12.513 11.77 0.000

Flyer 40 – 96 71.65±13.622 48 – 100 80.24±13.959 8.59 0.000

∆𝑥

5.29 8.47

p-value 0.139

0.007

paired t-test;

Wilcoxon;

Mann-Whitney, p-value > 0.05

Table 5. The effect of education with the podcasts on attitude.

Variable

Pretest Posttest

∆𝑥

p-value

Min-Max Mean±SD Min-Max Mean±SD

Podcast 66 – 100 84.00±6.476 70 – 98 86.88±7.053 2.88 0.036

Flyer 54 – 100 83.24±10.375 36 – 98 82.82±13.494 -0.42 0.472

∆𝑥

0.76 4.06

p-value 0.946

0.389

paired t-test;

Wilcoxon;

Mann-Whitney, p-value > 0.05

Podcast Education on Anemia’s Knowledge and Attitude of Female Adolescent in Central Jakarta

283

4 DISCUSSION

Based on the results of the study found that there was

an increase in students' knowledge about anemia after

being given education using audio podcasts and

flyers. The increase in students' knowledge of anemia

in the podcast audio group was better than the flyer

group, judging by the average post-test score. This

finding is supported by Mayangsari's study (2019)

which showed an increase in the average score of

knowledge after being given podcast audio was 9.5.

This occurs because the receipt of information with

podcast audio contains oral explanations using easy-

to-understand language so that the material is

delivered clearly and effectively. According to

Notoatmodjo (2012), knowledge is the result of

knowing after sensing a particular object. Knowledge

is essential in shaping one's actions. Efforts that can

be made to improve nutrition knowledge are by

participating in educational activities or nutrition

counseling (Fitriani et al., 2019).

There was a significant difference in knowledge

of anemia before and after podcasts and flyers

intervention. This is because an audio podcast uses

audio or sound that can clearly explain the material.

Podcasts also make listeners imagine the content

presented, in addition to containing learning materials

are also clarified with music and sound effect

(Indriastuti, 2014). The development of podcast audio

media is also proven to produce better knowledge due

to the repetition of material so that it can have an

impact on improving knowledge (Mayangsari, 2019).

The statistic result was supported by the subjects’

acceptance of the audio podcast showed agreeing and

strongly agreeing with the statement of "the podcasts

provide a good summary of the topic being

addressed" and "were a good aid to learning about the

subject". Increased knowledge of anemia in flyer

groups can occur due to the information provided in

the form of text and images that can illustrate the

message given. The capture of information will be

received by sensors memory and processed by the

brain until it becomes a new understanding so that, it

can increase students' knowledge about anemia

(Rusdi et al., 2021). The results of this study are

supported by Gian's findings (2020) which showed

the difference in the average knowledge of SMAN 10

Padang students in the prevention of anemia before

and after nutrition education in podcast and control

groups.

The study reported that there were significant

differences between knowledge in the podcast and

flyer audio groups with a mean difference of 8.47.

The podcast is better to transmit information than a

flyer. Effective, efficient, interesting, and targeted

media become one of the requirements for the

selection of educational media, so the message

delivered can be received well (Rusdi et al., 2021).

Podcasts are one of the new media in the digital era

as a place to produce interesting audio-based content

with a long duration (Faradinna, 2020). Podcasts as

an effective learning medium because they can adapt

the material to the purpose of learning, able to give an

idea of what is heard, and more dynamic. Podcasts

can also be used anywhere and anytime through the

audio player on smartphones so it is efficient as a

medium of remote education (Indriastuti, 2014). It

was supported by subjects’ acceptance of the audio

podcast, stated strongly agree with the statement of

“the podcasts were easy to access the podcasts”, “the

podcasts were easy to find online”, and “the podcasts

were useful for learning about the subject”.

According to Helgesen (2003), stated that the process

of listening aims to understand what we hear. The

more you hear, the more you can understand. This

study is supported by Drummond's research (2021),

which reported there were significant differences in

knowledge scores between podcast groups and

control groups. A total of 77% of respondents in the

study agreed that podcasts are an effective learning

tool.

Attitude is a person's closed reaction to an object

and not an action or activity but rather a

predisposition to the action of a behavior (Meidiana

et al., 2018). Attitude is also a person's willingness to

respond to an object's stimuli, both positive and

negative (Fitriani et al., 2019). Nutrition education is

one of the sustainable ways to increase knowledge

and also shape healthy attitudes and behaviors.

Attitudes are formed not only by education but by

people who are considered important, personal

experience, culture, mass media, education, religion,

and also emotional factors (Rusdi et al., 2021).

In this study, there were significant differences in

attitudes towards anemia before and after being

educated in the podcast group, but there was no

significant difference in attitudes towards anemia

before and after being educated in the flyer group.

This is because, in addition to being informed about

anemia, audio podcast groups are also given

encouragement and support to change their lifestyle

so that their views and attitudes are in a positive

direction towards anemia in adolescents. The

subjects’ acceptance toward audio podcasts were in

strongly agree with the statement of “The podcasts

gave me a better understanding of the subject

content”. While in the flyer group, only informed

about anemia and there’s no encouragement and

ICSDH 2021 - International Conference on Social Determinants of Health

284

support sentence to change their attitude. According

to Edgar Dale's Cone of Experience (1969), stated

that audio recording and still pictures have more

experience in remembering information than verbal

symbols (Sari, 2019).

The study reported that there was no significant

difference between female adolescent's attitudes in

podcast and flyer groups. The increased in attitude

scores of the podcast group is not that high. This is

because a person's attitude could not easily change in

a short time, it takes a longer period to get a change

in attitude in a more positive direction. In addition,

attitude is not only influenced by knowledge but also

personal experience and emotional factors, so that

good knowledge is not always accompanied by a

positive change in attitude (Rusdi et al., 2021). This

study is supported by Rusdi's study (2021), which

stated there was no significant difference between

female adolescent's attitudes in Instagram and

WhatsApp groups. There was a decrease in female

adolescent's attitude scores after education in the

WhatsApp group with a mean difference of -0.90.

5 CONCLUSION

In this study, there were significant increase of

knowledge and attitude score in podcast, but for flyer

group, the significant increase was only in knowledge

score. The podcast is significantly effective to

increase knowledge than flyers but not for attitude.

Implementation of using audio podcasts in

improving knowledge and attitudes towards anemia

is highly recommended and can be a new media of

nutrition education tool, however, it is necessary to

review the distance, time of education, length of

duration, and design of the audio podcast in order to

improve understanding of the information provided

through an audio podcast. Further research is

suggested comparing the effectiveness of online and

offline interventions with audio podcasts.

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