Application of The Theory of Planned Behavior to The Utilization Immunization Services for Infants in Surakarta City 2025
DOI:
https://doi.org/10.22437/jkmj.v9i2.47800Keywords:
intention, attitude, subjective norm, control, outcome evaluation, immunizationAbstract
Infectious diseases are the leading cause of child mortality in Indonesia, yet many deaths can be prevented through immunization. The 2023 Indonesian Health Survey reported a national full basic immunization coverage of only 35.8%, a decrease from 57.9% in 2018 and far from the 100% target. Surakarta City achieved a coverage of 98.34% in 2023, showing strong regional commitment, although it still does not fully meet national goals. This study analyzes the influence of the Theory of Planned Behavior (TPB) on the use of immunization services for infants in Surakarta. Using a cross-sectional design, 200 mothers with infants aged 12–24 months were selected through multistage random sampling. Independent variables include intention, attitude, subjective norm, and perceived behavioral control; the dependent variable is the use of infant immunization services. Data were collected via structured questionnaires and analyzed using linear regression and path analysis. The study found that intention directly affects the use of immunization services (b=0.20; 95% CI=0.07 to 0.33; p<0.00). Attitude, subjective norm, and outcome evaluation indirectly influence immunization service use through intention. The path model demonstrated good fit (CFI = 0.979; TLI = 0.964; RMSEA = 0.079; SRMR = 0.037). Intention plays a crucial role in the use of immunization services, with attitude, subjective norm, and outcome evaluation affecting use through intention. The study model shows good fit. Increasing immunization uptake should focus on strengthening intention through positive attitudes, social norms, and education.
References
1. Salim LA, Muthmainnah M, Zahro AF, Pratiwi DA, Nurmala I, Lin CY, et al. Enhancing Infant Immunization Rates: Determinants of Complete Routine Vaccination in an Urban Indonesian Primary Health Center. Media Publ Promosi Kesehat Indones. 2025;8(3):232–42.
2. Caso D, Capasso M, Fabbricatore R, Conner M. Understanding the psychosocial determinants of Italian parents’ intentions not to vaccinate their children: an extended theory of planned behaviour model. Psychol Heal. 2022;37(9):1111–31.
3. Capasso M, Conner M, Caso D. Testing an extended theory of planned behaviour in predicting Covid-19 vaccination intention over the course of the pandemic: A three-wave repeated cross-sectional study. Heliyon [Internet]. 2024;10(3):e24826. Available from: https://doi.org/10.1016/j.heliyon.2024.e24826
4. Sriatmi A, Martini, Jati SPB, Handayani N, Aditya Kusumawati, Armunanto. Parent’s Knowledge and Attitude as Key Determinants of Completeness Childhood Immunization in Central Java, Indonesia. J Kesehat Masy. 2024;20(1):89–100.
5. Garcia EM, de Souza EL, Matozinhos FP, da Silva TMR, Waldman EA, Sato APS. Associated factors with vaccine hesitancy in mothers of children up to two years old in a Brazilian city. PLOS Glob Public Heal. 2023;3(6):1–15.
6. Elbert B, Zainumi CM, Pujiastuti RAD, Yaznil MR, Yanni GN, Alona I, et al. Mothers’ knowledge, attitude, and behavior regarding child immunization, and the association with child immunization status in Medan City during the COVID-19 pandemic. IJID Reg. 2023;8(5):S22–6.
7. Yang L, Ji L, Wang Q, Xu Y, Yang G, Cui T, et al. Vaccination Intention and Behavior of the General Public in China: Cross-sectional Survey and Moderated Mediation Model Analysis. JMIR Public Heal Surveill. 2022;8(6):1–12.
8. Geraldine EU, Daniel ET, State B. Pentavalent Vaccine How safe is it among infant accessing Immunization in Nigerian Health Facilities. Paediatr Anaesth. 2024;1–27.
9. Burch E, Christensen H, Brooks-Pollock E. The effect of outcome choice on vaccine dose allocation: a modelling study. J Theor Biol [Internet]. 2025;610(April):112156. Available from: https://doi.org/10.1016/j.jtbi.2025.112156
10. Wolff K. COVID-19 Vaccination Intentions : The Theory of Planned Behavior , Optimistic Bias , and Anticipated Regret. 2021;12(June).
11. Limbu YB, Gautam RK. Predicting Vaccination Intention against COVID-19 Using Theory of Planned Behavior : A Systematic Review and. 2026;1–19.
12. Xiao X, Min R. Vaccine hesitancy and perceived behavioral control : A meta-analysis. Vaccine [Internet]. 2020;(xxxx). Available from: https://doi.org/10.1016/j.vaccine.2020.04.076
13. Benny G, Wirawan S, Luh N, Gustina Z, Harrista P, Pramana I, et al. Women ’ s Empowerment Facilitates Complete Immunization in Indonesian Children : A Cross-sectional Study. 2022;193–204.
14. Amoah A, Issaka J, Ayebeng C, Okyere J. Influence of women empowerment on childhood (12–23 months) immunization coverage: Recent evidence from 17 sub-Saharan African countries. Trop Med Health. 2023;51(1).
15. Dyda A, King C, Dey A, Leask J, Dunn AG. A systematic review of studies that measure parental vaccine attitudes and beliefs in childhood vaccination. BMC Public Health. 2020;20(1):1–8.
16. Dempsey RC, Wood AM. Perceived Social Norms and Vaccine Hesitancy. Curr Dir Psychol Sci. 2025;
17. Attwell K, Duong H, Morris A, Roberts L, Navin M. Drivers of Noncompliance With Vaccine Mandates—The Interplay Between Distrust, Rationality, Morality, and Social Motivation. Regul Gov. 2025;1–17.
18. Gustina, Mohar T, Mohamed S. Intellectual Discorse. Vol. 33, NASIG Newsletter. 2025.
19. Almokdad E, Kiatkawsin K, Lee CH. Antecedents of Booster Vaccine Intention for Domestic and International Travel. Sustain. 2023;15(8).
20. Rahman T, Das A, Abir MH, Nafiz IH, Mahmud AR, Sarker MR, et al. Cytokines and their role as immunotherapeutics and vaccine Adjuvants: The emerging concepts. Cytokine [Internet]. 2023;169(April):156268. Available from: https://doi.org/10.1016/j.cyto.2023.156268
21. Bradshaw A, Carter CG. An exploratory study of expectant mothers’ knowledge, attitudes and beliefs about infant vaccination. Qual Heal Commun. 2022;1(2):61–79.
22. Honggo F, Handayani PW, Azzahro F. The antecedents of intention to use immunization information systems and usage behavior. Informatics Med Unlocked [Internet]. 2022;34(July):101107. Available from: https://doi.org/10.1016/j.imu.2022.101107
23. Hasanah DR, Tampubolon E. Relationship of the Motivation of the Midwife and the Mother’s Compliance with Complete Basic Immunization in the Hana Kasih Clinic. Int J Clin Invent Med Sci. 2022;4(1):24–30.
24. Hobani F, Alhalal E. Factors related to parents’ adherence to childhood immunization. BMC Public Health [Internet]. 2022;22(1):1–11. Available from: https://doi.org/10.1186/s12889-022-13232-7
25. Moussaoui LS, Heiser NH, Desrichard O. Herd Immunity Versus Self-Interest Motives and Norms Effects on Influenza Vaccination Intention. Heal Psychol. 2024;43(3):237–45.
26. Obohwemu KO. Maternal Attitudes Towards Childhood Vaccination in Delta State, Nigeria. Front Med Sci Pharm J. 2024;04(12):43–66.
27. Obohwemu K, Christie-De Jong F, Ling J. Parental childhood vaccine hesitancy and predicting uptake of vaccinations: a systematic review. Prim Heal Care Res Dev. 2022;23.
28. Akbulut S, Boz G, Ozer A, Sahin TT, Colak C. Evaluation of the Turkish Population’s Perspective on COVID-19 Vaccine Hesitancy and Routine Childhood Vaccine Applications: National Survey Study. Vaccines. 2023;11(4):1–14.
29. Almutairi WM, Alsharif F, Khamis F, Sallam LA, Sharif L, Alsufyani A, et al. Article assessment of mothers’ knowledge, attitudes, and practices regarding childhood vaccination during the first five years of life in saudi arabia. Nurs Reports. 2021;11(3):506–16.
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Copyright (c) 2025 Julhan Irfandi, Bhisma Murti, Setyo Sri Rahardjo, Sumardiyono, Eti Poncorini Pamungkasari (Author)
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