SiMerah Digital Monitoring of Iron–Folic Acid Supplementation Adherence Among Adolescent Girls: A Quasi-Experimental Study

Eva Agustina Yalestyarini; Dedi Saifulah; Joko Sutrisno

doi:10.30994/jnp.v10i1.1245

Authors

Eva Agustina Yalestyarini Faculty of Nursing, Universitas STRADA Indonesia, Kediri, Indonesia https://orcid.org/0009-0003-2743-8117
Dedi Saifulah Faculty of Nursing, Universitas STRADA Indonesia, Kediri, Indonesia https://orcid.org/0009-0007-3136-5562
Joko Sutrisno Faculty of Nursing, Universitas STRADA Indonesia, Kediri, Indonesia https://orcid.org/0009-0007-6921-5041

DOI:

https://doi.org/10.30994/jnp.v10i1.1245

Keywords:

Adolescent Girls, Adherence, Anemia, Iron-Folic Acid Supplementation

Abstract

Background: Adherence to weekly iron-folic acid supplementation remains an important challenge in anemia-prevention programs for adolescent girls. Recent Indonesian evidence suggests that adherence is influenced by individual, peer, school, and program-delivery factors, while digital reminder interventions may improve supplementation behavior. SiMerah (Skrining Anemia pada Remaja Sehat) is a web-based digital application developed to support scheduled reminders, consumption recording, adherence monitoring, and validation of evidence of tablet intake.
Purpose: To evaluate adherence outcomes associated with SiMerah digital monitoring compared with routine school-based monitoring.
Methods: A two-group quasi-experimental pre-test–post-test study involved 186 adolescent girls (93 per group) at SMK Karya, Kediri, Indonesia. Adherence was calculated as the proportion of five scheduled weekly tablets recorded as consumed during each assessment period. Within-group paired tests, between-group comparison of change, and exploratory baseline-adjusted linear regression with heteroskedasticity-robust standard errors were performed.
Results: Mean adherence changed from 97.85% to 96.13% in the SiMerah group and from 92.04% to 89.25% in the comparison group. The between-group difference in change was 1.08 percentage points (95% CI -2.71 to 4.86; p=0.575). Baseline adherence differed between groups (p<0.001). Exploratory baseline-adjusted analysis showed a post-test difference of 5.16 points (95% CI 1.81 to 8.51; p=0.003), but the observational design and baseline imbalance limit causal interpretation.
Conclusion: The SiMerah group did not show a statistically significant improvement in recorded adherence relative to routine monitoring when comparing pre–post changes. High initial adherence, baseline imbalance, and strong existing school health monitoring warrant cautious interpretation. Future versions should evaluate post-consumption symptoms and usability.

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