Determinan Kepatuhan Konsumsi Tablet Tambah Darah Pada Remaja Putri Berdasarkan Model Precede-Proceed (Lawrence Green): Systematic Review dan Meta-Analisis

Iron deficiency anemia remains a significant public health problem among adolescent girls, despite the widespread implementation of Iron Supplementation Tablet (IST) programs. However, adherence to IST consumption remains suboptimal, requiring a more comprehensive analysis of its determinants. This study aimed to examine the effects of predisposing, enabling, and reinforcing factors on adherence to IST consumption among adolescent girls based on the PRECEDE–PROCEED model through a systematic review and meta-analysis. This study followed PRISMA 2020 guidelines, with literature searches conducted in Scopus, ScienceDirect, and PubMed databases covering the period 2015–2025. The screening process identified 1,726 articles, of which 15 studies met the inclusion criteria for analysis. Included studies were quantitative observational studies reporting Odds Ratios (ORs) and were analyzed using a random-effects model. Study quality was assessed using the Joanna Briggs Institute (JBI) checklist. The meta-analysis results showed that predisposing factors (OR = 3.17; 95% CI: 2.51–3.99), enabling factors (OR = 3.89; 95% CI: 3.12–4.85), and reinforcing factors (OR = 2.64; 95% CI: 2.14–3.26) were significantly associated with IST adherence. Enabling factors were the strongest determinant. These findings highlight the need for integrated PRECEDE–PROCEED-based interventions to improve adherence and reduce anemia risk among adolescent girls. Keywords: Iron Deficiency Anemia, Iron Supplementation Adherence, Adolescent Girls, PRECEDE–PROCEED Model. ABSTRAK Anemia defisiensi besi masih menjadi masalah kesehatan pada remaja putri meskipun program Tablet Tambah Darah (TTD) telah diterapkan secara luas. Namun, tingkat kepatuhan konsumsi masih belum optimal sehingga diperlukan analisis determinan yang lebih komprehensif. Penelitian ini bertujuan untuk menganalisis pengaruh faktor predisposisi, enabling, dan reinforcing terhadap kepatuhan konsumsi TTD pada remaja putri berdasarkan model PRECEDE–PROCEED melalui systematic review dan meta-analisis. Penelitian ini mengikuti pedoman PRISMA 2020 dengan pencarian literatur pada database Scopus, ScienceDirect, dan PubMed periode 2015–2025. Proses seleksi menghasilkan 1.726 artikel yang kemudian disaring hingga diperoleh 15 studi yang memenuhi kriteria inklusi. Studi yang dianalisis merupakan penelitian kuantitatif observasional yang melaporkan Odds Ratio (OR) dan dianalisis menggunakan random-effects model, serta dinilai menggunakan Joanna Briggs Institute (JBI). Hasil meta-analisis menunjukkan bahwa faktor predisposisi (OR = 3,17; 95% CI: 2,51–3,99), enabling (OR = 3,89; 95% CI: 3,12–4,85), dan reinforcing (OR = 2,64; 95% CI: 2,14–3,26) berhubungan signifikan dengan kepatuhan konsumsi TTD. Faktor enabling merupakan determinan paling kuat. Temuan ini menunjukkan perlunya pendekatan intervensi berbasis PRECEDE–PROCEED yang terintegrasi untuk meningkatkan kepatuhan dan menurunkan risiko anemia pada remaja putri secara berkelanjutan. Kata Kunci: Anemia Defisiensi Besi, Kepatuhan Konsumsi Tablet Tambah Darah, Remaja Putri, Model PRECEDE–PROCEED.