Impact of Web-Based Psychoeducation on Anxiety, Self-Efficacy, and Decision-Making Support of HPV Vaccination among Female Adolescents

Authors

  • Astri Mutiar Department of Maternity Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat 40173, Indonesia
  • Dewi Marfuah Department of Nursing, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat 40173, Indonesia
  • Linlin Lindayani Department of Medical Surgical, Sekolah Tinggi Ilmu Keperawatan PPNI Jawa Barat 40173, Indonesia

DOI:

https://doi.org/10.31674/mjn.2025.v16isupp2.002

Abstract

Background: Cervical cancer in Indonesia is a major public health concern, with Human Papillomavirus (HPV) vaccination being a key preventive measure. However, psychosocial barriers like anxiety and low self-efficacy hinder vaccination uptake among female adolescents, requiring web-based psychoeducation interventions. Objective: This study aimed to evaluate the impact of a web-based psychoeducation programme on anxiety, self-efficacy, and decision-making support regarding HPV vaccination among female adolescents in Indonesia. Methods: A quasi-experimental study design was employed, involving 200 female adolescents aged 15–19 years, divided equally into intervention and control groups. The intervention group received a structured web-based psychoeducation programme, while the control group received standard information. Psychosocial outcomes were assessed using validated instruments: Generalized Anxiety Disorder-7 (GAD-7), General Self-Efficacy Scale (GSES), and Decision-Making Self-Efficacy Scale. Pre- and post-intervention data were analysed using paired t-tests, ANCOVA, and MANCOVA. Results: The intervention group showed significant improvements in anxiety reduction (mean difference: -9.7, p<0.001), self-efficacy enhancement (mean difference: 8.0, p<0.001), and decision-making support (mean difference: 7.9, p<0.001) compared to the control group. Effect sizes indicated moderate to strong impacts across all psychosocial dimensions. Conclusion: Web-based psychoeducation significantly improves psychosocial outcomes, including anxiety, self-efficacy, and decision-making support, among female adolescents. These findings highlight the potential of digital interventions in promoting HPV vaccination acceptance and addressing mental health challenges.

Keywords:

Anxiety, Decision-Making Support, Digital Intervention, Female Adolescents, HPV Vaccination, Self-Efficacy, Web-Based Psychoeducation

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References

Abdulqader, A. Y. M. (2024). personal traits and their relationship to decision-making styles among yemeni universities students. Journal of Educational and Psychological Studies, 18(3), 278–292. https://doi.org/10.53543/jeps.vol18iss3pp278-292 .

Abuzoor, A., Eshareturi, C., Owens, M., Nesbitt, R., & Jonker, C. (2025). A health belief survey among Kuwaiti parents on human papillomavirus vaccination. International Journal of Infectious Diseases, 152. https://doi.org/10.1016/j.ijid.2024.107467.

Andei, L. E., Mihailescu, I., Buica, A. M., Moise, M., Dobrescu, I., & RADa, F. (2025). Gender differences in depressive disorders in children and adolescents: Results from a clinical sample. Maedica A Journal of Clinical Medicine, 20(1). https://doi.org/10.26574/maedica.2025.20.1.26.

Armaou, M. (2024). Research trends in the study of acceptability of digital mental health-related interventions: a bibliometric and network visualisation analysis. Social Sciences, 13(2), 114. https://doi.org/10.3390/socsci13020114.

Bandura, A. (1997). Self-efficacy: The exercise of control. New York: W. H. Freeman. Retrieved from: https://archive.org/details/selfefficacyexer0000band/page/n5/mode/2up . Accessed on 24th July, 2024.

Cantrell, A., Sworn, K., Chambers, D., Booth, A., Buck, E. T., & Weich, S. (2024). Factors within the clinical encounter that impact upon risk assessment within child and adolescent mental health services: a rapid realist synthesis. Health and Social Care Delivery Research, 12(1), 1–107. https://doi.org/10.3310/VKTY5822.

Cao, W., Qin, K., Li, F., & Chen, W. (2024). Comparative study of cancer profiles between 2020 and 2022 using global cancer statistics (GLOBOCAN). Journal of the National Cancer Center, 4(2), 128–134. https://doi.org/10.1016/j.jncc.2024.05.001 .

Capridasari, D. (2024). Peran ekonomi digital dan ketenagakerjaan dalam mendorong pertumbuhan ekonomi: Studi 5 negara asean [The role of the digital economy and employment in driving economic growth: A study of 5 asean countries]. Jurnal Ilmu Ekonomi Jie, 8(01), 52–67. https://doi.org/10.22219/jie.v8i01.31764.

Dewi, S. M., Bennett, L. R., & Barrett, A. (2024). Exploring Indonesian primary schoolgirls’ experiences of school-based HPV vaccination, knowledge of HPV risks and prevention, and preferences for Cervical Cancer Education. Asian Pacific Journal of Cancer Prevention: APJCP, 25(4), 1285-1292. https://doi.org/10.31557/APJCP.2024.25.4.1285 .

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146 .

Fischer-Grote, L., Fössing, V., Aigner, M., Fehrmann, E., & Boeckle, M. (2024). Effectiveness of online and remote interventions for mental health in children, adolescents, and young adults after the onset of the COVID-19 pandemic: Systematic review and meta-analysis. JMIR Mental Health, 11. https://doi.org/10.2196/46637 .

Fleszar-Pavlović, S. E., & Cameron, L. D. (2024). Developing a narrative communication intervention in the context of HPV vaccination. PEC Innovation, 4. https://doi.org/10.1016/j.pecinn.2024.100272 .

Fonagy, P., Chammay, R. El, Ngunu, C., Kumar, M., Verdeli, L., Allison, E., Anani, G., Fearon, P., Fouad, F., & Hoare, Z. (2024). Implementing and evaluating group interpersonal therapy for postnatal depression in Lebanon and Kenya—individually randomised superiority trial. Trials, 25(1), 217. https://doi.org/10.1186/s13063-024-08039-3.

Hassoun, A., Beacock, I., Carmody, T., Kelley, P. G., Goldberg, B., Kumar, D., Murray, L., Park, R. S., Sarmadi, B., & Consolvo, S. (2025). Beyond digital literacy: building youth digital resilience through existing “Information Sensibility” practices. Social Sciences, 14(4), 230. https://doi.org/10.3390/socsci14040230 .

Iova, C. F., Daina, L. G., Daina, M. D., & Ghitea, T. C. (2024). The effectiveness of interventions targeting adolescents in HPV vaccination—A scoping review. Medicina, 60(9), 1-21. https://doi.org/10.3390/medicina60091550 .

Jokhadze, N., Das, A., & Dizon, D. S. (2024). Global cancer statistics: A healthy population relies on population health. CA: A Cancer Journal for Clinicians, 74(3). Retrieved from: https://acsjournals.onlinelibrary.wiley.com/doi/pdf/10.3322/caac.21838 . Accessed on 24th July 2024.

Linardon, J., Torous, J., Firth, J., Cuijpers, P., Messer, M., & Fuller‐Tyszkiewicz, M. (2024). Current evidence on the efficacy of mental health smartphone apps for symptoms of depression and anxiety. A meta‐analysis of 176 randomized controlled trials. World Psychiatry, 23(1), 139–149. https://doi.org/10.1002/wps.21183.

Liu, S., Rawson, H., Islam, R. M., & Team, V. (2025). Impact of pressure injuries on health‐related quality of life: A systematic review. Wound Repair and Regeneration, 33(1), e13236. https://doi.org/10.1111/wrr.13236 .

Ma, Y., Gopal, S., Ma, X., Gallagher, K., Koch, M., & Kaufman, L. (2023). The deforestation and biodiversity risks of power plant projects in Southeast Asia: A big data spatial analytical framework. Sustainability, 15(19), 2-25. https://doi.org/10.3390/su151914461.

Maslowsky, J., Buss, E., & Wray-Lake, L. (2024). The role (and limits) of developmental neuroscience in determining adolescents’ autonomy rights: The case for reproductive and voting rights. Developmental Cognitive Neuroscience, 69. https://doi.org/10.1016/j.dcn.2024.101435 .

McKeithen, M. C., Gilkey, M. B., Kong, W. Y., Oh, N. L., Heisler-MacKinnon, J., Carlson, R., James, G., & Grabert, B. K. (2024). Policy approaches for increasing adolescent HPV vaccination coverage: A systematic review. Pediatrics, 153(5). 1-16 https://doi.org/10.1542/peds.2023-064692.

Michalek, I. M., Koczkodaj, P., & Didkowska, J. (2024). National launch of human papillomavirus (HPV) immunization program in Poland, 2023. Vaccine: X, 17. https://doi.org/10.1016/j.jvacx.2024.100436 .

O'Connor, A. M. (1995). Validation of a decisional conflict scale. Medical Decision Making, 15(1), 25–30. https://doi.org/10.1177/0272989X9501500105 .

Opozda, M. J., Oxlad, M., Turnbull, D., Gupta, H., Smith, J. A., Ziesing, S., Nankivell, M. E., & Wittert, G. (2024). Facilitators of, barriers to, and preferences for e-mental health interventions for depression and anxiety in men: Metasynthesis and recommendations. Journal of Affective Disorders, 346, 75–87. https://doi.org/10.1016/j.jad.2023.11.015 .

Poon, J. K., Benevides, T. W., & Bloom Emrick, B. (2025). Trends in adolescent mental and behavioral health: Opportunities to optimize care. Pediatrics, 155(4). https://doi.org/10.1542/peds.2024-070122.

Prydz, M. B., Czajkowski, N. O., Eilertsen, M., Røysamb, E., & Nes, R. B. (2024). A web-based intervention using "Five Ways to Wellbeing" to promote well-being and mental health: randomized controlled trial. JMIR Mental Health, 11(1). https://doi.org/10.2196/49050.

Renwick, L., Pedley, R., Johnson, I., Bell, V., Lovell, K., Bee, P., & Brooks, H. (2024). Mental health literacy in children and adolescents in low-and middle-income countries: A mixed studies systematic review and narrative synthesis. European Child & Adolescent Psychiatry, 33(4), 961–985. https://doi.org/10.1007/s00787-022-01997-6.

Schulte, C., Harrer, M., Sachser, C., Weiss, J., & Zarski, A.-C. (2024). Internet-and mobile-based psychological interventions for post-traumatic stress symptoms in youth: A systematic review and meta-analysis. NPJ Digital Medicine, 7(1), 50. https://doi.org/10.1038/s41746-024-01042-7

Schwarzer, R., & Jerusalem, M. (1995). Generalized Self-Efficacy scale. In J. Weinman, S. Wright, & M. Johnston (Eds.), Measures in health psychology: A user’s portfolio. Causal and control beliefs (pp. 35–37). Windsor, UK: NFER-Nelson.

Sedillo-Hamann, D. (2023). Building adolescent self-efficacy and resilience through social action. Child and Adolescent Social Work Journal, 40(3), 409–417. https://doi.org/10.1007/s10560-021-00788-3.

Silaban, H., Udjung, G. I. V. W., Gultom, A., & Aline, T. R. (2024). A cross-sectional analysis on knowledge and attitudes towards HPV vaccines among female youth in Jakarta, Indonesia. Asian Research Journal of Gynaecology and Obstetrics, 7(1), 106–118. Retrieved from: http://repository.uki.ac.id/id/eprint/14572. Accessed on 24th July 2024.

Simpson, A., Teague, S., Kramer, B., Lin, A., Thornton, A. L., Budden, T., Furzer, B., Jeftic, I., Dimmock, J., & Rosenberg, M. (2024). Physical activity interventions for the promotion of mental health outcomes in at-risk children and adolescents: A systematic review. Health Psychology Review, 18(4), 899–933. https://doi.org/10.1080/17437199.2024.2391787.

Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092.

Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209–249. https://doi.org/10.3322/caac.21660.

Tohit, N. F. M., Rashid, S. A. Z. A., Fakuradzi, W. F. S. W. A., Zaidi, N. A., & Haque, M. (2024). Exploring pathways from community involvement to empowerment in sexual and reproductive health: A public health perspective. Advances in Human Biology, 14(4), 296–307. https://doi.org/10.4103/aihb.aihb_112_24 .

Totzeck, C., van der Meer, A. S., Christiansen, H., Durlach, F., Li Sanchez, K., & Schneider, S. (2024). Systematic review: Patient and public involvement of children and young people in mental health research. Clinical Child and Family Psychology Review, 27(1), 257–274. https://doi.org/10.1007/s10567-024-00470-x .

Webster, E. M., Ahsan, M. D., Kulkarni, A., Peñate, E., Beaumont, S., Ma, X., Wilson-Taylor, M., Chang, J., Ipp, L., & Safford, M. M. (2024). Building knowledge using a novel web-based intervention to promote HPV vaccination in a diverse, low-income population. Gynecologic Oncology, 181, 102–109. https://doi.org/10.1016/j.ygyno.2023.12.005.

World Health Organization (WHO), (2020). Global strategy to accelerate the elimination of cervical cancer as a public health problem. World Health Organization Geneva, Switzerland. Retrieved from: https://www.who.int/publications/i/item/9789240014107 . Accessed on 2nd January 2025.

World Health Organization, (2022). WHO guidelines on mental health at work. World Health Organization. Retrieved from: https://www.who.int/publications/i/item/9789240053052. Accessed on 24th July 2024.

World Health Organization, (2020). WHO guidelines on physical activity and sedentary behaviour. World Health Organization. Retrieved from: https://www.who.int/publications/i/item/9789240015128. Accessed on 24th July 2024.

Published

25-06-2025

How to Cite

Mutiar, A. ., Marfuah, D. ., & Lindayani, L. . (2025). Impact of Web-Based Psychoeducation on Anxiety, Self-Efficacy, and Decision-Making Support of HPV Vaccination among Female Adolescents. The Malaysian Journal of Nursing (MJN), 16(Supplementary 2), 10-19. https://doi.org/10.31674/mjn.2025.v16isupp2.002

Issue

Section

SI 2025: Sustainable Health Information System (HIS) & e-healthcare in Nursing

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