Interactive Participation-Based Premarital Class Model for Reproductive Health and Marital Age Maturity in Support of the ASTA CITA Program
Abstract
Introduction: Early marriage and divorce remain persistent public health and social concerns in Indonesia, contributing to poor reproductive health outcomes and hindering human resource development. While premarital education programs exist, their modeled association in delaying marriage age and improving reproductive health is still uncertain. These challenges highlight the need for more engaging, evidence-based interventions that address not only knowledge gaps but also family dynamics, cultural norms, and participants’ readiness to adopt healthier marital and reproductive practices. This study aimed to design and empirically examine an interactive premarital class model by modeling participation as a mediating mechanism linking premarital education with reproductive health and marital age maturity within the ASTA CITA program.
Method: A cross-sectional survey was conducted from March to August 2025 at the Kulonprogo Religious Affairs Office, Yogyakarta. A total of 260 prospective brides and grooms were recruited using purposive sampling. Data were collected through a validated questionnaire and analyzed using Partial Least Squares–Structural Equation Modeling (PLS-SEM).
Results: Predisposing factors (knowledge, attitudes, and beliefs) (?=0.552; p<0.001) and reinforcing factors (family support and policy) (?=0.391; p<0.001) significantly increased participation. Participation showed a strong statistical association with reproductive health (?=0.763; p<0.001) and marital age maturity (?=0.789; p<0.001). The model showed strong explanatory power (R²=0.805 for participation; R²=0.582 for reproductive health; R²=0.622 for marital age maturity) and high predictive relevance (Q²>0.35).
Conclusion: The interactive premarital class model showed robust modeled associations between participation, reproductive health literacy, and marital age maturity. This participatory, family- and community-based approach may inform the development of premarital education strategies in similar institutional contexts, particularly in efforts to address early marriage and reproductive health challenges. However, given the cross-sectional design and single-site setting, these findings should be interpreted as exploratory, and broader implementation would require further validation through longitudinal or multi-site studies across diverse institutional and socio-cultural settings. Future research is needed to assess long-term outcomes and contextual adaptability.
References
Fitria M, Laksono AD, Syahri IM, Wulandari RD, Matahari R, Astuti Y. Education role in early marriage prevention: evidence from Indonesia’s rural areas. BMC Public Health. 2024;24(3323). https://doi.org/10.1186/s12889-024-20775-4.
Putri Y, Ketaren SO, Bangun HA, Nababan D, Manurung J. Factors associated with early marriage. J Prima Med Sains. 2024;6(2):125–30. https://doi.org/10.34012/jpms.v6i2.6277
Salsavira S, Jahra A, Mahendra FT, Dzakiyah L. Early marriage and human development index in Indonesia. J Ekon Kuantitatif Terap. 2021;18(1):31–41. https://doi.org/10.20956/j.v18i1.13975
Setiaatmitha SN, Ilman GM. Implementasi program Bimwin Catin untuk mewujudkan keluarga berkualitas di Kecamatan Sukolilo Kota Surabaya. J Media Adm. 2023;8(2):10–9. https://doi.org/10.56444/jma.v8i2.1153.
Kalamiyah MJ, Habibi MSS, Asy’ari SA. Revitalisasi dan digitalisasi bimbingan perkawinan: mencetak keluarga sakinah di era modern. CBJIS Cross-Border J Islam. 2025;7(2):342–53. https://doi.org/10.37567/cbjis.v7i2.4228
Hilmi M, Asyrof MN. Interfaith premarital education in Cirebon and its impacts on family resilience: a comparative study. Indones J Interdiscip Islam Stud. 2025;8(1). https://doi.org/10.20885/ijiis.vol8.iss1.art3
Andayani LS, Harahap J, Amelia R, Lubis NDA, Sari DK, Rohmawati L, et al. A premarital services education model of preventing stunting among prospective newlyweds from North Sumatera , Indonesia. Afr J Reprod Health. 2024;28(9):108–121. https://doi.org/10.29063/ajrh2024/v28i9.10
Silumbwe A, Nkole T, Munakampe MN, Cordero JP, Milford C, Zulu JM, et al. Facilitating community participation in family planning and contraceptive services provision and uptake: community and health provider perspectives. Reprod Health. 2020;17(1):1–11. https://doi.org/10.1186/s12978-020-00968-x
Ghorbani-Dehbalaei M, Loripoor M, Nasirzadeh M. The role of health beliefs and health literacy in women’s health promoting behaviours based on the health belief model: a descriptive study. BMC Women’s Heal. 2021;21(1):1–9. https://doi.org/10.1186/s12905-021-01564-2
He Y. Does Religious Community Participation Matter for Shaking off Poverty? MDPI. 2023;14(3):204. https://doi.org/10.3390/rel14030304
Hooper E, Mechkaroff O, Upitis A, Schofield E, Carland JE, Henry A. The modeled association of antenatal education on improving labour and birth outcomes – A systematic review and meta-analysis. Women and Birth [Internet]. 2025;38(1):101843. Available from: https://doi.org/10.1016/j.wombi.2024.101843
Rezaeizadeh G, Mansournia MA, Keshtkar A, Farahani Z, Zarepour F, Sharafkhah M, et al. Maternal education and its influence on child growth and nutritional status during the first two years of life: a systematic review and meta-analysis. EClinicalMedicine. 2024;71(102574). https://doi.org/10.1016/j.eclinm.2024.102574.
Marmi M, Riyadi S. Islamic principles in nursing leadership: Lesson learned from Rufaida Al-Aslami’s lens and legacy. J Holist Nurs Sci. 2025;12(1):326–32. https://doi.org/10.31603/jhns.v12i2.13718
Hair JF, Hult GTM, Ringle CM, Sarstedt M. A Primer on Partial Least Squares Structural Equation Modeling (PLS-SEM). 3rd ed. Sage Publishing; 2022.
Wong KKY. Partial least squares structural equation modeling (PLS-SEM) techniques using SmartPLS. Mark Bull. 2013;24(1):1–32.
Sarstedt M, Ringle CM, Hair JF. Partial least squares structural equation modeling. In: Homburg C, Klarmann M, Vomberg A, editors. Handbook of Market Research. Cham: Springer; 2017. p. 1–40.
Kock N, Hadaya P. Minimum sample size estimation in PLS-SEM: The inverse square root and gamma-exponential methods. Inf Syst J. 2018;28(1):227–61. https://doi.org/10.1111/isj.12131.
Cohen J. Statistical power analysis for the behavioral sciences, Stat. Vol. 567, Power Anal. Behav. Sci. New York: Routledge.; 1988.
Hair JF, Risher JJ, Sarstedt M, Ringle CM. When to use and how to report the results of PLS-SEM. Eur Bus Rev. 2019;31(1):2–24. https://doi.org/10.1108/EBR-11-2018-0203.
Henseler J, Ringle CM, Sarstedt M. A new criterion for assessing discriminant validity in variance-based structural equation modeling. J Acad Mark Sci. 2015;43(1):115–135. https://doi.org/10.1007/s11747-0140403-8
Rigdon EE. Rethinking partial least squares path modeling: Breaking chains and forging ahead. Long Range Plann. 2012;45(5–6):341–58. https://doi.org/10.1016/j.lrp.2012.09.010.
Green L, Kreuter M. Health program planning: An educational and ecological approach. 5th ed. McGraw Hill, New York; 2005.
Hamjah SH, Akhir NHM. Islamic approach in counseling. J Reli Heal. 2014;53(1):279–89. https://doi.org/10.1007/s10943-013-9703-4
Ali TS, Krantz G, Gul R, Asad N, Johansson E, Mogren I. Gender roles and their influence on life prospects for women in urban Karachi, Pakistan: a qualitative study. Glob Heal Action. 2011;4(1). https://doi.org/10.3402/gha.v4i0.7448
Wong LP, Chin CKL, Low WY, Jaafar J. HIV/AIDS-related knowledge among Malaysian young adults: findings from a nationwide survey. J Int AIDS Soc. 2008;10(6):148. https://doi.org/10.1186/1758-2652-10-6148
Castillo FA Del, Biana HT, Joaquin JJB. ChurchInAction: the role of religious interventions in times of COVID-19. J Public Heal (Oxf). 2020;42(3):633–4. https://doi.org/10.1093/pubmed/fdaa086.
Marmi, Riyadi S. The influence of adolescent knowledge about reproductive health on the intention to avoid smoking. Indones J Glob Heal Res. 2025;7(3):1-10. https://doi.org/10.37287/ijghr.v7i3.5632
Cordero DA. A Community-Based Sexual Ethics for Teens: Addressing Premarital Sex Using a Sociotheological Approach. Asia-Pacific Soc Sci Rev. 2017;17(1):34–51.
Vazhappilly JJ, Reyes MES. Couples’ Communication as a Predictor of Marital Satisfaction Among Selected Filipino Couples. Psychol Stud (Mysore). 2016;61(4). https://doi.org/10.1007/s12646-016-0375-5
Copyright (c) 2026 Journal of Public Health and Pharmacy
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Journal of Public Health and Pharmacy retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Journal of Public Health and Pharmacy.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
