The Role of Self-Efficacy in the Utilization of Integrated Health Service Post (IHSP) for NCDs Among Indonesian Industrial Workers

Abstract

Introduction:

Non-communicable diseases (NCDs) are currently the leading cause of mortality in Indonesia, particularly impacting the industrial workforce. Although the government provides the Integrated Health Service Post (IHSP) for NCDs as an early detection service, its utilization rate is low. This study aimed to analyze the influence of self-efficacy and social support (from family, IHSP cadres, health workers, and peers) on the use of IHSP NCD services among industrial workers.

Methods:

This quantitative study employed a cross-sectional design involving 1200 industrial workers across 4 provinces in Indonesia. Participants were selected using stratified random sampling. Data were collected through a structured questionnaire and analyzed using partial least squares structural equation modeling (PLS-SEM).

Results:

The findings revealed a low utilization rate of IHSP services, with only 40% of respondents participating. Hypothesis analysis showed that self-efficacy was the only significant predictor of service utilization (β = .385; P < .001). Conversely, social support variables, including family, cadre, health worker, and peer support, were found to have no statistically significant influence.

Discussion:

Self-efficacy is the dominant factor driving the utilization of NCD early detection services among industrial workers, surpassing the role of social support. Therefore, workplace health interventions should prioritize programs that build individuals’ confidence and their ability to manage their health.

Keywords

self-efficacy industrial workers NCDs occupational health health behavior

Introduction

Non-communicable diseases (NCDs) have indeed become a significant public health challenge in Indonesia, now recorded as the leading cause of national morbidity and mortality.¹ The burden of NCDs in Indonesia has been increasing, with notable rises in the prevalence of conditions such as diabetes and hypertension. For instance, diabetes prevalence increased from 6.9% in 2013 to 10.9% in 2018, and hypertension from 25.8% to 34.1% over the same period.^2,3 Data shows that NCDs, such as diabetes, hypertension, and heart disease, have been the cause of about 70% of total deaths and have placed a significant burden on Indonesia’s health system and economy.⁴ Among the populations most susceptible to NCDs are industrial workers, who, due to the demands of work, are often exposed to high-risk factors, including stress, irregular diets, and sedentary lifestyles.^5
-7 This condition not only threatens the health and well-being of individual workers but also can potentially reduce the industry’s overall productivity.^8
-10

Industrial workers are the backbone of the manufacturing sector, and their health is a vital asset of companies and the state.^11,12 NCDs that are not detected early can lead to absenteeism and, more detrimentally, presenteeism (work attendance but drastically decreased productivity).^13,14 This double burden of health care costs borne by companies and the loss of production output can hamper the industry’s competitiveness.^15
-18 This study offers health solutions and highly efficient economic strategies.^19,20 Interventions focused on improving self-efficacy are high-return investments in human resources, as they directly safeguard the most valuable asset in the production chain: a healthy and productive workforce.^21
-23 This situation requires an analysis of the utilization of health services because it touches on 3 crucial pillars: economic sustainability, modernization of public health policies, and validation of global behavioral theories.^24
-26 First, from an economic perspective, the health of industrial workers is a vital asset that directly supports national productivity; Poorly managed NCDs lead to losses due to absenteeism and presenteeism, thus identifying key factors to offer highly efficient intervention strategies to maintain workforce stability and industry competitiveness.^27
-30

In response to this challenge, the Indonesian government has initiated the establishment of NCD IHSP as a promotive and preventive strategy at the community level.³¹ Integrated Health Service Post (IHSP) or Posbindu PTM is a community-based health intervention adopted into the workplace setting. This service includes screening for the main risk factors for NCDs: blood pressure (hypertension), blood sugar (diabetes), body mass index (obesity), and brief lifestyle counseling. The program is designed to raise health awareness and facilitate early detection of NCDs, and it can potentially reduce their prevalence among industrial workers.^31
-33 However, the existence of NCD IHSP does not guarantee optimal utilization. The effectiveness of these programs is highly dependent on the active participation of the target population, which is influenced by a variety of complex factors.^34
-36 Challenges such as low individual confidence to maintain health (self-efficacy), lack of support from the social environment, such as family and colleagues, as well as the role of cadres and health workers that have not been maximized, are suspected to be the main obstacles to the participation of industrial workers^37
-40 in utilizing IHSP services.

Historically, public health programs in Indonesia, including IHSP, have relied heavily on a community-based model that mobilizes communities and relies on cadres as agents of change.^32,41 However, the finding that social support (family, peers, cadres) is insignificant for industrial workers indicates that this traditional model may no longer be adequate for all segments of the population, especially those in socio-economic transition. Industrial workers are often urban populations detached from rural communal structures, more individualistic, and exposed to different social dynamics. Therefore, the significance of this research lies in its role as a “call to action” for policymakers, urging them to modernize intervention approaches from communal-collective to more personalized and focused on individual psychological empowerment.

Although physical accessibility and cost are often significant barriers to public health services, the context of this study is unique in that services are provided in the workplace and at no cost. Therefore, structural barriers (such as distance and cost) have been minimized by program design, which justifies this study’s focus on psychosocial barriers (self-efficacy) and social support as the remaining and crucial explanatory variables. These conditions require a critical understanding that challenges the paradigm of public health intervention in Indonesia, which relies heavily on community-based models and social mobilization. By showing that this model is less effective for more modern and individualistic industrial worker populations, this study provides an urgent evidence base for governments to design more personalized policies that focus on the psychological empowerment of individuals as well as test health behavioral theories derived from Western contexts in non-Western environments whose results are expected to confirm the universality of the role of self-efficacy while intriguingly questioning generalization of the role of social support in society in a collectivist background, thus enriching the global health psychology literature with a more academic understanding such as health behavioral theory, including Social Cognitive Theory developed and validated in Western societies (WEIRD – Western, Educated, Industrialized, Rich, and Democratic).^42
-44

Therefore, this study aims to analyze in depth the dynamics of IHSP NCD use among industrial workers. Specifically, this study identifies obstacles and potential improvements by evaluating the influence of self-efficacy, family support, the role of IHSP cadres, health workers, and peer support. The results of this study are expected to be a scientific basis for formulating more relevant, inclusive, and evidence-based health policies to improve the effectiveness of early detection of NCDs and the welfare of workers in Indonesia.

Hypothesis

Specifically, this study identifies obstacles and potential improvements by evaluating the influence of self-efficacy, family support, the role of IHSP cadres, health workers, and peer support. Based on the theoretical framework and literature review, we propose the following hypotheses:

H1: Self-efficacy has a significant positive effect on the utilization of IHSP.

H2-H5: Social support (family, colleagues, cadres, health workers) has a positive relationship with the use of IHSP.

Research Methods

This study uses a quantitative design with a cross-sectional approach. This design was chosen because it is relevant for evaluating the relationships among self-efficacy, social support, and the simultaneous use of NCD IHSP at a specific time. The procedure began by identifying strata based on industrial sectors (eg, manufacturing, textiles, and food processing) and the geographic location of industrial estates. This research was conducted in strict compliance with the 1975 Helsinki Declaration, as revised in 2024.

Population and Sample

The target population in this study comprises all industrial workers employed in 7 strategic industrial estates in Indonesia, located in the provinces of Aceh, North Sumatra, Central Java, and Yogyakarta. The inclusion criteria are explicitly set: workers aged 30 to 60 with at least 5 years of service in their respective industries. To ensure data integrity, the following exclusion criteria were applied: (1) workers on long-term sick leave or undergoing intensive medical treatment during the data collection period; (2) individuals with known cognitive impairments that would hinder their ability to independently and accurately complete the structured questionnaire; and (3) workers who expressed a desire to withdraw from the study during the informed consent process.

The study sample comprised 1200 workers who met the criteria, providing adequate statistical power for complex multivariate analyses. The selection of the location and criteria aims to capture the characteristics of the established worker population and the high risk of NCDs. The sampling frame is compiled from each participating company’s payroll list of employees. From a list stratified by work department, participants were selected using computer-generated random numbers to minimize selection bias.

Sampling Techniques

To ensure the representativeness of the sample and the accuracy of generalizing the results, stratified random sampling techniques were used. This procedure begins by identifying strata based on industrial sectors (eg, manufacturing, textiles, and food processing) and the geographical location of industrial estates. From each stratum, respondents were randomly selected in proportion to the size of the working population in that stratum. The selection of this technique aims to minimize selection bias and enhance the external validity of the research findings, enabling the results to be generalized with high confidence to a broader population of industrial workers.

Data Collection Instruments and Procedures

The main instrument of the study was a structured questionnaire designed to measure demographic variables, self-efficacy, family support, the roles of cadres and health workers, and utilization of NCD services at IHSP. The questionnaire was not developed from scratch but instead adapted from an established scale to ensure construct validity. For self-efficacy, we adapted items from the General Self-Efficacy Scale (Schwarzer and Jerusalem), and for social support, we modified items from the Multidimensional Scale of Perceived Social Support (MSPSS) to the Indonesian industrial context.

Each latent construct is measured using 5 to 6 indicator items adapted from relevant literature and theory. The questionnaire uses a 5-point Likert scale, from “strongly disagree” (1) to “strongly agree” (5). Before use, the instrument underwent pilot testing with a small subset of workers to ensure clarity and validity. Field research is conducted in several stages to ensure the validity and reliability of the data collected. Initially, the preparatory phase involves identifying and collaborating with relevant stakeholders, including local health authorities, industry management, and trade unions, to facilitate the research’s implementation. This activity was followed by the development and pre-testing of survey instruments, conducted among a small sample of workers to ensure the clarity and appropriateness of the questions.

In the second phase, data collection took place from June to August 2024. Survey enumerators were trained to manage questionnaires and ensure consistent application of the Likert scale. All the fieldwork was done over 2 months, during which participants were recruited directly at their workplaces.

Before participating, all workers were provided with an information sheet explaining the study’s purpose and procedures. Participants who agreed to join the study provided written informed consent by signing a consent form attached to the front of the questionnaire. This written record of consent was securely stored separately from the response data to maintain anonymity. All data is collected anonymously, and personal identities (such as names or employee IDs) have been removed or re-encoded before analysis to maintain participant privacy, in accordance with the ethics agreement. Field researchers oversaw this process to ensure that participation was entirely voluntary and that all questions regarding the study were addressed before the consent was signed. All research procedures have received ethical approval from the Health Research Ethics Committee, Faculty of Medicine, Syiah Kuala University (no 020/EA/FK/2025).

Data Analysis

Data were analyzed using structural equation modeling (SEM) with a partial least squares (PLS) approach in SmartPLS 3.0. This approach was chosen not to develop a new mathematical model, but to test the predictive power of exogenous variables (self-efficacy and social support) against endogenous variables (service utilization) in complex populations. PLS-SEM is preferred over regular linear regression because it can handle multiple latent variables simultaneously and works well with perfectly undisturbed data, which is commonly found in social science studies in industrial settings.

PLS-SEM is considered the most appropriate analytical approach for testing the intervariable relationship model to identify the most influential determinants of IHSP utilization. The analysis was carried out in 2 main stages, following the SEM-PLS protocol. The first stage is the evaluation of the measurement model to test validity and reliability, which includes the convergent validity test (outer loadings >0.7 and average variance extracted (AVE) >0.5) and composite reliability (composite reliability >0.7). The second stage is the evaluation of structural models to test the research hypothesis. This test was carried out by analyzing the path coefficient, T-statistics, and P values generated from the bootstrapping procedure. The level of statistical significance for rejecting the null hypothesis was set at P < .05. The standard for threshold values used in the model evaluation is as follows: outer loadings >0.70, average variance extracted (AVE) >0.50, composite reliability >0.70, and HTMT <0.90 for discriminant validity.⁴⁵

Demographic Characteristics and Service Utilization

Analysis of demographic data from 1200 industrial workers in Indonesia shows a crucial preliminary finding. Only 40% of workers have ever used IHSP’s NCD services. The demographic characteristics of the respondents are presented in Table 1. The majority of respondents were women (69.8%), in the productive age range of 30 to 50 years (54.9%) and 51 to 60 years (45.1%) and had an average working period of 22 years. Based on education level, those educated in primary school were 28.3%, high school/equivalent (63.7%), and bachelor’s (9.8%), and most respondents were married (89%). This shows that the sample has sufficient work experience and relevant exposure to IHSP NCD services carried out by the government/company in the industrial work environment.

Table 1.

Demographic Characteristics of Respondents (N = 1200).

Characteristics	Categories	Frequency (n)	%
Gender	Woman	838	69.8
Gender	Man	362	30.2
Age	30-50 y	659	54.9
Age	51-60 y	541	45.1
Education	Elementary school	339	28.3
	High school	743	61.9
	Greater than bachelor	118	9.8
Marital status	Married	1068	89
Marital status	Unmarried	132	11

Furthermore, among the groups that have used the IHSP NCD, the practice is reported not to be carried out regularly, indicating a significant gap between service availability and workers’ active participation.

Structural Model Evaluation and Hypothesis Testing

Structural model evaluation was conducted to assess the model’s predictive strength and the relationships among variables. The R-square (R²) value for the endogenous variable “CPI effectiveness” was 0.404, indicating that the 5 predictor variables collectively explained 40.4% of the variation in CPI NCD utilization. This shows the model’s predictive power at a moderate level.

The hypothesis test results (summarized in Table 2) show the varying influence of each exogenous variable. The self-efficacy variable is statistically significant and positively most influential on the utilization of NCD IHSP (β = .385; T = 6.384; P < .001), with a value of f-square (f²) of 0.074. This variable contributes a small to medium-sized effect on the model and is the strongest predictor among the variables. Then the variable Role of Health Workers showed a positive influence (β = .197). but not statistically significant at the level of α = .05 (T = 1.953; P = .051). These results indicate a positive relationship. But the strength is at the significance threshold. And then 3 other variables; Family Support (β = .052; T = 0.941; P = .347). the role of IHSP cadres (β = .082; T = 0.825; P = .410). and Peer Support (β = −.043; T = 0.721; P = .471) was found to have no statistically significant effect on the utilization of NCDs of IHSP.

Table 2.

Test Results Mean, STDEV, T Values, P Values.

Variables tested	Original sample (B)	Sample mean (M)	STDEV	T-statistics (\|O/STDEV\|)	P values
Family support → IHSP effective	0.052	0.048	0.056	0.941	.347
Health workers → IHSP effective	0.197	0.201	0.101	1.953	.051
IHSP cadres → IHSP effective	0.082	0.078	0.100	0.825	.410
Peers → IHSP effective	−0.043	−0.042	0.060	0.721	.471
Self-efficacy → IHSP effective	0.385	0.384	0.060	6.384	.000

Abbreviation: STDEV, standard deviation.

Discussion

This study identified self-efficacy as a significant predictor in encouraging industrial workers’ utilization of NCD IHSP in Indonesia. These findings suggest a perspective that may challenge common assumptions regarding the central role of social support in health behaviors. In contrast. Social support variables, which included family. Co-worker and cadre roles were found to be unrelated. The following discussion will elaborate in depth on the potential implications of these findings.

One notable finding of the study was the weak association between family and peer support. This may be attributed to Indonesia’s unique socio-demographic context among industrial workers. Many workers are migrants who live far from their nuclear families. Often in modest rented rooms. This could effectively limit the daily line of family support. Families in rural areas may have lower health literacy about NCDs. So, they might not be able to provide practical, informed encouragement. Similarly, the insignificant peer influence could be attributed to the average worker’s relatively low level of education (high school), which may limit their capacity to share accurate health knowledge and motivate preventive behaviors. A hectic work schedule would also likely reduce the quality of social interaction for health-related discussions.

This research also reveals that the role of IHSP cadres has not significantly affected service use. A possible explanation could be the gap between cadres and the working community. Cadres often come from the public around industrial sites rather than from workers themselves, which may lead to social distancing and a lack of a deep understanding of workers’ realities. The lack of ongoing capacity building and training programs for cadres could exacerbate it. Making their knowledge and methods potentially less relevant to the complex NCD health challenges. Without optimal involvement and adequate capacity, the contribution of cadres may become less significant.

The main finding of this study. Self-efficacy emerged as the strongest driver of IHSP use. Aligns with the central premise of Albert Bandura’s Social Cognitive Theory. This theory states that a person’s belief in his ability to succeed in each situation (self-efficacy) is a primary determinant of his behavior. In this context. Workers who have strong convictions that they can manage their health. Understand NCD information. And taking preventive measures would be most likely to lead to proactively using the IHSP’s services, regardless of whether there is an external push. These results suggest that an individual’s internal motivation and self-confidence may be more influential than social environmental factors alone in sustaining preventive health behaviors.

The findings regarding the insignificance of social support in this study contrast with most of the international literature. Various studies and meta-analyses. Such as those conducted by DiMatteo (2004), have consistently shown that social support strongly predicts medical adherence and health-seeking behavior. However. This difference supports the argument that the effectiveness of health interventions may be highly context dependent. In contrast, social support might be crucial in the general population or in patients already diagnosed with chronic diseases. Its impact could be reduced in specific populations, such as migrant industrial workers in developing countries, where traditional social ties are weakened. Therefore. This study makes a significant contribution by highlighting the potential limitations of social support models and by emphasizing the role of individual cognitive factors in specific contexts.

Practical and Policy Implications

The results of this study have clear practical implications for stakeholders. Efforts to improve the early detection of NCDs among industrial workers must shift from programs based solely on general socialization to interventions that build individual self-efficacy. Some concrete recommendations include: (1) Micro Intervention: Designing health education in a “micro-learning” module (5-10 minutes) that can be accessed during the morning briefing (safety talk). Not a long seminar that interferes with working hours. (2) Shift Integration: Aligning the operational schedule of IHSP with work shift changes to ensure time accessibility without cutting wages or workers’ rest time. (3) Peer-Modeling: Use senior workers with high self-efficacy as “health ambassadors” to exemplify preventive behaviors. Not just giving theoretical talks.

Research Limitations and Future Research Directions

While it provides important insights, the study has some limitations. First, the cross-sectional design does not allow causal conclusions; the cause-and-effect relationship between self-efficacy and the utilization of IHSP cannot be ascertained. Future longitudinal research is needed to validate these findings. Second, the use of self-report questionnaires can lead to response bias. Future studies can combine survey data with actual attendance data from IHSP records. Third, the research sample. Although significant, it was limited to a few provinces in Indonesia. So, generalizations about the entire population of national industrial workers must be made carefully. Comparative research between different industry sectors and regions can provide richer insights in the future (Supplemental Appendix).

Conclusion

This study concludes that participation by industrial workers in Indonesia in the NCD early detection program through IHSP remains low. Only 40% of workers have used this service irregularly. More importantly, this study empirically proves that the self-efficacy of an individual’s belief in their ability to maintain health is the single most dominant and statistically significant predictor in encouraging the use of IHSP. In contrast, external social support factors, such as family support, co-workers, and the role of health cadres did not show a significant influence. These findings underscore the need to improve preventive health behaviors in these populations. Interventions must shift from focusing on social networks to strategies that directly build individual capacity and confidence. Therefore, health policies and workplace promotion programs should prioritize empowering workers through education and training to improve their self-efficacy. This is a fundamental step toward optimizing early detection of NCDs and improving long-term productivity and well-being.

Supplemental Material

sj-docx-1-his-10.1177_11786329261445981 – Supplemental material for The Role of Self-Efficacy in the Utilization of Integrated Health Service Post (IHSP) for NCDs Among Indonesian Industrial Workers

Supplemental material, sj-docx-1-his-10.1177_11786329261445981 for The Role of Self-Efficacy in the Utilization of Integrated Health Service Post (IHSP) for NCDs Among Indonesian Industrial Workers by Nasrul Zaman, Said Usman, Atik Badi’ah, Fahrun Nur Rosyid, Yuseva Sariati and Irwan Saputra in Health Services Insights

Footnotes

Acknowledgements

The authors extend their sincere appreciation to the management and industrial workers in Aceh, North Sumatra, Central Java, and Yogyakarta for their participation and cooperation in this study. We also acknowledge the use of AI-based tools, specifically Scopus AI, Grammarly, and DeepL, exclusively to improve the linguistic flow, readability, and grammatical accuracy of the manuscript. The application of these tools was strictly limited to copy-editing purposes; the scientific conceptualization, data analysis, interpretation of results, and conclusions remain the sole work and responsibility of the authors.

ORCID iD

Nasrul Zaman

Ethical Considerations

The Health Research Ethics Committee of the Faculty of Medicine. Universitas Syiah Kuala. Reviewed and approved this study (reference no 020/EA/FK/2025).

Author Contributions

NZ conceptualization, methodology, supervision, project administration, writing – original draft, writing – review and editing. SU and AB methodology, investigation, data curation, writing – review and editing. FNR formal analysis, software, visualization, writing – review and editing. YS investigation, resources, writing – review and editing. IS software, visualization, writing – review and editing.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The datasets generated and/or analyzed during the current study are not publicly available due to strict ethical restrictions regarding participant privacy and confidentiality agreements. However, the de-identified data supporting the findings of this study are available from the corresponding author upon reasonable request. We confirm that the editorial board can receive the anonymized raw dataset at any time if required for verification.

Supplemental Material

Supplemental material for this article is available online.

Instrument/Scale Permissions

The instrument used is an adaptation of a public domain scale (such as the General Self-Efficacy Scale) that does not require the purchase of a license for non-commercial research purposes, and the source has been correctly cited in the text.

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