Effectiveness of school-based peer education on knowledge, attitudes, and behavior of diabetes mellitus prevention among adolescents
Abstract
Background: Diabetes Mellitus (DM) has become a global health concern with a rapidly increasing prevalence, including among adolescents. Early prevention efforts are essential and can be implemented through school-based peer education approaches.
Objective: To determine the effectiveness of school-based peer education on knowledge, attitudes, and behaviors related to diabetes mellitus prevention among adolescents.
Methods: A quasi-experimental design with a pretest and posttest control group was employed. The sample consisted of 90 adolescents, divided equally into the intervention and control groups (45 participants each). The intervention group received peer education through four weekly sessions, each lasting 60 minutes, while the control group did not receive any intervention. Data were collected using validated and reliable questionnaires assessing knowledge, attitudes, and behaviors related to diabetes mellitus prevention. The analysis employed the Mann-Whitney U test, the Wilcoxon signed-rank test, the independent t-test, and the paired t-test.
Results: The intervention group exhibited a considerably greater increase in knowledge scores compared to the control group (p=0.001). Attitude scores improved in the intervention group but declined in the control group, with a statistically significant difference (p = 0.005). Despite a marginally bigger improvement in behavior scores within the intervention group, the difference lacked statistical significance (p=0.802).
Conclusion: School-based peer education improved adolescents’ knowledge and attitudes toward diabetes mellitus prevention but did not significantly influence preventive behaviors. Therefore, sustainable educational interventions that are integrated into school programs and support from various stakeholders
Full text article
References
2. Chen X, Zhang L, Chen W. Global, regional, and national burdens of type 1 and type 2 diabetes mellitus in adolescents from 1990 to 2021, with forecasts to 2030: a systematic analysis of the global burden of disease study 2021. BMC Med. 2025;23(1):1-12. doi:https://doi.org/10.1186/s12916-025-03890-w
3. Muharram FR, Swannjo JB, Melbiarta RR, Martini S. Trends of diabetes and pre-diabetes in Indonesia 2013–2023: a serial analysis of national health surveys. BMJ Open . 2025;15(9):1-11. doi:10.1136/bmjopen-2024-098575
4. Patterson CC, Karuranga S, Salpea P, et al. Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:1-9. doi:https://doi.org/10.1016/j.diabres.2019.107842
5. Boyko EJ, Magliano DJ, Karuranga S, et al. IDF Diabetes Atlas 10th Edition. 2021. www.diabetesatlas.org
6. Ameneh PD, Mohtasham G, Sakineh R, Yadollah M, Ali R. School-based peer-led diabetes intervention among female adolescents: a cluster randomized trial. BMC Public Health. 2023;23(1):1-11. doi:10.1186/s12889-023-15430-3
7. Nurhidayanti N, Ambarwati R, Jaelani M, Gizi J, Kemenkes Semarang P. Media E-Booklet Dapat Berpengaruh Terhadap Pengetahuan Dan Sikap Untuk Pencegahan DM Tipe 2 Pada Remaja. Jurnal Riset Gizi. 2023;11(2):2023. doi:10.31983/jrg.v11i2.10674
8. Suyanto E, Milwati S, Yuliwar R. Efektifitas E-Book Interaktif dalam Meningkatkan Pemahaman dan Perilaku Pencegahan Diabetes Mellitus pada Remaja. Jurnal Informasi Kesehatan Indonesia. 2023;09(03):298-306. doi:https://doi.org/10.31290/jiki.v9i3.5279
9. BMC Medicine. Diabetes education for better personalized management in pediatric patients. BMC Med. BioMed Central Ltd. 2023;21(1):1-2. doi:https://doi.org/10.1186/s12916-022-02709-2
10. Pan SC, Carpenter SK. Prequestioning and Pretesting Effects: a Review of Empirical Research, Theoretical Perspectives, and Implications for Educational Practice. Educ Psychol Rev. Springer. 2023;35(97):1-40. doi:https://doi.org/10.1007/s10648-023-09814-5
11. Saraipour F, Panahi S, Nemati-Anaraki L, Shahraki-Mohammadi A. Adolescents’ Health Information–Seeking Behavior: A Scoping Review. Journal of Adolescent Health. Elsevier Inc. 2025;77(4):592-601. doi:https://doi.org/10.1016/j.jadohealth.2025.05.030
12. Subki, Mauyah N, Hafsah US, Elvieta. Pemanfaatan Media Sosial Pada Remaja Putri Dalam Mengatasi Masalah Kesehatan Reproduksi di SMA Negeri 6 Kota Lhokseumawe. Nursing Care and Health Technology Journal. 2025;5(1):105-112. doi:10.56742/nchat.v5i1.108
13. Ariestiningsih ES, Syarifah Has DF, Kurniawan BA, Yuliati LY, Laurita HP, Arifani MN. Effectiveness of peer education based on social cognitive theory in preventing anemia among adolescent girls at the State Senior High School 1 Kebomas Gresik. AcTion: Aceh Nutrition Journal. 2025;10(2):461-470. doi:http://dx.doi.org/10.30867/action.v10i2.2576
14. Yurisma M, Agestika L, Hakiem Afrizal S. Efektifitas Peer Group Education Terhadap Pengetahuan Dan Sikap Mengenai Anemia Pada Remaja Putri Di Pondok Pesantren. Binawan Student Journal. 2024;6(2):96-104. doi:10.54771/pffky341
15. Rahmawati Kusumaningsih M, Alfadilah Surya Ningsih I, Realita F. Peningkatan Pengetahuan dan Sikap Remaja terhadap Pencegahan HIV/AIDS Melalui Peer Education : Literature Review. Jurnal Kesehatan Tambusai. 2024;5(1):1158-1168. doi:https://doi.org/10.31004/jkt.v5i1.25093
16. Dodd S, Widnall E, Russell AE, et al. School-based peer education interventions to improve health: a global systematic review of effectiveness. BMC Public Health. 2022;22(1):2247-2259. doi:https://doi.org/10.1186/s12889-022-14688-3
17. Brinsley J, Schmidt M, Curtis R, et al. Effectiveness of peer-led health behaviour interventions on adolescent’s mental health and wellbeing: a systematic review and meta-analysis. Sci Rep. 2025;15(1):1-11. doi:https://doi.org/10.1038/s41598-025-01053-8
18. Widnall E, Dodd S, Russell AE, et al. Mechanisms of school-based peer education interventions to improve young people’s health literacy or health behaviours: A realist-informed systematic review. PLoS One. 2024;19(5 May):1-23. doi:https://doi.org/10.1371/journal.pone.0302431
19. Firmansyah D, Saepuloh D. Social Learning Theory: Cognitive and Behavioral Approaches. Jurnal Ilmiah Pendidikan Holistik (JIPH). 2022;1(3):297-324. doi:https://10.55927/jiph.v1i3.2317
20. Yang MJ, Zhang MF, Fang XQ, Liu WJ, Dong LP, Liu T. A scoping review of the application of peer education in adolescent sexual health education. Nursing Communications. 2025;9(0):1-7. doi:https://doi.org/10.53388/in2025014
21. Ghasemi V, Simbar M, Fakari FR, Saei M, Naz G, Kiani Z. The Effect of Peer Education on Health Promotion of Iranian Adolescents: A Systematic Review. Int J Pediatr. 2019;7(63):9139-9157. doi:10.22038/ijp.2018.36143.3153
Authors
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.