Maternal Self-Efficacy as a Determinant of Childhood Immunization Completion in Rural Indonesia: A Cross-Sectional Study

Abstract

Background: Although national vaccination programs have made substantial progress, incomplete childhood immunization persists in several rural areas of Indonesia. Evidence regarding childhood immunization behavior through the lens of Health Promotion Model (HPM) constructs, particularly maternal self-efficacy, remains limited in these settings. This study aimed to identify HPM factors associated with complete childhood immunization among mothers in rural Indonesia. Methods: Employing a cross-sectional design, the study enrolled 120 mothers of children aged 12–24 months residing in a rural district of Banten Province. Data were collected using a structured questionnaire assessing perceived benefits, self-efficacy, perceived barriers, social support, situational influences, knowledge, and sociocultural factors. We confirmed childhood immunization status through maternal and child health records. Result: Childhood immunization status was verified using maternal and child health records. More than half of the children had incomplete immunization. In bivariate analysis, all Health Promotion Model constructs were associated with immunization status. After adjustment, maternal self-efficacy and social support remained independently associated with complete immunization. The unexpected positive association between weak social support and complete immunization should be interpreted cautiously due to possible imprecision and residual confounding. Contribution for Practice: This study highlights the importance of strengthening maternal self-efficacy in childhood immunization programs. Nurses and primary healthcare providers should provide targeted education, confidence-building counseling, and family-centered