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Introduction: Healthy eating behaviors during adolescence influence long-term health. Geographical disparities affect nutrition access, with coastal adolescents having better fish availability and upland areas facing protein limitations. This study evaluates a TTM-based education program to improve knowledge and attitudes toward healthy eating among adolescent girls in both regions.
Method: A quasi-experimental one-group pretest-posttest design was conducted without a control group. Although two different areas were compared highland and coastal, random assignment was not applied. Localities were purposively selected due to their distinct geographic and nutritional contexts. A total of 139 female adolescents aged 15–19 years were included (Cigedug: n = 94; Caringin: n = 45), all meeting criteria of anemia, chronic energy deficiency, and low nutrition knowledge. The intervention combining printed modules and simulation videos tailored to TTM stages. Data were collected through validated pre- and post-test questionnaires (30 items; Cronbach’s α = 0.87) and qualitative interviews with 20 informants.
Result: Before the intervention, most adolescents were in the pre-contemplation stage (highlands: 90.38%, coastal: 32.37%). After the intervention, transitions occurred to contemplation (highlands: 64.89%, coastal: 48.89%) and preparation stages (highlands: 78.69%, coastal: 54.55%).
Significant improvements in nutrition knowledge were observed in both areas: highlands (mean pre-test = 44.17, post-test = 50.15; p < 0.001) and coastal (pre-test = 41.91, post-test = 48.22; p = 0.004). Behavioral targets also improved, including daily breakfast (highlands: 93.75%, coastal: 75%), fruit and vegetable intake (highlands: 68.75%, coastal: 91.67%), and reduction in fast food consumption (75% in both). Statistically significant differences were found in one target, namely fruit and vegetable intake (p = 0.042).
Conclusion: A structured TTM-based intervention combining educational modules, simulation videos, and personal goal setting effectively improved knowledge and dietary behaviors among adolescent girls across highland and coastal contexts.
