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Efektifitas Model Komunikasi, Informasi, Edukasi Gizi Terhadap Stunting Masa 1000 Hari Pertama Kehidupan Di Kabupaten Aceh Tengah

BASRI ARAMICO. IB, Dr. dr. Emy Huriyati, M.Kes; Dr. Susetyowati, DCN, M.Kes; dr. Fatwa Sari Tetra Dewi, MPH, Ph.D

2022 | Disertasi | DOKTOR ILMU KEDOKTERAN DAN KESEHATAN

Latar belakang: Implikasi dari gizi buruk menyebabkan retardasi pertumbuhan linier (stunting). Jumlah balita stunting di dunia mencapai angka 144 juta, dengan prevalensi stunting 21%. Mayoritas keterbelakangan pertumbuhan dimulai sejak 2 atau 3 tahun pertama kehidupan merupakan dampak berdampak pada kondisi kesehatan anak pada kehidupan berikutnya. Retardasi pertumbuhan linear umumnya sulit dipulihkan serta menghambat gangguan perkembangan kognitif, kemampuan fisik, menurunnya produktivitas dan lost generations yang disebabkan akibat gizi buruk. Stunting dipengaruhi oleh pemahaman dan perilaku praktik pola asuh pemenuhan gizi yang tidak tepat. Tujuan: Menyusun model komunikasi, informasi dan edukasi (KIE) gizi yang efektif untuk meningkatkan pengetahuan, pemahaman dan perilaku pemenuhan gizi yang tepat sebagai upaya pencegahan stunting. Metode: Penelitian ini menggunakan metode penelitian kualitatif dan kuantitatif (mixed methods). Desain penelitian kualitatif menggunakan strategi pendekatan Sequential Exploratory, penelitian kuantitatif menggunakan disain Quasi Eksperimen non equivalent control group design. Sequential Exploratory yaitu rancangan penelitian yang diawali dengan tahapan pengumpulan dan analisis data kualitatif, dan dilanjutkan dengan pengumpulan dan analisis data kuantitatif. Tahap penelitian kualitatif melalui pengumpulan data FGD dan in-depth interview petugas kesehatan; bidan desa; kader kesehatan; ibu hamil; suami ibu hamil; tokoh agama untuk mengeksplorasi masalah dan kebutuhan penyusunan model KIE gizi. Tahapan penyusunan model KIE gizi berdasarkan analisis data kualitatif, dilanjutkan dengan penyusunan instrumen; uji validitas dan reliabilitas instrumen; dan pelatihan bidan. Tahap penelitian kualitatif diawali dengan pre-test kelompok intervensi dan kontrol; dilanjutkan dengan intervensi dan post-test hasil intervensi. Lokasi penelitian di delapan wilayah puskesmas, puskesmas kelompok intervensi (Lut Tawar; Pegasing; Bebesen; dan Atu Lintang). Puskesmas kelompok kontrol (Kebayakan; Bies; Silih Nara; dan Celala). Subjek penelitian ibu hamil trimester ke-tiga dengan usia kehamilan > 28 minggu. Subjek penelitian 106 ibu hamil pada kelompok intervensi, dan 118 ibu hamil pada kelompok kontrol. Intervensi menggunakan video dan modul gizi seimbang 1000 HPK dilakukan selama 4 bulan. Analisis data pre-test dan post-test variabel terikat pengetahuan, sikap, norma subjektif, efikasi diri, intensi dan perilaku menggunakan uji paired t-test, dan uji mann withney untuk data yang tidak berdistribusi normal. Hasil: Hasil analisis kualitatif terdiri dari 6 temuan utama: budaya dan kebiasaan berisiko terhadap stunting; persepsi keliru penyebab stunting: kendala dan materi KIE gizi 1000 HPK dan stunting; serta manajemen dan model KIE gizi Setimang Penting. Hasil uji statistik menunjukkan terdapat perbedaan skor bermakna pada kelompok intervensi antara pre-test dengan post-test variabel pengetahuan; sikap; efikasi diri; dan perilaku (p value <0,05), dan tidak terdapat perbedaan skor bermakna antara pre-test dengan post-test variabel norma subjektif p value 0,64 dan intensi p value 0,50. Terdapat perbedaan selisih skor bermakna pada kelompok intervensi dan kontrol antara pre-test dengan post-test variabel pengetahuan, sikap, norma subjektif, efikasi diri, intensi dan perilaku (p value <0,001). Intervensi Setimang Penting berpengaruh terhadap variabel pengetahuan, sikap, norma subjektif, efikasi diri, intensi dan perilaku (p value <0,001), dan berpengaruh terhadap stunting dengan (p value 0,005). Kesimpulan: Intervensi Setimang Penting berpengaruh terhadap peningkatan pengetahuan, perubahan sikap, efikasi diri dan perubahan perilaku upaya pencegahan stunting. Meskipun tidak berpengaruh signifikan terhadap norma subjektif dan intensi, namun intervensi memberikan pengaruh terhadap peningkatan skor sebelum intervensi dan setelah intervensi. Selanjutnya, proporsi stunting lebih banyak ditemukan pada kelompok kontrol dibandingkan dengan kelompok intervensi

Background: Stunting is one of the consequences of insufficient nutrition. Stunting affects 144 million under five-year-old children worldwide, with a prevalence rate of 21%. The majority of growth retardation issues begin in the second or third years of life and have an impact on the children's future lives. Linear growth retardation is a difficult condition to recover from, and it affects cognitive development, physical capacity, productivity, and generational loss due to inadequate nutrition. Stunting is influenced by poor understanding and lack of knowledge in terms of food parenting practice. Aims: To develop an effective model of information, education, and communication (IEC) for nutrition to raise knowledge, understanding, and proper nutrition fulfillment behavior as an approach to prevent stunting. Method: This study uses a mixed-method approach with Sequential Exploratory for qualitative design and Quasi Experiment non-equivalent control group for quantitative design. Sequential Exploratory is a research design that is commenced with a data collection process and qualitative data analysis, followed by data collection and analysis of quantitative data. A qualitative study is started with a data collection using Focus Group Discussion (FGD) and in-depth interviews of health workers, village midwives, pregnant mothers, and their husbands, and religious leaders, to explore problems and to gain information for the development of the model of IEC for nutrition. The model development process is based on qualitative data analysis, followed by instrument development, validity and reliability tests, and midwife training. Meanwhile, the quantitative study is started with a pre-test of both the intervention and control groups. Then, the intervention process is conducted, and finally, a post-test is carried out at the final stage of the study. This study is conducted in eight public health care center areas. The intervention group was selected from four public health care centers (Lut Tawar; Pegasing; Bebesen; and Atu Lintang public health care centers). Meanwhile, the control group is chosen from Kebayakan; Bies; Silih Nara; and Celala public health care centers. Participants are pregnant women (gestational age > 28 weeks), amounting to 106 people for the intervention group and 118 pregnant women for the control group. The intervention process uses videos and balanced nutrition in the first 1.000 days of life module. This process is done for four months. Data analysis (pre and post-tests) of dependent variables (knowledge, attitude, subjective norm, self-efficacy, intention, and behavior) utilizes a paired t-test. The Mann-Whitney test is used for abnormal data distribution. Result: The qualitative study discovers six major findings; culture and local practices are risk factors for stunting, misperception leads to stunting, constraints of IEC activities; IEC materials of the first 1.000 of life and stunting, and the management and Setimang Penting model of IEC for nutrition. The statistical analysis shows that pre-test and post-test scores of variables (knowledge, attitude, self-efficacy, and behavior) are significantly different (p-value <0,05). Pre-test and post-test scores for subjective norms and intention are not significantly different (p-value 0.64 and p-value 0.50). Furthermore, the scores for pre-test and post-test of knowledge, attitude, subjective norm, self-efficacy, intention, and behavior variables are significantly different both in the intervention and control groups. The Setimang Penting intervention influences knowledge, attitude, subjective norm, self-efficacy, intention, and behavior (p-value <0,001), and it also affects stunting (p-value <0,005). Conclusion: The Setimang Penting intervention has been proven increasing knowledge, change in attitude, self-efficacy, and behavioral change to prevent stunting. Although the intervention has no significant effect on subjective norms and intentions, it has an effect on raising scores before and after an intervention. Furthermore, the proportion of stunting is more prevalent in the control group than in the intervention group

Kata Kunci : stunting, the first 1000 days, model, effectiveness

  1. S3-2022-420281-Abstrak dan Abstract.pdf  
  2. S3-2022-420281-Bibliography.pdf  
  3. S3-2022-420281-TableofContent.pdf  
  4. S3-2022-420281-Title.pdf