The Influence of Infant and Child Feeding Pocket Book Media on Increasing Knowledge and Counseling Skills of Cadres in Stunting Locus Regions

Wilda Laila¹, Dezi Ilham², Maria Nova³, Nova Mustika⁴, Alya Misdhal Rini⁵, Hendra Mukhlis^6, Yensasnidar⁷, Sri Indrayati⁸

^1,2S1 Nutrition Program,

^3,5,6,7 D3 Nutrition,

^4,8D3 Medical Technology Laboratory Program Universitas Perintis Indonesia

DOI: https://doi.org/10.51244/IJRSI.2023.1012045

Received: 19 July 2023; Revised: 11 December 2023; Accepted: 14 December 2023; Published: 14 January 2024

ABSTRACT

Pasaman Regency is the district that occupies the second position in 2018 with the highest prevalence of stunting in West Sumatra Province at 40.6%. The stunting reduction strategy can be through PMBA training for cadres by developing a pocketbook to increase knowledge and counseling skills. This study aims to see the effect of PMBA pocketbook media on increasing the knowledge and counseling skills of cadres in the stunting locus area of Pasaman Regency.

The type of research carried out was a quasi-experimental with one group pre-post design which was carried out in the work area of the Pasaman District Health Office in August 2021. The sample consisted of 62 stunting locus cadres using a probability sampling technique. Data analysis using paired sample t-test with 95% CI.

The results showed that after the PMBA training with pocketbook media, there was an increase in the average knowledge of Integrated Healthcare Center cadres to 87.17 8.07 and counseling skills to 85.10 5.48. Furthermore, there is an influence of pocketbook media on feeding infants and children on the knowledge and counseling skills of stunting locus cadres with p = 0.0000 (<0.05). PMBA training with pocketbooks can increase knowledge and improve mastery of cadre counseling skills so that gaps in cadre skills in carrying out their duties can be resolved. Infant and child feeding training using pocketbook media affect increasing the knowledge and counseling skills of stunting locus cadres in the work area of the Pasaman District Health Office.

Keywords— Pocketbook, counseling skills, knowledge, PMBA, stunting

INTRODUCTION

Stunting is a condition where a person’s height turns out to be shorter than the height of other people in general (who are the same age) (Sandjojo, 2017). According to World Health Organization (WHO) in Global Nutrition Targets 2025, stunting is considered a growth disorder Irreversible which is mostly affected by the inadequate and repeated intake of nutrients during 1000 days of life. In 2017 22.2% or around 150.8 million toddlers in the world experienced stunting. However, this figure has decreased when compared to the number of stunting in 2000 which was 32.6%. (Ministry of Health, 2018c)

Basic Health Research in 2018 recorded the prevalence of stunting nationally in 2018 it was 30.8%. (Ministry of Health, 2018b) This means that growth is not optimal for around 8 million Indonesian children or one in three Indonesian children. (Heny Noor Wijayanti and Afroh Fauziah, 2019) The prevalence of stunting in West Sumatra Province in 2018 was slightly below the national prevalence of 29.9%. (Ministry of Health, 2018a).

Pasaman Regency is the district that occupied the second position in 2018 with a prevalence stunting the highest in West Sumatra Province. In 2018, the prevalence of stunting toddlers in Pasaman Regency was 40.6%. (Ministry of Health, 2018b). Based on e-PPGBM data, the prevalence of stunting was 20.06% in 2019 while in August 2020 it was 19.25%. In 2021, the prevalence of stunting increased to 19.4%.

The role of cadres is very important in preventing growth disorders. Cadres are the spearhead of socialization in the community. One of the tasks of cadres is to provide health information to the community which has a major influence on existing behavior in the community. The importance of the role of cadres is certainly balanced with cadre knowledge and skills such as counseling skills in their role towards health-related socialization. Good cadre knowledge makes cadres able to conduct counseling well and will make cadres always proactive and responsible in providing important health socialization, one of which is the importance of infant and child feeding to the community. (Fadjri, 2017) Firdawsyi Nuzula in his research showed that there was a significant difference in cadres’ knowledge after getting health education about specific nutritional interventions in the prevention of stunting with a value of 0.039.(Firdawsyi Nuzula et al, 2020).

Infant and Young Child Feeding (IYCF) Training or Infant and Child Feeding Training (PMBA) is a training designed to equip health workers at the community level (village midwives) or cadres, to help mothers, fathers, and other caregivers to be able to feed their children and babies optimally. (Fadjri, 2017) The strategy to expand the scope of Infant and Child Feeding counseling according to standards is through PMBA training to cadres who play a role in community development in the health sector through Integrated Healthcare Center activities. Training on PMBA in cadres is mainly to increase knowledge about PMBA as well monitor toddler growth, counseling skills, and effective use of counseling aids. Ira Kartika in her research showed that after receiving PMBA training, the average level of knowledge of cadres with a good category with a score of 12.7 while the average level of PMBA counseling skills of cadres with sufficient categories with a score of 21, and there was an increase in the level of knowledge of cadres with p = 0.000 with an average increase in knowledge of 2.543. (Ira Kartika, 2019).

The effectiveness of infant and child feeding training in Pasaman Regency is still not optimal in increasing knowledge and training counseling skills, Based on an initial study conducted by researchers assisted by nutrition management personnel and village midwives by interviewing 10 stunting locus cadres, the results of stunting locus cadres were obtained who have less knowledge about IMD by 70%, Exclusive Breastfeeding by 60% and about MPASI by 40%. In addition, stunting locus cadres have never counseled mothers under five about child and infant feeding to improve child growth and development.

The use of pocket books in training is beneficial especially for understanding the material and developing the mind. Pocketbooks also serve to increase memory and can develop the interest and motivation of cadres. In addition, pocketbooks are also made in small sizes, so they are easy to carry everywhere. The use of pocketbooks is expected to have an impact on behavior change in mothers. Using pocketbook media and infant and child feeding training (PMBA) is expected to be able to improve counseling knowledge and skills to change the behavior of mothers to create an optimal nutritional status for toddlers. (Ministry of Health, 2019)

Based on the above problems, researchers want to develop nutritional education media in the form of pocketbooks in infant and child feeding training (PMBA). This component of infant and child feeding training (PMBA) is to prepare village midwives or cadres with technical knowledge of breastfeeding and complementary feeding practices recommended for children aged 0-24 months, improve counseling, problem-solving, and negotiation skills and prepare to make effective use of related counseling tools and tools. (Ministry of Health, 2019) Development of pocketbooks to facilitate cadres in learning the material developed in the pocketbook. In addition, the pocketbook contains materials in a concise form that is easy to understand and practical for cadres to learn in simple, clear, concise, and concise language.

Winda Ismawati in her research showed that there was an increase in maternal knowledge about giving MP-ASI using pocketbook media by 10.3%. (Winda Ismawati and Kristien Andriani, 2018) Anjar Astuti in his research also showed that good knowledge before training was only 19%, while after being given pocketbook media training by cadres as a motivator for the success of exclusive breastfeeding to well-informed housewives 43.3%. The skills of cadres before and after were good from 40.5% to 78.4%.(Anjar Astuti et al, 2020)

Therefore, researchers are interested in seeing the influence of PMBA (Infant and Child Feeding) pocketbook media on increasing the knowledge and skills of counseling cadres in the Pasaman Regency Stunting Locus Area.

RESEARCH METHODS

This research is an experimental quasi-research with one group pre-test and post-test design. This research was carried out in October 2021 in the working area of the Pasaman Regency Health Office with all posyandu cadres in 19 stunting loci countries with as many as 645 people. The sample size can be calculated by the Lemeshow formula and the number of samples is 62 people. Sampling in this study used non-probability sampling techniques using purposive sampling. This study uses pocketbooks as the main tool in improving the knowledge and counseling skills of cadres in stunting locus areas.

RESULTS AND DISCUSSION

TABLE 1

DISTRIBUTION OF RESPONDENT CHARACTERISTICS IN THE WORKING AREA OF THE PASAMAN DISTRICT HEALTH OFFICE 2021

Table 1 shows that the distribution of respondents’ characteristics by age is most in the category Late adults (36-45 years) are 35.5% while the least in the late adolescent category (17-25 years) are 12.9%.

The highest frequency of formal education of cadres is graduating from high school / equivalent at 52.6% while the least is not graduating from elementary school / equivalent at 3.2% Furthermore, the characteristics of respondents show more cadres who work less or equal to three years by 59.7% while more than three years by 40.3%.

UNIVARIATE ANALYSIS

Knowledge

TABLE 2

DISTRIBUTION OF THE AVERAGE VALUE OF CADRE KNOWLEDGE IN STUNTING LOCUS AREAS IN THE WORKING AREA OF THE PASAMAN DISTRICT HEALTH OFFICE IN 2021

Based on Table 2, there was an increase in the average value of knowledge of cadres after the intervention to 87.17 with a minimum score of 70.00, and a maximum score of 100 with a standard deviation of 8.07. Meanwhile, before the intervention, the average value of cadre knowledge was only 69.51. This is due to the references and reading materials obtained by posyandu cadres as guidelines aimed at increasing cadre knowledge. Everything seen and heard will be absorbed by the brain and become knowledge.

This knowledge still cannot be seen from the outside, everyone has a different perspective on something he sees and hears, so someone has a different perception of something. This is what causes everyone’s level of knowledge to be different. (Notoatmodjo, 2014).

The results of this study are also in line with the research of Nur Indah Rahmawati et al, the average knowledge score of motivators before intervention was 64.5, and after the intervention was 72.1 (Nur Indah Rahmmawati et al, 2015) The results of this study are also by the research of Henry Noor Wijayanti and Afroh Fauziah which shows that the results of PMBA training on posyandu cadres can increase knowledge in cadres so that they can provide counseling and motivation to mothers under five, especially undernourished status and stunting. (Heny Noor Wijayanti and Afroh Fauziah, 2019).

In the educational process to increase the knowledge of locus cadres stunting Regarding infant and child feeding in infant and child feeding training (PMBA), tools or media are also needed so that the messages conveyed are more interesting and easy to understand so that cadres can learn and adopt knowledge from the media easily. The messages conveyed through the media can be more interesting and easy to understand so that the target can learn the message it decides to adopt a positive behavior. (Notoatmodjo, 2010)

One of the effective educational media used is pocketbooks. A pocketbook is a small size book the size of a pocket so that it is effective to carry everywhere, can be read anytime when needed, and has an attractive design so that cadres are interested in reading it. This can be seen from the increase in the average value of knowledge of stunting locus cadres before and after training on giving infants and children using pocketbooks. With the increasing knowledge of stunting locus cadres, especially related to infant and child feeding taught which aims to prevent stunting and can reduce the prevalence of stunting in Indonesia, especially in the working area of the Pasaman District Health Office.

Conseling skills

TABLE 3

DISTRIBUTION OF THE AVERAGE VALUE OF CADRE COUNSELING SKILLS IN STUNTING LOCUS AREAS IN THE PASAMAN DISTRICT HEALTH OFFICE WORK AREA IN 2021

Table 3 shows an increase in the average score of cadre counseling skills after being given the intervention to 85.10 with a minimum score of 68.80, a maximum score of 93.70 with a standard deviation of 5.43. Meanwhile, before the intervention, the average value of cadre counseling skills was only 65.75.

The results of this study are in line with research by Adillah Imansari et al in 2021 showing that the value of counseling skills before and after the intervention is known that nutrition education can significantly increase the value of nutrition counseling skills in the intervention group by 21.94 points, relatively higher than the control group, which is 7.22 points.(Adillah Imansari, 2021) Ira Kartika’s research also showed that after receiving PMBA training, the average level of PMBA counseling skills for cadres with sufficient categories with a score of 21. (Ira Kartika, 2019)

In the educational process to improve the counseling skills of stunting locus cadres regarding infant and child feeding, the material on counseling skills was given and carried out direct practice with clients of mothers of toddlers, then researchers made an assessment based on the observation sheets that had been provided and from each skill and PMBA counseling steps that could be done by cadres, scores were obtained about cadre counseling skills on stunting locus cadres.

Intervention through infant and child feeding training using pocketbooks is one way to accelerate and reduce stunting. Infant and Child Feeding Counseling Training (PMBA) for health workers, posyandu cadres, and others as health promoters and motivators to the community. The aim is to equip health workers with knowledge, skills, and tools to support mothers, fathers, and caregivers in optimally improving infant and child feeding practices as well as pregnant women focused on growth monitoring, breastfeeding, complementary feeding, and community-based maternal, infant, and child feeding.

Therefore, this complete information is considered important to be conveyed to posyandu cadres as a potential resource that is directly related to the PMBA target. (Ministry of Health, 2019b) A pocket book read by the locus cadre themselves stunting make it easier for cadres to absorb the information provided so that cadres’ PMBA knowledge increases, if cadres’ knowledge increases, skills in PMBA counseling will change for the better so that the purpose of nutrition education can be achieved.

BIVARIATE ANALYSIS

Differences in Cadre Knowledge in Stunting Locus Areas Before and After PMBA Pocketbook Intervention

TABLE 4

DIFFERENCES IN CADRE KNOWLEDGE IN STUNTING LOCUS AREAS BEFORE AND AFTER PMBA POCKETBOOK INTERVENTION IN PASAMAN DISTRICT HEALTH OFFICE WORK AREA 2021

Table 4 shows that there was an increase in the average value of cadre knowledge in the stunting locus area after the intervention using the infant and child feeding pocketbook, from 69.52 to 87.18 with an average score difference of 17.66. From the results of statistical tests, the average difference in knowledge of stunting locus cadres before and after the intervention obtained a p-value of 0.0000 (p<0.05), it can be concluded that there is a difference in the knowledge of stunting locus cadres before and after the PMBA pocketbook intervention.

This research is in line with the research of Anjar Astuti et al stated that there were differences in knowledge before and after training with a significant value of p = 0.000 (p < 0.05) and there were differences in cadre practice before and after training p = 0.000 (p < 0.05). (Anjar Astuti et al, 2020)

A person’s knowledge can become broader by having more sources of information, a person will tend to get information, both from other people and from mass media. The more knowledge possessed will affect the skills of cadres. Conversely, if respondents have a low level of knowledge, it will hinder the development of skills in obtaining information. (Anjar Astuti et al, 2020)

Differences in Cadre Counseling Skills in Stunting Locus Areas Before and After PMBA Pocketbook Intervention

TABLE 5

DIFFERENCE IN CADRE COUNSELING SKILLS IN STUNTING AREAS BEFORE AND AFTER PMBA POCKETBOOK INTERVENTION IN PASAMAN DISTRICT HEALTH OFFICE WORK AREA 2021

 in 2021

Table 5 above shows that there was an increase in the average score of cadre counseling skills in the locus area stunting After the intervention using the infant and child feeding pocketbook, it was 65.75 to 85.10 with an average difference of 19.34. From the results of statistical tests, the average difference in cadre counseling skills in locus areas was obtained stunting before and after the intervention was obtained p-value of 0,0000 (p<0.05), It can be concluded that there are differences in the counseling skills of locus cadres stunting before and after the PMBA pocketbook intervention. This is in line with the research of Nur Indah Rahmawati et al stating that there is a difference in the average score of motivator skills before and after training using pocketbooks.(Nur Indah Rahmmawati et al, 2015)

The combination of training techniques with supporting media such as pocketbooks has proven effective in improving cadres’ counseling skills. PMBA training is given to improve the mastery of skills and techniques for implementing cadre work so that it is detailed and routine so that the gap in cadres’ proficiency in carrying out their duties such as counseling can be resolved. (Anjar Astuti et al, 2020)

Effective counseling is a two-way communication between the client and the counselor about anything that allows for changes in the client’s eating behavior. This can be achieved if the counselor can grow the client’s confidence so that he is able and willing to perform new behaviors to achieve optimal nutritional status. For this reason, counselors need to master and apply listening skills and learn in the counseling process.(Cornelia et al, 2013)

The quality of the relationship between the counselor and the client can be assessed while the counselor and client can create a mutually professional relationship that is helpful and highly dependent on the quality of the counselor’s personality. Because, during the counseling process, a counselor must be able to involve the client fully so that the client can be open. In conducting counseling, a reciprocal relationship is needed that helps the counselor with clients through an agreement to work together, communicate and engage in a continuous process to provide knowledge, skills, potential calls, and resources. (Cornelia et al, 2013).

CONCLUSION AND ADVICE

Conclusion

1. The average value of cadre knowledge in the stunting locus area before the PMBA pocketbook intervention was 69.51 6.38 and after the PMBA pocketbook intervention was 87.17 8.07.

2. The average value of cadre counseling skills in the stunting locus area before the PMBA pocketbook intervention was 65.75 8.31 and after the PMBA pocketbook intervention was 85.10 5.43.

3. There was a difference in the average knowledge of cadres in the stunting locus area before and after the intervention obtained a p-value of 0.0000 (p<0.05)

4. There was a difference in the average counseling skills of cadres in the stunting locus area before and after the intervention obtained a p-value of 0.0000 (p<0.05).

Suggestion

1. It is expected that health workers, especially in the field of nutrition in the working area of the Pasaman Regency Health Office, can carry out educational activities by training in feeding infants and children using pocketbooks regularly to cadres

2. It is expected that cadres can improve their knowledge and skills in conducting nutrition counseling

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