Effect of care for child development training on cadres’ knowledge, attitude, and efficacy in Yogyakarta, Indonesia


nutritional status

How to Cite

Akhmadi, A., Sunartini, S., Haryanti, F., Madyaningrum, E., & Sitaresmi, M. N. (2021). Effect of care for child development training on cadres’ knowledge, attitude, and efficacy in Yogyakarta, Indonesia. Belitung Nursing Journal, 7(4), 311-319. https://doi.org/10.33546/bnj.1521


Background: Stunting is a common malnutrition problem among children in the world. The Care for Children Development (CCD) intervention is a strategy to reduce stunting. 

Objective: This study aimed to identify the effect of culturally modified CCD training on the knowledge, attitude, and efficacy (KAE) of cadres about stunting in the community.

Methods: We conducted a community-based study with a quasi-experimental research design using a comparison group. The study was conducted from March 2018 to February 2019 at three Public Health Centers in Yogyakarta, Indonesia. The total participants were 69 in the intervention group and 53 in the comparison group. Cadres in the intervention group received two days of training on a culturally modified CCD guideline. In contrast, cadres in the comparison group received a brief explanation (a one-day training) on that program. The nurses from three public health centers were facilitators in this training. Knowledge and self-efficacy were assessed using a modified Caregiver Knowledge of Child Development Inventory and General Self-efficacy Scale, respectively. Data were analyzed using Mann-Whitney U and Wilcoxon tests.

Results: All 122 cadres completed the training. In the intervention group, CCD training significantly increased cadres’ knowledge (median score 14 vs. 11), attitude (58 vs. 55), and efficacy (30 vs. 28), all with p <0.001. In the comparison group, the short explanation of CCD significantly improved cadres’ knowledge (median score 12 vs. 10) and efficacy (29 vs. 27) but not their attitude. The delta or change in score before and after CCD training for cadres’ attitude in the intervention group was significantly higher than that of the comparison group (3.78 vs. 0.72; p = 0.050). 

Conclusion: A culturally modified CCD training significantly improves cadres’ KAE in the intervention group and cadres’ knowledge in the comparison group. The learning delivery methods with demonstrations and role-plays significantly improved the cadres’ attitudes as health educators for stunted mothers in the community. For sustainability, community health nurses should regularly collaborate with cadres to improve the nutritional status of children in their area.



Al-Ashwal, F. Y., Kubas, M., Zawiah, M., Bitar, A. N., Mukred Saeed, R., Sulaiman, S. A. S., . . . Ghadzi, S. M. S. (2020). Healthcare workers’ knowledge, preparedness, counseling practices, and perceived barriers to confront COVID-19: A cross-sectional study from a war-torn country, Yemen. Plos One, 15(12), e0243962. https://doi.org/10.1371/journal.pone.0243962

Alam, M. A., Richard, S. A., Fahim, S. M., Mahfuz, M., Nahar, B., Das, S., . . . Ahmed, T. (2020). Impact of early-onset persistent stunting on cognitive development at 5 years of age: Results from a multi-country cohort study. Plos One, 15(1), e0227839. https://doi.org/10.1371/journal.pone.0227839

Alber, J. M., Paige, S., Stellefson, M., & Bernhardt, J. M. (2016). Social media self-efficacy of health education specialists: Training and organizational development implications. Health Promotion Practice, 17(6), 915-921. https://doi.org/10.1177/1524839916652389

Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal and Child Nutrition, 14(4), e12617. https://doi.org/10.1111/mcn.12617

Berhe, K., Seid, O., Gebremariam, Y., Berhe, A., & Etsay, N. (2019). Risk factors of stunting (chronic undernutrition) of children aged 6 to 24 months in Mekelle City, Tigray Region, North Ethiopia: An unmatched case-control study. Plos One, 14(6), e0217736. https://doi.org/10.1371/journal.pone.0217736

Chung, M. H. L., Hazmi, H., & Cheah, W. L. (2017). Role performance of community health volunteers and its associated factors in Kuching District, Sarawak. Journal of Environmental and Public Health, 2017, 9610928. https://doi.org/10.1155/2017/9610928

Ertem, I. O., Atay, G., Dogan, D. G., Bayhan, A., Bingoler, B. E., Gok, C. G., . . . Isikli, S. (2007). Mothers’ knowledge of young child development in a developing country. Child Care Health and Development, 33(6), 728-737. https://doi.org/10.1111/j.1365-2214.2007.00751.x

Forbes, C. E., & Schmader, T. (2010). Retraining attitudes and stereotypes to affect motivation and cognitive capacity under stereotype threat. Journal of Personality and Social Psychology, 99(5), 740-754. https://doi.org/10.1037/a0020971

Health Distric Yogyakarta Province. (2019). Health profile of Daerah Istimewa Yogyakarta. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ahUKEwif1bGtro3xAhU94XMBHS84AokQFjAAegQIAxAD&url=http%3A%2F%2Fwww.dinkes.jogjaprov.go.id%2Fdownload%2Fdownload%2F82&usg=AOvVaw1jtti4-lXvchLFtBUT58EK

Indonesian Ministry of Health. (2018). Basic health research [Riskesdas 2018]. Retrieved from https://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf

Kinyoki, D. K., Osgood-Zimmerman, A. E., Pickering, B. V., Schaeffer, L. E., Marczak, L. B., Lazzar-Atwood, A., . . . Local Burden of Disease Child Growth Failure, C. (2020). Mapping child growth failure across low- and middle-income countries. Nature, 577(7789), 231-234. https://doi.org/10.1038/s41586-019-1878-8

Lucas, J. E., Richter, L. M., & Daelmans, B. (2018). Care for child development: An intervention in support of responsive caregiving and early child development. Child Care Health and Development, 44(1), 41-49. https://doi.org/10.1111/cch.12544

Muleme, J., Kankya, C., Ssempebwa, J. C., Mazeri, S., & Muwonge, A. (2017). A framework for integrating qualitative and quantitative data in knowledge, attitude, and practice studies: A case study of pesticide usage in Eastern Uganda. Frontiers in Public Health, 5, 318-318. https://doi.org/10.3389/fpubh.2017.00318

Nshimyiryo, A., Hedt-Gauthier, B., Mutaganzwa, C., Kirk, C. M., Beck, K., Ndayisaba, A., . . . El-Khatib, Z. (2019). Risk factors for stunting among children under five years: A cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health, 19(1), 175. https://doi.org/10.1186/s12889-019-6504-z

OECD. (2019). Health at a glance 2019. Organization for Economic Co-operation and Development. Retrieved from https://www.oecd-ilibrary.org/content/publication/4dd50c09-en

Schwarzer, R., & Jerusalem, M. (1995). Measures in health psychology: A user’s portfolio. Causal and Control Beliefs, 1, 35-37.

Shepherd, S. M., Willis-Esqueda, C., Newton, D., Sivasubramaniam, D., & Paradies, Y. (2019). The challenge of cultural competence in the workplace: Perspectives of healthcare providers. BMC Health Services Research, 19(1), 135. https://doi.org/10.1186/s12913-019-3959-7

Shrestha, M., Ulak, M., Strand, T. A., Kvestad, I., & Hysing, M. (2019). How much do Nepalese mothers know about child development? Early Child Development and Care, 189(1), 135-142. https://doi.org/10.1080/03004430.2017.1304391

Solikhah, U., Kusnanto, H., Haryanti, F., & Prabandari, Y. S. (2018). Cadres competence in community-based management of child illness in Banyumas District, Central Java, Indonesia. Belitung Nursing Journal, 4(5), 492-501. https://doi.org/10.33546/bnj.542

Subandi, A., Alim, S., Haryanti, F., & Prabandari, Y. S. (2019). Training on modified model of programme for enhancement of emergency response flood preparedness based on the local wisdom of Jambi community. Jamba, 11(1), 801. https://doi.org/10.4102/jamba.v11i1.801

Tambi, I. F. S., Yueniwati., Y., & Setyoadi. (2019). The effect of theory of planned behavior models to behavior of cadres as the first aiders of stroke attacks. Indian Journal of Public Health Research and Development, 10(7), 584-589. https://doi.org/10.37506/ijphrd.v10i7.5796

The World Bank. (2021). Nurses and midwives (per 1,000 people)-Indonesia. Retrieved from https://data.worldbank.org/indicator/SH.MED.NUMW.P3?locations=ID&view=chart

Titaley, C. R., Ariawan, I., Hapsari, D., Muasyaroh, A., & Dibley, M. J. (2019). Determinants of the stunting of children under two years old in Indonesia: A multilevel analysis of the 2013 Indonesia Basic Health Survey. Nutrients, 11(5), https://doi.org/1106. 10.3390/nu11051106

UNICEF. (2020, March 17, 2021). Malnutrition prevalence remains alarming: Stunting is declining too slowly while wasting still impacts the lives of far too many young children. Malnutrition. Retrieved from https://data.unicef.org/topic/nutrition/malnutrition/

Vizeshfar, F., Zare, M., & Keshtkaran, Z. (2019). Role-play versus lecture methods in community health volunteers. Nurse Education Today, 79, 175-179. https://doi.org/10.1016/j.nedt.2019.05.028

Wang, W., Liang, Z., Blazeck, A., & Greene, B. (2015). Improving Chinese nursing students’ communication skills by utilizing video-stimulated recall and role-play case scenarios to introduce them to the SBAR technique. Nurse Education Today, 35(7), 881-887. https://doi.org/10.1016/j.nedt.2015.02.010

WHO. (2012). Care for child development: improving the care of young children. World Health Organization. Retrieved from https://apps.who.int/iris/bitstream/handle/10665/75149/9789241548403_eng_Participant_Manual.pdf?sequence=13

Woldehanna, T., Behrman, J. R., & Araya, M. W. (2017). The effect of early childhood stunting on children’s cognitive achievements: Evidence from young lives Ethiopia. The Ethiopian Journal of Health Development, 31(2), 75-84.

Yousafzai, A. K., Obradović, J., Rasheed, M. A., Rizvi, A., Portilla, X. A., Tirado-Strayer, N., . . . Memon, U. (2016). Effects of responsive stimulation and nutrition interventions on children’s development and growth at age 4 years in a disadvantaged population in Pakistan: A longitudinal follow-up of a cluster-randomised factorial effectiveness trial. The Lancet Global Health, 4(8), e548-e558. https://doi.org/10.1016/S2214-109X(16)30100-0

Zamani-Alavijeh, F., Araban, M., Harandy, T. F., Bastami, F., & Almasian, M. (2019). Sources of health care providers’ self-efficacy to deliver health education: A qualitative study. BMC Medical Education, 19(1), 16. https://doi.org/10.1186/s12909-018-1448-z

Copyright (c) 2021 Akhmadi Akhmadi, Sunartini Sunartini, Fitri Haryanti, Ema Madyaningrum, Mei Neni Sitaresmi
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Article Metrics

Abstract views: 241 | PDF views: 111


Download data is not yet available.