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

Abstract

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 tests 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.

Implementation of UNICEF and WHO's care for child development package: Lessons from a global review and key informant interviews

“…Others made substantive modifications by providing more specific recommendations on how to engage in responsive play and communication activities and creating a structured curriculum to guide delivery agents in their interactions with caregivers. For example, seven studies explicitly reported making substantive modifications to the play and communication activities of the CCD package (( 24 ) [Indonesia]; ( 25 ) [Mozambique], ( 26 ) [Tanzania]; ( 27 ) [Malawi]; ( 28 ) [Kenya]; ( 29 ) [India and Pakistan]; ( 17 ) [Pakistan] 5 ). In Malawi, this consisted of modifying play and communication activities to focus on touch, hearing, and other senses for children with visual impairments ( 27 ).…”

“…For example, some caregivers stated that they would have liked a better explanation of the service's purpose (( 48 ) [Mozambique]) and to have more explicit and repetitive messages on why specific activities are important for children's development (( 43 ) [Malawi]). Two of the reports (( 24 ) [Indonesia]; ( 30 ) [Turkey]) described the training of delivery agents in the CCD package and one of them reported data on delivery agents' program acceptance. General practitioners and nurse-midwives in Turkey appreciated the content and materials of the CCD package and felt that the training improved their ability to engage caregivers in ECD counseling ( 30 ).…”

“…Twenty-one studies reported using a train-the-trainer model, where government staff, supervisors, or other individuals were trained on service administration and then subsequently trained the delivery agents. Only thirteen services reported using active learning strategies (e.g., demonstration, role plays, practice with caregivers and children) in the training process (( 32 ) [Kenya]; ( 33 ) [Uganda]; ( 24 ) [Indonesia]; ( 53 ) [Rwanda]; ( 30 ) [Turkey]; ( 54 ) [Rwanda]; ( 26 ) [Tanzania]; ( 39 ) [South Africa]; ( 55 ) [India]; ( 35 ) [Tanzania]; ( 31 ) [India]; ( 36 ) [Egypt]; ( 50 ) [Pakistan]) and twelve reported hosting refresher sessions during service delivery (( 32 ) [Kenya]; ( 33 ) [Uganda]; ( 56 ) [Kenya]; ( 25 ) [Mozambique]; ( 26 ) [Tanzania]; ( 54 ) [Rwanda]; ( 39 ) [South Africa]; ( 57 ) [Armenia]; ( 35 ) [Tanzania]; ( 58 ) [Kenya]; ( 17 ), ( 26 ) [Pakistan]; ( 59 ) [China]). The handful of studies ( n = 9) that assessed delivery agents before, during, or after training generally reported improvements in knowledge about child development and competencies in delivering the service (( 32 ) [Kenya]; ( 24 ) [Indonesia]; ( 30 ) [Turkey]; ( 27 ) [Malawi]; ( 55 ) [India]; ( 29 ) [India and Pakistan]; ( 36 ) [Egypt, Iran, Tunisia]; ( 31 ) [India]; ( 50 ) [Pakistan]).…”

Determining Knowledge of Stunting among Prospective Brides in East Java, Indonesia

“…Tadesse et al (2023) showed that maternal education was an important predictor for narrowing the urban rural disparities in childhood stunting. Knowledge of stunted mother need to improve with demonstrations and role plays demonstrated by Akhmadi et al, (2021) .…”

Covid-19 and Post-infection Health Risk Assessment on Children Under Five Years: A Cross-sectional Study on Public Health Centres

“…19 and its health reasons based on the ICD-10 diagnosis code. The increasing number of patients' visits in the years 2021 and 2022 compared to 2020 might be affected by patients' decision to avoid healthcare during the beginning period of the pandemic.…”