Effectiveness of an integrated nutrition and sanitation education on community health cadres' knowledge and attitudes: A quasi-experimental study 10.55131/jphd/2026/240321
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Abstract
Stunting continues to represent a critical public health concern in Indonesia, with community health cadres playing a pivotal role in preventive efforts at the grassroots level. Despite this, empirical evidence evaluating integrated training approaches combining nutrition education with sanitation-based approaches remains limited. This study aimed to evaluate the effectiveness of the Integrated Stunting Prevention Education (SIDUCETING) program in improving the knowledge and attitudes of community health cadres. A quasi-experimental study with non-equivalent control groups was conducted from June to September 2019. A total of 63 cadres participated in the study, comprising an intervention group (n=32), and a control group (n=31). The intervention group consisted of a two-day SIDUCETING training program integrating nutrition-specific education with Community-Based Total Sanitation (STBM) principles, emphasizing experiential learning through practical demonstrations and hands-on skill development. Cadre’s knowledge was measured using a 20-item questionnaire, while attitudes were assessed using a 15-item Likert-scale instrument at baseline and immediately following post-intervention. Data were analyzed using the Mann-Whitney U test and the Wilcoxon signed-rank test. Baseline assessments indicated no significant differences between groups in knowledge (p=0.357) or attitude scores (p=0.985). Post-intervention, the intervention group demonstrated significant improvements in both knowledge (median: 10 to 18, p<0.001) and attitudes (median: 42 to 54, p<0.001), while the control group remained unchanged. Between-group analysis revealed significant differences in knowledge change (Cohen’s d=0.22; 95% CI: 0.05–0.39) and attitude change (Cohen’s d=0.76; 95% CI: 0.52–1.01). No significant correlations were identified between demographic characteristics and outcomes. These findings indicate that the SIDUCETING intervention is effective in improving community health cadres’ knowledge and attitudes toward stunting prevention, supporting the scalability of short-duration, integrated training programs for broader implementation with Indonesia’s community health system.
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