Effectiveness of an interactive nutrition education kit on mothers’ knowledge and attitudes toward stunting prevention: a quasi-experimental study
Abstract
Purpose: This study aimed to evaluate the effectiveness of KIT DENTING, an interactive multimodal nutrition education kit, in improving mothers’ knowledge and attitudes toward stunting prevention compared with conventional leaflet-based education.
Methods: A quasi-experimental study with a nonequivalent pre–post-test control group design was conducted among 60 mothers of children aged 0–23 months in the working area of Pakem Primary Health Center, Sleman Regency, Yogyakarta. Participants were assigned to an intervention group that received nutrition education using KIT DENTING or a control group that received leaflet-based education. Knowledge and attitudes were assessed at baseline (pre-test), 1 week after the intervention (post-test 1), and 4 weeks after the intervention (post-test 2). Data were analyzed using paired and independent statistical tests to examine within- and between-group differences.
Results: Both groups showed significant improvements in knowledge following the intervention. In contrast, the intervention group demonstrated greater and more sustained improvements in knowledge and attitudes at both follow-up points. Compared with the control group, the intervention group sustained knowledge gains and showed improvements in attitudes, but with reduced effect consistency at four weeks of follow-up.
Conclusion: Nutrition education using the interactive multimodal KIT DENTING was more effective than leaflet-based education in improving and sustaining mothers’ knowledge and attitudes toward stunting prevention. These findings support the integration of interactive, multimodal nutrition education tools into community-based IYCF and stunting-prevention programs at the primary health care level.
References
World Health Organization. Global nutrition target 2030: stunting brief. Geneva: World Health Organization; 2030. Available from: [Website]
World Health Organization. Joint child malnutrition estimates. Geneva: World Health Organization; 2024. Available from: [Website]
Ministry of Health of Republic Indonesia. Hasil survei status gizi Indonesia. Jakarta: Ministry of Health of Republic Indonesia; 2024. Available from: [Website]
World Health Organization. Complementary feeding. Geneva: World Health Organization; 2025. Available from: [Website]
Saleh A, Syahrul S, Hadju V, Andriani I, Restika I. Role of maternal in preventing stunting: a systematic review. Gaceta Sanitaria. 2021;35:S576 –82.
Debela BL, Demmler KM, Rischke R, Qaim M. Maternal nutrition knowledge and child nutritional outcomes in urban Kenya. Appetite. 2017;116:518 –26.
Rakotomanana H, Hildebrand D, Gates GE, Thomas DG, Fawbush F, Stoecker BJ. Maternal knowledge, attitudes, and practices of complementary feeding and child undernutrition in the Vakinankaratra Region of Madagascar: a mixed-methods study. Current Developments in Nutrition. 2020;4(11): nzaa163.
Hall C, Bennett C, Crookston B, Dearden K, Hasan M, Linehan M, et al. Maternal Knowledge of Stunting in Rural Indonesia. International Journal of Child Health and Nutrition. 2018;7(4):139–45.
Ministry of Health of Republic Indonesia. Pemberian makanan bayi dan anak (PMBA). Jakarta: Ministry of Health of Republic Indonesia; 2018. Available from: [Website]
President of Republic Indonesia. Presidential Regulation no 72 year 2021 issue Stunting Reduction Acceleration. Jakarta, Indonesia; 2021. Available from: [Website]
Siswati T, Sitasari A, Paramashanti BA, Tjaronosari T, Nurhidayat N, Wijanarka A, et al. Effect of mHealth-based intervention on maternal knowledge and practices of child care: a quasi-experimental study. Public Health of Indonesia. 2024;10(1):10–20.
Novita H, Siswati T, Wayansari L. The effectiveness of aoksigame cards in improving knowledge, attitudes, and practices of anemia among adolescent girls. Nutrition and Health Insights. 2025;2(2):63–70.
Oktavia V, Utami SB, Sitasari A, Siswati T. The effectiveness of training anthropometry using cards to increase adolescents’ knowledge and skill. Ficco Public Health Journal. 2025;2(1).
Masters K. Edgar Dale’s Pyramid of Learning in medical education: A literature review. Medical Teacher. 2013;35(11):e1584–93.
Lee SJ, Reeves TC. Edgar Dale: A significant contributor to the field of educational technology. Educational Technology. 2007;47(6):56. Available from: [Website]
Fahmida U, Htet MK, Ferguson E, Do TT, Buanasita A, Titaley C, et al. Effect of an integrated package of nutrition behavior change interventions on infant and young child feeding practices and child growth from birth to 18 months: Cohort evaluation of the baduta cluster randomized controlled trial in East Java, Indonesia. Nutrients. 2020;12(12):3851.
Siswati T, Iskandar S, Pramestuti N, Raharjo J, Rubaya AK, Wiratama BS. Impact of an Integrative Nutrition Package through Home Visit on Maternal and Children Outcome: Finding from Locus Stunting in Yogyakarta, Indonesia. Nutrients. 2022; 14(16):3448.
Lwanga SK, Lemeshow S. Sample size determination in health studies: A practical manual. Geneva: World Health Organization; 1991. Available from: [Website]
Sari SP, Mahmudah U. Penggunaan media cakram gizi terhadap perilaku konsumsi sayur dan buah remaja. Jurnal Nutrisia. 2020;22(1):1–7.
Zhitomirsky Y, Aharony N. The effect of a patient education multimodal digital platform on knowledge acquisition, self-efficacy, and patient satisfaction. CIN: Computers, Informatics, Nursing. 2023;41(5):356–64.
Bustomi S, Sulistiana D. Effectiveness of health education through video and leaflets on knowledge and waste sorting behavior among elementary school students : a quasi-experimental study. Journal of Applied Nursing and Health. 2025;7(3): 495–508.
Basiroh UM, Yuniastuti A, Maharani C. Development of promotional media for prevention of DM in children in Indonesia : a systematic review. Journal of Integrated Health Research. 2025;1(2):99–110.
Nassar AA, Aboalshamat KT, Alsanei BS, Alghamdi AS, Fudah AA, Alhilou AM. The effect of educational animation compared to leaflets on patients’ knowledge regarding root canal treatment: a randomized controlled trial. BMC Medical Education. 2024;24(1):808.
Brasser M, Frühholz S, Schneeberger AR, Ruschetti GG, Schaerli R, Häner M, et al. A randomized controlled trial study of a multimodal intervention vs. cognitive training to foster cognitive and affective health in older adults. Frontiers in Psychology. 2022;13:866613.
Santilli T, Ceccacci S, Mengoni M, Giaconi C. Virtual vs. traditional learning in higher education: A systematic review of comparative studies. Computers & Education. 2025;227:105214.
Saulle R, Sinopoli A, De Paula Baer A, Mannocci A, Marino M, De Belvis AG, et al. The PRECEDE- PROCEED model as a tool in Public Health screening: a systematic review. Clinica Terapeutica. 2020;171(2):e167–77.
Fitriani AN, Farisni TN, Syahputri VN, Lestary LA, Helmyati S. Implementing precede-proceed model toward the mothers’ perception on the importance of feeding of home-made complementary food to wasting and stunting toddlers. Current Research in Nutrition and Food Science Journal. 2020;8(2):489 –95.
Green LW, Ottoson JM. A framework for planning and evaluation: PRECEDE-PROCEED evolution and application of the model. Journées Annuelles de Santé Publique (JASP). Montreal, Quebec: Institut National de Santé Publique du Québec; 2005. Available from: [Website]
Kodagoda Gamage MW, Pu L, Moyle W, Barton M, Todorovic M. The effectiveness of educational interventions in enhancing health professionals’ and students’ pain assessment for people living with dementia: A systematic review. Nurse Education Today. 2025;148:106606.
Doré A, Rebitschek FG, Morello K, Stierstädter E, Thiemann KJ, Kubiak T. A systematic review and meta-analysis of the effects of entertainment- education interventions on persuasive health outcomes. Scientific Reports. 2025;15(1):27939.
Hill J, Gratton N, Kulkarni A, Hamer O, Harrison J, Harris C, et al. The effectiveness of evidence-based healthcare educational interventions on healthcare professionals’ knowledge, skills, attitudes, professional practice and healthcare outcomes: Systematic review and meta-analysis. Journal of Evaluation in Clinical Practice. 2024;30(6):909–35.
Sultan MA, Miller E, Tikkanen RS, Singh S, Kullu A, Cometto G, et al. Competency-based education and training for community health workers: a scoping review. BMC Health Services Research. 2025;25(1): 263.
Lane C, McCrabb S, Turon H, Bialek C, Couper L, Wilczynska M, et al. Learning health system for implementation, scale-up, and sustainment: a systematic review to consolidate guidance for improvement. Implementation Science. 2026;21:13.
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