Hrev_master Healthcare in Low-resource Settings 2024; volume 11966 Enhancing the knowledge and skills of health cadres and mothers to prevent developmental disorders through stimulation interventions Ningsih Jaya, Ambo Dalle, Sri Anggriani Faculty of Nursing, Poltekkes Kemenkes Makassar, Indonesia Abstract The golden age of toddlerhood is a crucial time for growth and development that requires special attention. Failure to support chil- dren during this time can cause developmental issues that affect their future growth. This study examined whether toddler growth and development interventions prevent developmental disorders. This pre-experimental study used a one-group pre-test/post-test design. The proportional random sample included 70 participants. The respondents’ age, occupation, education, use of toddler growth and development stimulation interventions, and health cadres’ and mothers’ knowledge and skills were variables. Data were analyzed using Wilcoxon and Mann-Whitney. There was a significant increase in health cadres and mothers’ knowledge and skills for promoting toddler growth and preventing developmental disorders (P=0.000<0.05). Effective toddler growth and development inter- ventions improve health cadres and mothers’ knowledge and skills, preventing developmental disorders in toddlers. These findings suggest that targeted educational programs for health cadres and mothers may reduce developmental disorders and promote health- ier growth trajectories for children. Introduction The early years of a child’s life, often referred to as the “gold- en age,” encompass the first 1000 days until they reach two years old.1 This critical period is crucial for growth and development, necessitating attention from all parties.2 Failure to support a child properly during this time can lead to significant developmental issues that impact their future growth and development.3 Consequently, it is imperative for parents, caregivers, and health- care professionals to work collaboratively to ensure the well-being and healthy development of children during these formative years.4 Over 200 million children under the age of five worldwide did not meet their developmental potential, with most of these chil- dren living in Asia and Africa.5 National data from the Indonesian Ministry of Health in 2014 indicated that 13-18% of children under five in Indonesia experience growth and development disor- ders. World Health Organization also reports that 5.25% of preschool-aged children suffer from minor brain dysfunctions, including impaired fine motor development. The survey from Basic Health Research (Riskesdas) in 2013 revealed that in Indonesia, 12.4% of children experience gross motor disorders, and 9.8% experience fine motor disorders, highlighting that motor development issues remain a significant public health concern.6 Monitoring growth and development closely is essential for early detection and minimization of developmental abnormalities, which can otherwise become permanent.7 However, interventions to stimulate toddler growth and development have not been max- imally implemented by health workers or mothers. Children who do not receive adequate growth and development stimulation are at risk of adverse effects on their future development.1 To prevent developmental disorders in children, it is crucial to implement growth and development stimulation interventions as early as possible.8 Parents and health cadres through integrated service posts (posyandu) activities, teachers, and health workers should all be involved. Health workers play a key role by provid- ing education, guidance, and monitoring the implementation of Correspondence: Ningsih Jaya, Faculty of Nursing, Poltekkes Kemenkes Makassar, Makassar, Indonesia. E-mail: ningsihjaya03@gmail.com Key words: knowledge; stimulation; growth and development; interven- tion; skills. Acknowledgments: we would like to acknowledge the contribution of the mentoring program conducted by The Research Centre of Excellence in Advancing Community Health, Surabaya, Indonesia. Contributions: NJ, AD, SA, conceptualization, data curation, formal analysis, methodology, investigation, visualization, review and editing; NJ, AD, initial writing; SA, early draft. All the authors approved the final version to be published. Conflict of interest: the authors declare no potential conflict of interest. Funding: this research received funding from the Dipa Poltekkes Kemenkes Makassar. Ethical approval and consent to participate: this research received ethical approval from the Ethics Commission for Health Research at the Makassar Ministry of Health based on the ethics certificate No. 0284/0/KEPK-PTKMS/III/2023 During the study, researchers paid atten- tion to ethical principles, namely information to consent, and respect for human rights, beneficence, and non-maleficence. Availability of data and materials: complete data is included in the analy- sis and discussion page. Consent for publication: written consent has been obtained for anonymized patient information to be published in this article. Received: 13 October 2023. Accepted: 11 June 2024. Early access: 22 July 2024. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2024 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2024; 12:11966 doi:10.4081/hls.2024.11966 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2024;12:11966] [page 563] Non -co mmerc ial us e o nly activities.9 Efforts to improve knowledge and skills related to stim- ulation, intervention, and early detection of child growth and development should target parents, health cadres, and the commu- nity. Enhancing the capabilities of health cadres ensures they can reach their maximum potential and actively contribute to public health through posyandu activities.10 Well-informed cadres can effectively detect early developmental issues and provide neces- sary interventions. Meanwhile, parents, as the closest figures to their children, continuously monitor and stimulate their growth and development.11 This study aimed to improve the knowledge and skills of health cadres and mothers of toddlers regarding the application of growth and development stimulation interventions to prevent developmental disorders in toddlers. Materials and Methods Research design The research was a pre-experimental design, utilizing a one- group pre-test and post-test design without a control group. The sample consisted of 70 participants selected through proportional random sampling. Variables included respondents’ age, occupa- tion, education, and the application of toddler growth and develop- ment stimulation interventions, as well as the improvement in knowledge and skills among health cadres and mothers of toddlers. Data were analyzed using the Wilcoxon and Mann-Whitney tests. Study participants The sample in this study was selected through proportional random sampling, targeting mothers of toddlers and health cadres residing in the research locations who met the inclusion and exclusion criteria. The sample size for mothers of toddlers was taken from 40% of the total population. All cadres present at the research location were included, resulting in a total sample size of 70 respondents. The inclusion criteria for the study were: mothers of toddlers, active health cadres, residing in the study area, willing to participate as respondents, and cooperative. The exclusion criteria were respondents who were not present during the study, and those who did not participate in the stimulation activities for toddler growth and development interventions until completion. Variables The independent variable is the application of stimulation interventions for toddler growth and development, while the dependent variable is the increased knowledge and skills of health cadres and mothers of toddlers. The instruments used in this study were developed by the researcher. The primary instrument was a questionnaire sheet designed to collect data from respondents. This questionnaire gathered information on the respondents’ characteristics, including age, education, and occupation. Additionally, it measured the respondents’ knowledge about the application of stimulation interventions for toddler growth and development aimed at preventing developmental disorders. Complementing the questionnaire, observation sheets were employed to assess the respondents’ ability to perform or demonstrate the stimulation interventions. These observations focused on how well the respondents could implement the growth and development interventions to prevent developmental disorders in toddlers. Data analysis The analysis aimed to describe the characteristics of the variables studied. Wilcoxon analysis was used to assess the level of knowledge and skills of health cadres before and after the intervention, with a significance level of α=0.05. To compare the average knowledge and skills between health cadres and mothers of toddlers, the Mann-Whitney test was employed. Ethical clearance This research received ethical approval from the Health Research Ethics Commission of the Makassar Ministry of Health, as indicated by ethics certificate No. 0284/O/KEPK- PTKMS/III/2023. Throughout the study, researchers adhered to ethical principles, including informed consent, respect for human rights, beneficence, and non-maleficence. Results Based on Table 1, the study included participants of various ages and educational backgrounds. The age distribution was as follows: 4.3% of participants were under 20 years old, 21.4% were between 20 and 29 years old, 35.7% were between 30 and 39 years old, 21.4% were between 40 and 49 years old, and 17.1% were between 50 and 59 years old. In terms of education, 7.1% of participants completed elementary school, 22.9% had completed junior high school, and a significant majority of 70.0% had completed senior high school. Table 2 presents a comparison of knowledge and skill scores in the cadre group before and after the intervention. The average knowledge score increased from 8.05 before the intervention to 11.30 after the intervention. Statistical analysis revealed a P-value of 0.000, which is less than 0.05, indicating a significant difference in knowledge scores before and after the intervention. Similarly, the average skill score increased from 4.20 before the intervention to 6.45 after the intervention. The statistical tests also yielded a P- value of 0.000, which is less than 0.05, signifying a significant dif- ference in skill scores between the pre- and post-intervention peri- ods. Table 3 shows a comparison of knowledge and skill scores in the group of mothers of toddlers before and after the intervention. The average knowledge score increased from 8.80 before the intervention to 11.62 after the intervention. Statistical analysis yielded a P-value of 0.000, which is less than 0.05, indicating a significant difference in knowledge scores before and after the intervention. In terms of skill scores, the average increased from 4.38 before the intervention to 6.58 after the intervention. The Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions Table 1. Characteristics of respondents (n=70). Characteristics n % Age <20 years 3 4.3 20-29 years 15 21.4 30-39 years 25 35.7 40-49 years 15 21.4 50-59 years 12 17.1 Education Elementary school 5 7.1 Junior high school 16 22.9 Senior high school 49 70.0 [page 564] [Healthcare in Low-resource Settings 2024;12:11966] Non -co mmerc ial us e o nly statistical tests also resulted in a P-value of 0.000, which is less than 0.05, signifying a significant difference in skill scores between the pre- and post-intervention periods. Table 4 presents the comparison of knowledge and skill delta scores between cadres and mothers of toddlers. In terms of knowledge, the delta score, or the change in knowledge, was 3.25 for cadres and 2.82 for mothers of toddlers. Statistical analysis yielded a P-value of 0.636, which is greater than 0.05. This indicates that there is no significant difference in delta scores (changes between before and after) in knowledge between cadres and mothers of toddlers. Similarly, for skills, the delta score was 2.25 for cadres and 2.20 for mothers of toddlers. The statistical tests resulted in a P-value of 0.705, which is also greater than 0.05. This implies that there is no significant difference in delta scores (changes between before and after) in skills between cadres and mothers of toddlers. Discussion To form one’s perspective, knowledge is a very important basis for a person. It is known that knowledge is the result of knowing someone who is understood through the five senses and knowledge can be influenced by age, interests, education, work, and experience obtained by someone from various sources.12 Based on the results of the research that has been conducted, it was obtained that from 70 respondents, both cadres and mothers of toddlers had less knowledge about stimulation of toddler growth and development interventions, and after being given the application of stimulation of toddler growth and development interventions in the prevention of developmental disorders. The same thing was done before that there is an influence of growth and development stimulation education on the ability to detect early growth and development of children aged 0-5 years by parents.13 Providing education on child growth and development stimulation can improve parents’ ability to provide early growth and development stimulation which will have a positive impact such as increasing children’s language and memory development.14 The application of stimulation provided is to stimulate the basic abilities of children to grow and develop optimally so that they have development that is appropriate for their age.15 The results of previous research that provide education on the stimulation of toddler growth and development given to mothers can increase knowledge in the stimulation of toddlers.16 In addition to using various methods by looking at the characteristics of respondents in terms of age, it can be said that the age of dominant respondents is between the ages of 30-39 years whereas the age is in adulthood, which is the age when someone is still able to work and produce something, According to Candrawati et al.,17 that age affects a person’s level of knowledge. The increasing age of a person causes mental psychological changes, while according to Resti et al.,18 age affects a person’s comprehension and mindset, Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions [Healthcare in Low-resource Settings 2024;12:11966] [page 565] Table 2. Knowledge and skill score comparison between before and after intervention in cadre groups. Cadre Knowledge P Skill P Pre Post Pre Post Mean 8.05 11.30 0.000* 4.20 6.45 0.000** SD 1.57 1.53 0.62 0.69 Median 8.00 11.00 4.00 6.00 Minimum 5.00 9.00 3.00 5.00 Maximum 11.00 15.00 5.00 8.00 SD, standard deviation. Table 3. Comparison of knowledge and skill scores before and after intervention in the mother-toddler group. Mother of toddler Knowledge P Skill P Pre Post Pre Post Mean 8.80 11.62 0.000 4.38 6.58 0.000 SD 1.71 1.61 0.81 0.73 Median 9.00 12.00 4.00 7.00 Minimum 5.00 8.00 3.00 5.00 Maximum 12.00 15.00 6.00 8.00 SD, standard deviation. Table 4. Knowledge and skill delta score between cadres and toddler mothers. Group Delta (pre-post) P* Mean SD Median Minimum Maximum Knowledge Cadre 3.25 2.05 2.00 1.00 8.00 0.636 Mother of toddler 2.82 1.38 2.00 1.00 7.00 Skill Cadre 2.25 0.64 2.00 1.00 3.00 0.705 Mother of toddler 2.20 0.57 2.00 1.00 3.00 SD, standard deviation. *Mann Whitney test. Non -co mmerc ial us e o nly the more mature a person is, the more developed one’s grasp and mindset will be, so that the knowledge gained will be better, as well as according to Fera et al.19 In research activities carried out in addition to the age factor respondents who are of productive age, are very active in participating in activities that are done so that can increase knowledge.20 Similarly, educational factors can significantly affect a person’s mindset. The results of the research showed that most respondents have a high school education. It is noted that knowledge is greatly influenced by educational factors – the higher the education, the better the knowledge a person is likely to have.20 However, this does not mean that someone with less formal education will necessarily lack knowledge, as knowledge can also be acquired through non-formal education.21 With the knowledge possessed by respondents both formally and informally as has been done through research, it will be very useful in guiding and monitoring children’s growth and development and providing stimulation effectively in the hope that children can grow and develop without experiencing developmental disorders.22,23 Health cadres who have been trained in applying stimulation interventions have gained knowledge that can be utilized in Posyandu activities. Developing the abilities of these cadres is essential, especially in the field of maternal and child health, to ensure that toddler growth and development interventions are properly implemented. This allows for effective monitoring of toddlers in the primary health care area and early intervention if problems arise. These findings align with previous research by Umam et al., which showed that cadres’ knowledge and skills improved significantly after training on stimulation interventions.24 Actions performed by individuals are often based on their knowledge, making it crucial for an effective implementation of stimulation activities.17 The more frequently respondents apply stimulation techniques to their children, the better the developmental outcomes, as frequent stimulation aligns development with the child’s age. The results are also consistent with research by Kurniasih et al., which found that knowledge is the most dominant factor affecting cadres’ skills in early detection of child growth and development.25 Cadres with good knowledge are 13.9 times more likely to have better skills than those with less knowledge. Therefore, it is essential for mothers of young children to engage in stimulation interventions to ensure optimal growth and development, preventing delays or developmental issues. The researchers conclude that applying stimulation interventions for toddler growth and development effectively enhances the knowledge and skills of health cadres and mothers, positively impacting children’s developmental phases and promoting optimal health. Conclusions The application of stimulation interventions for toddler growth and development to cadres and mothers has been proven to significantly increase their knowledge and skills in preventing child developmental disorders. This comprehensive approach ensures that both health cadres and mothers are better equipped to recognize and address early signs of developmental issues. By enhancing their understanding and practical abilities, these interventions empower them to provide more effective support and stimulation to toddlers, promoting optimal growth and development. Overall, the study confirms that the targeted application of stimulation interventions is an effective strategy for enhancing the capabilities of both cadres and mothers, ultimately contributing to the prevention of developmental disorders and fostering healthier developmental trajectories for children. References 1. Nindyaningrum SF, Muniroh L, Rifqi MA. relationship of three basic needs by mother with growth and development of children age 3-5 years in Mulyorejo, Surabaya. Indones J Public Heal 2023;18:93-105. 2. Ani A, Rachmawati PD, Efendi F, et al. The differences in the stimulation and personal social development of school-aged children between children who raised by their grandparents and parents respectively. J Glob Pharma Technol 2020;12:142- 50. 3. Dewi RK, Sumarni S. Parenting style and family empower- ment for children’s growth and development: a systematic review. J Public Health Africa 2023;14. 4. Has EMM, Prahasiwi DF, Wahyuni SD, et al. Mothers’ behav- iour regarding school-aged children’s nutrition: in Indonesia. Indian J Public Heal Res Dev 2018;9:317-22. 5. Engle PL, Black MM, Behrman JR, et al. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet 2007;369:229-42. 6. Ministry of Health R of I. Basic Health Research. Natl Inst Heal Res Dev Repub Indones 2013;1-384. 7. Widarto DAS, Sugiharto S, Supriyadi S. Pengaruh Pembelajaran Play & Games dengan Mendengarkan Musik terhadap Perkembangan Keterampilan Gerak Dasar Motorik Anak. J Pendidik Teor Penelitian dan Pengemb 2021;6:779. 8. Smythe T, Zuurmond M, Tann CJ, et al. Early intervention for children with developmental disabilities in low and middle- income countries - The case for action. Int Health 2021;13:222-31. 9. Putri NK, Ridlo IA. How do health worker qualities affect col- laborative skills? A qualitative study in rural indonesia primary health services. Educ Med J 2024;16:23-46. 10. Kemenkes RI. Profil Kesehatan Indonesia 2021. Pusdatin Kemenkes Go Id 2022. Kementrian Kesehatan Republik Indonesia. 11. Wirjatmadi B, Adriani M, Devy SR. The effect of psycososial stimulation assistance, child feeding and children health care to growth, motor development and the decrease frequency of upper respiratory tract infections for stunting children 2-3 years of age. Indian J Public Heal Res Dev 2019;10:1081-6. 12. Krisnana I, Rachmawati PD, Karimah AS, et al. Knowledge and action related to stimulation development of stunted chil- dren. J Pak Med Assoc 2023;73:S59-62. 13. Alfianty U, Sulistiyawati, Kumalawati Santoso N. Pengaruh Pemberian Edukasi Tentang Stimulasi Tumbuh Kembang Balita Terhadap Pengetahuan Ibu di Community Feeding Center di Wilayah Kerja Puskesmas Sedayu 2014;19:494-502. 14. Tarnoto N, Tentama F, Pranungsari D. Intervention model of children growth and development to improve stimulation skills of parents with early child. Adv Soc Sci Educ Humanit Res 2018;133:218-22. 15. Fitriyah L, Islamiyah N, Fatahillah A. Parents’ knowledge and commitment to stimulate child development. J Ilmu Kesehat dan Hum 2021;2:158-66. 16. Ultiyas Alfianty. Pengaruh Pemberian Edukasi Tentang Stimulasi Tumbuh Kembang Balita Terhadap Pengetahuan Ibu Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions [page 566] [Healthcare in Low-resource Settings 2024;12:11966] Non -co mmerc ial us e o nly Di Community Feeding Center Di Wilayah Kerja Puskesmas Sedayu II. Universitas Alma Ata Yogyakarta; 2017. 17. Candrawati RD, Wiguna PK, Malik MF. Promosi Dan Perilaku Kesehatan. Eureka Media Aksara 2023:1-43. 18. Resti HE, Indriati G, Arneliwati A. Gambaran Penanganan Pertama Kejang Demam Yang Dilakukan Ibu Pada Balita. J Ners Indones 2020;10. 19. Fera T, Marhaeni H. Profil Pengetahuan dan Sikap Ibu Terhadap Penatalaksanaan Awal Diare Pencegahan Dehidrasi Balita Di Puskesmas Gambesi di Kota Ternate 2020;2:83-92. 20. Nurjanah S, Anggraini FD, Solehah U, et al. Effect of stimula- tion using flashcard media on language and speech develop- ment in pre-school age children (3-5 years). Bali Med J 2023;12:2882-5. 21. Fitrah NE, Neherta M, Ira Mulya S. Analisis Faktor-Faktor Yang Berhubungan Dengan Kejadian Diare Pada Anak Balita. J Ilm Permas J Ilm STIKES Kendal 2024;14:75-82. 22. Khamenkan K, Homchampa P. Family skill development for attention deficit hyperactivity disorder behavior problem alle- viation model in at-risk preschool children: a mixed methods study. J Ners 2024;19:55-68. 23. Saputo H, Fazrin I, Yalestyarini EA. The Correlation Between Stimulation, Nutritional Status and Child Development. J Ners 2020;15:96-100. 24. Umam K, Cahyo R, Ridha AA. Effectiveness of training on constructivism learning methods to improve teaching skills self help material for early childhood education teachers. Int J Indian Psychol 2019;7:667-79. 25. Kurniasih A, Widyawati W, Akhmadi A, Haryanti F. Cadre Knowledge and self-efficacy following care for child develop- ment post intervention: a four-year prospective follow-up study. Jurnal Keperawatan Glob 2023;78-88. Transforming Healthcare in Low-Resource Settings: A Multidisciplinary Approach Towards Sustainable Solutions [Healthcare in Low-resource Settings 2024;12:11966] [page 567] Non -co mmerc ial us e o nly