Differences in the Effectiveness of Audiovisual Media and Leaflets on the Knowledge and Attitudes of Mothers of Toddlers in Bogorejo Village About Stunting

ABSTRACT


INTRODUCTION
In Indonesia, stunting is common among toddlers due to poor nutrition.
Children who are chronical malnutrition, a condition known as stunting, cause them to fail to reach their full height potential as  In this study, the sample was divided   on the data of the knowledge and attitude variables of the three groups revealed a sig value of 0,001<0,05, demonstrating that there are huge contrasts in all test groups (Table 3).Table 4 is   According to the study, the majority of respondents had inadequate health awareness prior to receiving health education.Many of them continue to have a poor impression and grasp of stunting's causes, traits, and impacts.They believe that all short children are stunts, and that stunts are not deadly diseases that must be treated promptly.In line with the respondents attitudes prior to receiving health education, respondents did'nt care much about how food was processed or nutritional fulfillment of the young, which was consistent with their view prior to getting health education.The majority of respondents chose to provide unevenly nutritious items, such as too much carbs and fast foods, without taking other nutritional intake (proteins, vitamins, minerals, and etc).on the basis that the toddler was full and didn't cry.

RESULTS AND DISCUSSION
Knowledge is the consequence of sensation through human senses (vision, taste, smell, touch, and hearing) where the results of sensing affect attention and perception on an object (Pratiwi et al., 2022;Rita Kirana, 2022).A person's attitude is the intensity with which they respond to a stimuli with either dislike (negative attitude) or favor (positive attitude) (Soltani,2023).Knowledge influences attitudes and behaviors and shapes people's beliefs in action.(Notoatmodjo, 2014).Following a health education, respondents knowledge climbed to a high level, and their attitude improved to a good level.This is due to the fact that human senses respondents were offered information (stimuli) about stunting for health education via leaflet and audiovisual media.The information is captured and retained in his memory so that the respondent's knowledge of the concepts, characteristics, and impact of stunting as well as the correct attitude of the mother to do so that the kid avoids stunting becomes better.
Leaflets are health education media in the form of paper that is folded and contains information in the form of text and images (Oktaviani,2022).Some of the advantages of this media are easy production costs, attractive design, easy to carry anywhere, and durable (Jatmika et al., 2019).Health education media will help convey information precisely and clearly so that the target can receive the information provided.This acceptance can be seen by an increase in target knowledge (Notoatmodjo, 2014).involve all of the senses; so, the more sensory systems that absorb information, the more probable it is that the knowledge will be processed and retained in human memory.(Sabarudin et al., 2020).

CONCLUSIONS AND SUGGESTIONS
The results of this study show that health education using media can improve the knowledge and attitude of mother of toddlers compared to health education without use a media.Based on the description above, it tends to be presumed that there are impacts and contrasts in average knowledge and attitudes as well as differences in media effectiveness in leaflet and audiovisual groups.
Audiovisual media is more successful in toddlers.A stunted toddler is a toddler with a Z-score of less than -2 SD according to WHO standart growth reference.(Berhanu et al., 2022) More than 149 million children in the world are stunted and most of the stunted children live in Asia and Africa.According to the Global Nutrition Report (2021), the number of stunted children is 30.9% in the West Africa region, 30.7% in South Asia, and 27.4% in Southeast Asia (WHO, 2019).The percentage of toddlers who were stunted in 2018 was 30.8%, according to data from the Indonesian Ministry of Health (2021).The frequency of stunting among Indonesia's toddler population was 27.7% in 2018, 24.4% in 2019, and 24.4% in 2021.Even if the rate of stunting has dropped, it is still higher than the 20% threshold established by the World Health Organization.This demonstrates that stunting is still a major issue in Indonesian toddlers (SSGI, 2021).East Java is one of the priority areas for handling stunting problems with a proportion of 23,5% based on the results of the Indonesian Nutrition Status Study (SSGI) by the BKPK Kemenkes RI in 2021.One of the focus areas for stunting in East Java is Magetan District.In 2021, fifteen stunting focus locations have been determined in Magetan Regency, one of which is Barat District.(Kominfo Magetan, 2021).Puskesmas Tebon is a public health center located in Barat District with the highest stunting cases in Bogorejo Village (21,9%), consisting of 25 short children and 9 very short children (Puskesmas Tebon Profile, 2022).Some factors that influence the high stunting rate are low birth weight, poor nutritional intake, children who don't take vitamins, lack of sanitary hygiene, missed immunizations, and not exclusively breastfed (Haq & Abbas, 2022; Yushananta & Ahyanti, 2022).Other factors include poor parenting due to lack of knowledge about stunting and nutritional deficiencies before, during and after pregnancy.(Ramadhanti et al., 2019).Level of knowledge influences mothers attitudes and behavior when choosing food (Hamimah & Azinar, 2020).Mothers who have good knowledge will apply their knowledge in choosing and processing food, so that the nutritional content of the food will be more secure (Wang & Fang, 2020).
into three groups based on the number of Posyandu posts in Bogorejo Village (three posts).First post as a health education group with leaflet media (32 respondents), second post as a health education group with audiovisual media (video) (32 respondents), and third post as a control group (without using media) (31 respondents).The independent variables of this study are health education without using media, using leaflets, and using audiovisual media (video), while the dependent variable is the knowledge and attitude of mothers of toddlers about stunting.In this study, a researcher-created questionnaire with established validity and reliability was used to collect data.The questionnaire consisted of 15 statements about knowledge and 10 statements about attitude.In the knowledge statement, a Guttman scale (true and false) is used, if the respondent answers "true" to the favorable statement, he gets a score of 1 (one) and if he answers "true" to the unfavorable statement, he gets a score of 0 (zero).Meanwhile, in an attitude questionnaire, a Likert scale is utilized which consists of four measuring scales: Strongly Agree, Agree, Disagree, and Strongly Disagree.If the respondent chooses "strongly agree" to the favorable statement, he gets a score of four, "agree" gets a score of three, "disagree" gets a score of two, and "strongly disagree" gets a score of one.And if the respondent responds "strongly agree" to the unfavorable statement, they get a score of one, "agree" gets a score of two, "disagree" gets a score of three, and "strongly disagree" gets a score of four.Health education using leaflets and audiovisuals were evaluated using the One Way Analysis of Variance (ANOVA) test, and the Tukey (Post-Hoc) test was used to compare the test groups' mean scores and identify the most effective media for increasing mothers of toddlers' knowledge and attitudes about stunting.With approval number 4828/B.1/KEPK-FKUMS/VI/2023 the Health Research Ethics Commission at the School of Medicine at Muhammadiyah University of Surakarta gave its stamp of approval to this study.
the result of Post Hoc Test analysis of respondents' knowledge and attitude variables.In the knowledge variable, the mean ± standard deviation of respondents' knowledge score before receiving the intervention was 10,78 ± 1,47 in the leaflet group, 11,78 ± 1,66 in the audiovisual group, and 11,26 ± 1,43 in the control group.After receiving intervention treatment, the average knowledge score was 14,78 ± 1,73 in the leaflet group, 16,06 ± 1,70 in the audiovisual group and 12,03 ± 1,40 in the control group.These results are in line with the average score of respondents' attitudes.group, 24,97 ± 2,17 in the audiovisual group, and 25,26 ± 3,32 in the control group.After the intervention, the mean scores were 31,78 ± 2,53 in the leaflet group, 32,90 ± 3,18 in the audiovisual group, and 2,77 ± 2,94 in the control group.The one way anova test also showed a significant difference in the attitude scores of leaflet and audiovisual group respondents (p=0,001<0,05) and an insignificant difference in the control group (p=0,980>0,05).To determine the comparison of media that effectively increases the knowledge and attitudes of respondents, the Post Hoc test was conducted.The knowledge and attitude variables in the leaflet and audiovisual groups have a P value of 0,001<0,05 indicating that there is a significant difference in both groups after receiving health education through both media.The mean difference value of knowledge improvement and attitude can be used to compare the effectiveness of various media in increasing respondents' knowledge and attitudes.On the knowledge variable, the leaflet group increased by 4,00, while the audiovisual group increased by 4,28.On the attitude variable, the score in the leaflet group improved by 7,56 , while the score in the audiovisual group increased by 7,93.This means that the audiovisual media is more effective in increasing the knowledge and attitude of mother of toddler in Bogorejo Village regarding stunting.The Tukey test is used to determine the differences between each group.When groups are in distinct subset columns, they are considered different greatly.Based on is because information in the leaflet is clear enough so that it can be understood well by the target.In line with research by Enindelastri (2021) and Kinanti (2021) also states that there are distinctions and a rise in knowledge and attitude among respondents after receiving health education via leaflet media.Audiovisual media is a combination of audio and visual media or commonly called hearing media.This media contains elements of sound that can be heard and elements of images that can be seen.This research is supported by Sofiana et al., (2023) according to which the value of information and attitudes typically increase after completing health education.The difference in average attitude scores also occurred in research of Wijayanti, (2023) and Fatimah, (2019) after the respondents received health education intervention using audiovisual media (video).This study is in line with the research of Musdalifah et al., (2020) which states that there are differences in effectiveness between leaflets and audiovisuals in increasing knowledge.The study states that health education using audiovisual media is more successful than leaflets in developing knowledge.This is evidenced by the mean post-test knowledge score of the audiovisual group higher than the other groups.In addition, the audiovisual group was the group that experienced the most reduction in the number of targets with poor knowledge among the leaflet and control groups.In line with the attitude variable Indah and Junaidi's research (2021) states that audiovisual media is also more effective in improving attitudes.In this study, the mean post-test attitude was higher than the leaflet and control groups even though the tukey test results were in the same column as the leaflet group.Audiovisual media is media that has the ability to deliver information better than other media.Information delivered by audiovisual media (video) is more interesting because it contains two media elements, that is sound that can be heard and images that can be seen by the senses.(Ginting et al., 2022) Information provided with attractive media will change the respondent's attitude for the better because it is easily understood by the examples seen and heard.The senses that channel a lot of knowledge to the brain are the eyes (≤75%-87%) and 13% to 25% of human knowledge is channeled through other senses (Holianto, 2021).Using audiovisual media as an educational medium can