Education Using WhatsApp and Face-to-Face Meetings on IYCF for the Nutritional Status of Infants
Condition: Nutritional Stunting
MeSH terms: Growth Disorders
Study type: Interventional

Summary: 
      The COVID-19 pandemic affects all activities, including stunting prevention. Almost all
      cities implement Internet-based learning can be used as an alternative to providing education
      and allows to exchange personal experiences and also establish interpersonal relationships.
      Education is one of the intervention efforts that aims to foster and improve the health
      status of the community, while counselling is a technical part of the educational process
      itself. blended counselling is the integration of online and offline counselling. Blended
      counselling is a strategy in the covid-19 pandemic condition and after pandemic. the virtual
      Education method has also been widely used around the world. The WhatsApp application ranks 2
      among the most popular social media in Indonesia.

      Blended education innovations are offered online in the form of digital booklets, videos,
      online discussions, and online consultations carried out via WhatsApp and offline visits
      according to health protocols. This blended education is expected to facilitate the work of
      cadres in providing Infant and young child feeding (IYCF) education, to improve IYCF
      practices for infant nutritional status.
    

Detailed description: 
      The selection of the research group as the intervention and control group was done by random
      allocation. Respondents were recruited by self-selection conducted by the research team and
      the sampling method within the group (treatment group and control group) used was purposive
      sampling. Recruitment was carried out by means of respondent data obtained from community
      health center data. Mothers who met the criteria were then included as the research sample.
      The sample size in this study was determined based on the formula for hypothesis testing on
      the following two population averages (Lemeshow, et al, 1997). the minimum sample size for
      the intervention and control groups from previous studies (saleem, et al, 2014) with the
      results of each group the number of participants for each group of 57 participants plus 10%
      lost to follow-up, which is 6. the minimum number of samples is 63 samples so that the total
      number of a minimum sample of 126 respondents.

      Participants were recruited by self-selection conducted by the research team and the sampling
      method within the group (intervention group and control group) used was purposive sampling.
      Recruitment was carried out by means of respondent data obtained from Primary health care
      data. Mothers who meet the criteria are then included as research samples. All eligible
      pregnant women who refer to primary health care for prenatal care at 36-40 weeks of gestation
      will be requested to participate in the study.

      The study uses quantitative data collection methods to evaluate the process and outcome of
      blended education program. The IYCF assessment include questions regarding demographic data,
      including age, education, employment status, social economic status, and birth spacing for
      descriptive information.

      The question pre-test post-test for cadres and IYCF education and counselling practice were
      drawn from IYCF counselling module ministry of health 2014. To assessed the quality of the
      trainers (research team, nutrition workers for IYCF counsellors and lactation counsellors),
      clarity of IYCF materials, presentations and training locations were drawn from the
      questionnaire developed by the researcher. The result effect education for participants by
      cadre assess using the questionnaire knowledge breastfeeding, responsive feeding and
      complementary feeding, attitude breastfeeding, self-efficacy breastfeeding and
      complementary-feeding. the validity and reliability of the questionnaire were tested.

      The question pre-test post-test for participants using the questionnaire knowledge
      breastfeeding, responsive feeding and complementary feeding, attitude breastfeeding,
      self-efficacy breastfeeding and complementary-feeding. the validity and reliability of the
      questionnaire were tested. To assessed the quality of the cadre clarity of IYCF materials,
      presentations and WhatsApp media education were drawn from the questionnaire developed by the
      researcher. the research team and cadre will assess the respondent (using a questionnaire)
      about IYCF practice. The data taken at the time of observation were early initiation of
      breastfeeding, exclusive breastfeeding, breastfeeding >6 months, complementary feeding and
      continued breastfeeding. Anthropometric measurements for infant nutritional status were
      carried out from birth to 7 months of age. Bodyweight, height, and head circumference were
      measured by cadres accompanied by research assistants. Measurement of weight and height using
      GAMAKIDS, while head circumference using a tape measure. Measurements were taken once a month
      at the same time, without wearing clothes.

      Plan for missing data will be used regression imputation and last observation carried
      forward. In regression imputation, the existing variables are used to make a prediction, and
      then the predicted value is substituted as if an actual obtained value. This studies are
      performed with the longitudinal or time-series approach, in which the subjects are repeatedly
      measured over a series of time-points because the blended education intervention start from
      birth to 7 month old. This method replaces every missing value with the last observed value
      from the same subject. Whenever a value is missing, it is replaced with the last observed
      value.

      Descriptive statistics will be used for baseline data. the collected data will be analyzed in
      the SPSS software (version 20) using descriptive statistics, such as frequency distribution
      tables. Also, T-test to see the difference in the average scores between the intervention
      group and the control group, as well as the pretest-posttest value, namely the influence of
      the blended education from antenatal period about IYCF on maternal knowledge, attitudes, and
      self-efficacy. A Chi-square test was also carried out to determine the relationship between
      two variables whose measurement parameters have been categorized.

      One-way analysis of variance (ANOVA) will be used to the effect of blended education from
      antenatal period about IYCF on infant nutritional status together with knowledge, attitude,
      self-efficacy, and infection status. The confounding factors and the effect of modifier,
      stratification analysis was used mantel hanzel's test. The p value of less than 0.05 will be
      considered statistically significant
    

Intervention name(s): Blended education of Infant and Young Child Feeding
Intervention type(s): Behavioral
Intervention description(s): Blended education is an intervention about IYCF consisting of 3 components: Education via WhatsApp group, counselling face to face, Consultation with nutritionist via WhatsApp call. In the intervention group, participants will get blended education about IYCF provided by trained cadres. Education via WhatsApp group. The implementation of this educational program was carried out for 3 meeting sessions, where previously trained cadres had distributed videos and digital booklets for IYCF material and opened a discussion session at the end of the meeting in WhatsApp group. Face to face Counselling (Home visit). The cadres conduct home visits every month when the participants have given birth until the child is 7 months old. Consultation with nutritionist via WhatsApp call. Consultations were carried out via WhatsApp calls about IYCF practice was for infants aged 1 month, 3 months, 6 and 7 months.
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: blended education; Infant and Young Child Feeding; Nutritional status of Infant