Effectiveness of a tailored education module for improving the health and nutrition of adolescent females in rural Bali, Indonesia
Authors: Lubis Dinar Saurmauli , Adhi Kadek Tresna , Pinatih Gde Ngurah Indraguna , Mahendra I Gusti Agung Agus , Bangkyt I Putu Gede 
Published: July 2023

Purpose
There are insufficient health and nutrition education interventions targeting adolescent females in rural contexts in Indonesia. There is also a paucity of research evaluating the impact of implemented programs. This paper aims to develop and test the validity of a tailored education module to improve the knowledge, attitude and skills of adolescent females on health and nutrition.

Design/methodology/approach
The study was conducted between 2019 and 2023 in Ban Village, Karangasem Regency. This study used an explanatory sequential mixed methods research approach consisting of three stages: formative research using mixed methods, validation and review of the module by experts using the Delphi technique and pilot testing of the module. In the formative research stage, there were 40 female adolescent respondents implicated, in the validation and module review stage, there were 14 nutrition and public health experts implicated, and in the pilot test, a new cohort of 60 female adolescents were recruited. Validity was assessed by exploring the feasibility, reliability and linguistics of the module. The Delphi score was measured by the mean score and standard deviation.

Findings
The Health and Balanced Nutrition Education Module was impactful in improving the health and nutrition of female adolescents in Ban Village. The validation score of the module shows that from the total score of 4, construct reliability obtained a score of 3.18 with a 0.35 standard deviation. The construct feasibility and language revealed better scores, which were 3.31 with 0.4 standard deviations and 3.29 with 0.46 standard deviations, respectively. After dissemination of the module, participants’ mean score of knowledge on the importance of balanced nutrition significantly improved by 68.8% (p-value = 0.0001).

Research limitations/implications
The Health and Balance Nutrition Education Module has been proven to improve the awareness of adolescents on balanced nutrition. Nevertheless, this study also has limitations due to the small number of respondents attending the information sessions and the pilot testing. Further studies should consider using implementation research for scale-up in other parts of Bali.

Practical implications
This study provides insight for health and nutrition educators for creating modules that better align with the context and information needs of the target group particularly for adolescents in rural areas, which are seldom neglected.

Social implications
This study indicates that the trialed education materials can play a role in improving female adolescents’ knowledge of nutrition throughout their life cycle and their role in preventing stunting and noncommunicable diseases in later adult life.

Originality/value
The health and nutrition module trialed in the study is tailored specifically to the context of rural areas of Bali and validated by public health experts, then tested with 60 adolescents.