Nursing Journal Volume 10.
Issue 2.
Page 165-172 e-ISSN: 2354-6050 https://ejurnal.
id/index.
php/JKep/article/view/x DOI: https://doi.
org/10.
32668/jkep.
EFFECTIVENESS OF CHALLENGE CARD MEDIA IN ENHANCING
MATERNAL KNOWLEDGE ON STUNTING AND RELATED
NUTRITION PRACTICES
1st Ika Rizki Anggraini 2nd Novia Fitriyani1 3rd Henny Dwi Susanti1 4th Lilis Setyowati1 Faculty of Health Sciences.
Department of Nursing.
University of Muhammadiyah Malang.
Jln.
Bendungan Sutami No.
noviafitriyani105@webmail.
Keywords:
Challenge Cards Innovative Education Mother's Knowledge Stunting Abstract With a prevalence of 24.
1%, stunting is a major health issue in Indonesia.
Due to linear growth abnormalities brought on by malnutrition and insufficient nutritional intake, this ailment poses a threat to the country's future generation's quality of life.
Increasing mothers' awareness of stunting is therefore crucial, and using visualbased instructional materials is one of the best ways to do this.
This study aims to analyze the effect of card challenge, a visual-based educational media, on increasing maternal knowledge about stunting.
A quasi-experimental one-group pretestAeposttest design was employed involving 50 mothers of toddlers in Bangkalan Regency.
The intervention consisted of health education using Challenge Cards, conducted in small group sessions.
Maternal knowledge was measured using a validated 10-item questionnaire covering the definition, causes, impacts, and prevention of stunting.
Data were analyzed using the Wilcoxon Signed-Rank Test.
The results showed that there was a significant increase in maternal knowledge after being given a card challenge game with a value of p = 0.
< This indicates that the intervention using card challenge games has succeeded in significantly increasing mothers' understanding of Card challenge games have proven to be effective in increasing mothers' knowledge about stunting, providing a positive impact on stunting prevention efforts.
This study underscores the importance of innovative, interactive, and culturally adaptable health education methods to empower mothers in improving child health and The intervention model has the potential to be scaled up and integrated into broader stunting reduction programs in Indonesia.
Received: April 2025 Accepted: July 2025 Published: November 2025 A year The Authors.
Published by Published Department of Nursing.
Health Polytechnic of the Ministry of Health Jakarta i.
This is Open Access article under the CC-BY-SA License .
ttp://creativecommons.
org/licenses/by-sa/4.
0/).
DOI:
https://doi.
org/10.
32668/jkep.
INTRODUCTION
Stunting is a nutritional problem that threatens the quality of life z-score of height by age (TB/U) <-2SD 7.
Stunting can endanger the quality of Indonesia's human resources 8.
of the nation's next generation due to failure to grow and low Globally, the number of stunting children is 28.
5% with 31.
productivity in young adulthood and the risk of degenerative in developing countries while in Southeast Asia it is 29.
4% 9,10.
diseases 1Ae3.
Stunting is quite common in countries with low According to the Indonesian Ministry of Health, .
, the economies 4,5.
Based on the standards of World Health number of stunted toddlers in Indonesia is 24.
Reporting Organization (WHO), stunting is defined as a linear body from the EPPGBM SIGIZI (Electronic Application for growth disorder caused by chronic malnutrition and also a lack Community-Based Nutrition Recording and Reportin.
on of adequate nutrient intake on a regular basis 6.
Marked with a January 20, 2021, there were 1,325,298 .
6%) of 11,499,041 children under five who were stunting in 34 provinces 11.
JKEP (Journal of Nursin.
Vol 10 Issue 2.
November 2025.
Page 165-172 e-ISSN: 2354-6050 2021.
Bangkalan Regency had as many as 38.
9% of stunted education principles and adapted from previous community toddlers, making it the area with the highest incidence of empowerment models used in maternal and child health stunting in East Java 12.
Based on 2021 data on the Bina promotion (Kusumaningrum et al.
, 2022.
Wulandari & Hartati.
Bagda/Ministry of Home Affairs application, there are 27 Several studies have shown that game-based or stunting locus villages in Bangkalan, most of which come from participatory learning tools such as challenge cards are more villages with extreme poverty.
In 2022, the number of villages effective in improving knowledge retention, motivation, and with stunting incidence decreased to 16, but in 2023, the number behavioral change compared to conventional lecture-based will increase again to 20 villages 13.
There were 27 stunting health education methods (Rahmawati et al.
, 2020.
Nugraheni locus villages identified in Bangkalan in 2021, most of which et al.
, 2.
The closeness between health workers and the were classified as areas with extreme poverty, poor sanitation, community can be conveyed better through direct and limited access to health services.
Efforts by the local government and health sector, including the implementation of METHODS the Program Bangkalan Sehat and the involvement of posyandu This research is a quantitative study with a quasi-experimental cadres, contributed to a decline in the prevalence of stunting to design method.
The type of design used was a one-group pre 2% in 2022.
and post-test with a sample of 50 mothers who had toddlers.
The According to the World Health Organization (WHO) concept inclusion criteria were: .
mothers with children aged 0Ae5 framework in the decision of the Indonesian Ministry of Health, .
able to read and write.
willing to participate by .
, stunting is considered to be the result of a combination signing an informed consent form.
available for the of several factors, including poor nutritional intake, poor entire intervention process.
The exclusion criteria were: .
maternal knowledge, inadequate breast milk .
reast mil.
, and mothers who were ill or unable to complete the intervention animal protein in complementary foods (MPASI).
Based on and .
participants who submitted incomplete research, mothers who do not know about nutrition will greatly The sampling technique used in this study is affect their child's health, such as not being able to choose and total sampling.
Data collection was conducted using a providing healthy food 14.
The quality of human resources will questionnaire on maternal knowledge about stunting that had be affected by the level in the future, which will have an impact previously been tested for validity and reliability.
Respondents on the Human Development Index 15.
totaling 25 people were obtained the results of all questions To reduce the prevalence of stunting in Indonesia, it is very having a value of > r table .
=25, c=0.
05 then r table = 0.
important to provide information about the problem.
One of the so that the 10 questions were declared valid and got an alpha efforts that can be made is to increase mothers' knowledge about cronbach of 0.
664 > 0.
60, which means that the questionnaire stunting through health education 16.
Therefore, the researcher was declared reliable.
The questionnaire contains 10 question is interested in implementing a community empowerment items that include the definition, impacts, characteristics, and program in Bangkalan Regency with the theme "Smart causes of stunting.
This questionnaire contains 10 questions Education" to increase mothers' knowledge about stunting.
This containing definitions, causes, characteristics, impacts, and activity will include stunting education and health education stunting prevention.
If you answer correctly and according to the using challenge card media.
key, you will get a score of 1, and if the answer is wrong or does not match the key, you will get a score of 0.
The intervention This card challenge is an innovation that contains health applied in this study was an educational game called the information packaged with an attractive design, as well as a Challenge Card Game, designed to enhance mothersAo desire to achieve sustainable lesson learning.
This card was knowledge about stunting through active and enjoyable developed by the research team based on evidence-based health The game consisted of 20 challenge cards, each JKEP (Journal of Nursin.
Vol 10 Issue 2.
November 2025.
Page 165-172 e-ISSN: 2354-6050 containing short questions or scenarios related to stunting cleanliness, toddler visits to posyandu, immunization coverage, .
efinition, causes, impacts, and preventio.
Each card was adequacy of breast milk .
reast mil.
and animal protein in color-coded and visually illustrated to increase participant Complementary Foods (MPASI) that must be done or Each session lasted approximately 30Ae40 minutes.
completed according to the instructions listed.
Data were analyzed using the Wilcoxon Signed Rank Test, as Participants are instructed to complete the tasks or answer the the pretest and posttest data were not normally distributed based questions written on each card according to the provided on the ShapiroAeWilk test results.
This nonparametric test was The activities are designed to stimulate discussion, chosen to determine the difference in mothersAo knowledge encourage critical thinking, and promote peer learning among scores about stunting before and after the Challenge Card Game This interactive approach allows mothers to actively A significance level of = 0.
05 was applied for all apply their knowledge to real-life situations, rather than passively receiving information.
This research has passed the ethics test from the KEPK.
Faculty The Challenge Card game was developed by the research team of Medicine.
University of Muhammadiyah Malang with based on principles of participatory learning and health certificate number No.
a/138/KEPK-UMM/V/2024.
The promotion theory, aiming to transform health education into a analysis of data normality shows that the data is not normally more dynamic and contextually relevant experience.
Compared distributed, so what is used in testing the hypothesis of this study to conventional lecture-based education, this game-based is the Wilcoxon test.
method encourages active engagement, collaboration, and The intervention provided was in the form of a challenge card- experiential learning, making it more effective for increasing based health education to mothers who have toddlers in one of knowledge retention and behavior change related to stunting the villages in Bangkalan Regency in May 2024.
This challenge card game is carried out in groups with each group containing 10 players.
Before the intervention, the researcher asked the respondents to do a pre-test first and then continue with RESULTS AND DISCUSSION After the education was carried out, the researcher began to lead Table 1.
Characteristics of Respondents Based on Age.
Last Education, and Occupation N=50 Characteristic Frequency Percentage (N) (%) Age 20-35 Years 35-45 Years Final Education Junior High School/Equivalent High School/Equivalent College Work Work Not Working In table 1.
The majority of respondents .
%) were aged the card challenge game.
The next meeting was a card challenge 20-35, which is considered the ideal time to have game and ended with a post-test.
The Card Challenge game is children, as physical and reproductive conditions are at made with an attractive design using cards that contain their peak 17.
However, the level of knowledge of challenges and commands regarding mothers' knowledge, mothers in this age group is still influenced by the which include poor nutritional intake, environmental education received 18.
Meanwhile, respondents aged education about stunting.
The intervention provided was a challenge card-based health education program for mothers with toddlers in one of the villages in Bangkalan Regency in May 2024.
This challenge card game was conducted in groups, with each group consisting of 10 participants.
Before the intervention, the respondents completed a pre-test, followed by an educational session about stunting.
The author chose the challenge card method because it encourages active participation, enhances engagement through play-based learning, and facilitates better understanding and retention of health information among mothers.
JKEP (Journal of Nursin.
Vol 10 Issue 2.
November 2025.
Page 165-172 e-ISSN: 2354-6050 35-45 .
%) have an advantage of parenting experience.
Table 2.
Mother's Level of Knowledge about Stunting but are often less exposed to the latest information N=50 related to child health 19.
Challenge card-based Knowledge educational interventions were found to be effective in improving understanding in both age groups, although Mean MinMax Std.
Dev school education .
%), followed by college .
%).
0-10 2.
Before Intervention 8-10 0.
After the Intervention Table 2 shows a significant improvement in mothersAo Formal education is not always directly proportional to knowledge after participating in the Challenge Card Game children's health knowledge, as factors such as access to The mean knowledge score increased from 4.
information and cultural influences are often barriers (SD = 2.
before the intervention to 9.
84 (SD = 0.
Game-based educational media and visual aids The Wilcoxon Signed Rank Test yielded Z = -5.
have been proven to be able to bridge the knowledge gap p < 0.
001, indicating a statistically significant increase in at various levels of education 6.
knowledge levels.
The effect size .
= 0.
demonstrates a the interactive approach was more acceptable to younger age groups 20.
Most mothers have a high strong practical impact of the educational game on mothersAo As many as 74% of respondents are housewives, while 26% are understanding of stunting.
Significant differences were found in Mother's employment status affects access to the mother's level of knowledge before and after the intervention information and time to receive education 23.
Housewives are .
-value < 0.
The average level of knowledge increased more focused on parenting, but often lack evidence-based 50 before the intervention, suggesting that the challenge In contrast, working mothers have a greater card game was effective in improving the mother's chance of accessing information at work, even though time understanding of stunting.
Similar studies have shown that constraints are an obstacle 25.
Knowledge enhancement longer intervention durations, such as 6-12 months, produce requires a multidimensional approach, including holistic and more significant impacts 27,28.
According to another study, relevant training 26.
knowledge level measurements were carried out through pre- Mother's knowledge about stunting test and post-test with evaluation up to three months after the Mothers' knowledge about stunting was measured using pre- intervention, showing similar durations to assess effectiveness and post-test questionnaires.
The Shapiro-Wilk normality test and knowledge retention 29Ae31.
Research by Butler and Raley, was performed with a significance of p = 0.
000 O c .
however, shows that evaluations over longer time frames, such as 10 months, provide a more comprehensive picture of Statistical analysis with a Wilcoxon signed-rank rating test knowledge retention and its impact on clinical practice.
because the data is not normally distributed.
combination of measurements over a duration of three months The findings demonstrate that the use of challenge cards as an and longer can provide more holistic insights into the mothersAo effectiveness of educational interventions 32.
understanding of stunting and its prevention.
Before the intervention, the low mean score reflected limited knowledge In the context of a short study program, the duration of regarding the causes and preventive measures of stunting, which knowledge measurement may be shorter because of the focus may be due to a lack of engaging educational media or limited on short-term attitude and behavior change 33.
Other studies on access to health information.
After the intervention, mothers stunting prevention, however, tend to involve long-term measurements to see the impact of maternal knowledge on showed substantial improvement, suggesting that interactive, game-based learning promotes active engagement, peer feeding behaviors and child growth 34,35.
Previous studies on discussion, and long-term retention of health information.
stunting prevention typically adopt medium to long-term JKEP (Journal of Nursin.
Vol 10 Issue 2.
November 2025.
Page 165-172 e-ISSN: 2354-6050 measurement timelines, ranging from three to six months to expanding their targets such as pregnant women and parents-to- evaluate the retention of maternal knowledge and its influence on feeding practices and child growth outcomes.
The ACKNOWLEDGMENT .
knowledge gained during the intervention persists and leads to measurable behavioral changes in areas such as complementary feeding, hygiene practices, and utilization of posyandu services.
Other studies also highlight the importance of maternal education in stunting prevention, although the duration of knowledge measurement in these studies may differ 36.
This research has passed the ethics test from the KEPK.
Faculty of Medicine.
University of Muhammadiyah Malang with certificate number No.
a/138/KEPK-UMM/V/2024.
The researcher has explained the research objectives, its benefits, and potential risks during the research process.
All respondents understand and agree to participate by signing an informed The short duration in this study still gave positive results because consent form.
of the interactive and interesting delivery method.
This approach
allows mothers to understand the material in a way that is fun
REFERENCES