Journal of Health Innovation and Environmental Education Vol.
No.
June 2026, pp.
ISSN: 3062-9632.
DOI: 10.
37251/jhiee.
The Effect of Health Education on Childhood Diarrhea on Knowledge and Anxiety Levels of Parents with Toddlers at Abdul Wahab Syahranie Regional Hospital.
Samarinda Rizal Renaldy1.
Faruk Bojaxhi2 1Department of Public Health.
Muhammadiyah Samarinda College of Health Sciences.
Samarinda.
Indonesia 2 Environment Faculty.
University of Prizren Forestry.
Prizren.
Kosovo
Article Info
ABSTRACT
Article history:
Purpose of the study: This study aimed to assess the effect of health education on childhood diarrhea on parentsAo knowledge and anxiety levels regarding their toddlers, focusing on improving both informational and emotional outcomes in a hospital setting.
Received Dec 22, 2025 Revised Feb 2, 2026 Accepted Feb 18, 2026 Online First March 13, 2026 Keywords:
Childhood Diarrhea Health Profession Parental Knowledge Parental Anxiety Toddlers Methodology: A quasi-experimental design with pretest-posttest was employed involving 50 parents of toddlers admitted to the Melati ward at Abdul Wahab Syahranie Regional Hospital.
Samarinda.
Data were collected using structured questionnaires for knowledge and a validated anxiety scale.
Paired t-tests analyzed pre- and post-intervention scores using SPSS version 25.
Ethical approval and informed consent were obtained.
Main Findings: The results showed a significant increase in parental knowledge scores from 55.
2 A 8.
3 to 82.
5 A 6.
< 0.
Anxiety levels decreased significantly from 52.
4 A 10.
1 to 38.
7 A 7.
< 0.
Health education effectively enhanced parentsAo competence in managing diarrhea and reduced psychological stress, confirming the dual impact of the intervention.
Novelty/Originality of this study: This study uniquely integrates both cognitive and emotional outcomes, demonstrating that structured health education simultaneously improves knowledge and reduces anxiety.
Unlike previous research focusing only on information, this study highlights the psychosocial dimension of parental support, providing practical insights for hospital-based educational programs and contributing to holistic pediatric care strategies.
This is an open access article under the CC BY license Corresponding Author:
Rizal Renaldy.
Department of Public Health.
Muhammadiyah Samarinda College of Health Sciences.
Jl.
Ir.
Juanda No.
Sidodadi.
Samarinda Ulu District.
Samarinda City.
East Kalimantan 75124.
Indonesia.
Email: rzlrenaldy@gmail.
INTRODUCTION
Childhood diarrhea remains a major public health concern, particularly in lowAc and middleAcincome countries, due to its persistent high incidence and significant contribution to morbidity and mortality among children under five years of age .
Evidence shows that health education interventions significantly strengthen caregiversAo knowledge and home management of childhood diarrhea, with structured educational programs improving understanding of causes, symptoms, and appropriate care practices among caregivers of underAcfives .
Furthermore, studies on parental knowledge and behavioral practices regarding diarrhea prevention have found that better informed caregivers exhibit more appropriate care behaviors, which are critical for reducing disease burden and complications .
Research on health literacy also suggests that enhanced health Journal homepage: http://cahaya-ic.
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literacy is associated with lower parental stress and anxiety because increased understanding enables caregivers to make more informed decisions and navigate health challenges more confidently .
However, there remains a gap in the literature regarding the combined impact of health education on both knowledge and emotional outcomes such as anxiety levels in hospital settings, making it necessary to evaluate integrated educational strategies that support both cognitive and psychological needs of parents caring for toddlers with diarrhea.
Previous studies have shown that inadequate parental knowledge often leads to delayed or improper management of childhood diarrhea, contributing to increased morbidity and complications among children under five .
, .
Interventions focusing on health education have demonstrated that structured educational programs significantly increase parentsAo understanding of diarrhea prevention and management, thus improving caregiving behavior in home and clinical settings .
Research exploring the relationship between parental knowledge and selfAcefficacy further indicates that higher competence in handling diarrhea correlates with better early management and recovery outcomes .
HospitalAcbased studies also highlight a significant association between parental knowledge and diarrhea incidence, suggesting that insufficient knowledge may contribute to repeated or prolonged episodes among toddlers .
Despite documented educational benefits, few studies integrate emotional outcomes such as parental anxiety or stress within the same research framework, even though these factors affect caregiving confidence and decisionAcmaking.
Furthermore, descriptive surveys confirm that many caregivers lack adequate understanding of diarrhea causes and appropriate actions, reinforcing the need for comprehensive interventions that not only increase knowledge but also address emotional and psychological aspects of caregiving .
Several studies indicate that parental knowledge about diarrhea and related practices significantly influence health outcomes and parental psychological responses.
For example.
Ilyas and Susilowati found that parental knowledge about diarrhea prevention correlates with better preventative behaviors, emphasizing the role of education in reducing disease burden in young children .
Similarly, research analyzing maternal knowledge and selfAcefficacy in diarrhea management among caregivers showed that increased knowledge positively influences confidence in handling diarrhea episodes at home (SpearmanAos test, p < 0.
, implying that empowerment through information may affect emotional responses as well .
Moreover, studies assessing parental attitudes and perceptions towards emergency signs and first aid for diarrheal episodes reported variability in knowledge and response capacity, indicating gaps that could contribute to anxiety or stress during acute illness .
Beyond diarrhea, broader research on parentsAo anxiety during pediatric hospitalization reveals that many parents experience mild to moderate anxiety when their child is hospitalized, highlighting the psychological strain of caring for a sick child .
Finally, a recent multiAccenter study on health literacy and parental anxiety in gastrointestinal diseases .
ncluding diarrhe.
demonstrated that lower health literacy is significantly associated with higher anxiety levels, suggesting that informational deficits may exacerbate emotional stress in caregivers .
Although prior research has evaluated the role of health education in improving parental knowledge, few studies in Indonesia have specifically addressed its effect on parental anxiety concerning childhood diarrhea.
Previous crossAcsectional research has confirmed that lower parental health literacy is significantly associated with higher stress and anxiety among parents of children with chronic gastrointestinal diseases, suggesting a psychological burden linked to limited health understanding .
Other studies on pediatric settings indicate that providing structured educational materials can reduce parental anxiety levels during child illness, demonstrating the potential value of targeted health education .
Research in emergency and surgical pediatric contexts also reports that parents experience high levels of anxiety related to information needs and health literacy, underlining gaps in communication and support mechanisms .
Additionally, correlational studies show that improved eAchealth literacy among parents is associated with better management behaviors and may indirectly relate to anxiety responses in caregiving situations .
Diarrhea remains a persistent and significant health issue among children under five, especially in lowAcresource settings, where inconsistent prevention practices contribute to continued morbidity and mortality.
Studies have shown that education interventions significantly improve parental and caregiver knowledge about diarrhea prevention and management in children, highlighting the importance of targeted health education programs to reduce disease burden in communities .
However, despite gains in knowledge stemming from educational efforts, there is still substantial variability in how such information translates into behavior change and anxiety reduction among caregivers, indicating that knowledge alone may not fully address emotional responses to child illness .
Additionally, broader evidence suggests that enhancing health literacy can reduce parental stress and anxiety levels in the context of pediatric gastrointestinal conditions, underscoring the value of comprehensive educational strategies that include psychosocial support .
These findings collectively emphasize the urgency of structured health education programs that address both informational and emotional needs of parents, thereby supporting more effective and holistic approaches to childhood diarrhea The novelty of this research lies in its integrated approach, simultaneously measuring the effects of health education on parental knowledge and anxiety levels.
Unlike previous studies that treat these variables The Effect of Health Education on Childhood Diarrhea on Knowledge and Anxiety A (Rizal Renald.
A ISSN: 3062-9632 separately, this study investigates their relationship and combined influence on child health outcomes.
Additionally, the study provides localized evidence from Samarinda, contributing data that can inform regional healthcare policies.
By highlighting the emotional impact alongside knowledge acquisition, this research introduces a comprehensive perspective on parental support.
Ultimately, the study aims to strengthen health education interventions to be both informative and psychologically supportive for parents of toddlers with RESEARCH METHOD 1 Study Design In this study, a quasiAcexperimental design with a pretestAeposttest approach was employed to assess the effect of health education on parentsAo knowledge and anxiety levels regarding childhood diarrhea, allowing comparison of outcomes before and after intervention and reflecting realAcworld application in hospital settings.
QuasiAcexperimental designs have been widely used to evaluate educational interventions that aim to improve parental knowledge and reduce anxiety, including maternal health education models which significantly affected both maternal knowledge and anxiety following structured delivery modes .
Such designs are practical in clinical environments because they enable measurement of changes within the same participants over time without full randomization, enhancing feasibility while still yielding meaningful insights .
Similar research in pediatric contexts has demonstrated that structured educational or preparatory interventions can decrease parental stress and burnout levels in hospital settings, emphasizing the value of preAc and postAcintervention assessments in understanding parental psychological responses .
Evidence also shows that culturally tailored and simulationAcbased educational programs can produce significant reductions in parent anxiety about common child health concerns, further validating the pretestAeposttest intervention model .
Moreover, quasiAcexperimental approaches have been applied in various digital and telehealth education interventions that effectively improve caregiver knowledge and reduce psychological burden, illustrating the designAos broad applicability in pediatric health education research .
The pretestAeposttest design is particularly suitable for this study because it captures immediate changes in both cognitive and emotional domains following health education, thereby providing robust evidence for intervention impact in contexts where controlled trials are challenging to implement .
2 Population and Sample The target population consisted of parents of toddlers aged 1Ae5 years diagnosed with diarrhea and admitted to the hospital during the study period.
A total of 50 parents were selected using purposive sampling based on inclusion criteria, including willingness to participate and being the primary caregiver of the child.
Parents whose children had chronic illnesses or other severe comorbidities were excluded to reduce confounding The sample size was deemed sufficient to detect significant changes in both knowledge and anxiety Demographic characteristics, such as age, education, and previous experience with diarrhea, were 3 Study Setting and Duration The study was conducted in the Melati ward at Abdul Wahab Syahranie Regional Hospital.
Samarinda, which provides care for pediatric patients.
Data collection occurred over a two-month period, from September to October 2025.
Health education sessions were delivered individually to parents in a controlled hospital The sessions included interactive discussions, demonstration of proper diarrhea management, and distribution of educational materials.
Follow-up assessments were conducted immediately after the intervention to measure changes in knowledge and anxiety.
4 Variables and Operational Definitions The independent variable was the health education intervention on childhood diarrhea, which included information about causes, signs, prevention, and home management.
Dependent variables were parental knowledge and anxiety levels.
Knowledge was measured using a structured questionnaire consisting of multiplechoice and true/false questions covering essential aspects of diarrhea management.
Anxiety was measured using a validated anxiety scale adapted for parents, assessing emotional responses to their childAos illness.
Higher scores indicated greater knowledge and higher anxiety, respectively.
5 Data Collection and Analysis Data were collected through preAc and postAcintervention questionnaires administered by trained research assistants, and several recent studies demonstrate the validity of such methods in intervention research.
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in outcomes such as knowledge or anxiety after an intervention .
For example, paired tActests have been widely used to compare preAc and postAcintervention scores on psychological measures and health knowledge indicators, indicating significant changes following educational or preparatory interventions .
Ethical approval and informed consent procedures are also commonly reported, with participants providing written consent before completing baseline and followAcup assessments to ensure compliance with research ethics standards .
RESULTS AND DISCUSSION
1 Demographic Characteristics of Participants A total of 50 parents participated in this study.
The majority were mothers .
%), aged between 25Ae35 years .
%), and had at least a high school education .
%).
Most parents .
%) had previous experience caring for a child with diarrhea.
Table 1 summarizes the demographic characteristics of the participants.
Understanding these characteristics is important because factors like education and prior experience may influence both knowledge and anxiety levels.
Table 1.
Demographic Characteristics of Participants .
= .
Characteristics Gender Ae Mother Ae Father Age .
Ae 20Ae24 Ae 25Ae35 Ae >35 Education Ae Elementary/Junior High Ae Senior High/Equivalent Previous Experience Caring Ae Yes Ae No 2 Effect of Health Education on Knowledge Pre-intervention knowledge scores ranged from 40 to 70 .
ean = 55.
2 A 8.
, indicating moderate knowledge among parents.
After the health education intervention, scores increased significantly, ranging from 70 to 95 .
ean = 82.
5 A 6.
Paired t-test results showed that the increase in knowledge was statistically significant .
< 0.
, indicating that health education effectively improved parental knowledge about childhood diarrhea.
Table 2 shows the comparison of pre- and post-intervention knowledge scores.
Variable Knowledge Table 2.
Pre- and Post-Intervention Knowledge Scores Pre-Intervention Mean A SD Post-Intervention Mean A SD 2 A 8.
5 A 6.
p-value <0.
3 Effect of Health Education on Anxiety Pre-intervention anxiety scores ranged from 30 to 70 .
ean = 52.
4 A 10.
, indicating moderate anxiety levels among parents.
Post-intervention scores decreased significantly, ranging from 25 to 50 .
ean = 38.
The reduction in anxiety was statistically significant according to the paired t-test .
< 0.
, suggesting that health education not only increased knowledge but also reduced parental anxiety.
Table 3 presents the comparison of anxiety levels before and after the intervention.
Variable Anxiety Table 3.
Pre- and Post-Intervention Anxiety Scores Pre-Intervention Mean A SD Post-Intervention Mean A SD 4 A 10.
7 A 7.
p-value <0.
The Effect of Health Education on Childhood Diarrhea on Knowledge and Anxiety A (Rizal Renald.
A ISSN: 3062-9632 4 Summary of Findings The results demonstrate that structured health education significantly improves parentsAo knowledge about childhood diarrhea.
In addition, it effectively reduces their anxiety levels related to their childAos illness.
These findings confirm that knowledge and emotional support are both critical in managing pediatric diarrhea.
The combination of pretest-posttest measurement and statistical analysis strengthens the validity of these results.
Overall, this study highlights the importance of hospital-based educational interventions for parents of toddlers.
The findings of this study demonstrate that health education significantly increases parentsAo knowledge about childhood diarrhea.
Pre-intervention knowledge scores were moderate, but post-intervention scores improved substantially, confirming the effectiveness of structured educational sessions.
This aligns with previous research showing that targeted health education can enhance parental understanding and promote proper child care practices.
The results also indicate that parents become more confident in managing diarrhea at home after receiving clear guidance.
Therefore, health education plays a crucial role in improving parental competence in pediatric care.
In addition to increasing knowledge, the study found a significant reduction in parental anxiety levels following the intervention.
Parents who initially reported moderate to high anxiety experienced relief after understanding the causes, signs, and proper management of diarrhea .
Similar findings have been reported in studies emphasizing that improved parental health literacy and structured education can reduce stress and psychological burden in caregivers .
, .
However, previous research rarely examines both knowledge and anxiety simultaneously, highlighting a gap that this study addresses .
, .
By integrating emotional and cognitive aspects, this study provides a more comprehensive understanding of parental responses to childhood diarrhea and supports the implementation of hospital-based health education programs that target both knowledge acquisition and anxiety reduction .
The novelty of this research lies in its dual focus on knowledge and anxiety within the context of a hospitalAcbased intervention, because few studies have evaluated both informational and emotional outcomes simultaneously in parental education programs.
Prior research on psychoeducational mobile applications for parents of young children demonstrated that such interventions significantly increased parental knowledge about child health problems while also reducing parenting stress, indicating that structured educational support can influence both cognitive and emotional domains of caregiving .
Studies have also shown that parental health literacy is directly associated with levels of perceived stress and anxiety among caregivers of children with chronic gastrointestinal conditions, supporting the idea that improving health knowledge can alleviate emotional burden in pediatric care contexts .
Moreover, quasiAcexperimental research in hospital settings has reported that structured digital education packages delivered during hospitalization can decrease anxiety in children, suggesting that educational interventions may have beneficial psychological effects in clinical environments and reinforcing the relevance of dual outcome approaches .
These findings collectively support comprehensive parentAccentered educational programs in pediatric wards that simultaneously target increased knowledge and reduced anxiety, highlighting the contribution of this study to understanding the psychosocial impact of health education interventions in pediatric care.
The implications of these findings are substantial for nursing practice and hospital policy, as structured health education not only improves caregiversAo knowledge but also enhances the overall quality of pediatric care Studies demonstrate that health education provided by nurses is positively perceived by parents and linked to improved understanding of child health issues, which can support better home caregiving and health outcomes in pediatric populations .
Moreover, systematic evidence shows that parental involvement interventions, especially those that are nurseAcled and structured, significantly improve quality of life and healthAcrelated outcomes among children with chronic conditions, underscoring the importance of integrating parents into care strategies to achieve broader health benefits .
Based on these insights, hospitals can integrate similar educational programs as a routine part of pediatric care, focusing on both knowledge transfer and emotional support to empower families to take preventive and appropriate actions.
Furthermore, educating parents strengthens their confidence and competence in caregiving roles, which can reduce complications associated with mismanagement of illnesses like diarrhea and improve compliance with health This underscores the importance of combining informational and psychosocial strategies in health education programs to enhance child health outcomes and support familyAccentered care in hospital Despite these promising results, several limitations should be noted.
The study used a relatively small sample from a single hospital, which may limit the generalizability of the findings to other regions.
The shortterm follow-up did not assess whether knowledge and reduced anxiety were maintained over time.
Self-reported measures of anxiety may also introduce subjective bias, as responses depend on individual perceptions.
Future research should consider larger, multi-center studies with long-term follow-up and objective assessments of behavioral changes.
Addressing these limitations will strengthen the evidence base for hospital-based parental education interventions.
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CONCLUSION
This study concludes that structured health education on childhood diarrhea significantly improves parentsAo knowledge and simultaneously reduces their anxiety levels, fulfilling the primary objective of assessing both cognitive and emotional outcomes.
The findings indicate that providing clear, hospital-based educational interventions equips parents with the necessary information to manage diarrhea effectively at home while alleviating psychological stress, which aligns with the gaps identified in previous studies that focused solely on The novelty of this research lies in its integrated approach, demonstrating that addressing both informational and emotional needs can enhance parental competence and confidence in pediatric care, particularly in the context of fluctuating diarrhea cases among toddlers in Samarinda.
These results have practical implications for nursing practice and hospital policy, suggesting that incorporating regular, interactive health education sessions for parents can improve child health outcomes, prevent complications, and promote proactive caregiving behaviors.
Future studies are recommended to expand the sample size, include multi-center settings, and conduct long-term follow-ups to evaluate sustained effects, while also integrating objective behavioral assessments to strengthen the evidence base for parental education interventions in pediatric ACKNOWLEDGEMENTS The authors would like to express their sincere gratitude to the management and staff of Abdul Wahab Syahranie Regional Hospital.
Samarinda, for their support during data collection.
Special thanks are extended to all parents who participated in this study for their cooperation and willingness to share their experiences.
also appreciate the guidance and input from our supervisors and colleagues, which greatly contributed to the completion of this research.
Finally, the authors acknowledge the institutions and resources that facilitated this USE OF ARTIFICIAL INTELLIGENCE (AI)-ASSISTED TECHNOLOGY The authors confirm that no artificial intelligence (AI)-assisted technologies were utilized in the preparation, analysis, or writing of this manuscript.
All stages of the research process, including data collection, data interpretation, and the development of the manuscript, were conducted solely by the authors without any support from AI-based tools.
REFERENCES