Development of “No Anemia No Stunting” (Si NaNing) Modules and Application in Efforts to Prevent Stunting in Archipelago Regions

The average prevalence of stunting toddlers in Indonesia from 2005 to 2017 is 36.4%. Incidence of stunting toddlers (short) is a major nutritional problem faced by Indonesia. Stunting cases in the Riau Islands reached 24 percent of the number of babies born in 2018. One of the causes of stunting is the lack of nutrients fulfilment during pregnancy, including anemia in pregnancy. Currently, there is no media module and application for stunting prevention health promotion. The purpose of the study was to determine the effectiveness of the "No Anemia No Stunting" (Si NaNing) application and the Si NaNing Module on stunting prevention. The study was conducted in Tanjungpinang City in May-November 2020. The research design was quasi-experimental with pre-posttest with control group design. The instrument used is a structured questionnaire. Data collection is during the pre test and post test. The population is all pregnant women in Tanjungpinang City. The sample is 30 respondents/pregnant women from Independent Practice of Midwives in Tanjungpinang City. Data analysis used Dependent T Test for the intervention group (application) and Wilcoxon for the control group (module). The results showed that there was a significant difference in knowledge (p value 0.001), attitude (p value 0.001), and motivation (p value 0.001) in pregnant women before and after being given health education using the Si NaNing application. Meanwhile, in the module group, only motivation (p value 0.000) had a significant difference. kehamilan. Saat ini belum ada media modul dan aplikasi untuk promosi kesehatan pencegahan stunting. Tujuan penelitian untuk mengetahui efektifitas Aplikasi “No Anemia No Stunting” (Si NaNing) dan Modul si NaNing terhadap pencegahan stunting. Penelitian dilakukan di Kota Tanjungpinang bulan Mei-November 2020. Desain penelitian quasi experiment dengan pre-posttest with control group design. Instrumen yang digunakan kuesioner terstruktur. Pengumpulan data yaitu saat pre test dan post test. Populasi semua ibu hamil di Kota Tanjungpinang. Sampel ibu hamil di Praktik Mandiri Bidan sejumlah 30 responden di Kota Tanjungpinang. Analisis data meggunakan Dependent T Test untuk kelompok intervensi (aplikasi) dan Wilcoxon untuk kelompok kontrol (modul). Hasil menunjukkan ada perbedaan yang bermakna pada pengetahuan (nilai p 0,001), sikap (nilai p 0,001), dan motivasi (nilai p 0,001) pada ibu hamil sebelum dan sesudah diberikan pendidikan kesehatan menggunakan aplikasi Si NaNing. Sedangkan pada kelompok modul hanya motivasi (nilai p 0,000) yang memiliki perbedaan bermakna.

Riskesdas 2018 states that toddlers are very short and short by 30.8%, which has increased from 2017. In 2019 it decreased to 27.67%. The SIGIZI ePPGBM report (as of January 20, 2021) from 34 provinces shows that out of 11,499,041 children under five whose nutritional status was measured based on height for age (TB/U) there were 1,325,298 toddlers with TB/U <-2 SD or it F. Aminin, J. Kristianto, D.P. Rianda, Haryadi, J.C. Cintiani, Development of "No Anemia No Stunting" (Si NaNing)  can be said 11.6% of toddlers are stunting (Kemenkes RI, 2020 However, in 2020 the number of stunting cases increased again to 7.2%. (Kemenkes RI, 2020). This figure still needs to be reduced to zero or the absence of stunting.
One of the efforts to prevent stunting is with adequate and adequate nutritional intake.
Every pregnant woman is expected to have sufficient knowledge about nutrition for pregnant women, infants, and toddlers to prevent stunting (Kemenkes RI, 2018

METHOD
The research design was quasiexperimental with a pre-posttest with a control group design. In this study, there are two groups, namely the treatment group and the control group, who will be given a questionnaire before and after the  knowledge. This is because there is information that supports stunting in the application. This is supported by the theory, which states that the more often a person receives information, his/her knowledge and insight will increase. In contrast, if he/she does not get information, their knowledge and understanding will not increase. (Febrina and Antarsih, 2021).
Engaging media will give the respondents confidence to achieve cognitive, affective, and psychomotor changes (Erawati, 2020).
The results of the mean difference test between the intervention group and the Someone who easily accesses information will learn aster (Kasjono and Suryani, 2020). The NaNing application is installed on the respondent's smartphone, making it easier for respondents to access information about anemia anywhere and anytime.

The Difference between Stunting
Precautionary Attitude Before and After

Getting the Application
The results showed a significant difference in stunting attitudes before and after the intervention. The results of this study are also following research conducted by Rista Sewa (2019) Knowledge is needed as support in growing self-confidence as well as attitudes and behavior every day, so it can be said that knowledge is a fact that supports one's actions. Knowledge is one of the factors that influence health behavior (Rosdiana et al., 2018).
The use of the Si NaNing application provides information related to stunting, including the definition of stunting, the causes of stunting, the characteristics, and how to prevent stunting. Health education using the Si NaNing application provides information that is easily accessible and can be accessed by pregnant women at any time so that pregnant women have good knowledge and become the basis for a significant increase in attitudes after using the Si NaNing application. The knowledge that a mother has will influence decisionmaking and also affect her behavior (Rosdiana et al., 2018).
Health education is a long-term behavioral investment as a process of changing behavior in a person. In a short time weight loss (Carter et al., 2013).
Knowledge can make a person aware so that he behaves in accordance with the knowledge she has.

The Difference between Anemia
Precautionary Attitude Before and After

Getting the Application
The results showed a significant difference in the Attitude toward anemia before and  (Wardani, Husna and Saumiana, 2020).
Education on the prevention and treatment of anemia in pregnant women is an effort to convey the importance of preventing and treating anemia. (Sukmawati, Mamuroh and Nurhakim, 2019). Attitude is a form of readiness, willingness to act, or predisposition to a person's behavior (action) (Devi, Lumentut and Suparman, 2021). The results of previous studies also stated that most regions in Indonesia had a positive attitude toward preventing anemia (Devi, Lumentut and Suparman, 2021).
Pregnant women who know and understand the consequences of anemia and how to prevent it will have positive behaviors and actions to avoid the effects and risks of anemia during pregnancy. Good knowledge will affect health behavior so that it affects health behavior (Chandra, Junita and Fatmawati, 2019).

The Difference between Stunting Precautionary Motivation Before and After Getting the Application
The results showed a significant difference in stunting motivation before and after the themselves and their fetuses, the mother was motivated to prevent this from happening so that there was encouragement in the form of mother's willingness and awareness to prevent iron deficiency anemia. This is because individuals tend to be motivated after using the Si NaNing application.

CONCLUSION
The Si NaNing application can increase knowledge, attitudes and motivation to prevent anemia and stunting. Suggestions based on research results are the need for application development by adding some more interesting and useful features.

ACKNOWLEDGEMENT
The researchers would like to express their gratitude to all parties involved in the present study, particularly the Riau City Government and respondents, for their massive support of the accomplishment of this study.