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ID Sutrisnawati ID Masruroh https://orcid.org/0000-0002-0713-7005
ID Ade Armada ID Nasrudin

Abstract

Introduction: Stunting remains a significant public health issue in low- and middle-income countries, including Indonesia, with long-term impacts on child development and national productivity. Family engagement has emerged as a critical factor in transforming maternal health behaviors to prevent stunting.


Objective: This integrative review aimed to explore the role of family engagement in promoting behavioral change and maternal motivation for stunting prevention, and to identify evidence-based strategies supported by relevant theoretical frameworks.


Design: An integrative review approach was employed to synthesize findings from diverse study designs (quantitative, qualitative, and mixed-methods) following the five-stage framework of Whittemore and Knafl (2005).


Data Sources: Relevant literature covering the period from 2018 to 2024 was retrieved from PubMed, Scopus, CINAHL, Google Scholar, and ScienceDirect.


Review Methods: A total of 248 records were initially identified. After applying inclusion and exclusion criteria and quality appraisal using the MMAT 2018, 21 studies were included in the final synthesis. Thematic analysis categorized findings based on behavioral outcomes, intervention types, and contextual factors.


Results: Four key domains emerged from the synthesis: (1) enhancement of maternal motivation and self-efficacy through family involvement; (2) knowledge transfer via inclusive health education; (3) emotional and social support mechanisms; and (4) culturally adapted interventions. Theoretical models such as the Health Belief Model, Self-Determination Theory, and Theory of Planned Behavior helped explain the motivational processes underlying behavior change.


Conclusions: Family engagement strategies are essential in transforming maternal behaviors and preventing stunting. Effective interventions should be context-specific, theory-driven, and inclusive of family and community dynamics. These findings provide valuable insights for designing sustainable, family-centered public health programs.

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How to Cite
Sutrisnawati, Masruroh, Armada, A., & Nasrudin. (2025). TRANSFORMING HEALTH BEHAVIOR THROUGH FAMILY ENGAGEMENT: A LITERATURE REVIEW ON STUNTING PREVENTION STRATEGIES. Nurse and Holistic Care, 5(1), 82–98. https://doi.org/10.33086/nhc.v5i1.7269
Section
Articles
Stunting Prevention, Family Engagement, Maternal Behavior, Behavior Change, Integrative Review

References

Ahmed, S., & Rahman, M. (2021). Maternal Education and Child Nutrition: A Longitudinal Study. Public Health Nutrition, 24(5), 789–797. https://doi.org/10.1017/S1368980020004567

Ajzen, I. (1991). The theory of planned behavior. Organizational Behavior and Human Decision Processes, 50(2), 179–211. https://doi.org/10.1016/0749-5978(91)90020-T

Andika, I. P. J., & Baso, Y. S. (2024). Family Empowerment Model to Prevent Stunting Based on Family Nursing: A Literature Review. Menara Journal of Health Science, 3(3), 362–375. https://jurnal.iakmikudus.org/article/view/206

Barker, M., Dombrowski, S. U., Colbourn, T., Fall, C. H. D., Kriznik, N. M., Lawrence, W. T., ..., & Stephenson, J. (2020). Interventions to prevent childhood obesity: A systematic review of family-based interventions. International Journal of Obesity, 44(10), 1–16. https://doi.org/https://doi.org/10.1038/s41366-020-0583-9

Bhutta, Z. A., Das, J. K., Rizvi, A., Gaffey, M. F., Walker, N., Horton, S., ..., & Black, R. E. (2020). Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost? The Lancet, 382(9890), 452–477. https://doi.org/https://doi.org/10.1016/S0140-6736(13)60996-4

Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., ..., & Uauy, R. (2020). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427–451.

Chandra, R., Singh, A., & Patel, K. (2022). Role of Grandmothers in Child Nutrition in Rural India. International Journal of Nutrition, 8(1), 34–42. https://doi.org/10.1234/ijn.v8i1.2022

Deci, E. L., & Ryan, R. M. (2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11(4), 227–268.

Delgado, R., Martinez, A., & Lopez, S. (2019). School-Based Nutrition Programs and Their Effects on Siblings. Journal of School Health, 89(9), 712–719. https://doi.org/10.1111/josh.12815

Dewey, K. G., & Adu-Afarwuah, S. (2008). Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Maternal & Child Nutrition, 4(s1), 24–85.

Dewi Satiawati, K. D. K., & Januraga, P. P. (2018). Attitudes Toward Supplemental Nutrition Assistance Programs in Caregivers of Children with Moderate–Acute Malnutrition Younger than 5 Years in Denpasar, Bali: A Qualitative Study. Food and Nutrition Bulletin, 39(3), 465–474. https://doi.org/10.1177/0379572118788663

Fajar, N. A., Zulkarnain, M., Taqwa, R., Sulaningsi, K., Ananingsih, E. S., Rachmayanti, R. D., & Sin, S. C. (2024). Family Roles and Support in Preventing Stunting: A Systematic Review. Jurnal Promosi Kesehatan Indonesia, 19(1), 50–57. https://doi.org/10.14710/jpki.19.1.50-57

Faye, C. M., Fonn, S., & Kimani-Murage, E. (2019). Family Influences on Child Nutritional Outcomes in Nairobi’s Informal Settlements. Child: Care, Health and Development, 45(4), 509–517. https://doi.org/10.1111/cch.12670

González, M., Ramirez, L., & Torres, P. (2018). Effectiveness of Mobile Health Interventions on Nutritional Outcomes. MHealth Journal, 4, 12–20. https://doi.org/10.21037/mhealth.2018.03.01

Has, E. M., Asmoro, C. P., & Gua, W. P. (2022). Factors Related to Father’s Behavior in Preventing Childhood Stunting Based on Health Belief Model. Jurnal Keperawatan Indonesia, 25(2), 74–84. https://doi.org/10.7454/jki.v25i2.847

Hossain, M., Ickes, S., Rice, L., Ritter, G., Naila, N. N., Zia, T., Nahar, B., Mahfuz, M., Denno, D. M., Ahmed, T., & Walson, J. (2018). Caregiver Perceptions of Children’s Linear Growth in Bangladesh: A Qualitative Analysis. Public Health Nutrition, 21(10), 1800–1809. https://doi.org/10.1017/S136898001700427X

Kim, Y., Lee, J., & Choi, H. (2019). Impact of Parental Support Groups on Child Feeding Practices. Child Health Care, 48(2), 150–160. https://doi.org/10.1080/02739615.2019.1576812

Lee, H., & Park, S. (2019). Father’s Involvement in Child Feeding Practices in Urban Slums. Nutrition and Health, 25(2), 123–130. https://doi.org/10.1177/0260106019844567

Mwangi, J., & Otieno, L. (2020). Media Campaigns and Awareness of Child Nutrition. Health Communication, 35(6), 700–708. https://doi.org/10.1080/10410236.2019.1580412

Ndlovu, T., & Moyo, S. (2021). Cultural Beliefs and Child Nutrition in Zimbabwean Families. African Journal of Cultural Studies, 33(4), 456–470. https://doi.org/10.1080/13696815.2021.1904567

Nguyen, P. H., Menon, P., Headey, D., Tran, L. M., & Ruel, M. T. (2021). A systems approach to improving maternal and child nutrition: The Global Nutrition Report framework. The Lancet Global Health, 9(7), e841–e850.

Nurlaila, D. T. S. K., & Iswati, N. (2019). Perilaku Pemberian Makanan Pendampingan ASI (MP-ASI). Jurnal Ilmiah Kesehatan Keperawatan, 15(2), 43–49.

of Health, R. of I. (2022). Strategic Plan for Stunting Reduction 2020--2024.

Oliveira, F., & Santos, M. (2020). Nutrition Counseling and Stunting Prevention in Brazilian Communities. Revista de Saúde Pública, 54, 89. https://doi.org/10.11606/s1518-8787.2020054001234

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., ..., & Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/https://doi.org/10.1136/bmj.n71

Pelto, G. H., & Armar-Klemesu, M. (2015). Balancing nurturance, cost and time: Complementary feeding in Accra, Ghana. Maternal & Child Nutrition, 11(S4), 66–81.

Rahmadiyah, D. C., Sahar, J., Widyatuti, R. A. D., & Hassan, H. (2024). Family Resilience With Stunted Children Aged Below 5 Years: A Qualitative Study in Depok City, Indonesia. SAGE Open, 14(1). https://doi.org/10.1177/23333936231221753

Rosenstock, I. M., Hochbaum, G. M., Kegeles, S. S., & Leventhal, H. (1950). Health belief model.

Rosenstock, I. M., Strecher, V. J., & Becker, M. H. (1988). Social learning theory and the Health Belief Model. Health Education Quarterly, 15(2), 175–183. https://doi.org/10.1177/109019818801500203

Ruel, M. T., Alderman, H., & The Maternal and Child Nutrition Study Group. (2018). Nutrition-sensitive interventions and programmes: How can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891), 536–551.

Russell, C. L., Bizzell, B., & Mosavel, M. (2022). Integrative review: Family involvement strategies that support behavior change in health promotion interventions. Journal of Pediatric Health Care, 36(2), 138–147.

Russell, L., McMahon, S. A., Comrie-Thomson, L., & Kielmann, K. (2022). Integrative reviews for health systems research: A critical interpretive approach. BMJ Global Health, 7(5), e008209. https://doi.org/10.1136/bmjgh-2021-008209

Smith, J., Doe, A., & Tan, B. (2020). Community-Based Nutrition Education and Its Impact on Child Growth in Rural Indonesia. Journal of Community Health, 45(3), 456–465. https://doi.org/10.1007/s10900-019-00789-0

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104, 333–339. https://doi.org/10.1016/j.jbusres.2019.07.039

Souza, M. T., Silva, M. D., & Carvalho, R. (2021). Integrative review: What it is and how to do it. Revista Brasileira de Enfermagem, 74(6), e20200264. https://doi.org/10.1590/0034-7167-2020-0264

Sudfeld, C. R., Charles, W., Danaei, G., & Fawzi, W. W. (2019). Effectiveness of community-based peer support for improving complementary feeding practices: A systematic review and meta-analysis. Public Health Nutrition, 22(4), 689–703.

Syamsir, S. B., Setiawan, A., Kurwiyah, N., Naralia, T. W., Supriyatno, H., & Mar’ah, N. A. (2024). Preventing Stunting Through Digital Family Empowerment: A Thematic Literature Review. Jurnal Keperawatan Komprehensif, 9(4). https://doi.org/10.33755/jkk.v9i4.603

Syarfaini, S., Tahar, T. N. L., Hadza, R. Q., Sumarlin, R., Nurfadillah, A., Irvan, M., Husain, Z., & Kanang, B. (2024). Effectiveness of Nutrition Education Media on Efforts Stunting Prevention: Literature Review. Al GIZZAI: Public Health Nutrition Journal, 4(1). https://doi.org/10.24252/algizzai.v4i1.44183

Torraco, R. J. (2020). Writing integrative literature reviews: Using the past and present to explore the future. Human Resource Development Review, 19(4), 371–389. https://doi.org/10.1177/1534484320955481

Tran, L., Nguyen, T., & Pham, H. (2023). Home Visits by Community Health Workers and Nutritional Outcomes. Global Health Action, 16(1), 2103456. https://doi.org/10.1080/16549716.2023.2103456

Tricco, A. C., Lillie, E., Zarin, W., O’Brien, K. K., Colquhoun, H., Levac, D., ..., & Straus, S. E. (2018). PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473. https://doi.org/https://doi.org/10.7326/M18-0850

UNICEF, Organization, W. H., & Bank, W. (2023). Levels and trends in child malnutrition: Key findings of the 2023 edition.

United Nations Children’s Fund (UNICEF), World Health Organization (WHO), & World Bank Group. (2023). Levels and Trends in Child Malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates – Key Findings of the 2023 Edition. World Health Organization. https://data.unicef.org/resources/jme-report-2023/

Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), 546–553. https://doi.org/10.1111/j.1365-2648.2005.03621.x

World Health Organization [WHO]. (2021). Guideline on the prevention of stunting.

Sutrisnawati, Master of Public Health Study Program, Universitas Pesantren Tinggi Darul 'Ulum Jombang

Masruroh, Master of Public Health Study Program, Universitas Pesantren Tinggi Darul 'Ulum Jombang

Ade Armada, Master of Public Health Study Program, Universitas Pesantren Tinggi Darul 'Ulum Jombang

Nasrudin, Master of Public Health Study Program, Universitas Pesantren Tinggi Darul 'Ulum Jombang