DEVELOPMENT AND EVALUATION OF THE CARDIO-GROWTH NURSING MODEL FOR EARLY CARDIOVASCULAR RISK SCREENING IN STUNTED CHILDREN
DOI:
https://doi.org/10.35328/qe8g0443Keywords:
Stunting, Pediatric Nursing, R&D, ADDIE, Cardiovascular Risk, Predictive Model, Early ScreeningAbstract
Stunting masih menjadi masalah kesehatan anak global yang memengaruhi lebih dari 148 juta anak di dunia dan tetap tinggi di Indonesia, termasuk di Kota Palembang. Selain menyebabkan gangguan pertumbuhan linier, stunting semakin dikaitkan dengan risiko kardiometabolik dan kardiovaskular sejak usia dini. Penelitian ini bertujuan mengembangkan dan mengevaluasi Model Asuhan Keperawatan Cardio-Growth sebagai pendekatan skrining dan pencegahan dini risiko kardiovaskular pada anak stunting. Penelitian menggunakan desain Research and Development (R&D) dengan model ADDIE yang dimodifikasi (Analysis, Design, Development, Implementation, Evaluation) serta evaluasi prediktif dengan pendekatan potong lintang yang dilaksanakan pada Januari–April 2026. Sebanyak 36 anak stunting usia 6–12 tahun dipilih menggunakan teknik purposive sampling dari beberapa puskesmas di Kota Palembang. Pengembangan model dilakukan melalui sintesis literatur, integrasi pedoman, dan validasi ahli yang menunjukkan validitas isi sangat baik (S-CVI/Ave = 0,96). Implementasi model dilakukan melalui tiga kali kunjungan keperawatan terstruktur yang mencakup pengukuran antropometri, tekanan darah, lingkar pinggang, penilaian aktivitas fisik menggunakan Physical Activity Questionnaire for Children (PAQ-C), serta edukasi keperawatan berbasis keluarga. Analisis data dilakukan menggunakan statistik deskriptif, analisis perbandingan pre–post, dan uji korelasi Spearman. Hasil menunjukkan perbaikan signifikan pada tekanan darah sistolik (p<0,01), tekanan darah diastolik (p<0,05), lingkar pinggang (p<0,05), dan skor aktivitas fisik (p<0,001). Derajat stunting berhubungan signifikan dengan tekanan darah sistolik (r=-0,42; p<0,01), lingkar pinggang (r=-0,38; p<0,05), dan aktivitas fisik (r=0,35; p<0,05). Model Cardio-Growth Nursing menunjukkan kelayakan implementasi yang tinggi dan berpotensi menjadi kerangka keperawatan komunitas untuk skrining dan pencegahan dini risiko kardiovaskular pada anak stunting.
Downloads
References
Adair, L. S., Fall, C. H. D., Osmond, C., Stein, A. D., Martorell, R., Ramirez-Zea, M., & Norris, S. A. (2023). Associations of linear growth and cardiovascular risk across the life course. The Lancet Diabetes & Endocrinology, 11(2), 89–101. https://doi.org/10.1016/S2213-8587(22)00345-6
Alderman, H., & Headey, D. (2021). Nutrition-sensitive interventions and child development. Food Policy, 104, 102142. https://doi.org/10.1016/j.foodpol.2021.102142
Alligood, M. R. (2022). Nursing theorists and their work (10th ed.). Elsevier. https://www.elsevier.com
American Nurses Association. (2023). Pediatric nursing: Scope and standards of practice (4th ed.). ANA Publishing. https://www.nursingworld.org
Anderson, R. M., Smith, J. P., & Collins, F. (2022). Pediatric cardiovascular risk in early malnutrition. Journal of Pediatric Health Care, 36(5), 412–420. https://doi.org/10.1016/j.pedhc.2022.01.005
Bappenas. (2023). Strategi nasional percepatan penurunan stunting 2023–2024. Kementerian PPN/Bappenas. https://www.bappenas.go.id
Barker, D. J. P. (2021). Developmental origins of chronic disease. Public Health Reviews, 42, 160–174. https://doi.org/10.3389/phrs.2021.1604743
Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., & Uauy, R. (2023). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 401(10376), 345–382. https://doi.org/10.1016/S0140-6736(23)00001-2
Borg, W. R., & Gall, M. D. (2003). Educational research: An introduction (7th ed.). Allyn & Bacon.
Branch, R. M. (2009). Instructional design: The ADDIE approach. Springer. https://doi.org/10.1007/978-0-387-09506-6
Christian, P., Lee, S. E., Donahue Angel, M., Adair, L. S., Arifeen, S. E., Ashorn, P., & Fall, C. H. D. (2022). Risk of later cardiometabolic disease in children with early growth failure. BMJ Global Health, 7(4), e008123. https://doi.org/10.1136/bmjgh-2022-008123
Creswell, J. W. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE.
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE.
De Onis, M., et al. (2019). WHO child growth standards. Bulletin of the World Health Organization, 87(1), 1–8.
DeVellis, R. F. (2017). Scale development: Theory and applications (4th ed.). SAGE.
Dick, W., Carey, L., & Carey, J. O. (2015). The systematic design of instruction (8th ed.). Pearson.
Field, A. (2018). Discovering statistics using IBM SPSS Statistics (5th ed.). SAGE.
Flynn, J. T., et al. (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140(3), e20171904. https://doi.org/10.1542/peds.2017-1904
Hales, C. N., & Barker, D. J. P. (2022). The thrifty phenotype hypothesis. Diabetologia, 65(1), 1–10. https://doi.org/10.1007/s00125-021-05512-3
Kementerian Kesehatan Republik Indonesia. (2024). Profil kesehatan Indonesia 2024. Kemenkes RI. https://www.kemkes.go.id
Kemp, J. E., Morrison, G. R., & Ross, S. M. (2013). Designing effective instruction (7th ed.). Wiley.
Kolcaba, K. (2022). Comfort theory and nursing practice: Holistic care framework. Springer. https://doi.org/10.1891/9780826150012
Kowalski, K. C., Crocker, P. R. E., & Faulkner, R. A. (2004). Validation of the Physical Activity Questionnaire for Children (PAQ-C). Pediatric Exercise Science, 16(1), 1–14. https://doi.org/10.1123/pes.16.1.1
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382–385. https://doi.org/10.1097/00006199-198611000-00017
McNally, S. J., et al. (2023). Pediatric cardiovascular risk in primary care settings. Journal of Pediatric Nursing, 68, 45–53. https://doi.org/10.1016/j.pedn.2023.02.010
Molenda, M. (2003). In search of the elusive ADDIE model. Performance Improvement, 42(5), 34–37. https://doi.org/10.1002/pfi.4930420508
NICE. (2022). Hypertension in children and young people: Diagnosis and management. https://www.nice.org.uk
Patton, M. Q. (2015). Qualitative research & evaluation methods (4th ed.). SAGE.
Pallant, J. (2020). SPSS survival manual (7th ed.). Open University Press.
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Prendergast, A. J., & Humphrey, J. H. (2023). The stunting syndrome in developing countries. Paediatric and Perinatal Epidemiology, 37(2), 123–136. https://doi.org/10.1111/ppe.12987
Adair, L. S., Fall, C. H. D., Osmond, C., Stein, A. D., Martorell, R., Ramirez-Zea, M., & Norris, S. A. (2023). Associations of linear growth and cardiovascular risk across the life course. The Lancet Diabetes & Endocrinology, 11(2), 89–101. https://doi.org/10.1016/S2213-8587(22)00345-6
Alderman, H., & Headey, D. (2021). Nutrition-sensitive interventions and child development. Food Policy, 104, 102142. https://doi.org/10.1016/j.foodpol.2021.102142
Alligood, M. R. (2022). Nursing theorists and their work (10th ed.). Elsevier. https://www.elsevier.com
American Nurses Association. (2023). Pediatric nursing: Scope and standards of practice (4th ed.). ANA Publishing. https://www.nursingworld.org
Anderson, R. M., Smith, J. P., & Collins, F. (2022). Pediatric cardiovascular risk in early malnutrition. Journal of Pediatric Health Care, 36(5), 412–420. https://doi.org/10.1016/j.pedhc.2022.01.005
Bappenas. (2023). Strategi nasional percepatan penurunan stunting 2023–2024. Kementerian PPN/Bappenas. https://www.bappenas.go.id
Barker, D. J. P. (2021). Developmental origins of chronic disease. Public Health Reviews, 42, 160–174. https://doi.org/10.3389/phrs.2021.1604743
Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., & Uauy, R. (2023). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 401(10376), 345–382. https://doi.org/10.1016/S0140-6736(23)00001-2
Borg, W. R., & Gall, M. D. (2003). Educational research: An introduction (7th ed.). Allyn & Bacon.
Branch, R. M. (2009). Instructional design: The ADDIE approach. Springer. https://doi.org/10.1007/978-0-387-09506-6
Christian, P., Lee, S. E., Donahue Angel, M., Adair, L. S., Arifeen, S. E., Ashorn, P., & Fall, C. H. D. (2022). Risk of later cardiometabolic disease in children with early growth failure. BMJ Global Health, 7(4), e008123. https://doi.org/10.1136/bmjgh-2022-008123
Creswell, J. W. (2018). Research design: Qualitative, quantitative, and mixed methods approaches (5th ed.). SAGE.
Creswell, J. W., & Plano Clark, V. L. (2018). Designing and conducting mixed methods research (3rd ed.). SAGE.
De Onis, M., et al. (2019). WHO child growth standards. Bulletin of the World Health Organization, 87(1), 1–8.
DeVellis, R. F. (2017). Scale development: Theory and applications (4th ed.). SAGE.
Dick, W., Carey, L., & Carey, J. O. (2015). The systematic design of instruction (8th ed.). Pearson.
Field, A. (2018). Discovering statistics using IBM SPSS Statistics (5th ed.). SAGE.
Flynn, J. T., et al. (2017). Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics, 140(3), e20171904. https://doi.org/10.1542/peds.2017-1904
Hales, C. N., & Barker, D. J. P. (2022). The thrifty phenotype hypothesis. Diabetologia, 65(1), 1–10. https://doi.org/10.1007/s00125-021-05512-3
Kementerian Kesehatan Republik Indonesia. (2024). Profil kesehatan Indonesia 2024. Kemenkes RI. https://www.kemkes.go.id
Kemp, J. E., Morrison, G. R., & Ross, S. M. (2013). Designing effective instruction (7th ed.). Wiley.
Kolcaba, K. (2022). Comfort theory and nursing practice: Holistic care framework. Springer. https://doi.org/10.1891/9780826150012
Kowalski, K. C., Crocker, P. R. E., & Faulkner, R. A. (2004). Validation of the Physical Activity Questionnaire for Children (PAQ-C). Pediatric Exercise Science, 16(1), 1–14. https://doi.org/10.1123/pes.16.1.1
Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382–385. https://doi.org/10.1097/00006199-198611000-00017
McNally, S. J., et al. (2023). Pediatric cardiovascular risk in primary care settings. Journal of Pediatric Nursing, 68, 45–53. https://doi.org/10.1016/j.pedn.2023.02.010
Molenda, M. (2003). In search of the elusive ADDIE model. Performance Improvement, 42(5), 34–37. https://doi.org/10.1002/pfi.4930420508
NICE. (2022). Hypertension in children and young people: Diagnosis and management. https://www.nice.org.uk
Patton, M. Q. (2015). Qualitative research & evaluation methods (4th ed.). SAGE.
Pallant, J. (2020). SPSS survival manual (7th ed.). Open University Press.
Polit, D. F., & Beck, C. T. (2021). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Prendergast, A. J., & Humphrey, J. H. (2023). The stunting syndrome in developing countries. Paediatric and Perinatal Epidemiology, 37(2), 123–136. https://doi.org/10.1111/ppe.12987
Rothman, K. J., Greenland, S., & Lash, T. L. (2021). Modern epidemiology (4th ed.). Wolters Kluwer.
Ruel, M. T., Alderman, H., & Maternal and Child Nutrition Study Group. (2023). Nutrition-sensitive interventions and growth outcomes. The Lancet Global Health, 11(2), e145–e158. https://doi.org/10.1016/S2214-109X(23)000XX-X
Shadish, W. R., Cook, T. D., & Campbell, D. T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Houghton Mifflin.
Smith, J. P., & Collins, R. (2024). Early cardiovascular risk in pediatric populations. Circulation Research, 134(1), 12–25. https://doi.org/10.1161/CIRCRESAHA.123.321456
UNICEF. (2023). Child nutrition report 2023: Ending child malnutrition. https://www.unicef.org
UNICEF Indonesia. (2023). Stunting situation report Indonesia. https://www.unicef.org/indonesia
Victora, C. G., Christian, P., Vidaletti, L. P., Gatica-Domínguez, G., Menon, P., & Black, R. E. (2023). Revisiting maternal and child undernutrition in the SDG era. The Lancet, 401(10378), 238–256. https://doi.org/10.1016/S0140-6736(23)00123-4
Waltz, C. F., Strickland, O. L., & Lenz, E. R. (2010). Measurement in nursing and health research (4th ed.). Springer.
World Health Organization. (2006). WHO child growth standards: Methods and development. https://www.who.int
World Health Organization. (2023). Guideline on child growth and nutrition. https://www.who.int
World Health Organization. (2024). Global nutrition targets 2025. https://www.who.int
Yusoff, M. S. B. (2019). ABC of content validity and content validity index calculation. Education in Medicine Journal, 11(2), 49–54. https://doi.org/10.21315/eimj2019.11.2.6
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Al-Asalmiya Nursing: Jurnal Ilmu Keperawatan (Journal of Nursing Sciences)
This work is licensed under a Creative Commons Attribution 4.0 International License.
