A Qualitative Study on Barriers to Stunting Primordial Prevention during the PentaCOME Project

Abstract

Introduction: The government of Gianyar district in Indonesia has successfully decreased the stunting prevalence from 12.1% in 2018, became 11.1% in 2019, and ended up with 5.1% in 2021, which was less than the stunting prevalence in Bali province (10.9% in 2021) and much lower than the national wide (24.4%). The PentaCOME (Pentahelix Community-Based Medical Education) project, the collaboration of the Warmadewa University, the Indonesian Ministry of Education, Culture, Research, and Higher Education, as well as PT. Sido Muncul, is intended to continuously lower stunting prevalence via “Stunting Primordial Prevention Through Future Brides and Grooms Accompaniment” initiative in Payangan District. The present study sought to determine barriers to implementing such initiative. Methods: This is a qualitative study. The data were derived from in-depth interviews and focus group discussions (FGDs). The key informants were purposefully selected to represent pentahelix model (i.e., academician, business, community, government, and media). Twenty key informants were interviewed during 1 September 2022 – 15 October 2022 period: three key informants were from academician, two from business, nine from community, three from government, and three from media. Two FGDs were conducted and attended by the representatives of academician, community, government, and media. The business representatives failed to attend both FGDs. The data were transcribed and coded independently by two coders. The codes were then categorised into the social ecological model. Results: At the intrapersonal level, informants described not knowing about ELSIMIL application (ELSIMIL stands for electronic “Siap Nikah dan Hamil” in Indonesian, which means electronic “Ready to Marry and Get Pregnant”). At the interpersonal level, we detected social pressure to get pregnant prior to marriage among Balinese (“no pregnancy, no marriage” motto). At the institutional level, key informants found the Future Brides and Grooms Accompaniment and ELSIMIL application campaign to be insufficient. At the community level, the family support team community has been engaged actively, however, they could not function adequately due to “no pregnancy, no marriage” motto. At the policy level, the traditional village assembly (commonly known as “Majelis Desa Adat” in Indonesian), which has not issued regulation regarding the future brides and grooms accompaniment, and lack of cross-sector collaboration were reported as barriers to this initiative. Conclusions: A well-developed promotion could improve the knowledge about ELSIMIL application among future brides and grooms. Advocacy to the traditional village assembly might slowly diminish “no pregnancy, no marriage” motto among Balinese hence enhance primordial prevention toward stunting. Cross-sector collaboration (known as pentahelix collaboration) needs to be empowered to achieve the “zero stunting for golden generation” goal accordingly.
 Key words: stunting, primordial prevention, ELSIMIL, PentaCOME, Bali