Evaluating the knowledge, roles, and skills of health cadres in stunting prevention: A mixed-method study in Indonesia.

Background: Stunting remains a critical public health issue in Indonesia, threatening the well-being of future generations. Community involvement, particularly by health cadres, is essential for effective prevention. However, structured assessments and follow-up initiatives to enhance their participation remain limited. Objective: This study aimed to evaluate health cadres' knowledge, roles, and skills in stunting prevention programs. Methods: A mixed-methods design with an embedded approach was applied in three phases. Phase 1: A quantitative survey assessed stunting knowledge among 193 cadres across 10 stunting locus villages in Bangka Belitung Province, Indonesia (October-December 2022). The survey tool was adapted from previous studies and analyzed using the RASCH IRT model and descriptive statistics. Phase 2: Qualitative data were collected through semi-structured interviews with 20 cadres selected from the survey pool, and analyzed thematically. Phase 3: The same 20 cadres were observed conducting anthropometric measurements to assess skill accuracy. Results: Knowledge levels were generally low, with 52% of cadres scoring low to very low and only 48% achieving moderate to high scores. Three themes emerged: 1) cadres' perspectives on the causes and consequences of stunting, 2) their roles and actions in stunting prevention, and 3) their experiences during the COVID-19 pandemic. Observations revealed significant inaccuracies in anthropometric measurement techniques. Conclusion: There is a clear need to improve cadres' knowledge and skills, especially in anthropometric assessment. Recommendations include implementing certification-based training, introducing innovative and standardized measurement tools, and offering accessible web-based learning platforms. Nurses play a crucial role in supporting cadre training and ensuring accurate growth monitoring at the community level.