Atomic Habits Parenting Validating a Behavioral Framework for Stunting Prevention
Abstract
Introduction: Atomic Habits Parenting focuses on small, consistent actions by caregivers to detect and prevent stunting in children. A valid and reliable instrument is essential for early detection and effective prevention. This study aims to evaluate the validity and reliability of the Atomic Habits Parenting instrument and its association with stunting prevention in children under five. This method differs from others as the consistent daily practice of small habits leads to a 37-fold improvement over one year.
Methods: A cross-sectional study was conducted in Jeneponto, Barru, and Sinjai Districts of South Sulawesi, Indonesia, involving 900 children aged 0-59 months. Data were collected from February to August 2024. Validity and reliability were assessed using Cronbach's alpha, sensitivity, and specificity with ROC analysis, and the association with stunting was measured using the Chi-Square test.
Results: The instrument demonstrated high reliability with Cronbach's alpha values above 0.8 for all parenting practices. ROC analysis showed excellent sensitivity (75.6%) and specificity (82.3%) at a threshold score of 313.5. A significant association was found between Atomic Habits Parenting and stunting prevention (p<0.001).
Conclusion: The Atomic Habits Parenting instrument is valid and reliable, with strong sensitivity and specificity. It is significantly associated with the prevention of stunting in children under five, making it a valuable tool for public health programs. Adapting this approach globally in high-stunting regions (>20%) could support a sustainable stunting reduction roadmap.
References
Beal T, Tumilowicz A, Sutrisna A, Izwardy D, Neufeld LM. A review of child stunting determinants in Indonesia. Matern Child Nutr. 2018 Oct 17;14(4):e12617. Available from: https://onlinelibrary.wiley.com/doi/10.1111/mcn.12617
Krishna A, Mejía?Guevara I, McGovern M, Aguayo VM, Subramanian S V. Trends in inequalities in child stunting in South Asia. Matern Child Nutr. 2018 Nov 19;14(S4). Available from: https://onlinelibrary.wiley.com/doi/10.1111/mcn.12517
Palutturi S, Syam A, Asnawi A, Hamzah. Stunting in a political context: A systematic review. Enferm Clin. 2020 Jun;30:95–8. Available from : https://doi.org/10.1016/j.enfcli.2019.10.049
Keats EC, Das JK, Salam RA, Lassi ZS, Imdad A, Black RE, et al. Effective interventions to address maternal and child malnutrition: an update of the evidence. Lancet Child Adolesc Health. 2021 May;5(5):367–84. Available from : https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30274-1/abstract
Black RE, Alderman H, Bhutta ZA, Gillespie S, Haddad L, Horton S, et al. Maternal and child nutrition: building momentum for impact. The Lancet. 2013 Aug;382(9890):372–5. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60988-5/abstract
Fabrizio CS, van Liere M, Pelto G. Identifying determinants of effective complementary feeding behaviour change interventions in developing countries. Matern Child Nutr. 2014 Oct 5;10(4):575–92. Available from: https://onlinelibrary.wiley.com/doi/10.1111/mcn.12119
Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, et al. What works? Interventions for maternal and child undernutrition and survival. The Lancet. 2008 Feb;371(9610):417–40. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(07)61693-6/abstract
Martin SL, Zongrone AA, Craig HC, Litvin K, Fort P, Cooper S, et al. Measuring the intangible resources caregivers need to provide nurturing care during the complementary feeding period: a scoping review in low- and lower-middle-income countries. Public Health Nutr. 2024 Jan 15;27(1):e78. Available from: https://doi.org/10.1017/S1368980024000065
Purwestri RC, Barati Z, Wirawan NN, Fahmi I, Lauvai J, Scherbaum V. What explains stunting among children living in a rice surplus area in Central Java, Indonesia? In: Diversity and change in food wellbeing. The Netherlands: Wageningen Academic Publishers; 2018. p. 137–51. Available from : https://doi.org/10.3920/978-90-8686-864-3_7
Titaley CR, Ariawan I, Hapsari D, Muasyaroh A, Dibley MJ. Determinants of the Stunting of Children Under Two Years Old in Indonesia: A Multilevel Analysis of the 2013 Indonesia Basic Health Survey. Nutrients. 2019 May 18;11(5):1106. Available from : https://doi.org/10.3390/nu11051106
Rachmi CN, Agho KE, Li M, Baur LA. Stunting, underweight and overweight in children aged 2.0-4.9 years in Indonesia: Prevalence trends and associated risk factors. PLoS One. 2016;11(5). Available from : https://doi.org/10.1371/journal.pone.0154756.
Rah JH, Sukotjo S, Badgaiyan N, Cronin AA, Torlesse H. Improved sanitation is associated with reduced child stunting amongst Indonesian children under 3 years of age. Matern Child Nutr. 2020 Oct 1;16(S2). Available from : https://doi.org/10.1111/mcn.12741.
Soekatri MYE, Sandjaja S, Syauqy A. Stunting Was Associated with Reported Morbidity, Parental Education and Socioeconomic Status in 0.5–12-Year-Old Indonesian Children. Int J Environ Res Public Health. 2020 Aug 27;17(17):6204. Available from : https://doi.org/10.3390/ijerph17176204.
Anastasia H, Hadju V, Hartono R, Samarang, Manjilala, Sirajuddin, et al. Determinants of stunting in children under five years old in South Sulawesi and West Sulawesi Province: 2013 and 2018 Indonesian Basic Health Survey. PLoS One. 2023 May 11;18(5):e0281962. Available from : https://doi.org/10.1371/journal.pone.0281962
Keats EC, Das JK, Salam RA, Lassi ZS, Imdad A, Black RE, et al. Effective interventions to address maternal and child malnutrition: an update of the evidence. Lancet Child Adolesc Health. 2021 May;5(5):367–84. Available from : https://doi.org/10.1016/s2352-4642(20)30274-1.
James Clear. Atomic Habits. Gramedia Jakarta; 2018. 1-340 p : Available from : Atomic Habits by James Clear.pdf.pdf - Google Drive.
Oddo VM, Roshita A, Rah JH. Potential interventions targeting adolescent nutrition in Indonesia: a literature review. Public Health Nutr. 2019 Jan 23;22(1):15–27. Available from : https://doi.org/10.1017/S1368980018002215
Rachmi CN, Agho KE, Li M, Baur LA. Stunting coexisting with overweight in 2·0–4·9-year-old Indonesian children: prevalence, trends and associated risk factors from repeated cross-sectional surveys. Public Health Nutr. 2016 Oct 28;19(15):2698–707. Available from : https://doi.org/10.1017/S1368980016000926.
Gleason PM, Harris J, Sheean PM, Boushey CJ, Bruemmer B. Publishing Nutrition Research: Validity, Reliability, and Diagnostic Test Assessment in Nutrition-Related Research. J Am Diet Assoc. 2010 Mar;110(3):409–19. Availale from : https://www.jandonline.org/action/showPdf?pii=S0002-8223%2809%2901956-7.
Doocy S, Emerson J, Colantouni E, Strong J, Amundson-Mansen K, Menakuntuala J. Evaluating interventions to improve child nutrition in Eastern Democratic Republic of Congo. Public Health Nutr. 2019 Jan 6;22(1):3–14. Available from : https://doi.org/10.1017/S1368980018002859.
Hydery T, Shields S, Hen E, Rizzo P, Sullivan K, Savageau JA. The Impact of Local Education and Resource Distribution on Maternal Health Behaviors. Matern Child Health J. 2022 Aug 21;26(8):1676–88. Available from : https://link.springer.com/article/10.1007/s10995-022-03416-3.
Zeraatkar D, Johnston BC, Guyatt G. Evidence Collection and Evaluation for the Development of Dietary Guidelines and Public Policy on Nutrition. Annu Rev Nutr. 2019 Aug 21;39(1):227–47. Available from : https://doi.org/10.1146/annurev-nutr-082018-124610.
Marples O, Baldwin C, Weekes CE. The effect of nutrition training for health care staff on learner and patient outcomes in adults: a systematic review and meta-analysis. Am J Clin Nutr. 2017 Jul;106(1):284–310. Available from : https://doi.org/10.3945/ajcn.116.144808.
Anato A, Baye K, Tafese Z, Stoecker BJ. Maternal depression is associated with child undernutrition: A cross?sectional study in Ethiopia. Matern Child Nutr. 2020 Jul 12;16(3). Available from : https://doi.org/10.1111/mcn.12934.
Alderman H, Fernald L. The Nexus Between Nutrition and Early Childhood Development. Annu Rev Nutr. 2017 Aug 21;37(1):447–76. Available from : https://doi.org/10.1146/annurev-nutr-071816-064627.
Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health. 2014 Nov 13;34(4):250–65. Available from : https://doi.org/10.1179/2046905514Y.0000000158.
Arini D, Nursalam N, Mahmudah M, Faradilah I. The Incidence of Stunting, the Frequency/Duration of Diarrhea and Acute Respiratory Infection in Toddlers. J Public Health Res. 2020 Jul 3;9(2):jphr.2020.1816. Available from : https://doi.org/10.4081/jphr.2020.1816.
Mireku MO, Cot M, Massougbodji A, Bodeau-Livinec F. Relationship between Stunting, Wasting, Underweight and Geophagy and Cognitive Function of Children. J Trop Pediatr. 2020 Oct 1;66(5):517–27. Available from : https://doi.org/10.1093/tropej/fmaa009.
Stewart CP, Iannotti L, Dewey KG, Michaelsen KF, Onyango AW. Contextualising complementary feeding in a broader framework for stunting prevention. Matern Child Nutr. 2013 Sep 18;9(S2):27–45. Available from: https://doi.org/10.1111/mcn.12088.
Bommer C, Vollmer S, Subramanian S V. How socioeconomic status moderates the stunting-age relationship in low-income and middle-income countries. BMJ Glob Health. 2019 Feb 8;4(1):e001175. Available from: https://doi.org/10.1136/bmjgh-2018-001175.
Sari DDP, Sukanto S, Marwa T, Bashir A. The Causality between Economic Growth, Poverty, and Stunting: Empirical evidence from Indonesia. Jurnal Perspektif Pembiayaan dan Pembangunan Daerah. 2020 Apr 30;8(1):13–30. Available from: https://doi.org/10.22437/ppd.v8i1.8834.
Raiten DJ, Bremer AA. Exploring the Nutritional Ecology of Stunting: New Approaches to an Old Problem. Nutrients. 2020 Jan 31;12(2):371. Available from: https://doi.org/10.3390/nu12020371.
de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr. 2016 May 17;12(S1):12–26. Available from: https://doi.org/10.1111/mcn.12231.
Shekar M, Kakietek J, D’Alimonte MR, Rogers HE, Eberwein JD, Akuoku JK, et al. Reaching the global target to reduce stunting: an investment framework. Health Policy Plan. 2017 Jun;32(5):657–68. Available from: https://doi.org/10.1093/heapol/czw184.
United Nations. The Sustainable Development Goals Report. 2021. Available from: https://unstats.un.org/sdgs/report/2024/.
Health Ministry Republic of Indonesia. Indonesian Basic Health Survey 2013. 2013.
Health Ministry Republic of Indonesia. Indonesian Basic Health Survey 2018. 2018;
Health Ministry Republic of Indonesia. Survey of Nutritional Status 2022. 2022. 1-154 p. Available from : https://drive.google.com/file/d/1tZuQNyUaKe0i_kyj1nbYx7aNo7KWjNZ8/view.
Bisits Bullen PA. The positive deviance/hearth approach to reducing child malnutrition: systematic review. Tropical Medicine & International Health. 2011 Nov 12;16(11):1354–66. Available from: https://doi.org/10.1111/j.1365-3156.2011.02839.x.
Rose AJ, McCullough MB. A Practical Guide to Using the Positive Deviance Method in Health Services Research. Health Serv Res. 2017 Jun 28;52(3):1207–22. Available from: https://doi.org/10.1111/1475-6773.12524.
Copyright (c) 2025 Journal of Public Health and Pharmacy
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Journal of Public Health and Pharmacy retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Journal of Public Health and Pharmacy.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
