Effectiveness of a nurse-led early stimulation and parenting programme for neurodevelopment among toddlers at risk of stunting: A quasi-experimental study
Abstract
Background. Stunting remains a major public health challenge in low- and middle-income countries (LMICs), including Indonesia, with consequences extending beyond linear growth deficits to impaired neurodevelopment. Although early stimulation and parenting interventions have been shown to improve neurodevelopmental outcomes and mitigate these effects, few studies have evaluated structured, nurse-led programmes targeting toddlers at risk of stunting. Objective. To assess the effectiveness of a nurse-led early stimulation and structured parenting education intervention on neurodevelopment among toddlers at risk of stunting. Methods. This quasi-experimental pretest–post-test control group study involved 200 toddlers aged 36 months in Tangerang Regency, Indonesia. There were 100 participants in the intervention group and 100 in the control group. The intervention group received six weekly nurse-led sessions incorporating play-based stimulation and parenting education, while the control group received routine care. The Bayley‑III Scales of Infant and Toddler Development were used to measure neurodevelopmental outcomes, which were analysed using ANCOVA and multiple linear regression. Results. Postintervention, the intervention group showed significantly higher adjusted scores across all Bayley‑III domains, namely cognitive (F=20.21; p<0.001; η²=0.093), receptive language (F=18.64; p<0.001; η²=0.087), expressive language (F=17.82; p<0.001; η²=0.083), fine motor (F=21.47; p<0.001; η²=0.098) and gross motor (F=24.10; p<0.001; η²=0.109). Regression analysis revealed that pretest scores (p<0.001) and session attendance (p<0.05) were significant predictors of post-test outcomes, while maternal education and child’s age were not. Conclusion. Nurse-led early stimulation and parenting interventions were associated with significant improvements in neurodevelopmental outcomes among toddlers at risk of stunting. This model could be integrated into primary healthcare services and may provide a scalable approach to addressing developmental delays in LMICs.