Social and Behavior Change Communication Framework

Abstract

The Social and Behavior Change Communication (SBCC) framework is an approach used to influence and improve public health behaviors. This framework integrates principles of communication theory and social psychology to create more effective messages for behavior change. There are four stages in the SBCC framework: First, situational analysis involves collecting and analyzing data about the health behaviors that need to be changed. Second, planning and strategy is a continuation of the situational analysis, where the next step is to plan and select the appropriate communication strategy to achieve the desired goals. This strategy may involve delivering messages through mass media, information campaigns, or individual interventions. Third, message and communication material development involves developing relevant and appealing messages and communication materials for the public. Messages should be designed while considering social and cultural factors, language used, and media preferences used by the public. Fourth, evaluation is used to assess the effectiveness of messages and strategies used. Evaluation can be done by measuring changes in health behavior, public awareness of specific health issues, and factors that influence behavior. In health communication, the SBCC framework can help to increase public awareness of health issues, motivate them to change unhealthy behaviors, and encourage healthier behavior.

1. Introduction

The problem of stunting persists in the world and poses a significant obstacle in attempts to attain optimal child welfare and development [1, 2]. Stunting, also known as stunted growth, happens when a child does not reach the physical growth that should occur at a specific age, resulting in him being shorter than the average child his age [3].

Stunting is common in many countries, especially underdeveloped countries and Indonesia and is an indicator of unresolved health and nutrition issues [4]. Stunting has substantial long-term consequences, including lower cognitive ability and intellect, increased risk of chronic disease in maturity, and diminished children’s future potential for personal achievement and prosperity [5].

Although stunting rates have decreased in some nations in recent years, the obstacles that remain in combating stunting are complicated and varied. The main reasons of high stunting rates are malnutrition, insufficient food, restricted access to health services and clean water, poor sanitation, poverty, and socioeconomic inequality [4]. Stunting is also linked to poor feeding habits, such as not providing newborns with exclusive breastfeeding, not offering healthy supplementary foods after six months of age, and a lack of diversity and quality of food in a child’s diet. Diet and child care are also influenced by social, cultural, and economic factors, which might increase the risk of stunting [6].

Overcoming the stunting problem is a complex endeavor that necessitates a multi-sectoral approach, institutional collaboration, and a strong commitment from the government, civil society organizations, the commercial sector, and society as a whole. Stunting efforts must be supported by policies that emphasize balanced nutrition, accessible and high-quality health care, and changes in people’s behavior toward healthy eating practices.

Stunting is still a pressing issue in human development and world health. By recognizing the importance of addressing stunting and raising awareness of its long-term consequences, it is hoped that a stronger commitment and action may be taken to provide children with the protection and assistance they require to grow and develop properly [6].

From the standpoint of communication studies, one solution to addressing stunting is to present a holistic and integrated approach, including the use of the Behavior Change Communication Framework, which is a strategy that combines aspects of communication and behavior change to achieve the desired social change goals. Social Behavior Change Communication Framework is an excellent strategy for changing people’s ideas, attitudes, and behavior toward balanced nutrition, good feeding, and optimal infant care in the context of combating stunting.

Indonesia has a distinct cultural, socioeconomic, and geographical variety. As a result, the Social Behavior and Change Communication (SBCC) that is adopted must take these contextual distinctions into account and build a communication strategy that is tailored to the peculiarities of the Indonesian people. The SBCC strategy is intended to raise awareness of the need of balanced nutrition and stunting prevention, as well as to encourage people to adopt behaviors that promote optimal growth and development. SBCC works with a variety of partners in Indonesia to combat stunting, including the government, health institutions, civil society, and the commercial sector. Collaboration among all of these stakeholders is critical in order to maximize efforts to combat stunting through an effective and coordinated communication approach [7].

In this chapter, we will examine further the implementation of SBCC in dealing with stunting in Indonesia. This approach is expected to provide better insight into appropriate communication strategies, effective communication channels, and stronger community involvement in stunting prevention efforts. The results of this research are expected to be a reference for policymakers and practitioners in designing and implementing effective and sustainable stunting prevention programs in Indonesia.

2. Stunting cases in Indonesia

In 2020, there will be 149.2 million stunted, 45.4 million wasting, and 38.9 million overweight children worldwide. Except for Africa, all areas are seeing a decrease in the number of children with stunting. Asia as a whole is home to more than three-quarters of all children with severe wasting, and more than half of all children affected by wasting live there. At the national level, the stunting target is where countries are making the most success, with over two-thirds of them observing at least some improvement. In contrast, the majority of nations have either made little progress or worsened when it comes to the obesity [8].

As shown in Figure 1, globally, there has been improvement in the rates of chronic undernourishment and linear growth stunting in children under the age of five; however, these rates are still high in many areas. The growth and development of children may be enhanced by policies, programs, and interventions that support maternal and child health and nutrition. Data from the Indonesian Ministry of Health, one in three of the country’s nine million children were stunted in 2018 [9, 10]. The Delivery of Additional Food program is then used nationwide to carry out the government’s objective to combat stunting. This program delivers healthy biscuits to toddlers and pregnant women, with a special emphasis on undernourished toddlers. In underdeveloped nations, stunting in toddlers is closely linked to hunger because chronic malnutrition affects the prevalence of stunting. Height and body weight can be used to assess growth and development, which can have an impact on both physical and psychological growth and development in toddlers [11]. To prevent stunting in children, dietary supplementation is, therefore, crucial during the toddler years.

Figure 1.

Global overview of stunting [9].

By 2025, Indonesia aims to achieve its Sustainable Development Goal of a 40% reduction in stunting. Analyzing the dietary intake of children under the age of five hence requires more investigation. A critical time for a child’s growth and development is when they are newborns and young infants to toddlers. The growth of the child’s body and mind will be stunted by stunting situations [12, 13]. Stunting is typically brought on by children’s inadequate nutritional intake, which is linked to diet and infection [14, 15]. One of the research-based risk factors for stunting indicates that environmental sanitation outcomes, such as the accessibility of latrines and the quality of drinking water, carry a higher risk [16, 17]. Lead exposure is linked to a number of nutritional deficiencies, which ultimately stunts children’s neurodevelopment [18]. Children who consume contaminated food and are exposed to environmental toxins like metals are, especially susceptible to poor nutrition absorption. Stunted growth is one common sign of a nutritional deficiency and happens when a child’s height (or length) for that age falls below the 5th percentile [17].

The previous research showed that stunted conditions (22%) with a z score of 3 to 2 standard deviations (SD), followed by severely stunted circumstances (8%) with a z score of 3 SD, dominated the evaluation of the stunting status of children under five in 2021. The study showed that the condition of stunting was not caused by environmental causes. However, it was thought that drinking boiled water increased the risk of stunting. Additionally, our data demonstrated a correlation between the state of stunting and exclusive breastfeeding, which supplied a protective factor for stunting in toddlers [19].

Ambitious international nutrition goals have been established during the current Sustainable Development Goals era. The World Health Assembly set the goal of reducing stunting in children under the age of five by 40% by 2025 as one of its objectives. According to the World Health Organization, stunting is the decreased growth and development of children as a result of inadequate nutrition, frequent infections, and insufficient psychosocial stimulation. If a child’s height for age is less than −2 standard deviations from the WHO Child Growth reference, they are considered stunted. Though the overall number of stunted children has reduced, there are still 150 million of them in the globe under the age of five. This figure represents a tiny portion of the kids whose linear growth is being slowed down for a variety of reasons. The main focus is on supporting breastfeeding, complementary feeding, and anti-infection measures for kids. All of these are crucial for a child’s health and survival, yet they have little to no impact on stunting. Adolescent females’ health and nutrition must be promoted through action. Often, the first pregnancy occurs too early.

As shown in Figure 2, The Sustainable Development Goals Report 2022 provides a global overview of progress on implementation of the Agenda for Sustainable Development, using the latest available data and estimates. Prenatal nutrition is required in cases of food insecurity, along with other prenatal or early pregnancy interventions. “Reducing the burden of stunting requires a paradigm shift from interventions focusing solely on children and infants to those that reach mothers and families and improve their living environment and nutrition,” the authors of the Danaei research write in their conclusion.

Figure 2.

The sustainable development goals report 2022 [20].

Indonesia’s COVID-19 epidemic has had an effect on a number of areas, including the economy, education, and other facets of communal life, such as health issues. Despite being quite a heavy burden on the health sector, the government’s various efforts to foresee the effects of the COVID-19 pandemic, particularly for vulnerable populations like pregnant women and young children, have produced quite encouraging results as the issue of stunting in Indonesia has decreased over the past two years. This evaluation of toddler nutrition status is also strongly related to the key objectives of the Healthy Indonesia Program in the 2020–2024 National Medium-Term Development Plan (NMTDP), namely enhancing the nutritional and health status of Indonesian children.

The national stunting rate has reduced by 1.6% every year, from 27.7% in 2019 to 24.4% in 2021, according to the findings of the 2021 SSGI [21]. Only 5 of the 34 provinces show a rise from 2019 while the majority of them show a fall. This demonstrates that the government’s efforts to reduce stunting in Indonesia have shown some promising results. The Health Research and Development Agency of the Ministry of Health’s SSGI 2021 study not only gives an overview of toddlers’ nutritional status, but it can also be used as a tool for tracking and assessing the success of sensitive interventions and specific intervention indicators that have been implemented at the national and district/city levels starting in 2019 and lasting until 2024. At the moment, stunting is more common in Indonesia than in Myanmar (35%), although it is still more common than in Vietnam (23%), Malaysia (17%), Thailand (16%), and Singapore (4%).

Over the previous 10 years, Indonesia has maintained a high frequency of child stunting, which currently stands at about 37% nationwide. Uncertainty exists over the alignment of Indonesia’s current child stunting prevention strategies with the available scientific data. We examine the available literature using the World Health Organization conceptual framework on child stunting to determine what has been examined, what can be said about the causes of child stunting in Indonesia, and where data gaps still exist [1]. Consistent evidence indicates that factors contributing to child stunting in Indonesia include nonexclusive breastfeeding for the first six months, low household socioeconomic position, early birth, short birth length, and low maternal height and education.

Figure 3 shows that the prevalence of stunting in children aged 0–59 months who live in homes with unimproved restrooms and untreated water are also more at risk throughout one decade. Child stunting has frequently been linked to neighborhood and socioeconomic problems, specifically a lack of access to health care and living in rural areas. There are not many published research on how education, society, culture, food production, water, sanitation, and the environment affect child growth. This thorough review of the research on the factors that influence child stunting in Indonesia identifies at-risk groups, effective interventions, and areas in which additional study is required to close knowledge gaps. According to the WHO framework, household and family factors, inadequate complementary feeding (poor quality foods, inadequate practices, and food and water safety), breastfeeding (inadequate practices), and infection (clinical and subclinical infection) are the main factors that contribute to child stunting. It classifies comparable contextual variables into the following subelements: political economics; health and health care; education; society and culture; agricultural and food systems; and water, sanitation, and environment. It also classifies contextual components into the general category of community and societal factors.

Figure 3.

Prevalence of stunting (%) in children 0–59 months by district in 2013.

Stunting-risk family-based interventions are developed as a result of the accelerated program to reduce stunting, with an emphasis on preparing for parenthood, ensuring a healthy diet, improving parenting, expanding access to and improving the quality of health services, and expanding access to drinking water and sanitation. Monitoring and evaluation, the fifth pillar of the National Strategy for Stunting, is seen as critical and crucial in the quest to understand the effects of interventions on stunting prevention and control. This is anticipated to help lessen the issue of stunting in Indonesia in general and in priority districts/cities in particular [21]. Although the prevalence rate is currently below 20% in some places, it still falls short of the 14% target set by the NMTDP for 2024. Even though 14% has been met, stunting still exists in Indonesia. The next goal is to lower the stunting rate to a low category or below 2.5%.

3. The role of social behavior and change communication

SBCC (Social and Behavior Change Communication) is a method of changing behavior and social practices in order to improve society’s health, well-being, and progress. To achieve the desired change, SBCC integrates components of communication, behavior modification, and community participation [22].

The major purpose of SBCC is to positively influence and modify individual and group behavior. This is accomplished through the delivery of clear, relevant, and convincing messages, as well as the creation of an atmosphere conducive to behavior change. SBCC is a two-way process in which message recipients and message senders communicate continuously [23].

Social and Behavior Change Communication plays a critical role in dealing with stunting through lobbying, social mobilization, and education to achieve the behavior change required for preventing and overcoming stunting. The following is a detailed explanation of the SBCC’s role in this context:

Advocacy: SBCC advocacy focuses on influencing policy, funding allocation, and support from key stakeholders. SBCC may express essential messages about stunting to policymakers, government agencies, and donor agencies through advocacy, with the goal of increasing awareness of the malnutrition problem, pushing necessary policy changes, and increasing financing for stunting treatment [24].

SBCC advocacy also includes working with civil society organizations, advocacy groups, and other stakeholders to raise awareness and demand for stunting. SBCC can use this strategy to promote policy changes, advocate for proper financial allocation, and create frameworks that support effective nutrition programs.

• Social mobilization entails actively involving the community in changing behavior and practices that promote stunting prevention. To engage and motivate the community to take steps that lower the risk of stunting, SBCC employs a communication approach that includes public campaigns, lectures, group discussions, and other participation activities. SBCC can raise public knowledge about the need of balanced nutrition and effective feeding habits, such as exclusive breastfeeding, timely supplemental feeding, and infant growth monitoring, through social mobilization. SBCC can also promote active community participation in existing nutrition programs, facilitate groups of mothers and families to share information and experiences, and gain community support for good change.

• Education is a crucial component of SBCC in combating stunting. Through education, SBCC provides people, families, and communities with accurate and relevant information on nutrition, child growth and development, and stunting prevention techniques. SBCC education includes learning about balanced nutrition, the importance of exclusive breastfeeding, the introduction of appropriate solid meals, and the importance of paying special attention to children’s nutrition. Furthermore, teaching entails imparting motivational and inspirational messages about the positive effects of healthy dietary habits and the harmful repercussions of stunting. SBCC education also focuses on developing practical skills such as cooking, food selection, and how to evaluate children’s growth. SBCC can help communities understand the importance of behavior change and provide the tools and methods needed to implement good nutrition habits in everyday life by using an interactive and participatory educational approach. SBCC teaching also helps to dispel myths and incorrect assumptions about nutrition and stunting. SBCC can influence people’s attitudes and ideas through correct information and an effective communication technique, allowing them to adopt healthier nutritional practices and prevent stunting.

4. SBCC intervention in stunting management

SBCC interventions (Social and Behavior Change Communication) are communication methods and activities that try to change people’s behavior, attitudes, and practices in order to improve their health, well-being, and quality of life [22]. SBCC interventions aim to address social and health issues by disseminating information, changing views, raising awareness, and pushing individuals and communities to adopt healthier habits. SBCC intervention entails employing an effective communication strategy, either verbal or nonverbal messages, to achieve the targeted behavior change [25]. This is accomplished by comprehending and respecting the intended target group’s requirements, beliefs, culture, and social context.

SBCC interventions aim to promote long-term behavior change by affecting individuals’ and society’s knowledge, attitudes, norms, beliefs, and skills. This can involve health promotion, nutrition improvement, contraceptive use, sanitation behavior modification, disease control behavior, and other activities. SBCC intervention also entails determining the best communication channels, such as mainstream media, social media, formal and non-formal education, individual counseling, discussion groups, and mass communication campaigns. SBCC interventions use an integrated strategy to achieve a significant impact in enhancing people’s welfare and addressing many social and health challenges [26].

Interventions in tackling stunting involve a series of communication efforts aimed at changing behavior and practices related to nutrition and child care. SBCC interventions in handling stunting, especially in Indonesia, as shown in Figure 4.

Figure 4.

SBCC intervention in handling stunting.

According to Figure 4, the components of SBCC intervention in handling stunting from the smallest part is from the individual level and the largest part is based on political system. All of the levels are explained as follows:

4.1 Individual level

At the individual level, SBCC interventions in handling stunting aim to change the behavior and practices of individuals and family members that have a direct impact on nutrition and child care [27]. The following describes SBCC interventions at the individual level:

• Counseling and Education: Through counseling and education, individuals, especially pregnant women, nursing mothers, and other family members, are given appropriate information about the importance of good nutrition and child care. This counseling can be carried out by health workers or competent nutrition service providers. They provide support and one-on-one guidance to individuals, helping them understand healthy practices that are important in stunting management.

• Personal Approach: Through a personal approach, SBCC interventions at the individual level can be tailored to the unique needs and situation of the individual or family. This approach includes intensive and ongoing communication between service providers and individuals, allowing individuals to share their problems, questions, and concerns face-to-face. With this approach, service providers can provide more personalized support and assist individuals in adopting appropriate nutrition and child care practices.

• Child Growth Monitoring: SBCC interventions at the individual level also involve the importance of regular monitoring of child growth. Individuals are given an understanding of how to monitor children’s growth, such as measuring weight, height, and head circumference. This information assists the individual in quickly identifying a child’s growth problem and seeking medical attention if needed.

• Education on Exclusive Breastfeeding: One of the main focuses at the individual level is to provide education about the importance of exclusive breastfeeding during the first six months of a child’s life. Individuals are given information about the benefits of breastfeeding for the growth and development of children, as well as the right way to give exclusive breastfeeding.

• Healthy and Balanced Feeding Practices: SBCC interventions at the individual level also aim to increase understanding and adoption of healthy and balanced feeding practices in children. Individuals are given information about nutritious food, the right portion, the frequency of feeding, and the introduction of appropriate complementary foods when the child reaches the appropriate age.

Through SBCC interventions at the individual level, it is hoped that individuals and family members can obtain accurate knowledge, understand healthy practices, and implement the necessary behavioral changes to ensure optimal nutrition and care for children.

4.2 Family level

SBCC intervention at the family level aims to give family members with information, education, and assistance in the prevention of stunting. Families can grasp the importance of balanced nutrition and excellent feeding practices for children’s growth and development through effective communication. Messages were distributed to raise awareness of the need of nutrition in the first 1000 days of life, from conception to the age of two.

At the family level, SBCC interventions can include nutritional advice, healthy eating behaviors, exclusive breastfeeding, the introduction of suitable solid meals, and effective child care practices. Families are also encouraged to frequently evaluate their children’s growth, adhere to immunization regimens, and deal with nutritional issues on a proactive basis.

SBCC interventions at the family level also include psychosocial support and the enhancement of parental abilities in coping with child nutrition issues. Interpersonal contact between parents and children is improved in order to foster a positive atmosphere that is responsive to the needs of children. It is envisaged that the SBCC intervention at the family level will result in behavioral changes such as increased frequency of appropriate and balanced nutrition feeding, exclusive breastfeeding, and increased attention to children’s health and nutrition. Stunting prevention programs can be more effective and long-lasting with active family participation.

4.3 Community level

SBCC interventions at the community level include a variety of activities and communication tactics geared at specific groups of people with significant social contacts and cultural ties. The primary purpose is to raise awareness, change attitudes, and support activities that can help avoid stunting.

Interventions at the community level can include health education, group discussions, awareness campaigns, and participatory activities engaging community members in the context of dealing with stunting. The messages provided in this intervention will be tailored to the cultural context, language, and local requirements of the community so that they are properly received.

Furthermore, SBCC interventions at the community level might include the active participation of community leaders or community leaders with influence within their circles. These individuals can serve as change agents by informing community members about the importance of balanced diet and stunting prevention.

Collaborative efforts with numerous local stakeholders, such as community organizations, NGOs, health personnel, and educational institutions, are also critical during community interventions. This collaboration has the potential to improve the implementation of SBCC treatments, broaden the breadth of messaging, and establish a community atmosphere that encourages desirable behavior change.

SBCC interventions at the community level are critical in building an environment that promotes stunting prevention and long-term behavior modification. It is intended that through enlisting the active participation and involvement of community people, common awareness, social support, and good norms linked to balanced nutrition and optimal infant care will be established in order to avoid stunting.

4.4 School level

SBCC interventions at the school level entail efforts to communicate relevant messages about healthy nutrition and stunting prevention to kids, teachers, and parents in the school setting. Here are some examples of SBCC interventions that can be implemented at the school level:

• Health Education: Health education initiatives in schools can focus on healthy diet and stunting prevention. This could be a lecture, seminar, or workshop that informs youngsters on the need of balanced diet and healthy eating practices. These messages can also emphasize the significance of exclusive breastfeeding, the proper introduction to solid meals, and other preventive actions.

• School Campaigns and Activities: Schools can initiate programs focusing on good nutrition and stunting prevention. They can, for example, arrange poster contests, theater performances, or other creative activities to improve students’ knowledge of the necessity of nutritious food and healthy lifestyle choices. These types of activities can include kids, teachers, and even parents to encourage active engagement and good behavior modification.

• Healthy School Canteens: Schools can develop healthy canteen policies to meet the nutritional needs of their kids. This involves providing nutritious food and beverages, supporting local and organic foods, and avoiding foods rich in sugar and saturated fat. Messages regarding the benefits of eating nutritious foods and developing excellent eating habits can also be displayed in the canteen.

• Parental Involvement: By hosting specific meetings or communication sessions, schools can involve parents in SBCC interventions. On this occasion, parents can be given information about healthy nutrition and stunting prevention, as well as assistance and guidance on proper feeding methods and the importance of living a healthy lifestyle. Stunting prevention advocacy can also benefit from increased collaboration between schools and parents.

SBCC’s school-based programs aim to provide an educational environment that promotes health and stunting prevention. This intervention can give knowledge, impact attitudes, and support good behavior changes in terms of healthy nutrition and stunting prevention in the school setting by including kids, teachers, and parents.

4.5 Workplace level

SBCC interventions in the workplace include efforts to raise workers’ understanding and practice of health, as well as efforts to build work environments that promote health and stunting prevention. Here are some examples of SBCC initiatives at this level:

• Health Education: Workplace health education programs can be held to enlighten employees about the importance of balanced diet and stunting prevention. Trainings and workshops on issues such as exclusive breastfeeding, healthy feeding practices, and the necessity of appropriate child care can be organized. These messages can be delivered in the workplace through presentations, printed materials, or movies.

• Health Promotion: SBCC activities may also include workplace health promotion initiatives. Posters, pamphlets, or messages on internal media, for example, can be used to remind employees about the need of balanced diet and stunting prevention methods. Workplace arrangements that promote access to nutritious food and provide separate areas for breastfeeding or storing breast milk might also be encouraged.

• Employee Involvement: Involving employees in the formulation and implementation of health programs is an important part of SBCC interventions at the workplace level. Workers can contribute to program design and provide input on their needs and preferences using the participatory approach. Setting up workplace health committees or designating health leaders among employees could be examples of this.

• Community Support: The workplace can serve as a community where employees interact socially and support one another. SBCC interventions could take advantage of this by developing support groups or community-based activities in the workplace that promote good nutrition and stunting prevention. Workers can share information, experiences, and incentive to maintain excellent health and nutrition in this setting.

• Monitoring and Feedback: SBCC interventions at the workplace level may also include health-related monitoring and feedback systems. Regular nutritional status assessments or child development monitoring programs, for example, can be implemented to ensure personnel understand and follow desired health practices. Regular feedback to employees and management can encourage good behavior change.

4.6 Religious level

SBCC religious interventions involve collaboration with religious leaders and community leaders who play crucial roles in the community. The goal is to deliver messages about balanced nutrition and stunting prevention by employing societal religious values and religious beliefs. The SBCC intervention uses this strategy to promote positive and long-term behavior change in the community.

A variety of activities can be carried out as part of the SBCC intervention at the religious level, such as incorporating nutrition and stunting issues into religious lectures, recitations, or sermons in places of worship. Important messages regarding the necessity of balanced diet and stunting prevention methods can be transmitted by employing community-relevant allusions and holy texts.

Furthermore, small group conversations with religious and community leaders can be arranged to address the role of religion in dealing with stunting. Through open and participatory discourse, awareness, and greater understanding of religion’s crucial role in supporting proper nutrition and preventing stunting can be established.

SBCC religious involvement may also include engagement with religious institutions such as religious-based religious groups, foundations, or social institutions. Through this collaboration, nutrition and stunting prevention health education programs can be linked into social activities such as social service activities, fundraisers, or support programs for persons in need.

SBCC intervention at the religious level is expected to influence behavior and rally societal support. This intervention can harness the power of religious principles in promoting healthy diets, sound nutritional practices, and the role of families and communities in stunting prevention by involving religious leaders and community leaders as change agents.

4.7 Healthcare facility level

Communication and techniques are focused at health professionals and health facility management at the Health Facility (Faskes) level [28]. The goal is to improve their understanding, abilities, and behavior in providing effective stunting management health services.

• Health Workers Training: Health workers in health facilities can obtain stunting management training and capacity building. This training may involve an understanding of stunting, risk factors, early detection, child growth monitoring, and optimal feeding practices. SBCC can also be used in this training to highlight the importance of their involvement in detecting and delivering early intervention for stunting.

• Monitoring and Feedback: SBCC can be used to improve child growth monitoring in health care institutions. Health practitioners can explain the importance of correctly measuring and recording children’s growth by using clear and consistent messages. They can also give parents feedback on their child’s development and make recommendations for nutritional improvements or interventions as needed.

• Educational materials and information: SBCC at the Faskes level can entail providing health staff and parents with suitable educational materials and information. This material could contain health care recommendations, pamphlets, posters, or booklets about balanced nutrition, proper feeding practices, and stunting prevention strategies. Health workers can help parents realize the importance of their participation in avoiding stunting by providing clear and easy-to-understand information.

• Counseling and Support: SBCC at the Faskes level can also involve parent and family counseling and support. Health professionals can advise on appropriate eating habits, breastfeeding, when to introduce solid meals, and proper feeding techniques. Furthermore, emotional and motivational assistance can be provided to ensure that families are actively participating in stunting prevention.

• SBCC intervention at the Health Facility level is critical for delivering quality health services and successful stunting prevention. Through effective communication and the correct methodology, health workers can become change agents in the fight against stunting at the individual and family levels.

4.8 Food industry level

The goal at the food industry level is to encourage food makers and retailers to produce, distribute, and promote nutritious food. These interventions include communications to food sector players such as manufacturers, retailers, and food companies [29].

One strategy for SBCC interventions in the food business is to communicate messages that inspire positive changes in food production and promotion practices. To raise knowledge about the need of balanced nutrition and its impact on stunting, communication initiatives might be established. These messages should include enhancing food product nutritional quality, reducing salt, sugar, and saturated fat, and increasing the availability and marketing of healthy foods, particularly for youngsters.

Food sector intervention could also entail the development of nutritional guidelines or standards for food goods produced and marketed in Indonesia. Working with health authorities and regulatory bodies to promote policies that support the adoption of better dietary guidelines is a part of this. SBCC interventions at this level could focus on the role of responsible advertising and promoting healthy food as a better choice in terms of promotion and marketing.

Furthermore, SBCC engagement in the food business might drive product innovation and the development of nutrient-rich functional meals. Effective communication can be utilized to raise the food industry’s awareness of children’s nutritional needs and encourage collaborative efforts to create better, stunting-prevention products. Because it can alter the availability and accessibility of healthy food in the market, SBCC involvement at the food industry level is a crucial step in attempts to combat stunting. It is thought that through modifying the food industry’s behavior and methods, it will be possible to establish a food environment that is more supportive of child development and avoid stunting in Indonesia.

4.9 Technology and innovation level

At the level of innovation and technology, it entails using technology and innovation as a tool to communicate messages about health and behavior change to the general public. It seeks to promote comprehension, awareness, and good choice making [30].

SBCC interventions at the level of innovation and technology may involve employing mobile applications, text messages, digital platforms, or social media to deliver health information and education to parents or caregivers of children in the context of tackling stunting. Technology can also be utilized to provide reminders and assistance in the adoption of appropriate nutrition practices and the avoidance of stunting. Parents, for example, can receive nutrition, parenting, and good eating practices information via a mobile app.

This program can also serve as a reminder for feeding schedules and trips to medical institutions, as well as practical advice on appropriate food choices. As a result, technology can facilitate access to important information and encourage positive behavior change [31].

Furthermore, digital platforms like social media can be used to disseminate campaigns and information about healthy nutrition and stunting prevention. These messages can reach a wider audience through interesting and simple material, particularly among the younger population and young mothers who use social media. Online conversations, forums, or virtual support groups can also be developed to enable the exchange of information and experiences among parents or families who are worried about child nutrition or have stunting concerns.

SBCC interventions that are innovative and technological in nature have the ability to reach a larger audience and provide better accessibility to the community. However, it is critical to address the digital gap that may exist in specific areas or among certain categories of people. In this scenario, initiatives must be taken to guarantee that all sectors of society have access to and successfully utilize technology in order to combat stunting.

4.10 Finance and donor level

SBCC’s interventions at the funding and donor levels aim to mobilize the support and resources needed to tackle stunting [32]. At this level, strategic communication and advocacy is used to engage financial institutions and donors in understanding stunting issues, the importance of preventive action, and the urgent need to address the problem of malnutrition among children in Indonesia.

SBCC interventions at the financial and donor levels entail delivering compelling messages and persuading them to participate in existing nutrition programs or offer more cash for stunting initiatives. These messages contain information regarding the long-term effects of stunting on child growth and development, as well as the consequences for human resource quality and overall country development [33].

Furthermore, interventions at the financing and donor levels include effective communication to stakeholders such as international financial institutions, donor organizations, and appropriate government agencies about nutrition issues. This is intended to motivate them to invest resources and take measures compatible with the goals of dealing with stunting.

SBCC interventions at the financing and donor levels also include advocacy, whether through meetings, presentations, or continuing discussion. The goal of this lobbying is to influence policies and budget allocations at the national and international levels so that stunting is prioritized and adequately funded.

To achieve the goals of SBCC interventions at the funding and donor levels, it is critical to collect robust data and evidence about the positive impact of nutrition interventions on society, as well as to provide regular reports and evaluations on the use of funds and the outcomes of the programs implemented. This will boost donor and financial institution trust and involvement in efforts to combat stunting in Indonesia.

4.11 Political and system level

SBCC interventions at the political and system levels are aimed at modifying policies, regulations, and service delivery mechanisms to support stunting prevention. At this level, the SBCC can lobby policymakers to boost stunting handling priorities and expenditures, develop regulatory frameworks for nutrition and child care, and ensure collaboration between agencies and associated sectors [34]. The goal is to establish an enabling environment in society for behavior change and sustainable practices. Some approaches that can be employed in SBCC interventions are as follows:

• Education and Information: Provide individuals, families, and communities with accurate and relevant information about healthy nutritional practices and effective child care. This can be accomplished through education, communication campaigns, flyers, and other forms of media.

• Counseling and Personal Approach: Enlisting the help of healthcare specialists to give nutrition counseling and care to people and families. Personal therapy might be provided to provide more intensive assistance and motivation.

• Public Relations Campaign: Using mass media such as television, radio, and social media to communicate vital nutrition and child care information to the larger population. To boost the appeal and impact of the message, this campaign might be supplemented with testimonials from prominent figures or celebrities.

• Using Local Culture: Using local culture to transmit SBCC messages. This can be accomplished through the use of traditional art, folklore, or local festivals that can draw attention and affect social standards in society.

• Policy Change and Advocacy: Advocating for policymakers to prioritize and promote stunting elimination. Sharing scientific evidence, conducting meetings and campaigns, and partnering with appropriate organizations and institutions to promote laws and regulations that support stunting reduction are all part of this effort.

• The goal of SBCC’s stunting prevention intervention in Indonesia is to establish an environment that promotes healthy nutrition and child care practices, as well as to raise individual and community awareness, knowledge, and skills in dealing with stunting. This intervention, with the involvement of numerous stakeholders, is predicted to have a substantial impact on reducing stunting rates and enhancing the quality of life for children in Indonesia.

To achieve the goals outlined, the SBCC stunting strategy must be implemented through a staged method based on the SBCC model and planning principles [35]. This method is founded on evidence and a vision for a participative and long-term effort that incorporates all parties involved in dealing with stunting [36]. The steps that can be taken can be seen in Table 1 below:

Stages	Description
Situation analysis	This stage involves an in-depth analysis of the situation related to the issue to be resolved. The purpose of the situational analysis is to understand the factors influencing behavior and practice regarding the issue, and to identify the target group to address. Situation analysis includes the collection of data and information, and the use of various research tools and methods to gain a comprehensive understanding of the context and characteristics of the target group.
Setting goals and targets	This stage involves setting clear and measurable goals and objectives for the SBCC program. These goals and objectives must be specific, measurable, achievable, relevant, and time-limited. In setting goals and objectives, various factors such as the level of awareness, knowledge, attitudes, and behavior that need to be changed are carefully considered.
Strategy design and development	This stage involves designing a strategy that will be used in the SBCC program. An effective strategy must be based on a deep understanding of the target group, context, and factors influencing behavior. Strategies can cover a variety of approaches such as media campaigns, individual counseling, training, discussion groups, etc. Strategy design also involves selecting appropriate messages, communication channels, and identifying suitable evaluation methods.
Material development and communication tools	This stage involves developing materials and communication tools that will be used in the SBCC program. Communication materials and tools must be adapted to the target group and the intended context. This includes creating messages that are attractive, clear, and appropriate to the needs of the target group, as well as selecting the right communication channels to reach the target group effectively.
Implementation	The implementation phase involves implementing the SBCC program according to a predetermined plan. This includes distribution of communication materials, delivery of messages, training, counseling, and various other activities that have been planned in the strategy. Implementation must be done with care, ensuring that the message is conveyed correctly, interaction with the target group occurs, and the necessary support is provided.
Monitoring and Evaluation	Monitor and evaluate the implemented SBCC program, to monitor progress, measure results, and make adjustments if necessary.

Table 1.

SBCC model and planning principles.