DOI : http://dx.doi.org/10.21776/ub.jik.2023.011.02.01 p-ISSN: 2829-7075 Website : http://www.jik.ub.ac.id
@JNSU. This is an open access article under the CC BY-NC 4.0 license
109 Original Research
The Relationship Between Mothers’ Characteristics and Mothers’ Level of
Knowledge About Children’s Diet in Overweight Children With A Risk of Diabetes Mellitus in An Elementary School in Tangerang
Aunike Paquita Tehuajo1, Rachel Aprilia Leviana2, Yoela Damayanti3, Maria Maxmila Yoche Arkianti4, Erniyati Fangidae5*
1,2,3,4,5Faculty of Nursing, Universitas Pelita Harapan
*Corresponding author:
Erniyati Fangidae
Faculty of Nursing Universitas Pelita Harapan
Jl. Vila Permata No.42, Bencongan, Kec. Klp. Dua, Kabupaten Tangerang, Banten 15810 Email: [email protected]
How to cite this article: Tehuajo, A. P., Leviana, R. A., Damayanti, Y., Arkianti, M. M. Y., & Fangidae, E.
(2023). The Relationship Between Mothers’ Characteristics and Mothers’ Level of Knowledge About Children’s Diet in Overweight Children With A Risk of Diabetes Mellitus in An Elementary School in Tangerang. Journal of Nursing Science Update, 11(2), 109–116.
Article Info ABSTRACT
Article History:
Received 8 February 2023 Revised 23 November 2023 Accepted 28 November 2023
Diabetes Mellitus (DM) is a disease characterized by high blood sugar levels that could occur in school-age children. One of the risk factors of DM is being overweight, which is influenced by an unbalanced diet.
Good knowledge of mothers in providing good nutritional intake to overweight children can reduce the risk of DM in children. This study aims to identify the relationship between mothers’ characteristics (age, occupation, education level, exposure to information from mass media, and family history of DM) and mothers’ level of knowledge about the diet of overweight children with the risk of DM in children aged 6-12 years in an elementary school in Tangerang. This study used a descriptive quantitative method with univariate and bivariate analysis. A purposive sampling of 31 mothers with overweight children was involved. The research instrument was a questionnaire measuring the mothers' level of knowledge about the diet of overweight children with a risk of DM. The results showed that only education level revealed a relationship with mothers’ level of knowledge (p-value <0.05), while other characteristics indicated no relationship (p-value > 0.05). Increasing mothers ‘knowledge about healthy diets for children can be obtained from formal education, but non-formal education also plays an important role. Schools can reach out to health units to provide health education about the diet of school-age children and provide a clean and healthy canteen. Further research should identify other factors influencing the mother's knowledge level.
Keywords:
Children Diet
Mother's Knowledge Overweight
Risk of DM
110 Introduction
Diabetes Mellitus (DM) is a non- communicable disease caused by metabolic disorders characterized by a high level of sugar in the blood because of impaired insulin function, which is a contributor to the high death rate in Indonesia (Marasabessy et al., 2020). According to Ikatan Dokter Anak Indonesia (IDAI), the threat of DM can be found in groups of children between the ages of 5 and 6 and 10 and 12 (IDAI, 2020). Types of DM that can occur in children are type 1 DM and type 2 DM, where type 1 DM occurs due to the destruction of beta cells in the pancreas, which results in absolute insulin deficiency caused by autoimmune and idiopathic. In contrast, type 2 DM occurs when body cells reject the normal effect of insulin, pushing glucose in the blood into the inside of the cells, which is called insulin resistance (Fadinata et al., 2020).
The International Diabetes Federation (IDF) recorded that the incidence of type 1 DM in children and adolescents aged <20 years old reached 1.1 million, while type 2 DM in children did not have actual data, but there was an increase in the incidence compared to the previous year (IDF, 2019).
One of the risk factors for DM is being overweight or obese (Masih & Oroh, 2018).
Obesity is caused by eating complementary foods (MP-ASI) too early and taking nutritional intake from instant food or drinks (soft drinks and fast food) too early (Masih & Oroh, 2018). Obesity can inhibit glucose absorption into muscle and fat cells, resulting in increased blood glucose levels (Masih & Oroh, 2018). Being overweight is a condition of comparison between body weight and height that exceeds the standard, with an increase in total body fat >23%
(Prihaningtyas et al., 2018).
Riset Kesehatan Dasar (Rikesdas, 2019) reported that the prevalence of obesity in children aged 5-12 years in Banten Province was 10.04%, and in the 13–15-year age group was 4.19%. Another factor that causes the risk of DM in children (Murti, 2019) is the level of mothers' knowledge about the diet and nutritional intake of children, where it was found that 52.5% of mothers have less knowledge about eating patterns.
Preliminary data collection on 166
children at SD Strada Slamet Riyadi 2 in Tangerang found that 18.6% of children were categorized as overweight. Moreover, based on the short interview results, ten 15 mothers did not know that DM could occur in children. They also do not know that DM in children can be triggered by children's irregular and excessive eating patterns of more than three times a day, excess weight, and a history of parents who have DM. Based on the observations conducted by researchers around the school environment, it was found that children had easy access to unhealthy foods such as fried and sweet foods and drinks. This easy access to unhealthy foods can pose a risk for children to consume more food than their daily energy needs. Based on interviews with school principals, it was found that before the COVID-19 pandemic, many children often consumed street food around the school, and even during the COVID-19 pandemic, sometimes the teacher still found students coming to buy street food nearby the school.
Apart from supporting factors causing DM, such as genetic factors that cannot be modified, other factors can be modified by adjusting the child's diet (Donaldson et al., 2019). According to Indriyani (2015), mothers play an essential role in the growth and development of children, so they need to have good knowledge to regulate children's eating patterns. Mothers with good knowledge of providing good nutritional intake to overweight children can reduce the risk of DM.
Based on the phenomena described above, the researchers are interested in identifying the relationship between mothers 'characteristics and the mother’s level of knowledge about the diet of overweight children with a risk of DM.
Method
The research design was quantitative descriptive correlational with a cross- sectional approach. Quantitative research is research that is structured to assist in generalizing predictive theories that are appropriate (Jaya, 2020). This study used univariate analysis and bivariate analysis.
Univariate analysis was used to identify the characteristics of respondents consisting of
111 age, education, occupation, information exposure from mass media, and family history of DM. In contrast, bivariate analysis using chi- square was conducted to identify the relationship between mothers ‘characteristics, namely age, education, occupation, information exposure and family history of having DM with the mother’s level of knowledge about the diet of overweight children with a risk of DM.
This research was conducted in an elementary school in Tangerang from Monday, March 21, 2022 – Friday, March 25, 2022. The population is the entire research object consisting of humans, objects, animals, plants, symptoms, test scores, or events as data sources with specific characteristics in a study (Roflin et al., 2021). The population of this study was 166 mothers of students aged 6-12 years old. Purposive sampling was applied, and 31 mothers with overweight children were involved in this study, in which the child's weight and height were calculated using the formula and included in the overweight body mass index category.
After obtaining ethical approval with number 119/KEPFON/I/2022, the researcher submitted a research permit to the Faculty of Nursing at Pelita Harapan University, which was addressed to the research setting. After gaining the research permit, the researcher contacted the principal, as the representative of the school where the research was conducted, to work together to distribute research questionnaires to the mothers of
students at the school.
The researcher approached the principal to help approach the students’
mothers. The researcher then sent a Google form link containing a brief explanation of the research and informed consent to the students’ mothers to be filled in according to the instructions on the questionnaire. If the respondent is unwilling to participate in the study, the questionnaire page will not appear, but if the respondent chooses to participate in this study, then they will go to the question sheet. After all the data was collected, the researcher selected the data according to the required sample characteristics: mothers with overweight children according to the Body Mass Index (BMI)category.
The researchers developed the research questionnaire regarding the mothers' level of knowledge. The validity and reliability test was carried out in an elementary school in Kisamaun on 30 mothers with overweight children. From the 40 questions that were tested, 17 questions were valid and reliable with the results of r count >
r table (0.3061), and Cronbach's alpha value was 0.87 (> 0.6). The remaining invalid questions were excluded from the questionnaire. The categories of knowledge level will be divided into Good >75%, Moderate: 56%-75%, and Less: <56%
(Nursalam, 2016). This research has received ethical approval from the Research Ethics and Committee Faculty of Nursing Pelita Harapan with No.119/KEPFON/I/2022.
Result and Discussion
Most respondents in this study, 87.1%
were ≤45 years old, and 12,9% were >45 years old. Regarding education, it was recorded that 61.3% had a bachelor's degree in tertiary education, the remaining (35.5%) completed senior high school education, and at least 3,2%) completed junior high school.
Furthermore, there are (45.2%) of mothers
working in the private sector employed, (41.9%) as housewives, 9,7% as civil servants, and only 3,2% as entrepreneurs. Regarding the mother’s experience of exposure to information about DM, (77.4%) said they had received information, and only (22.6%) had never been exposed. Then, as many as (54.8%) of respondents did not have a family history of DM, and 45.5% accounted for having a family history of DM.
Table 1. Distribution of Respondents’ Characteristics (n=31)
Category Frequency Percentage (%)
Age ≤45 years old 27 81.7%
>45 years old 4 12.9%
Education
Junior high school 1 3.2%
Senior high school 11 35.5%
Bachelor 19 61.3%
112
Category Frequency Percentage (%)
Occupation
Civil servant 3 9.7%
Private sector employee 14 45.2%
Entrepreneur 1 3.2%
Housewife 13 41.9%
Expose to information from mass media
Yes 24 77.4%
No 7 22.6%
Family history of having DM
Yes 14 45.2%
No 17 54.8%
Table 2. Mothers’ Knowledge Level of Overweight Children's Diet with Diabetes Risk
Knowledge level Frequency Percentage
Good 27 87.1%
Moderate 3 9.7%
Less 1 3.2%
Total 31 100%
The results on the mothers’ knowledge level about the diet of overweight children with the risk of DM. which was found that most respondents. as much as 87.1%. had a good level of knowledge.
9.7% had a moderate level of knowledge and only 3.2% had less knowledge.
Table 3. Relationship between Mothers’ Characteristics and Mothers’ Level of Knowledge about Overweight Children's Diet with Diabetes Risk (n=31)
Mothers’
Characteristic Knowledge Level P Value
Good Moderate Less
Age ≤ 45 years old 23 3 1 0.712
>45 years old 4 0 0
Education Junior high school 0 1 0 0.034
Senior high school 11 1 0
BacheLor 16 1 1
Occupation Civil servant 3 0 0 0.901
Private sector employee 11 2 1
Entrepreneur 1 0 0
Housewife 12 1 0
Expose to information Yes 21 2 1 0.782
No 6 1 0
Family history of having DM Yes 10 3 1 0.062
No 17 0 0
The chi-square test results showed that of the five characteristics of mothers identified to be related to the mother's level of knowledge. it was found that only educational characteristics were related to the level of knowledge with a value (p-value= 0.034). At the same time. characteristics such as age.
occupation. exposure to information from mass media. and family history of DM did not
have a relationship with the mother’s level of knowledge about the diet of overweight children and the risk of DM with p-value 0.712.
0.901. 0.782.0.062 respectively.
The relationship between mothers’
characteristics and the mother’s level of knowledge was examined. Age is one of the factors that affect knowledge. The older a person. the more they develop their grasping
113 power and maturity in thinking to receive information better (Notoatmodjo. 2012).
According to the researchers. age can provide an overview of a person's level of knowledge because a younger age is considered to gain more knowledge from the environment.
However. this study found no relationship between age and the mother's level of knowledge. This result may be due to the limitation of this study. where there are only two age categories (≤45 years and >45 years).
so it is necessary to examine this relationship with a more diverse age. Thus. the researchers concluded that age is not always related to a person's level of knowledge.
Furthermore. this study displayed a relationship between education level and the mothers’ level of knowledge. According to the researchers. the level of education will affect one's knowledge of something because. in the educational process. one is encouraged to solve problems by thinking critically. This study's results align with the (Chomaidi &
Salamah. 2018) that people with higher education levels will have better knowledge than people with low levels of education. The higher a person's education level. the easier she/he is to receive information or ideas to improve knowledge. which eventually improves critical thinking skills in solving a problem (Notoatmodjo. 2012). A study conducted by (Pahlawati & Nugroho. 2019) conveyed that higher education increases a person's awareness to prevent illness.
In contrast. Casando et al.. 2022 Oktorina et al.. 2019 and Ramli. 2020 found no significant relationship between education and knowledge level. This is because knowledge can be obtained not only from formal education but also from non-formal education. This statement was supported by a study conducted by Ramli (2020) that even though most of the respondent’s education level was senior high school. they had good knowledge about providing food intake to children because the mothers had the initiative to ask the post-integrated health (Posyandu) staff about the healthy diet for children. A person's level of education is related to the level of knowledge. However. it does not rule out the possibility that someone who does not have a high level of education could have a good level of knowledge.
The results of this study showed no
relationship between occupation and mothers' level of knowledge. According to the researchers. the mother's profession is related to the level of knowledge because the work environment can provide information to mothers through the relationships in the world of work. According to Notoatmodjo (2012). occupation can affect the level of knowledge because through work.
opportunities to obtain information or knowledge. either directly or indirectly. are more accessible. This finding is in line with the study by (Putri & Lasri. 2016). which examined the relationship between occupation and mothers' knowledge about balanced nutrition in preschool children in a kindergarten in Malang and reported no relationship between those two variables. A study by Iqmy (2016) stated that mothers who do not work or as homemakers had better knowledge than working mothers because homemakers have more time to relate to the community through social activities. Hence.
getting information from interaction with people is more accessible. It can be concluded that the type of work does not determine a person's level of knowledge. as in this digital era. information can be accessed easily by anyone to increase their knowledge about something (Handi & Hua. 2019).
The results of this study indicated that most of the mothers had been exposed to information about the diet of children with a risk of DM and had a good level of knowledge.
Notoatmodjo (2012) stated that exposure to information can affect a person's level of knowledge. The results of this study align with research conducted by Handi & Hua (2019).
which shows that mothers who get exposed to information through mass media have a relationship with their level of knowledge.
Information is news that can be known by someone and can improve one's literacy skills.
Information can be obtained directly from other people or the mass media (Fajeriani et al.. 2019). The sources of knowledge are obtained from information through social media. advertisements. or other digital media (Notoatmodjo. 2012). Picauly et al. (2018) stated that there was an increasing percentage of parents’ knowledge influenced by exposure to information. The strategies conducted by Picauly et al. (2018) to increase the knowledge of parents were providing information
114 through leaflets. flipcharts. slide shows. TV advertisements. and others. and it was found that there was an increase in parental knowledge from the previous 52% to 93%.
Furthermore. this study revealed no relationship between exposure to information from mass media and a person's level of knowledge. According to Mugiati (2015).
information from books or newspapers could give the reader a better understanding as information provided in books is more analytical than information from mass media.
Moreover. a family history of having DM affects the mothers' level of knowledge about the diet of overweight children with a risk of DM. Notoatmodjo (2012) suggested that a person uses experience to learn to deal with a problem. They are supported by a study conducted by Paramita & Lestari (2019) that shows that the longer a person suffers from DM. the better the knowledge of patients and families about managing blood sugar levels.
Another study by Hisni et al. (2017) revealed that family experience in caring for DM sufferers can increase a person's knowledge about healthy eating patterns because the family is a supporting system for DM sufferers to adhere to the DM diet. This study showed no relationship between family history of DM and mothers' level of knowledge. In line with the research conducted by Isriani (2021). it showed that the history of DM in the family did not have a relationship with a person's level of knowledge. There is a limitation of literature that discusses the relationship between a family history of DM disease and a person's level of knowledge. However. a study conducted by Aycock et al. (2015) aimed to identify the relationship between a family history of Stroke disease and a person's level of knowledge and showed that a family history of stroke did not translate into a better understanding of stroke. They stated that a person with a family history of stroke may not understand the significance of the disease.
especially when the disease is a combination of several risk factors. such as obesity.
hypertension. and insufficient activity. Thus. it might be concluded that a family history of having DM does not guarantee that a person would have better knowledge as they do not understand the significance of their family's illness.
Conclusion
In conclusion. education level showed a relationship with the mother’s level of knowledge in regulating the diet of children with diabetes risk. Increasing mothers 'knowledge can be obtained from formal education. but non-formal education also plays a vital role in improving mothers' knowledge to prepare a healthy diet for children to reduce the risk of diabetes. Even though other characteristics such as age.
occupation. exposure to information from mass media. and family history of having DM did not have a relationship with mothers' level of knowledge. those characteristics should be considered when delivering information about a healthy diet for children.
This study suggests that schools can reach out to health units to educate mothers about the diet of school-age children.
Providing a clean and healthy canteen for students might be a helpful solution to prevent students from eating street food. Furthermore.
the results of this study could encourage community nurses to be able to provide education related to the diet of overweight children to mothers. Finally. the results of this study can be a reference for further research.
and it is hoped that further research can examine the risk factors for DM in school-age children.
Limitations of the study
In addition. although other maternal characteristics in this study. such as age.
occupation. information exposure. and family history of having DM. did not have a relationship. the study results could not be generalized to other populations due to a small sample size. Thus. future research can be done on a larger sample to generalize the results. Additionally. there were only two age categories (≤45 years and >45 years). which might influence the result of this study regarding the relationship between age and level of knowledge. Therefore. a more diverse age group of mothers having children with overweight might be able to produce more valid results. Finally. future research could examine this further due to the limitation of literature that discusses the relationship between respondent characteristics. such as the family history of DM and knowledge.
115 Acknowledgement
The authors thank the Faculty of Nursing Universitas Pelita Harapan for approval of ethical clearance. The author also would like to thank the supervisors who have provided input so that the writing of this research can run well. Moreover. the author would like to thank the school for giving permission. the principal for helping approach parents. and all respondents who took the time to participate in this study.
Conflict of Interest
The authors declare that there is no conflict of interest to disclose.
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