The Effect of Nutrition Education Using Cooperative Learning on

Knowledge and Attitudes About Body Image in Adolescent Women in

West Metro Sub-District, Metro City, Lampung Province, Indonesia

Sofyan Musyabiq Wijaya

1,*

, Sowiyah

, Ramadhana Komala

and Dian Isti Angraini

Faculty of Medicine, University of Lampung, Lampung, Indonesia

Faculty of Education, University of Lampung, Lampung, Indonesia

Keywords: Body Image, Cooperative Learning, Young Women.

Abstract: Young women is a time of growth that takes place quite quickly. Development includes physical, cognitive,

and psychosocial. This period is a transition period marked by many changes, including increasing muscle

mass, body fat tissue, and hormonal changes. It is essential to pay more attention to young women because

the trend of marriage age is getting younger or young marriage when a person is still a teenager. One of the

learning methods in the community is cooperative learning. This research is carried out with a quasi-

experimental research design. The design used is a pre-test Time Series Design with cooperative learning

treatment. Analyse the effect of cooperative learning on attitudes and knowledge using paired t-tests. The case

population in this study was all Young Women in West Metro District, totalling 60 people, with a sample

number of 25 people. This study lasts six months, from April to October 2023. This research was conducted

in Ganjar Agung Village, West Metro District, Metro City. The test results significantly affected respondents'

knowledge (p < 0.05) after the cooperative learning intervention. However, there was no significant difference

in body image attitude (p > 0.05) before and after the intervention. There is an effect of nutrition education

using cooperative learning on knowledge about body image, while it does not affect attitudes about body

image in adolescent girls.

1 INTRODUCTION

Nutrients affect growth and development during

infancy, toddler, and adolescence, with nutritional

needs in adolescents greater than in previous times.

This is because, in adolescence, there is a rapid

growth called a growth spurt. Adolescence is a time

of growth that takes place quite quickly. Growth

includes physical, cognitive, and psychosocial. This

period is a transition period marked by many changes,

including increasing muscle mass, body fat tissue,

and hormonal changes (Susetyowati, 2016).

The Indonesian Nutrition Survey (Kementerian

Kesehatan RI, 2022) concludes that stunting

prevention efforts are better than treatment efforts for

stunting itself. Ministry of Health (2022) Prevention

efforts are carried out in the First 1000 Days of Life.

However, it is important to pay more attention to

adolescence because the trend of marriage age is

getting younger or younger marriage when a person

is still a teenager.

According to behavioural theory, a person's

behaviour is strongly influenced by intensity, attitude,

subjectiveness, and perception of a person judging an

object received. In addition, perception can influence

changes in a person's behaviour if the role of internal

or external factors is more dominant, such as

education, experience, and environment, as a

consideration in making decisions (Hadisaputro,

2011).

One of the learning methods in the community is

cooperative learning. This learning method leads to

the exchange of information between members in the

group, and each member is responsible for the group

and himself and is motivated to improve other

learning (Budiarti, 2011). The results of research

conducted by Mariamah (2012) stated that

cooperative learning can increase students'

achievement and motivation. This study aimed to

determine the effect of nutrition education using

cooperative learning on knowledge and attitudes

about body image in young women in the Metro Barat

sub-district.

Wijaya, S. M., Sowiyah, , Komala, R. and Angraini, D. I.

The Effect of Nutrition Education Using Cooperative Learning on Knowledge and Attitudes About Body Image in Adolescent Women in West Metro Sub-District, Metro City, Lampung Province,

Indonesia.

DOI: 10.5220/0013672200003873

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Medical Science and Health (ICOMESH 2023), pages 347-352

ISBN: 978-989-758-740-5

347

2 METHODS

2.1 Research Design

This research was conducted with a quasi-

experimental research design. The design used is a

pre-post time series design, with cooperative learning

treatment to determine the effect of interventions on

attitudes and knowledge about body image in

adolescent girls. This design is used as an evaluation

of whether this intervention method has a significant

impact between before and after.

2.2 Location and Time

This research was conducted in Ganjar Agung

Village, West Metro District, Metro City from April

to October 2023.

2.3 Population and sample

The population in this study was all adolescent

women in the West Metro sub-district, totaling 60

people. The subjects of this study were Early

Adolescents aged 12-24 years. The number of

samples used is by the total sampling method,

meaning that the entire population will be sampled

after being determined by inclusion criteria (not

breastfeeding, not pregnant, and not sick) and

exclusion (not willing to be respondents). However,

during the implementation of the study, the

respondents who attended were 25 people.

2.4 Stages of Intervention

The intervention uses cooperative learning with no 6

stages. According to Suprijono (2013), the stages of

cooperative learning are as follows:

1. Convey the objectives and preparation of

participants

The first stage is to convey the purpose of

nutrition education by providing a case to

the group for discussion about body image

in order to form a positive perception of

body image. At this stage, participants are

also prepared by looking at the total

participants who come.

2. Present Initial Information

Participants are informed about the technical

activities to be carried out. At this stage,

participants are ready with the scenario that

has been given by the researcher or

facilitator.

3. Create Groups

The facilitator formed 4 groups with each

group given different questions related to the

given case.

4. Help teamwork and learning

At this stage, the group has carried out its

activities by discussing based on empirical

knowledge or experience that has been

possessed by each group member. The

facilitator assists so that the discussion does

not go off track from the discussion.

5. Evaluate

Participants make presentations regarding

the answers to questions that have been

given by the facilitator. In addition, after

listening to the answers from each group, the

facilitator or researcher provides appropriate

information about the questions in each

group.

6. Give Rewards

The award is given after evaluation

activities. The award is given to the group

that answers the most appropriately.

2.5 Research Ethics

In the study, researchers carried out an ethical

clearance procedure from the Research Ethics

Commission with number

2053/UN26.18/PP.05.02.00/2023. Researchers

explain to respondents about informed consent orally

and in writing. Researchers will keep the personal

identity of respondents confidential, and the data

obtained is only used for research purposes. The

instruments used in this study are quantitative

research instruments.

2.6 Statistical Analysis

Results were analysed univariately with descriptive

analysis of respondent characteristics. Bivariate

analysis used an independent t-test to compare

adolescent girls' knowledge and attitudes about body

image. The significance value of the bivariate

analysis uses a p < 0.005.

3 RESULTS

The research was conducted in Ganjar Agung

Village, West Metro District, Metro City, Lampung,

on August 27, 2023. The respondents were 25 women

domiciled in Ganjar Agung Village, West Metro

District, with the characteristics in Table 1.

ICOMESH 2023 - INTERNATIONAL CONFERENCE ON MEDICAL SCIENCE AND HEALTH

348

The average age of respondents in this study was

17.36 years, with the majority of education being in

Senior High School, which is 16 people. Based on the

data obtained with an average height of 155 cm and

an average body weight of 52 kg.

The stages of research carried out were preceded

by an introduction by the head of the committee, then

an introduction at the same time opened by the head

of the community association. The next stage is the

provision of a pre-test questionnaire regarding

knowledge about body image. The next stage is to

explain the learning objectives, after which a group of

participants is formed.

The groups that have been formed are given the same

scenario, but each group is given different questions.

The next stage is discussion and continues with the

presentation. Groups that answer questions from the

most appropriate scenario get a reward. The last stage

is the provision of a post-test questionnaire. The

purpose of giving this questionnaire is to evaluate by

comparing initial knowledge before carrying out

cooperative learning.

Table 1: Characteristics of Young Women Respondent

(n = 25 people)

Characteristic n

Avera

e A

e of res

ondents 17

Last Level of Education

a. Elementary School

b. Junior High School

c. Senior High School

d. Universit

Average Body Weight 52

Avera

e Hei

ht 155.2

Body Mass Index

a. Less

b. Normal

c. Overweight

Diet History

a. Yes

. No

3.1 Knowledge of Body Image in

Young Women

Knowledge of body image was measured using

questionnaires before and after the intervention. The

measurement of body image knowledge at the

beginning is aimed at knowing the initial knowledge

of respondents. Ultimately, it was used to determine

the effect of cooperative learning interventions on

adolescent girls. The results of the analysis can be

found that the p < 0.05.

Table 2: Young Women's Knowledge of Body Image

(n =25)

Variable Average

Pre-Test

Scores

Average

Post Test

Score

P value

Young

women

Body Image

Knowled

5.12 ± 1.74 6.32± 1.80 < 0.05

3.2 Attitude towards Body Image in

Young Women

Attitude is a perception in adolescent girls, especially

in this study, about body image. The initial attitude

before the intervention aims to see the responses of

adolescent girls before the intervention. In contrast,

the attitude assessment at the end aims to assess the

responses after being given information or education

about body image. The results stated that adolescent

girls' attitudes showed no difference before and after

the intervention, with a p>0.05. This is because the

respondents had a good body image attitude value at

the beginning and at the end of the intervention.

Table 3: Young Women's Attitudes on Body Image (n =25)

Variable

Average

Pre-Test

Scores

Average

Post Test

Score

P value

Young women's

Body Image

attitudes

7.64 8.12 > 0.05

4 DISCUSSION

The average age of respondents in this study was 17

years, with the majority of education being in Senior

High School (SMA), which is 16 people. Based on

the data obtained with an average height of 155 cm

and an average body weight of 52 kg, this study's

respondents' weight is estimated to have a medium

and ideal body shape (P2PTM, 2018). This is also in

line with the BMI, with most children, as many as 16

respondents, having average BMI values. Body Mass

Index (BMI) is a simple tool to monitor the nutritional

status of adults, especially those who are underweight

and overweight (Destiara et al., 2017). With the

results showing that the BMI of most respondents is

normal, it shows a good environment and supports

around respondents in fulfilling their nutrition.

The Effect of Nutrition Education Using Cooperative Learning on Knowledge and Attitudes About Body Image in Adolescent Women in

West Metro Sub-District, Metro City, Lampung Province, Indonesia

349

Based on the data obtained, respondents who have

a history of diet are ten people. Most respondents in

high school tend to have a diet history due to various

factors (Astuti et al., 2022; Dewi & Adriyanti, 2020).

Adolescents in the emotional phase often make quick

decisions without considering the risks and

consequences that may occur in the future, one of

which is the decision to go on a diet. Usually, this

condition occurs when they feel less confident

because they feel too fat (Yunita et al., 2020) without

realising that these habits may affect their nutritional

status both now and the future (Abdelaziz et al., 2015;

Bharthi et al., 2017).

Nutritional problems that often occur in

adolescent girls are underweight and overweight.

Lack of nutrition occurs because energy consumption

and other nutrients need to meet the body's needs.

However, in adolescent girls, malnutrition is

generally because young women limit the amount of

food they eat due to their perception of their bodies,

commonly called body image. In meeting nutritional

needs, nutrition knowledge is essential. Deep and

extensive knowledge about nutrition will help

someone choose the type of food they will consume

in terms of quality, variety, and how to present the

idea of nutrition (Margiyanti, 2021).

Based on the tests that have been done, there is a

significant effect of knowledge before and after the

cooperative learning intervention (p <0.05). The

bivariate analysis results for knowledge can be seen

in Table 4. This condition is by research conducted

by (Herlina et al., 2021). After young women were

given counselling on body image, they had better

knowledge. This condition is reflected in the post-test

value, which is better than the pre-test.

Based on the tests that have been done, knowledge

has a significant effect on body image. Body image

today is known as how people experience their self-

manifestation, such as physical appearance

characteristics, including physical functional

competence and biological integrity (Laus et al.,

2014). To positively impact body image in young

women, it is essential to explore the factors that

influence body image and identify strategies that can

be used to reduce body image disorders. This is by

increasing adolescent girls' knowledge, especially

about positive body image (Kerner et al., 2018),

which can positively affect healthy diets and lifestyles

in adolescent girls in the future through increasing

self-confidence and self-esteem (Tiggemann &

Anderberg, 2020).

A person's attitude towards their body, also known

as body image, significantly influences their mental

and emotional well-being (Harris, 2006;

Mazurkiewicz et al., 2021). The positive attitudes that

exist in most respondents in this study show that

adolescent girls tend to make efforts to constantly

improve self-confidence, well-being, and overall

quality of life, compared to negative attitudes that can

cause dissatisfaction and mental well-being problems

such as depression and eating disorders (Bellard et

al., 2022).

Healthy nutritional habits are essential for

maintaining a healthy body weight and are associated

with a positive body image (Baceviciene &

Jankauskiene, 2021). However, most adolescent girls

experience enormous psychological distress related

to academic requirements, financial issues, issues

related to social support, body image issues, and

health-related lifestyles; most of them will perform

specific actions to be able to fulfil the body image

they want and desire which will later be related to the

fulfilment of their nutrition.

The results stated that adolescent girls' attitudes

had no significant difference before and after the

intervention (p > 0.05). This condition occurs

because, at the beginning, the respondent has a good

body image attitude value, and at the end of the

intervention. Young women often have a wrong view

of their bodies; young women want an ideal body

shape (Yusintha & Adriyanto, 2018). Body image

problems can be divided into body image and attitude

knowledge issues (Cash, 2011).

The knowledge dimension of body image refers to

impaired perception of one's body. The attitudinal

dimension refers to the affective, behavioural, and

cognitive components of one's relationship with one's

body (Gardner, 2011; Hamamoto et al., 2022). As a

result of young women's dissatisfaction with their

body shapes, one of them is low self-confidence (Ifdil

et al., 2017); however, this condition does not apply

to respondents who became a study this time. This is

under anthropological measurements based on height

and weight, showing that most respondents already

have a medium and ideal body shape.

The attitude of respondents in this study has

shown good conditions. It is positive, especially in

aspects of their self-esteem, social acceptance,

physical appearance, and body abilities that have

created body positivity. Based on research conducted

by (Rekkers et al., 2022), with a good level of attitude

towards adolescent girls' body image, young women

will reduce various negative attitudes towards their

health and body benefits such as skipping meals,

picky eating habits, excessive diet and exercise

behaviour, and other habits.

However, various conditions related to the body

image attitude of young women at this time need to

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be monitored. The results of previous research by

(Nomate et al., 2017) showed that although

adolescent girls have ideal body shapes and positive

body image attitudes, they tend to feel more

significant than their actual size. This puts most

respondents at risk of having an attitude to lose

weight in unhealthy ways, including consuming

slimming products, doing excessive exercise, and

following a diet that limits energy consumption (fats

and carbohydrates) (Dianningrum & Satwika, 2021).

5 CONCLUSIONS

The research was conducted in Ganjar Agung

Village, West Metro District, Metro City, Lampung

on August 27, 2023. The respondents were 25 young

women domiciled in Ganjar Agung Village, Metro

Barat District. The test results showed a significant

effect on respondents' knowledge (p < 0.05) after the

cooperative learning intervention. However, there

was no significant difference in body image attitude

(p > 0.05) before and after the intervention. This is

because respondents have had a good body image

attitude since the beginning of the intervention. There

is an effect of nutrition education using cooperative

learning on knowledge about body image, while it has

no effect on attitudes about body image in adolescent

girls. Based on these results, it is important to educate

more deeply about body image in adolescent girls

such as counselling to create optimal nutritional

status.

ACKNOWLEDGEMENT

We would like to thank all the parties involved in this

study (LPPM Lampung University, Youth

Organization at West Metro District, and Student of

Medical Faculty Lampung University)

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