Effectiveness of Emotional Demonstration in Changing Knowledge,

Attitudes and Behavior of Eating Snacks for Obese Elementary

School Students in East Jakarta

Putri Saba Khairul Afidah, Leni Sri Rahayu and Luthfiana Nurkusuma Ningtyas

Department of Nutrition, Faculty of Health Sciences, University of Muhammadiyah Prof. Dr. Hamka, Jakarta, Indonesia

Keywords: Behaviour, Emodemo, Obesity, Snacks .

Abstract: The purpose of this study was to determine the effect of emodemo with magnetic poster media on the

knowledge, attitudes and eating behavior of obese students at two elementary school in East Jakarta City.

This is Quasi Experimental research with pre and posttest design method. The sample in this study was 48

obese children in grades IV and V. Data was collected using a questionnaire and the SQ FFQ (Food

Frequency Questionnaire) form and analysis used the Wilcoxon Test and the Paired T Test. The results

showed a difference in the average knowledge (p value < 0.001), attitudes (p value < 0.001), snack eating

behavior, namely energy intake (p value < 0.001), and fat intake (p value < 0.001) after giving healthy

snacks emodemo with magnetic poster media. However, in fiber intake, there was no change in the mean

before and after the intervention (p = 0.719). This study recommends that posters are very appropriate and

relevant to be used as a form of learning media in increasing knowledge, understanding of snacking

attitudes and behavior by being able to add a more varied list of snacks not only in the school environment

but also in the neighborhood where they live.

1 INTRODUCTION

According to the World Health Organization, obese

children are at high risk for degenerative diseases,

premature death, disability, difficulty breathing,

insulin resistance and an increased risk of fractures

in adulthood (World Health Organization, 2021). In

addition, obese children also have a risk of

experiencing delays in motor and mental

development compared to children who have normal

nutritional status (Cataldo et al., 2016).

The prevalence of children aged 5-19 years in the

world in 2016 reached 42,7%(World Obesity

Federation, 2019). The World Obesity Federation

(2019) also predicts that Indonesia is in fourth place

with 9 million obese children in 2030 or an increase

of 17.7% aged 5-9 years and 11.8% aged 10-19.

RISKESDAS data shows an increase in the number

of obese children aged 5-12 years from 8.8% in

2013 to 9.2% in 2018 (Ministry of Health, 2018).

The incidence of obesity in children is influenced

by many factors, such as genetics (OR = 4.3)

(Nuzula et al., 2021), imbalance in energy intake

(OR = 14.59) (Kurniawati & Fayasari, 2018), snack

habits (OR = 4.3) (Rahmad, 2018), sedentary life

style (OR = 6.93) (Arundhana et al., 2016), habit of

skipping breakfast (OR = 2.8) (Sidiartha & Pratiwi,

2020), and short sleep duration (OR = 5.4) (Marfuah

& Hadi, 2013).

Previous study showed that snack foods

contributed one third of the energy needs of school

children due to the number and type of snack

choices that were not appropriate (Aini, 2019).The

Ministry of Health of the Republic of Indonesia also

states that 40-44% of school children's snacks do not

meet health requirements because of the use of

hazardous food ingredients and unbalanced

nutritional content (high in fat and lacking in fiber)

(BPOM, 2016).

Research on 34 obese students at SDN 20 Banda

Aceh found 79.4% of obese children had excessive

snack consumption, the results of the analysis

showed that children with excess snacks had four

times the risk of being obese (OR = 4.3 and p-value

= 0.012) (Rahmad, 2018). Nisak & Mahmudiono's

research (2017) on 112 children at SDN Ploso I,

Tambaksari Sub-district, Surabaya showed that

children who had obese nutritional status tended to

Aﬁdah, P., Rahayu, L. and Ningtyas, L.

Effectiveness of Emotional Demonstration in Changing Knowledge, Attitudes and Behavior of Eating Snacks for Obese Elementary School Students in East Jakarta.

DOI: 10.5220/0011645100003608

In Proceedings of the 4th International Conference on Social Determinants of Health (ICSDH 2022), pages 13-19

ISBN: 978-989-758-621-7; ISSN: 2975-8297

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

choose fatty snacks and were eight times more likely

to be obese (OR = 8.7 and p-value = 0.045).

Seeing the inappropriate behavior of snacking in

obese school children, obesity prevention is an

important part that must be done as early as possible

(Hastoety et al., 2017; Julita et al., 2021). Prevention

in the form of health promotion or intervention is

one way that can be done, interventions with the

topic of healthy snacks can be modified and help in

preventing obesity at school age (Health, 2014).

Emotional demonstration or emodemo is an

educational method that uses a behavior centered

design (BCD) approach where the method used is

simple, fun and can touch emotions (Birawida et al.,

2019). Emodemo with the play-based learning

method is a fun and appropriate game-based learning

method in influencing knowledge and attitudes

(Viggiano et al., 2015).

Research on 28 children of Assa'adah Islamic

Elementary School Cilandak showed that emodome

media in the form of balanced nutrition videos was

able to increase children's knowledge regarding

energy balance, building blocks and regulatory

substances (Arumsari & Fitriani, 2020). The

research of (Safitri et al., 2021) also showed an

increase in knowledge scores of 18.25% in 20 5th

graders at SDN Tologosari 02 and SDN Palebon 02

after nutrition emodemo with puzzle media was

carried out. This increase in numbers was greater

than children who were only given education with

lectures, where the increase was only 12.25%

The results of a preliminary survey conducted on

30 students showed 29% of children had obesity

nutritional status. The sample in this study were

grades IV and V because they were able to receive

messages easily so that they were able to influence

changes in knowledge, attitudes and behavior

towards the better (Arimurti, 2012). We used two

schools as sample was due to different

characteristics in the provision of food service in

schools. We assumed that the aspects of food service

condition were one of the causative factors in the

behavior of eating snacks at school.

Based on the above background, researchers are

interested in conducting research related to the effect

of healthy snacks emodemo with eating behavior by

obese students at SDN Utan Kayu Selatan 13 Pagi

and SD Islam PERSIS 69 Matraman, East Jakarta.

2 METHOD

This study method is a quantitative study with a

Quasi Experimental design with a one group pretest

posttest design. This research was conducted at SDN

Utan Kayu 13 Pagi and SDI PERSIS Matraman in

May – June 2022. The population in this study was

48 obese students in grades IV and V. Sampling was

done by total sampling method that met the

inclusion criteria.

The inclusion criteria in this study were students

in grades IV and V who had BMI/U values >2SD

and were willing to fill out informed consent.

Meanwhile, the exclusion criteria in this study were

students who were color blind and could not read.

The independent variables in this study were

knowledge of snacks, attitudes of snacks and

behavior of eating snacks. Snack food knowledge is

information that children have regarding the

characteristics, for example, the nutritional content

of snacks and the impact of consuming unhealthy

snacks. Snack food attitude is the opinion and

assessment of children in choosing snack foods

purchased at school and outside school and snack

eating behavior is the average amount of energy,

fiber and fat consumed by children from snack

foods.

Instruments used in research is an emotional

demonstration with a magnetic poster media for

healthy snacks made by researchers as an

educational media. Magnetic healthy snacks poster

is a poster that contains pieces of magnets, where in

one magnetic poster package there are sheets related

to the characteristics of healthy and unhealthy

snacks, magnetic pieces of examples of healthy and

unhealthy snacks, one shopping basket and two

shopping lists.

The emotional demonstration used in the

intervention is to invite respondents to participate in

the research process, namely by playing a role play

between the seller and the buyer, where a story is

made as if the seller and buyer are making a sale and

purchase transaction for healthy and unhealthy

snacks with a grocery list guide.

Knowledge and attitude data about snacks were

taken using a questionnaire, while for snack eating

behavior using the SQ FFQ (Semi Quantitative Food

Frequency Questionnaire) by looking at the average

difference in knowledge, attitude and average intake

of energy, fat, and fiber (grams) before and after

being given a magnetic poster demonstration of

healthy snacks emotional intervention.

Differences in knowledge scores and attitudes

about snack foods before and after the intervention

were tested with the Wilcoxon Signed Rank Test.

Differences in snack eating behavior in the form of

average intake of energy, fat, and fiber before and

ICSDH 2022 - The International Conference on Social Determinants of Health

after the intervention were tested with the Paired T-

Test.

3 RESULTS

3.1 Page Setup

The study involved the 48 students which 28

children (58.3%) from SDN 13 Pagi and 20 children

(41.7%) from SDI PERSIS. Respondents in this

study were mostly from class V, which was 31

children (61.4) compared to class IV students,

namely 17 children (35.4%). As for the age of the

respondents, most of them were 11 years old,

namely 30 children (62.5%) and the gender of the

respondents was mostly dominated by boys, namely

30 children (62.5%) compared to girls, namely 18

children (37. 5%) (table 1).

Table 1: Distribution of Respondents by Characteristics.

Characteristics N %

School

SDN 13 Pagi 28 58,3

SDI PERSIS 20 41,7

Total 48 100

Grade

IV 17 35,4

V 31 64,6

Total 48 100

Age

9 years old 2 4,2

10 years old 12 25

11 years old 30 62,5

12 years old 4 8,3

Total 48 100

Gende

Man 30 62,5

Women 18 37,5

Total 48 100

3.2 Knowledge, Attitude, and Eating

Behavior

This study's result showed an increase in the average

value of snack food knowledge with an increase of

16.46 (Table 2). In addition, there was also an

increase in the lowest score in the pre and posttest,

where in the pretest the lowest value was 50 and in

the post test it was 70. However, in the pretest and

posttest, the maximum score was the same, which

was 100.

Table 2: Mean Pre-Post Test Score Snack Food

Knowledge, Attitudes and Behavior.

Variable

Pre-Test Post Test

Mean Min-Max Mean Min-Max

Knowledge 78,75 50-100 95,21 70-100

Attitudes 89,89 70-100 96,56 85-100

Behavior

Mean Mean

Energy

(

kkal/da

381,28 345,63

Fat

r/da

14,86 13,32

Fiber

r/da

1,50 1,3

An increase in the average value of snack food

attitudes with an increase of 6.67 (Table 2). In

addition, there was also an increase in the lowest

score in the pre and posttest, where in the pretest the

lowest score was 70 and in the post test it was 85.

The maximum value in the pretest and posttest was

the same, namely 100, where this result showed that

there are students who can answer statement of the

attitude of street food perfectly.

The Study showed the average intake of energy,

fat, and fiber. Before and after the intervention

decreased by a difference of 87.58 kcal in energy,

3.41 grams of fat and 0.15 grams of fiber (Table 2).

This average, when compared with the RDA for

children aged 9-12 years, the percentage of energy

and fat intake from snacks in the pre-test showed

results >20% (21% and 24%) and decreased in the

post-test results with results <20 % (16% and 18%).

Meanwhile, fiber intake in both pre-test and post-test

did not reach 1%, only (0.06% and 0.05%).

3.3 Differences before and after

Intervention

Based on the Wilcoxon test, it showed that the

average score of pre-test and post-test knowledge of

snacks has a difference of 16.45 with p-value <0.05.

This indicates a significant average difference

between knowledge of snacks before and after the

intervention with healthy snacks magnetic poster

media. The test results also showed that the score

changes before and after the intervention were

mostly in the positive direction, namely 71% which

means that there were 71% of respondents who

experienced an increase in the score of snack food

knowledge after being given the intervention.

Effectiveness of Emotional Demonstration in Changing Knowledge, Attitudes and Behavior of Eating Snacks for Obese Elementary School

Students in East Jakarta

The average score of pre-test and post-test

attitude towards snacks also has a difference of 6.67

with p value <0.05, this indicates that there is a

significant difference between the attitudes of snacks

before and after the intervention using the media.

healthy snacks magnetic poster. In addition, the

results also showed that there was a change in the

score before and after the intervention in the most

positive direction, namely 69%, which means that

there were 69% of respondents who experienced an

increase in knowledge scores.

Based on the Paired T Test statistical test, the p-

value was obtained for energy (p value = 0.001) and

fat (p value = 0.001), while based on the Wilcoxon

test on fiber (p value = 0.719). P-value on the

amount of energy and fat intake <0.005 which

indicates a significant difference in the average

amount of energy and fat intake before and after the

intervention using a magnetic poster media for

healthy snacks. While the p value of fiber intake >

0.05 which means there is no significant difference

in the average amount of fiber intake before and

after the intervention using the magnetic poster

media of healthy snacks.

Table 3: Differences in Average Knowledge, Attitudes and

Behavior of Snacks Before and After Intervention.

Knowledge

Value

P Value

Mean ± 𝑆𝐷

Min

–

Max

Pre-Test

78,75 ± 11,96

50 - 100 0,001

Post Test

95, 20 ± 7,71

–

100

Attitude

Value

Mean ± 𝑆𝐷

Min – Max

Pre-Test

89,89 ± 6,56

70 – 100 0,001

Post Test

96,56 ± 4,51

85 - 100

Table 4: Differences in Average Behavior (Energy, Fat

and Fiber) Before and After Intervention.

Intake Average

Nutrition

Before After

P-

Value

Mean ± 𝑆𝐷 Mean ± 𝑆𝐷

Energy

381,28 ± 113,22 345,63 ± 90,86

0,001

Fat

14,88 ± 5,36 13,32 ± 4,06

0,001

Fiber

1,50 ± 1,46 1,30 ± 0,77

0,719

4 DISCUSSIONS

According to mayasari et al (2020) poster media has

a great influence in increasing one's knowledge

compared to leaflet or comic media, through posters

one can absorb as much as 30% of information from

images and 10% of information read on posters.

Healthy snacks magnetic poster emodemo media

is a media based on the play-based learning method,

which is made like a poster but adds magnetic pieces

to each image and writing on the poster, so that

respondents who use magnetic poster media feel like

they are just playing. The use of media with the

play-based learning method is a fun and appropriate

game-based learning method in influencing

knowledge and attitudes (Viggiano et al., 2015).

Harsono et al (2019) also explained that providing

information through interesting media and a pleasant

atmosphere can increase children's motivation to

receive messages and make it easier to remember

them.

This is in line with the research of Safitri et al.,

(2021) which showed an increase in knowledge

scores of 18.25% in 20 5th graders at SDN

Tologosari 02 and SDN Palebon 02 after nutrition

emodemo was carried out with puzzle media. media.

another study on 60 fourth grade students at SDN 11

Serang which showed the effect of increasing

knowledge related to the safety of snacks before and

after giving the intervention using snakes and

ladders game media.

The increase in children's attitudes regarding

snack foods can be influenced by an increase in

children's knowledge regarding snack foods as well,

where good knowledge will help and shape

children's attitudes in choosing food (Nuryanto et al.,

2014).

Previous research by Afra et al (2021) showed

that there was a significant difference between

attitudes about balanced nutrition in 40 students at

SDN Tanjung Duren 01 pagi before and after being

given an intervention using picture cards, Enjelina et

al also (2020) explain where there is an increase in

the average attitude of 31% after a snack food safety

intervention with monopoly game media.

A very visible change in attitude is the

perception of children regarding choosing and

buying snacks in a clean place where it can be seen

from the increase in the number of students who

answered correctly on the posttest with the statement

by 25%. According to Notoatmodjo (2007) attitudes

will not be formed if they have not there is a

readiness within the individual to change behavior in

order to reduce health risks.

This study, students' attitudes towards snack

foods were influenced by sensing the images

displayed in magnetic posters, where the magnetic

posters and PowerPoints used in the intervention

displayed objects related to the characteristics and

impacts of unhealthy or clean snacks. In addition, in

the magnetic poster media there are pieces of

ICSDH 2022 - The International Conference on Social Determinants of Health

magnets in the form of pictures of healthy or

unhealthy snacks that are very easily recognizable

by respondents. during the intervention the

respondents were brought to learn while playing,

with a role play game as a buyer and seller in which

the activity could attract the attention of the

respondents as seen from the enthusiasm of the

emodemo participants.

Magnetic poster media is a visual media, where

one of the advantages of visual media is that it can

be used repeatedly and is able to make users really

have a specific understanding and knowledge about

the concept of information conveyed in the media

(Swamilaksita et al., 2021) The habit of

consuming snacks is very popular among elementary

school children and difficult to break (Iklima, 2017;

Legii et al., 2017). According to (BPOM RI, 2013)

snack foods contributed 31.1% to the total energy

intake of daily energy needs, in addition Bardosono

& Pansawira (2021) explained that snack foods

should only contribute 10-20% of daily nutritional

needs or 160 - 300 kcal. while in this study the

average daily energy intake of snacks both before

and after the intervention was more than 300 kcal.

The high energy contribution of snack foods

should be a consideration in choosing the type of

snack food, namely by choosing healthy snacks, but

in this study the high energy of street food is caused

by the selection of snacks that are less healthy and

only have high energy without any advantages in

consuming snacks. other nutrients, the following is

the amount of energy snacks available in both school

environments:

One of the factors that cause high energy intake

in respondents is because the types of snacks

available in the school environment are snacks that

have a high calorific value, such as, sakura noodles,

toast, cakwe and arum manis.

Behavior change can be achieved with two types

of approaches, the first approach is through

education and the second is through coercion, in this

study the type of approach taken is through

education with interesting media, where education is

obtained from exposure to information on snacks.

snack eating behavior is a person's way of thinking,

knowing and having views about street food which

is manifested in the form of eating and choosing

snacks (Nurcahyani, 2020).

The use of interesting media and based on play-

based learning facilitates the delivery and

information will be easier to accept and understand,

one of which is the use of posters which are props in

health promotion activities to school children. this is

in line with the research of Nasution & Arifin (2021)

where there is an influence in the act of choosing

snacks on the actions of students at SDN 06 Medan

after the intervention using role play-based poster

media. Another study by also showed an increase in

the behavior of eating healthy snacks from an

average of 18.28 to 33.67 in 43 students of SDN 183

Pinrang regency after an intervention with picture

card game media (Astasari & Umar, 2021).

5 CONCLUSIONS

There is a difference and increase in the knowledge,

attitudes and behavior eating snacks (energy and fat)

of respondents before and after intervention. The

intervention carried out was in the form of an

emotional demonstration by combining the methods

of emotional demonstration and play based learning

with magnetic poster media, as evidenced by the

average results of the study seen in the differences

before and after the intervention in obese elementary

schools on SDN Utan Kayu Selatan 13 Pagi and SD

Islam PERSIS Matraman. During the intervention

students played an active and enthusiastic role in

using healthy snacks media, magnetic posters, for

further researchers who wish to conduct similar

research, it is hoped that further research can

innovate on magnetic poster media in the form of

snacks that are not only in the school environment

but also in the surrounding environment, like at

home. In addition, it can carry out sustainable

interventions by creating healthy canteens in the

school environment by collaborating with teachers

and employees in the school environment.

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