Integrated Approach for Early Detection and Prevention of Abnormal Child Growth: A Kansei Design and Quality Function Deployment Study

Sustainable development aims to reduce inequalities, including health inequalities. Focusing on early identification and prevention of growth and developmental disorders, as advocated in the article, contributes to reducing health disparities, which is a key aspect of sustainability. This article delves into the significance of assessing an individual’s physique as an initial diagnostic method for evaluating well-being, addressing both physical and mental health aspects. Body mass index (BMI) is commonly used to assess anthropometric height/weight attributes, aiding in nutrition evaluation and categorization, contributing to the promotion of healthy lives and well-being. The focus lies on growth monitoring for infants and children. The stunting not only impacts mental and physical development but also contributes to lifelong health disparities. Indonesia ranks fifth in global stunting cases. The government aims to reduce stunting by 14% in 2024, employing specific nutritional interventions. Stunting’s consequences span increased illness rates, compromised growth and learning, susceptibility to diseases in adulthood, and diminished productivity. Early identification and prevention are essential, with Posyandu serving as a platform for community-driven health progress. Regarding the early detection of stunting, it is imperative to involve healthcare workers in the design process of growth monitoring tools and interventions. This ensures that these tools and interventions are practical and user-friendly in real-world scenarios. Utilizing user-centered design approaches like Kansei Design Thinking and Quality Function Deployment can lead to the development of more effective and engaging tools and interventions.


Introduction
Assessing an individual's physique serves as an initial diagnostic method employed to assess their well-being.Presently, the body mass index (BMI) is utilized to establish the anthropometric height/weight attributes, aiding in evaluating nutrition and segregating individuals into distinct categories.Additionally, it serves as a prevalent parameter for predicting the likelihood of various health concerns.On the other hand, a reduced BMI might suggest inadequate nourishment and insufficient body weight [1].Monitoring growth and facilitating healthy growth are fundamental aspects of primary healthcare for infants, youngsters, and teenagers.Growth monitoring includes consistent evaluations of children's weight, height, or length, and for infants and toddlers, their head circumference.These measurements are then compared to a standardized growth chart as outlined by the World Health Organization.This process aids in validating a child's sound growth and progress, or in efficiently recognizing any potential dietary or medical concerns.Consequently, health workers and parents can take proactive measures to address any impending nutritional or health issues before they escalate into significant problems [2].
Persistent undernourishment during early childhood results in a condition known as stunting, which can detrimentally impact both the mental and physical development of children.Among the countries with the highest stunting cases globally, Indonesia ranks fifth.As of 2021, the global count of stunted children was estimated at 149.2 million, which corresponds to approximately 22 percent of all five-year-old children [3].Specifically in Indonesia, the prevalence of stunted children stands at 24.4%.The objective outlined in accordance with the national mid-term development strategy spanning from 2020 to 2024, aligned with the 2024 Sustainable Development Goals (SDGs), The Deputy Minister of Health of the Republic of Indonesia also said that the government is targeting stunting cases to fall by 14% in 2024.To achieve this target, the Ministry of Health intervenes with a specific nutritional approach.This specific nutritional approach is performed before and after a child's birth [4].
The consequences of child stunting manifest in the short term as well as over the long run, encompassing increased rates of illness and death, compromised child growth and learning capacities, heightened susceptibility to infections and chronic diseases during adulthood, and reduced productivity and economic potential [5], and the difficulty in visually identifying stunted children and the lack of routine assessment of linear growth in primary health care services explains why it has taken so long to recognize the magnitude of this hidden scourge.To mitigate child growth issues originating from malnutrition, early identification and preventive measures are imperative.Given the substantial child population in Indonesia, comprising approximately 10% of the total population, both governmental involvement and individual participation in the early detection of abnormal child growth hold immense significance.Through consistent monitoring of a child's physical dimensions, their growth trajectory can be closely and persistently tracked.Consequently, this approach facilitates early detection and timely intervention for malnourished children.Presently, the identification process is primarily conducted through physical measurements such as height, weight, head circumference, arm circumference, and arm length, often undertaken at public health centers, clinics, and hospitals.In addition to measurements taken at public health centers, which usually occur monthly, it is crucial to conduct frequent at-home measurements.
With these positive objectives in mind, ensuring the prevention of growth and developmental disorders in children involves vital steps such as the timely identification of abnormalities in growth and development.This encompasses the early recognition of growth disorders and initial developmental stages in children through accurate and meticulous measurements of their physical proportions.This is crucial because a child's bodily growth is intricately linked to their overall development.This connection is particularly evident in the context of product design, wherein technical solutions are implemented based on prior quality function deployment analysis.The outcome of this analysis results in a simplified product design, a user-friendly interface, easily operable buttons, data recording capabilities, and a foldable design for convenient portability.

Literature Review 2.1. Stunting
Stunting is a chronic nutritional issue that arises from multiple factors and is intergenerational.Within the context of Indonesia, the community often views height as a matter of descent.However, research findings indicate that the role of descent only contributes to about 15% of the issue.The most significant factors are related to nutrition, growth hormones, and recurring infectious diseases [6] [7].The initial 1000 days of life (1000 HPK) represent a crucial period in the development of stunting among children under the age of five [8].
This issue has enduring consequences that extend throughout the life cycle.While insufficient nutrition, especially among children under five, leads to immediate consequences such as increased morbidity, the chronic nature of this nutritional concern affects cognitive function, resulting in reduced intelligence levels and ultimately impacting the quality of human resources.This issue continues to repeat throughout the life cycle, with children lacking proper nutrition during the early 1000 HPK period facing a risk of non-communicable diseases, commonly referred to as degenerative diseases, in adulthood [9].Stunting is a significant social health concern that requires serious attention.Previous research establishes a significant connection between stunting and birth weight, as well as the adequacy of maternal breastfeeding and supplementary feeding practices [10].
Stunting that occurs in early childhood has the potential to persist and elevate the risk of short stature as individuals transition into adolescence.Children who have short stature at ages 0-2 and remain short at 4-6 years old face a 27-fold risk of remaining short until puberty.Conversely, children who exhibit normal growth in their early years but experience growth faltering at ages 4-6 are at a 14-fold risk of becoming short during pre-puberty.Thus, interventions to prevent stunting remain necessary even beyond the first 1000 days of life [11].

Posyandu
Posyandu serves as a platform for sharing technological advancements in public health services, specifically beginning with family planning, within the community, by the community, and for the community.This concept, referred to as the Integrated Service Post (Posyandu), is a pivotal element in Indonesia's healthcare strategy.Posyandu, an abbreviation for Integrated Service Post, is a community-driven healthcare initiative in Indonesia that operates collaboratively with and for the community to facilitate health progress.Its primary function is to empower the community, ensuring easy access to fundamental health services and expediting the reduction of maternal and infant mortality rates [12].Operating in tandem with local Public Health Centers (Puskesmas), Posyandu extends integrated services and health monitoring to the populace.
These services also encompass health promotion, environmental health, parent-child healthcare, nutrition guidance, and health screenings.By means of Posyandu, the government endeavors to deliver crucial services that encompass improved nutrition and health, educational initiatives, child development, economic enhancement for families, and even food security and social welfare.Unlike Puskesmas facilities that provide daily services, Posyandu operates at least once a month, with conveniently located centers accessible to the community.[13]

Kansei Design Thinking
Kansei refers to the emotional sensation and mental impression experienced by a consumer regarding a particular product or service.The shift in product satisfaction encompasses not just functional and practical aspects but delves into a profound, emotive, and sentimental contentment rooted in genuine necessity [14].The primary objective of Kansei is to comprehend the emotional response of customers towards a specific product, establishing connections between these emotions and the product's attributes, and subsequently integrating them into design components [15].It's important to consider the execution procedure in Kansei's design.The elucidation of the Kansei design process is outlined as follows [16]: 1.The selection of the product domain involves identifying the product category, market segment, and intended audience.2. Exploring semantic space encompasses gathering Kansei expressions from diverse sources like relevant literature, customer interviews, publications, online resources, and others.Subsequently, the structure of Kansei perceptions is determined.3. Encompassing the spectrum of attributes involves utilizing the designated domain as a foundation.Kansei expressions are then refined and streamlined to a specific set of terms.The compiled data serves to streamline the subsequent amalgamation process.4. Integration, denoting the phase in which the semantic realm and attribute space are interconnected as depicted in Figure 2.With each acquisition of a Kansei term, a range of IOP Publishing doi:10.1088/1755-1315/1324/1/0120194 product attributes is also identified, influencing the Kansei term.

Validation Testing involves comparing the outcomes of the initial factor analysis (after
Kansei terms selection/refinement) with the subsequent analysis (after integration completion).This comparison aims to detect Kansei terms devoid of any impact.6. Model Construction, signifying the point at which successful data obtained from the integration process, validated through the testing phase, is formulated into a model presentation.

Quality Function Deployment
Quality Function Deployment (QFD) involves two main aspects: ( 1) identifying what will fulfill customer needs and (2) converting those customer expectations into specific design targets.The aim is to capture a comprehensive comprehension of customer preferences and to explore alternative procedural solutions.This data is then assimilated into the ongoing product development.QFD is implemented in the early stages of the design process to assist in discerning customer contentment and determining where quality-focused efforts should be concentrated.One of the tools within the realm of QFD is the house of quality, a visual technique for delineating the correlation between customer desires and a given product or service.Only through precise delineation of these connections can managers create products and procedures endowed with features that align with customer preferences [17].

Methods
The initiation of the design procedure involved the compilation of a literature review, online resources, and consultation with medical experts.Insights obtained from this research were then used to identify the initial values, often referred to as "Kansei words," which should be incorporated into the design.The term "Kansei" encompasses emotional and sensory expressions that describe an individual's feelings or perceptions of a particular product, experience, or environment.These Kansei words serve as a valuable tool for designers, aiding in the understanding and quantification of users' emotional and sensory reactions.By considering these responses, designers can tailor products to better meet the needs and preferences of their target users, as illustrated in Table 1.It's important to note that these Kansei words can vary depending on the context and the specific emotions or sensory experiences that designers aim to convey or evoke in their products.After obtaining the initial design, a simple mock-up is made, so that the design can be seen and felt directly by users.Making simple mock-ups is useful to help users see, observe, imagine, and feel the initial design.Users will rate this simple mock-up.The results of the assessment carried out on the initial design will then be used as feedback for the author in the process of developing and revising the next design, until reaching an appropriate final design.Design revisions are carried out so that the initial prototype development stage becomes the embodiment of the design.The prototyping process is carried out using acrylic material that is cut and bent.Then the acrylic parts are assembled, and the electronic parts (sensors, displays, etc.) are attached.The prototype is tested, and its functional suitability and problems are observed.The test results will be concluded and used in subsequent research.

Kansei Word Analysis
Gleaned from interviews held with four medical professionals, valuable and intricate understandings were gathered.These understandings encompass vital particulars, ranging from the diagnostic protocols at the puskesmas, and common symptoms, to obstacles tied to equipment utilization, inconveniences, and necessities.Considering this wealth of information, an examination of Kansei expressions is utilized as an approach to deconstruct user requirements, which aids the designer in formulating initial design concepts, as shown in Fig. 1.

Quality Function Deployment (QFD).
The initial phase of the design process involves translating conceptual ideas into tangible forms.This is often done by creating a mock-up using a polystyrene board, serving as a physical representation of the early design concept.This mock-up plays a crucial role in communicating the vision to stakeholders, particularly medical experts who provide valuable insights for shaping the final product.Following the presentation of the polystyrene board mock-up, a comprehensive review occurs, during which feedback and suggestions are gathered from the experts.This feedback undergoes meticulous analysis and interpretation, employing techniques such as the Quality Function Deployment (QFD) approach.The QFD approach is used to translate customer requirements, in this case, feedback from medical experts, into appropriate technical specifications.Feedback data is transformed into quantifiable scores and integrated into the QFD analysis alongside other inputs.
Figure 2 illustrates the results of this analysis, organizing technical requirements based on their percentage scores from highest to lowest priority.It identifies the primary technical priority as the need for a straightforward product shape design, emphasizing the importance of an intuitive and user-friendly design aligned with end-users' needs.The analysis also highlights the significance of clear button design, emphasizing the importance of designing buttons that are easily understandable to diverse users, thus enhancing usability.Additionally, it addresses several other technical aspects, including data recording capability, material selection, mechanism simplicity, ergonomic handle design, and interface clarity, each ranked in descending order of priority scores.
The utilization of the QFD approach enables a structured and systematic analysis of feedback data, facilitating the identification and prioritization of key technical requirements crucial for successful product development.By aligning design decisions with end-users needs and expectations, this approach ensures the creation of a product that not only meets but exceeds customer expectations.-While Kansei Engineering isn't a conventional approach to health diagnostics, its principles of user-centered design, emotional understanding, and continuous improvement can be creatively applied to develop more effective and engaging tools and interventions for early stunting detection.The evolution of the product incorporates technical resolutions sourced from preceding analyses using the quality function deployment approach.The resultant product embodies a design that closely adheres to established benchmarks, accentuated by certain augmentations like a simplified design, a more intuitive user interface, easily manageable buttons, data recording capabilities, and a collapsible structure that bolsters user mobility.-User preferences, particularly those of health workers, play a significant role in addressing the ongoing problem of childhood stunting.This is especially relevant in the design process of essential growth monitoring tools and interventions to ensure their practicality, ease of use in real-world scenarios, and effectiveness while remaining attractive.-The results of the quality function analysis can be utilized for the design of future prototype growth monitoring tools and interventions.However, it is imperative to conduct ongoing studies to ensure the development of effective and proper growth monitoring tools and interventions.

Figure 2 .
Figure 2. Quality Function Deployment Analysis Result5.ConclusionThe study's findings have led to the following conclusions: -Early recognition of growth and developmental irregularities plays a pivotal role in averting instances of growth and developmental disorders among children.-The identification of growth disorders and early developmental challenges in children requires precise measurements of the child's physical dimensions.This is crucial due to the intricate relationship between a child's growth and their overall development.-Essential measurements vital for diagnosing children encompass weight corresponding to age and height, height or body length corresponding to age, and age-based body mass index.-While Kansei Engineering isn't a conventional approach to health diagnostics, its principles of user-centered design, emotional understanding, and continuous improvement can be creatively applied to develop more effective and engaging tools and interventions for early stunting detection.The evolution of the product incorporates technical resolutions sourced from preceding analyses using the quality function deployment approach.The resultant product embodies a design that closely adheres to established benchmarks, accentuated by certain augmentations like a simplified design, a more intuitive user interface, easily manageable buttons, data recording capabilities, and a collapsible structure that bolsters user mobility.-User preferences, particularly those of health workers, play a significant role in addressing the ongoing problem of childhood stunting.This is especially relevant in the design process of essential growth monitoring tools and interventions to ensure their practicality, ease of use in real-world scenarios, and effectiveness while remaining attractive.-The results of the quality function analysis can be utilized for the design of future prototype growth monitoring tools and interventions.However, it is imperative to conduct ongoing studies to ensure the development of effective and proper growth monitoring tools and interventions.