Extending the Theory of Planned Behaviour: A Structural Model of Toddler Health Cadre Performance in Growth Monitoring Driven by Motivation, Empowerment, and Perception

Abstract

Background: Stunting remains a critical public health issue in Indonesia, particularly among children under two years, with long-term effects on growth, cognition, and health. Toddler health cadres, as community volunteers in Posyandu, play a vital role in growth monitoring, yet their performance is shaped by psychological and structural factors requiring empirical study.

Objective: This study aimed to develop and test a structural model of toddler health cadre performance in growth monitoring based on the Theory of Planned Behaviour (TPB), examining the roles of motivation, empowerment, and perception.

Methodology: A cross-sectional survey of 200 cadres from eight community health centres in Sleman Regency, Indonesia, was conducted using validated Likert-scale questionnaire copies. Data were analysed with Structural Equation Modelling (SEM) via LISREL, testing direct, indirect, and mediation pathways.

Results: Cadres demonstrated high motivation (M=94.29), empowerment (M=64.05), perception (M=65.96), and performance (M=100.68). SEM revealed significant effects of motivation on empowerment (β=0.255, p<0.001), perception (β=0.204, p<0.01), and performance (β=0.294, p<0.001). Empowerment affected perception (β=0.489, p<0.001) and performance (β=0.143, p<0.05). Perception was the strongest predictor of performance (β=0.473, p<0.001). Indirect effects confirmed mediation through empowerment and perception. The model fit was excellent (RMSEA=0.036, CFI=0.995, GFI=0.946), explaining 51.5% of variance.

Conclusion: Cadre performance reflects the synergy of motivation, empowerment, and perception. While motivation initiates engagement, empowerment provides structural support, and perception is the strongest driver of performance.

Unique Contribution: This study extends TPB by showing a multi-level mediation pathway (motivation → empowerment → perception → performance), underscoring that motivation alone is insufficient without empowerment and positive role perception.

Key Recommendation: Policymakers and programme designers should: 1) Combine motivation-building, empowerment opportunities, and perceptual strengthening in interventions; 2) Redesign training to emphasise reflection, participatory learning, and social meaning; and 3) Adopt longitudinal and multi-source evaluations to refine cadre development strategies across community contexts.