KMS for overcoming stunting in early childhood and pregnant women using the Soft System Methodology (SSM) with the Learning Lesson System (LLS) approach
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Abstract
This study addresses the concerning prevalence of stunting among early childhood and pregnant women in Indramayu Regency, which reached 18.4% in 2024, exceeding the national target of 14%. It aims to develop a Knowledge Management System (KMS) to support integrated stunting control efforts by employing Soft Systems Methodology (SSM) for comprehensive problem identification and the Learning Lesson System (LLS) to incorporate proven best practices. The KMS is designed to optimize information distribution regarding the causes, impacts, and interventions for the stunting issue, while enhancing collaboration among government, community, and families. The integration of SSM and LLS allows the system to adapt to changing local conditions and needs, providing relevant, evidence-based information. This research result suggests that the implementation of KMS can significantly improve the effectiveness of health policies and intervention programs at reducing stunting, particularly among vulnerable populations. However, questions remain regarding the specific features of the KMS, the implementation strategy within communities, and the evaluation measures for assessing its long-term effectiveness in combating stunting.
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How to Cite
Krisnanik, E., Adrezob, M., Kraugusteeliana, K., Yulistiawan, B. S., & Susramae, I. G. (2026). KMS for overcoming stunting in early childhood and pregnant women using the Soft System Methodology (SSM) with the Learning Lesson System (LLS) approach . International Journal of Basic and Applied Science, 14(3), 110–125. https://doi.org/10.35335/ijobas.v14i3.834
References
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[2] W. H. Organization, “Levels and trends in child malnutrition: UNICEF,” 2023.
[3] WHO, “Stunting in a nutshell,” WHO. [Online]. Available: https://www.who.int/News/Item/19-11-2015-Stunting-in-a-Nutshell
[4] A. Prasetyo, N. Noviana, W. Rosdiana, M. A. Anwar, B. P. Harwijayanti, and M. Fahlevi, “Stunting convergence management framework through system integration based on regional service governance,” Sustainability, vol. 15, no. 3, p. 1821, 2023, doi: https://doi.org/10.3390/su15031821.
[5] S. Indriasari, D. I. Sensuse, Y. Resti, M. Wurzinger, D. S. Hidayat, and B. Widodo, “Requirements engineering of knowledge management system for smallholder dairy farmers,” J. Human, Earth, Futur, vol. 5, no. 2, pp. 151–172, 2024, doi: https://doi.org/10.28991/HEF-2024-05-02-02.
[6] P. M. Putri, A. S. Shafira, and G. S. Mahardhika, “Stunting Reduction Strategy In Indonesia: Maternal Knowledge Aspects,” Indones. J. Public Heal., vol. 19, no. 2, p. 329, 2024, doi: https://doi.org/10.20473/Ijph.v19i2.2024.329-343.
[7] J. Hoddinott, H. Alderman, J. R. Behrman, L. Haddad, and S. Horton, “The economic rationale for investing in stunting reduction,” Matern. Child Nutr., vol. 9, no. S2, pp. 69–82, 2013, doi: https://doi.org/10.1111/mcn.12080.
[8] F. El-Jardali et al., “Knowledge management tools and mechanisms for evidence-informed decision-making in the WHO European Region: a scoping review,” Heal. Res. Policy Syst., vol. 21, no. 1, p. 113, 2023, doi: https://doi.org/10.1186/s12961-023-01058-7.
[9] M.-H. Wang and T.-Y. Yang, “Investigating the success of knowledge management: An empirical study of small-and medium-sized enterprises,” Asia Pacific Manag. Rev., vol. 21, no. 2, pp. 79–91, 2016, doi: https://doi.org/10.1016/j.apmrv.2015.12.003.
[10] M. Dobbins, K. DeCorby, P. Robeson, H. Husson, D. Tirilis, and L. Greco, “A knowledge management tool for public health: health-evidence. ca,” BMC Public Health, vol. 10, no. 1, p. 496, 2010, doi: https://doi.org/10.1186/1471-2458-10-496.
[11] M. R. Mehregan, M. Hosseinzadeh, and A. Kazemi, “An application of soft system methodology,” Procedia-Social Behav. Sci., vol. 41, no. 1, pp. 426–433, 2012, doi: https://doi.org/10.1016/j.sbspro.2012.04.051.
[12] S. J. W. Astuti, S. S. Dwiningwarni, and S. Atmojo, “Modeling environmental interactions and collaborative interventions for childhood stunting: A case from Indonesia,” Dialogues Heal., vol. 6, no. 6, p. 100206, 2025, doi: https://doi.org/10.1016/j.dialog.2025.100206.
[13] R. Raflizar, M. Damris, A. Johari, and H. Herlambang, “Community-Based Educational Approaches to Stunting Prevention,” Heal. Educ. Heal. Promot., vol. 13, no. 1, pp. 21–30, 2025, [Online]. Available: https://hehp.modares.ac.ir/browse.php?a_id=78430&sid=5&slc_lang=en&html=1
[14] I. Ojukwu and P. Bednar, “Exploring barriers to effective organisational change using combined approach: Soft Systems Methodology (SSM) and ETHICS (a socio-technical design approach),” in 10th International Conference on Socio-Technical Perspectives in Information Systems, STPIS 2024, CEUR Workshop Proceedings, 2024, pp. 77–88. [Online]. Available: https://researchportal.port.ac.uk/en/publications/exploring-barriers-to-effective-organisational-change-using-combi/
[15] S. Salavati and A. Mirijamdotter, “Soft Systems Methodology and Cognitive Mapping: A Linkage between the Initial Phases of SSM,” in Vienna 2017 International Society for System Sciences, The 61st ISSS World Conference, Vienna, July 9-14, 2017, International Society for the Systems Sciences, 2017. [Online]. Available: https://www.diva-portal.org/smash/record.jsf?pid=diva2%3A1200019&dswid=-5664
[16] P. Hanafizadeh and M. Mehrabioun, “Application of SSM in tackling problematical situations from academicians’ viewpoints,” Syst. Pract. Action Res., vol. 31, no. 2, pp. 179–220, 2018, doi: https://doi.org/10.1007/s11213-017-9422-y.
[17] L. Mathiassen and P. A. Nielsen, “Interaction and Transformation in SSM,” Syst. Res. Behav. Sci. Off. J. Int. Fed. Syst. Res., vol. 17, no. 3, pp. 243–253, 2000, doi: https://doi.org/10.1002/(SICI)1099-1743(200005/06)17:3%3C243::AID-SRES316%3E3.0.CO;2-9.
[18] S. M. Drei, E. G. Miranda, T. da S. R. Paz, V. R. R. Mota, and N. C. R. Bergiante, “PROPOSING A NOVEL CONCEPTUAL MODEL FOR THE MEDICAL CLINIC WITHIN A MID-SIZED HOSPITAL THROUGH THE APPLICATION OF SOFT SYSTEM METHODOLOGY (SSM),” Pesqui. Operacional, vol. 43, p. e275528, 2023, doi: https://doi.org/10.1590/0101-7438.2023.043.00275528.
[19] U. E. Buthelezi et al., “Optimizing the role and functions of CHWs in service of a people-centred community health system in sub-Saharan Africa. A realist synthesis,” SSM - Heal. Syst., vol. 5, no. 100089, pp. 1–16, 2025, doi: https://doi.org/10.1016/j.ssmhs.2025.100089.
[20] H. Augustsson, K. Churruca, and J. Braithwaite, “Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare,” BMC Health Serv. Res., vol. 20, no. 1, p. 1063, 2020, doi: https://doi.org/10.1186/s12913-020-05929-5.
[21] K. Kotiadis et al., “Using a model of the performance measures in Soft Systems Methodology (SSM) to take action: a case study in health care,” J. Oper. Res. Soc., vol. 64, no. 1, pp. 125–137, 2013, doi: https://doi.org/10.1057/jors.2012.21.
[22] A. Floyde, G. Lawson, S. Shalloe, R. Eastgate, and M. D’Cruz, “The design and implementation of knowledge management systems and e-learning for improved occupational health and safety in small to medium sized enterprises,” Saf. Sci., vol. 60, no. 1, pp. 69–76, 2013, doi: https://doi.org/10.1016/j.ssci.2013.06.012.
[23] J. E. Platt, M. Raj, and M. Wienroth, “An analysis of the learning health system in its first decade in practice: scoping review,” J. Med. Internet Res., vol. 22, no. 3, p. e17026, 2020, doi: https://doi.org/10.2196/17026.
[24] D. Easterling, A. C. Perry, R. Woodside, T. Patel, and S. B. Gesell, “Clarifying the concept of a learning health system for healthcare delivery organizations: implications from a qualitative analysis of the scientific literature,” Learn. Heal. Syst., vol. 6, no. 2, p. e10287, 2022, doi: https://doi.org/10.1002/lrh2.10287.
[25] E. Santos, M. Carvalho, and S. Martins, “Sustainable enablers of knowledge management strategies in a higher education institution,” Sustainability, vol. 16, no. 12, p. 5078, 2024, doi: https://doi.org/10.3390/su16125078.
[26] M. E. Latino, A. Corallo, I. Capone, D. Martino, and A. Trifoglio, “Lesson learned and best practice management: A tool to support the enterprise,” Knowl. Process Manag., vol. 23, no. 3, pp. 230–244, 2016, doi: https://doi.org/10.1002/kpm.1513.
[27] J. Crawley, “How can a deeper understanding of the professional situation of LLS teacher educators enhance their future support, professional development and working context?,” Bath Spa University, 2014. doi: https://doi.org/10.17870/bathspa.00005029.
[28] W. R. King, T. R. Chung, and M. H. Haney, “Knowledge Management and Organizational Learning,” Omega, vol. 36, no. 2, pp. 167–172, 2008, doi: 10.1016/j.omega.2006.07.004.
[29] M. N. A. Sharif, K. M. Mohamad, R. A. Alias, S. Shahibudin, and N. H. Zakaria, “Knowledge management (KM) framework for representing lessons learned system for Communities of practice in Institutions of higher learning,” Malaysian J. Comput. Sci., vol. 17, no. 1, pp. 1–12, 2004.
[30] B. Bergvall-Kåreborn, A. Mirijamdotter, and A. Basden, “Reflections on CATWOE , a Soft Systems Methodology Technique for Systems Designs,” Proc. 9th Annu. CPTS Work. Conf., pp. 1–12, 2003.
[31] E. M. PERDANA, D. MANONGGA, and A. IRIANA, “Model Konseptual bagi Pengembangan Knowledge Management di SMA Menggunakan Soft System Methodology,” J. Teknol. Inf. dan Ilmu Komput., vol. 6, no. 2, p. 169, 2019, doi: 10.25126/jtiik.201962932.
[2] W. H. Organization, “Levels and trends in child malnutrition: UNICEF,” 2023.
[3] WHO, “Stunting in a nutshell,” WHO. [Online]. Available: https://www.who.int/News/Item/19-11-2015-Stunting-in-a-Nutshell
[4] A. Prasetyo, N. Noviana, W. Rosdiana, M. A. Anwar, B. P. Harwijayanti, and M. Fahlevi, “Stunting convergence management framework through system integration based on regional service governance,” Sustainability, vol. 15, no. 3, p. 1821, 2023, doi: https://doi.org/10.3390/su15031821.
[5] S. Indriasari, D. I. Sensuse, Y. Resti, M. Wurzinger, D. S. Hidayat, and B. Widodo, “Requirements engineering of knowledge management system for smallholder dairy farmers,” J. Human, Earth, Futur, vol. 5, no. 2, pp. 151–172, 2024, doi: https://doi.org/10.28991/HEF-2024-05-02-02.
[6] P. M. Putri, A. S. Shafira, and G. S. Mahardhika, “Stunting Reduction Strategy In Indonesia: Maternal Knowledge Aspects,” Indones. J. Public Heal., vol. 19, no. 2, p. 329, 2024, doi: https://doi.org/10.20473/Ijph.v19i2.2024.329-343.
[7] J. Hoddinott, H. Alderman, J. R. Behrman, L. Haddad, and S. Horton, “The economic rationale for investing in stunting reduction,” Matern. Child Nutr., vol. 9, no. S2, pp. 69–82, 2013, doi: https://doi.org/10.1111/mcn.12080.
[8] F. El-Jardali et al., “Knowledge management tools and mechanisms for evidence-informed decision-making in the WHO European Region: a scoping review,” Heal. Res. Policy Syst., vol. 21, no. 1, p. 113, 2023, doi: https://doi.org/10.1186/s12961-023-01058-7.
[9] M.-H. Wang and T.-Y. Yang, “Investigating the success of knowledge management: An empirical study of small-and medium-sized enterprises,” Asia Pacific Manag. Rev., vol. 21, no. 2, pp. 79–91, 2016, doi: https://doi.org/10.1016/j.apmrv.2015.12.003.
[10] M. Dobbins, K. DeCorby, P. Robeson, H. Husson, D. Tirilis, and L. Greco, “A knowledge management tool for public health: health-evidence. ca,” BMC Public Health, vol. 10, no. 1, p. 496, 2010, doi: https://doi.org/10.1186/1471-2458-10-496.
[11] M. R. Mehregan, M. Hosseinzadeh, and A. Kazemi, “An application of soft system methodology,” Procedia-Social Behav. Sci., vol. 41, no. 1, pp. 426–433, 2012, doi: https://doi.org/10.1016/j.sbspro.2012.04.051.
[12] S. J. W. Astuti, S. S. Dwiningwarni, and S. Atmojo, “Modeling environmental interactions and collaborative interventions for childhood stunting: A case from Indonesia,” Dialogues Heal., vol. 6, no. 6, p. 100206, 2025, doi: https://doi.org/10.1016/j.dialog.2025.100206.
[13] R. Raflizar, M. Damris, A. Johari, and H. Herlambang, “Community-Based Educational Approaches to Stunting Prevention,” Heal. Educ. Heal. Promot., vol. 13, no. 1, pp. 21–30, 2025, [Online]. Available: https://hehp.modares.ac.ir/browse.php?a_id=78430&sid=5&slc_lang=en&html=1
[14] I. Ojukwu and P. Bednar, “Exploring barriers to effective organisational change using combined approach: Soft Systems Methodology (SSM) and ETHICS (a socio-technical design approach),” in 10th International Conference on Socio-Technical Perspectives in Information Systems, STPIS 2024, CEUR Workshop Proceedings, 2024, pp. 77–88. [Online]. Available: https://researchportal.port.ac.uk/en/publications/exploring-barriers-to-effective-organisational-change-using-combi/
[15] S. Salavati and A. Mirijamdotter, “Soft Systems Methodology and Cognitive Mapping: A Linkage between the Initial Phases of SSM,” in Vienna 2017 International Society for System Sciences, The 61st ISSS World Conference, Vienna, July 9-14, 2017, International Society for the Systems Sciences, 2017. [Online]. Available: https://www.diva-portal.org/smash/record.jsf?pid=diva2%3A1200019&dswid=-5664
[16] P. Hanafizadeh and M. Mehrabioun, “Application of SSM in tackling problematical situations from academicians’ viewpoints,” Syst. Pract. Action Res., vol. 31, no. 2, pp. 179–220, 2018, doi: https://doi.org/10.1007/s11213-017-9422-y.
[17] L. Mathiassen and P. A. Nielsen, “Interaction and Transformation in SSM,” Syst. Res. Behav. Sci. Off. J. Int. Fed. Syst. Res., vol. 17, no. 3, pp. 243–253, 2000, doi: https://doi.org/10.1002/(SICI)1099-1743(200005/06)17:3%3C243::AID-SRES316%3E3.0.CO;2-9.
[18] S. M. Drei, E. G. Miranda, T. da S. R. Paz, V. R. R. Mota, and N. C. R. Bergiante, “PROPOSING A NOVEL CONCEPTUAL MODEL FOR THE MEDICAL CLINIC WITHIN A MID-SIZED HOSPITAL THROUGH THE APPLICATION OF SOFT SYSTEM METHODOLOGY (SSM),” Pesqui. Operacional, vol. 43, p. e275528, 2023, doi: https://doi.org/10.1590/0101-7438.2023.043.00275528.
[19] U. E. Buthelezi et al., “Optimizing the role and functions of CHWs in service of a people-centred community health system in sub-Saharan Africa. A realist synthesis,” SSM - Heal. Syst., vol. 5, no. 100089, pp. 1–16, 2025, doi: https://doi.org/10.1016/j.ssmhs.2025.100089.
[20] H. Augustsson, K. Churruca, and J. Braithwaite, “Change and improvement 50 years in the making: a scoping review of the use of soft systems methodology in healthcare,” BMC Health Serv. Res., vol. 20, no. 1, p. 1063, 2020, doi: https://doi.org/10.1186/s12913-020-05929-5.
[21] K. Kotiadis et al., “Using a model of the performance measures in Soft Systems Methodology (SSM) to take action: a case study in health care,” J. Oper. Res. Soc., vol. 64, no. 1, pp. 125–137, 2013, doi: https://doi.org/10.1057/jors.2012.21.
[22] A. Floyde, G. Lawson, S. Shalloe, R. Eastgate, and M. D’Cruz, “The design and implementation of knowledge management systems and e-learning for improved occupational health and safety in small to medium sized enterprises,” Saf. Sci., vol. 60, no. 1, pp. 69–76, 2013, doi: https://doi.org/10.1016/j.ssci.2013.06.012.
[23] J. E. Platt, M. Raj, and M. Wienroth, “An analysis of the learning health system in its first decade in practice: scoping review,” J. Med. Internet Res., vol. 22, no. 3, p. e17026, 2020, doi: https://doi.org/10.2196/17026.
[24] D. Easterling, A. C. Perry, R. Woodside, T. Patel, and S. B. Gesell, “Clarifying the concept of a learning health system for healthcare delivery organizations: implications from a qualitative analysis of the scientific literature,” Learn. Heal. Syst., vol. 6, no. 2, p. e10287, 2022, doi: https://doi.org/10.1002/lrh2.10287.
[25] E. Santos, M. Carvalho, and S. Martins, “Sustainable enablers of knowledge management strategies in a higher education institution,” Sustainability, vol. 16, no. 12, p. 5078, 2024, doi: https://doi.org/10.3390/su16125078.
[26] M. E. Latino, A. Corallo, I. Capone, D. Martino, and A. Trifoglio, “Lesson learned and best practice management: A tool to support the enterprise,” Knowl. Process Manag., vol. 23, no. 3, pp. 230–244, 2016, doi: https://doi.org/10.1002/kpm.1513.
[27] J. Crawley, “How can a deeper understanding of the professional situation of LLS teacher educators enhance their future support, professional development and working context?,” Bath Spa University, 2014. doi: https://doi.org/10.17870/bathspa.00005029.
[28] W. R. King, T. R. Chung, and M. H. Haney, “Knowledge Management and Organizational Learning,” Omega, vol. 36, no. 2, pp. 167–172, 2008, doi: 10.1016/j.omega.2006.07.004.
[29] M. N. A. Sharif, K. M. Mohamad, R. A. Alias, S. Shahibudin, and N. H. Zakaria, “Knowledge management (KM) framework for representing lessons learned system for Communities of practice in Institutions of higher learning,” Malaysian J. Comput. Sci., vol. 17, no. 1, pp. 1–12, 2004.
[30] B. Bergvall-Kåreborn, A. Mirijamdotter, and A. Basden, “Reflections on CATWOE , a Soft Systems Methodology Technique for Systems Designs,” Proc. 9th Annu. CPTS Work. Conf., pp. 1–12, 2003.
[31] E. M. PERDANA, D. MANONGGA, and A. IRIANA, “Model Konseptual bagi Pengembangan Knowledge Management di SMA Menggunakan Soft System Methodology,” J. Teknol. Inf. dan Ilmu Komput., vol. 6, no. 2, p. 169, 2019, doi: 10.25126/jtiik.201962932.
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