Modelling of Family Functioning, Dietary Diversity, Family Environmental Sanitation, Household Food Insecurity Access, and Stunting: A Cross-Sectional Study in Rural Areas of Indonesia

Purpose: Risk factors associated with stunting are often studied individually, while their combined effect within a single framework is poorly understood. This study aimed to model the interrelationships between family function, dietary diversity, family environmental sanitation, and household food insecurity access as predictors of stunting in rural areas of Indonesia.Methods: A descriptive-analytic, cross-sectional approach was conducted on 339 mothers with stunted children under five years of age in a rural area of Indonesia from June to August 2025. Data were collected using questionnaires and measurements of stunting. Data analysis utilised Structural Equation Modelling (SEM) based on Partial Least Squares (PLS) to examine the relationships among mothers' factors, child factors, family functioning (as measured by the Family Assessment Device - FAD), dietary diversity, family environmental sanitation (FES), household food insecurity access (HFIA), and stunting.Results: The final structural model demonstrated that dietary diversity (p=.001; β=.16) and family functioning (p=.003; β=.20) were the most significant direct predictors of stunting. Notably, 'child factors' (e.g., medical history) also had a direct effect on stunting (p=.029; β=0.14), but more importantly, exerted a powerful indirect influence by significantly shaping family functioning, FES, and HFIA. While 'mother factors' (e.g. education) influenced household food and hygiene, they did not have a direct statistical effect on stunting in the final model.Conclusion: Alongside dietary diversity, family functioning is a key predictor of stunting. To be effective, community nursing interventions must integrate strategies that support family dynamics with traditional nutritional guidance.