Environment-Based Adaptation Strategy for Addressing Child Malnutrition in Climate-Vulnerable West Sumatra: An ISM–MICMAC Study

This study aims to prioritise leverage points across the Independent, Linkage, and Dependent quadrants and their levelled hierarchies, and to synthesise a prioritised adaptation sequence that culminates in improved essential health-service utilisation, food and nutrition quality, and policy integrity with IT-enabled cross-sector coordination. Interpretive Structural Modelling (ISM) combined with MICMAC was employed to construct a hierarchical structure of causal influence among elements (drivers to outcomes) and to map Driver Power (DP) and Dependence (DE) across four quadrants (Independent, Linkage, Dependent, Autonomous). Experts were engaged through Delphi/FGD to refine elements and validate levels and thresholds. In the constraints set, four sub-elements exhibit the highest DP (DP = 11): E1, E2, E3, E7; E4 and E6 fall within Linkage E5, E8, E9, E10, E11 are Dependent none are Autonomous. In the programmes set, three sub-elements show the highest DP (DP = 10): E1, E2, E4, E7, E8, E9 constitute the Linkage layer E3, E5, E10 act as Dependent outcomes. In the institutions set, E5 has the highest DP (DP = 8) and functions as the core driver E1 and E2 follow (DP = 7) as operational drivers E4, E6, E7 are Linkage nodes; E3 and E8 are Dependent. Overall, ISM–MICMAC shows that child malnutrition in climate-vulnerable West Sumatra is driven by hazards, diseases, behaviour deficits, and weak adaptation. Priorities are to curb risks and infections, strengthen behaviours and adaptation, then stabilise consumption and food security, while removing information, trust, gender, and workforce.