Missed opportunities in hypertension risk factors screening in Indonesia: a mixed-methods evaluation of integrated health post (POSBINDU) implementation

Abstract

ObjectivesTo assess the implementation and contextual barriers of POSBINDU, a community-based activity focusing on screening of non-communicable diseases (NCDs), mainly hypertension and diabetes, in Indonesia.DesignThis was a concurrent mixed-methods study, with a cross-sectional analysis of secondary data and focus group discussions (FGDs) on stakeholder of POSBINDU.SettingThe study was conducted in seven districts in three provinces in Indonesia, with approximately 50% of the primary healthcare (PHC) were selected as areas for data collection (n PHC=100).ParticipantsFrom 475 POSBINDU sites, we collected secondary data from 54 224 participants. For the qualitative approach, 21 FGDs and 2 in-depth interviews were held among a total of 223 informants.Primary outcomes and measuresProportion of POSBINDU visitors getting the hypertension screening and risk factors’ assessment, and barriers of POSBINDU implementation.ResultsOut of the 114 581 POSBINDU visits by 54 224 participants, most (80%) were women and adults over 50 years old (50%) showing a suboptimal coverage of men and younger adults. Approximately 95.1% of visitors got their blood pressure measured during their first visit; 35.3% of whom had elevated blood pressure. Less than 25% of the visitors reported to be interviewed for NCDs risk factors during their first visit, less than 80% had anthropometric measurements and less than 15% had blood cholesterol examinations. We revealed lack of resources and limited time to perform the complexities of activities and reporting as main barrier for effective hypertension screening in Indonesia.ConclusionsThis study showed missed opportunities in hypertension risk factors screening in Indonesia. The barriers include a lack of access and implementation barriers (capability, resources and protocols).

Participation in community-based healthcare interventions and non-communicable diseases early detection of general population in Indonesia

“…Posbindu PTM personnel consist of 5–8 Kaders (trained community health volunteers) who are trained and supervised by primary healthcare nurses and medical doctors. The main activities in the Posbindu PTM and Posbindu Lansia include: (1) screening for NCDs, mainly hypertension and diabetes; (2) assessing risk factors, i.e., smoking behaviour, diet, and physical activities; (3) health education; and (4) facilitates referral to primary health care ( Indonesia Ministry of Health, 2012 ; Widyaningsih et al, 2022 ).…”

Health challenges of the 21st century - Empirical essays on the health and economic burden of non-communicable diseases and climate change in Southeast Asia

“…Some countries, such as Indonesia, the Philippines and Myanmar, have made a first step into this direction by starting to integrate the WHO's "Package of Essential Noncommunicable Disease (PEN) interventions for primary health care" into their national health agendas, yet with limited success so far (Aye et al, 2020;Capuno et al, 2021;Rattanavipapong et al, 2016;World Health Organization, 2020a). Low awareness of and knowledge about NCDs, as well as the historical focus on combating communicable and infectious diseases and providing acute instead of preventive care limit the effectiveness of such interventions (Dans et al, 2011;Kruk et al, 2015;Meiqari et al, 2020;Widyaningsih et al, 2022).…”

“…Hence, even if access to care is granted, low levels of knowledge about NCDs, their risk factors, symptoms and consequences limit the effectiveness of NCD prevention and treatment interventions. As a consequence, a vast literature has emerged assessing knowledge, awareness and health practices concerning NCDs among the general population (e.g., Demaio et al, 2013;Legesse et al, 2022), among NCD patients (e.g., Amarasekara et al, 2016;Gautam et al, 2015), or among (community-) health care workers (e.g., Ojo et al, 2017;Onagbiye et al, 2020;Widyaningsih et al, 2022). These studies find evidence for a strong negative relation between levels of knowledge and awareness and the prevalence of NCD risk factors and unhealthy behaviors, including low health care seeking.…”

“…This in turn may take too much of the time and resources which may then be lacking at other places. Widyaningsih et al (2022) report that community health workers in Indonesia, often working on a voluntary basis, have to provide up to five different community programs, all regulated under different directorates of the Ministry of Health. A lack of financial resources and inadequate training of the health care workers were also identified as problematic.…”

“…Ligita et al (2018) provide an extensive literature review on the profile of diabetes healthcare professionals in Indonesia and conclude that they often lack skills and knowledge in providing diabetes education and care. Further, Widyaningsih et al (2022) present evidence that health workers in the national community-based screening program for diabetes and hypertension (POSBINDU ) suffer from unsatisfactory knowledge about the disease and lack the required abilities for health screening and education. These findings imply that individuals need to be aware of their individual risk status to demand a professional screening.…”