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Ekawati FM, Listiani P, Idaiani S, Thobari JA, Hafidz F. Cervical cancer screening program in Indonesia: is it time for HPV-DNA tests? Results of a qualitative study exploring the stakeholders' perspectives. BMC Womens Health 2024; 24:125. [PMID: 38365690 PMCID: PMC10873967 DOI: 10.1186/s12905-024-02946-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 02/01/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES Cervical cancer is a significant public health concern in Indonesia, and effective screening methods are necessary to improve the detection and reduce mortality. This study aimed to explore the perspectives of high-level stakeholders involved in cervical cancer screening in Indonesia and whether the use of human papillomavirus-deoxyribonucleic acid (HPV-DNA) methods for cervical cancer screening is acceptable in Indonesian settings. METHODS A qualitative research approach guided by realist evaluation was applied using focus group discussions (FGDs) between December 2021 and February 2022, conducted with stakeholders involved in cervical cancer screening in Indonesia. They were representatives of practitioners and policymakers involved in the screening, and were recruited through purposive recruitment. The data were analysed using inductive approach of thematic analysis. RESULTS The analysis of two FGDs with 29 participants identified four main themes: (i) Visual inspection with acetic acid (VIA) method as the most common modality used for cervical cancer screening, (ii) the applied screening programs in the community, (iii) the perceived challenges on the screening program, such as limitations of the National Health Insurance benefits package and a lack of regulations regarding screening procedures, and (iv) the possibilities of HPV-DNA testing as another modality for cervical cancer screening. Incorporating HPV-DNA testing also needs to ensure the capacity of the workers and the readiness of healthcare facilities. CONCLUSION Although HPV-DNA testing is a promising modality, challenges on the cervical cancer screening in Indonesia remain on the coverage, accessibility of the tools in practice and the women's awareness towards the screening. Ultimately, the findings of this study would help inform policies to improve cervical cancer screening programs in Indonesia.
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Affiliation(s)
| | - Putri Listiani
- Centre for Health Financing Policy and Health Insurance Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Sri Idaiani
- Research Centre for Preclinical and Clinical Medicine, National Research and Innovation Agency Indonesia, Jakarta, Indonesia
| | - Jarir At Thobari
- Indonesian Health Technology Assessment Committee, The Indonesian Ministry of Health, Jakarta, Indonesia
- Department of Pharmacology and Therapy, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Firdaus Hafidz
- Centre for Health Financing Policy and Health Insurance Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Department of Health Policy Management, Universitas Gadjah Mada, Yogyakarta, Indonesia
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McElroy LM, Mohottige D, Cooper A, Sanoff S, Davis LA, Collins BH, Gordon EJ, Wang V, Boulware LE. Improving Health Equity in Living Donor Kidney Transplant: Application of an Implementation Science Framework. Transplant Proc 2024; 56:68-74. [PMID: 38184377 DOI: 10.1016/j.transproceed.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
BACKGROUND Interventions to improve racial equity in access to living donor kidney transplants (LDKT) have focused primarily on patients, ignoring the contributions of clinicians, transplant centers, and health system factors. Obtaining access to LDKT is a complex, multi-step process involving patients, their families, clinicians, and health system functions. An implementation science framework can help elucidate multi-level barriers to achieving racial equity in LDKT and guide the implementation of interventions targeted at all levels. METHODS We adopted the Pragmatic Robust Implementation and Sustainability Model (PRISM), an implementation science framework for racial equity in LDKT. The purpose was to provide a guide for assessment, inform intervention design, and support planning for the implementation of interventions. RESULTS We applied 4 main PRISM domains to racial equity in LDKT: Organizational Characteristics, Program Components, External Environment, and Patient Characteristics. We specified elements within each domain that consider perspectives of the health system, transplant center, clinical staff, and patients. CONCLUSION The applied PRISM framework provides a foundation for the examination of multi-level influences across the entirety of LDKT care. Researchers, quality improvement staff, and clinicians can use the applied PRISM framework to guide the assessment of inequities, support collaborative intervention development, monitor intervention implementation, and inform resource allocation to improve equity in access to LDKT.
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Affiliation(s)
- Lisa M McElroy
- Department of Surgery, Duke University, Durham, North Carolina; Department of Population Health Sciences, Duke University, Durham, North Carolina.
| | | | - Alexandra Cooper
- Social Science Research Institute, Duke University, Durham, North Carolina
| | - Scott Sanoff
- Department of Medicine, Duke University, Durham, North Carolina
| | - LaShara A Davis
- Department of Surgery and J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas
| | | | - Elisa J Gordon
- Department of Surgery, Vanderbilt University, Nashville, Tennessee
| | - Virginia Wang
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
| | - L Ebony Boulware
- Department of Population Health Sciences, Duke University, Durham, North Carolina; Department of Medicine, Duke University, Durham, North Carolina
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Ekawati FM, Muchlis M, Tuteja A. Adopting international recommendations to design a model for maternal health service to cope with pandemic disruption for Indonesian primary care. BMC Pregnancy Childbirth 2023; 23:132. [PMID: 36859249 PMCID: PMC9975861 DOI: 10.1186/s12884-023-05433-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/07/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Limited evidence is available as the reference for the model of care on providing maternity care in low-and-middle-income countries (LMICs) to cope with pandemic disruption. This study aimed to adopt international recommendations to develop the model of care with the context of Indonesian settings. METHODS Four codesign workshops and substitute interviews with stakeholders, covering the (i) exploration of service provision during the pandemic, (ii) adoption of international recommendations, (iii) designing and (iv) finalising model of care for maternal health services in primary care under the COVID-19 pandemic. The study took place in Yogyakarta Province Indonesia from July-November 2021. The participants were general practitioners, midwives, nurses, patients, and obstetricians. The data were analysed thematically. RESULTS Twenty-three participants were recruited. As many as 23, 16, 14 and 16 participants participated in the first to fourth codesign workshops or substitute interviews. Key recommendations agreed upon in the workshop were health screening, maintaining antenatal-postnatal breastfeeding care, limiting visitors, using telemedicine, and creating a multidisciplinary team to provide the care. A model of care for improving maternal service was also agreed and received suggestions from the participants. Identified barriers to the recommendation implementation, such as the available clinical resources and negotiating providers' authority in practice. CONCLUSION Recommendations and the model of care for improving maternity care in Indonesia are beneficial to be implemented in Indonesian primary care during the COVID-19 pandemic. Further research includes pilot studies to explore the acceptability of the model and recommendation implementation in practice.
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Affiliation(s)
- Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Farmako Sekip Utara Sleman, Yogyakarta, Indonesia.
| | - Mumtihana Muchlis
- grid.8570.a0000 0001 2152 4506Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Jalan Farmako Sekip Utara Sleman, Yogyakarta, Indonesia ,Iwoimendaa Primary Health Center, Kolaka Regency, South-east Sulawesi, Indonesia
| | - Amita Tuteja
- grid.1008.90000 0001 2179 088XDepartment of General Practice, University of Melbourne, Victoria, Australia
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Rabin BA, Cakici J, Golden CA, Estabrooks PA, Glasgow RE, Gaglio B. A citation analysis and scoping systematic review of the operationalization of the Practical, Robust Implementation and Sustainability Model (PRISM). Implement Sci 2022; 17:62. [PMID: 36153628 PMCID: PMC9509575 DOI: 10.1186/s13012-022-01234-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background The Practical, Robust Implementation and Sustainability Model (PRISM) was developed in 2008 as a contextually expanded version of the broadly used Reach, Adoption, Effectiveness, Implementation, and Maintenance (RE-AIM) framework. PRISM provides researchers a pragmatic and intuitive model to improve translation of research interventions into clinical and community practice. Since 2008, the use of PRISM increased across diverse topics, populations, and settings. This citation analysis and scoping systematic review aimed to assess the use of the PRISM framework and to make recommendations for future research. Methods A literature search was conducted using three databases (PubMed, Web of Science, Scopus) for the period of 2008 and September 2020. After exclusion, reverse citation searches and invitations to experts in the field were used to identify and obtain recommendations for additional articles not identified in the original search. Studies that integrated PRISM into their study design were selected for full abstraction. Unique research studies were abstracted for information on study characteristics (e.g., setting/population, design), PRISM contextual domains, and RE-AIM outcomes. Results A total of 180 articles were identified to include PRISM to some degree. Thirty-two articles representing 23 unique studies integrated PRISM within their study design. Study characteristics varied widely and included studies conducted in diverse contexts, but predominately in high-income countries and in clinical out-patient settings. With regards to use, 19 used PRISM for evaluation, 10 for planning/development, 10 for implementation, four for sustainment, and one for dissemination. There was substantial variation across studies in how and to what degree PRISM contextual domains and RE-AIM outcomes were operationalized and connected. Only two studies directly connected individual PRISM context domains with RE-AIM outcomes, and another four included RE-AIM outcomes without direct connection to PRISM domains. Conclusions This is the first systematic review of the use of PRISM in various contexts. While there were low levels of ‘integrated’ use of PRISM and few reports on linkage to RE-AIM outcomes, most studies included important context domains of implementation and sustainability infrastructure and external environment. Recommendations are provided for more consistent and comprehensive use of and reporting on PRISM to inform both research and practice on contextual factors in implementation. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-022-01234-3.
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Bogart LM, Shazi Z, MacCarthy S, Mendoza-Graf A, Wara NJ, Zionts D, Dube N, Govere S, Bassett IV. Implementation of South Africa's Central Chronic Medicine Dispensing and Distribution Program for HIV Treatment: A Qualitative Evaluation. AIDS Behav 2022; 26:2600-2612. [PMID: 35122215 PMCID: PMC8815398 DOI: 10.1007/s10461-022-03602-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/19/2022]
Abstract
We used the Practical, Robust Implementation and Sustainability Model to evaluate implementation of South Africa’s Central Chronic Medicine Dispensing and Distribution (CCMDD) program, a differentiated service delivery program which allows clinically stable HIV-positive patients to receive antiretroviral therapy refills at clinic- or community-based pick-up points. Across ten clinics, we conducted 109 semi-structured interviews with stakeholders (pick-up point staff, CCMDD service providers and administrators) and 16 focus groups with 138 patients. Participants had highly favorable attitudes and said CCMDD decreased stigma concerns. Patient-level barriers included inadequate education about CCMDD and inability to get refills on designated dates. Organizational-level barriers included challenges with communication and transportation, errors in medication packaging and tracking, rigid CCMDD rules, and inadequate infrastructure. Recommendations included: (1) provide patient education and improve communication around refills (at the patient level); (2) provide dedicated space and staff, and ongoing training (at the organizational/clinic level); and (3) allow for prescription renewal at pick-up points and less frequent refills, and provide feedback to clinics (at the CCMDD program level).
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Affiliation(s)
- Laura M Bogart
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Zinhle Shazi
- AIDS Healthcare Foundation, Durban, South Africa
| | - Sarah MacCarthy
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA, 90407-2138, USA
- Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Nafisa J Wara
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Dani Zionts
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
| | - Nduduzo Dube
- AIDS Healthcare Foundation, Durban, South Africa
| | | | - Ingrid V Bassett
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA, USA
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
- Center for AIDS Research (CFAR), Harvard University, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Ekawati FM, Licqurish S, Gunn J, Brennecke S, Lau P. Hypertensive disorders of pregnancy (HDP) management pathways: results of a Delphi survey to contextualise international recommendations for Indonesian primary care settings. BMC Pregnancy Childbirth 2021; 21:269. [PMID: 33794799 PMCID: PMC8017638 DOI: 10.1186/s12884-021-03735-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 03/18/2021] [Indexed: 11/13/2022] Open
Abstract
Background Hypertensive disorders of pregnancy (HDP) are a significant contributor to the high maternal mortality rate in Indonesia. At the moment, limited guidelines are available to assist primary care providers in managing HDP cases. A previous review of 16 international HDP guidelines has identified opportunities for improving HDP management in Indonesian primary care, but it has not determined the suitability of the recommendations in practice. This study aims to achieve consensus among the experts regarding the recommendations suitability and to develop HDP pathways in Indonesian primary care. Methods Maternal health experts, including GPs, midwives, nurses, medical specialists and health policy researchers from Indonesia and overseas were recruited for the study. They participated in a consensus development process that applied a mix of quantitative and qualitative questions in three Delphi survey rounds. At the first and second-round survey, the participants were asked to rate their agreement on whether each of 125 statements about HDP and HDP management is appropriate for use in Indonesian primary care settings. The third-round survey presented the drafts of HDP pathways and sought participants’ agreement and further suggestions. The participants’ agreement scores were calculated with a statement needing a minimum of 70% agreement to be included in the HDP pathways. The participants’ responses and suggestions to the free text questions were analysed thematically. Results A total of 52 participants were included, with 48, 45 and 37 of them completing the first, second and third round of the survey respectively. Consensus was reached for 115 of the 125 statements on HDP definition, screening, management and long-term follow-up. Agreement scores for the statements ranged from 70.8–100.0%, and potential implementation barriers of the pathways were identified. Drafts of HDP management pathways were also agreed upon and received suggestions from the participants. Conclusions Most evidence-based management recommendations achieved consensus and were included in the developed HDP management pathways, which can potentially be implemented in Indonesian settings. Further investigations are needed to explore the acceptability and feasibility of the developed HDP pathways in primary care practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03735-3.
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Affiliation(s)
- Fitriana Murriya Ekawati
- Department of Family and Community Medicine, Universitas Gadjah Mada, Sleman, Yogyakarta, Indonesia. .,Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Victoria, 3000, Australia.
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Jane Gunn
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Victoria, 3000, Australia
| | - Shaun Brennecke
- University of Melbourne Department of Obstetrics and Gynaecology, Royal Women's Hospital, Parkville, Victoria, Australia.,Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Phyllis Lau
- Department of General Practice, University of Melbourne, Level 2, 780 Elizabeth Street, Melbourne, Victoria, 3000, Australia
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