Adapting international hypertensive disorders of pregnancy (HDP) management recommendations to the context of Indonesian primary care

Background: Indonesia has one of the highest mortality rates due to HDP in Asia. And currently, international HDP management recommendations have been limitedly adopted in the primary care setting. Aim/Objectives: To explore experts’ consensus on the feasibility of international HDP management recommendations for the development of HDP management pathways in Indonesian primary care. Methods: Three rounds of Delphi survey were conducted to facilitate the consensus development process. Experts from various health disciplines were recruited to participate. In rounds 1 and 2, they were asked to rate 125 statements taken from international guidelines, ranging from screening to long-term follow-up of HDP using five-point Likert scales. In rounds 2 and 3, they were presented with results of the previous survey rounds and were asked whether they wished to revise their answers on statements that had not reached consensus. Data were analysed descriptively using Microsoft Excel. Statements that had at least 70% agreement were included in the drafted HDP management pathways, which were also presented to participantsin round 3 for consensus. Findings: Fifty-two participants, including general practitioners, nurses, midwives, obstetricians, and policymakers from Indonesia and United States participated; 48 completed round 1, 45 round 2, and 37 round 3, respectively. Consensus (range 70–100% agreement) was reached for 115 of the 125 statements. Drafts of HDP management pathways based on the 115 statements were agreed by all participants in round 3. Further suggestions for improvement were received from some participants. Implications: The developed HDP management pathways may assist primary care clinicians in Indonesia.