Management of hypertensive disorders of pregnancy (HDP) in Indonesian primary care settings : the views of stakeholders

Context: Maternal mortality attributed to HDP in Indonesia is high. Primary care providers are involved in HDP management, but the way they manage the disease is limitedly known in the literature. Objective: This study aims to explore the way Indonesian primary care providers manage HDP and their recommendations for the future of HDP management in primary care. Design: This study applied a qualitative methodology. Participants were purposively recruited through the researchers' professional networks. Data were collected through interviews and the questions were informed by implementation science frameworks. Data were analysed using mixed of deductive and inductive approach of thematic analysis. Setting: This study was conducted with participants in Yogyakarta province, Indonesia. Participants: Stakeholders involved in HDP management and policy in primary care, including general practitioners, midwives, nurse, specialists, policymakers and patients with a past history of HDP. Findings: A total of 25 participants were interviewed. Three major themes were identified: community culture, continuity of care and providers' confidence. There were community beliefs that complications during pregnancy, including having hypertension, were 'normal'. It was not uncommon for Indonesian pregnant women to visit different providers, so their care was fragmented with little continuity of care. Providers also expressed a lack of confidence in their ability to handle maternal complications. They expressed a desire for more practical guidance to help them appropriately manage HDP. The implication(s) for practice: The development and implementation of a management pathway for HDP in primary care is recommended to improve the providers' confidence and management of HDP.