The acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesia

Background: Hypertensive disorders of pregnancy (HDP) management pathways have been developed for Indonesian primary care practice. But they have not been explored for their feasibility in practice settings. Aim/Objectives: To explore the HDP pathways’ acceptability and feasibility in Indonesia. Methods: The pathways were short-implemented in three primary care clinics in Yogyakarta for a month guided by implementation science frameworks(Medical Research Council and Practical, Robust, Implementation and Sustainability Model). Evaluations were conducted using a triangulation approach, including focus groups, interviews and observations with general practitioners, nurses, midwives, and patients. Qualitative data were thematically analysed using a mix of inductive and deductive approaches. Findings: Fifty providers, including general practitioners, nurses and midwives, four obstetricians, head of maternal health division of the local health officer, and 61 patients participated in the implementation. Of these, 48 participated in the focus groups or interviews at the end of one month. All three clinics applied recommendations from the developed pathways at various degrees. GPs and nurse participants felt that the pathways improved their practice, particularly on preeclampsia screening. Health officer and obstetricians also supported the providers in conducting more procedures before referring HDP patients to the hospital. However, the implementation was challenged by multi-factorial barriers, including hierarchy and boundaries between primary care providers and specialists. Implications: The developed HDP primary care management pathways are acceptable and feasible in primary care practice. Strategies to minimise the implementation challenges and scale-up studies are needed to determine the pathways’ value and enhance its translation into practice.