Challenges and barriers to noncommunicable disease management at community health centers in south Sumatera province, Indonesia: A qualitative study
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Abstract
Background & Aim: Noncommunicable diseases (NCDs) are the leading cause of morbidity and mortality worldwide, heavily impacting low and middle-income countries like Indonesia. Community Health Centers (CHCs) play a critical role in providing healthcare, including NCD management, but they face significant challenges. This study explores the challenges and barriers to NCD management at CHCs in South Sumatra Province, Indonesia.
Methods & Materials: To gain an in-depth understanding of healthcare workers’ management of NCDs, an exploratory content analysis approach was employed. Data were collected through semi-structured interviews with 12 health workers, including nurses, doctors, midwives, and public health workers. Content analysis was used for data analysis.
Results: The content analysis identified five themes: Resource constraints in primary healthcare, lack of effective interprofessional collaboration, social and cultural issues; work area coverage, and government policy and support.
Conclusion: These findings highlight the complex challenges faced by CHCs. Addressing them requires a comprehensive strategy to enhance NCD care and primary healthcare services. Policymakers and health system managers can use these insights to develop targeted interventions. Further research is recommended to assess the effectiveness of specific strategies in overcoming these barriers in low-resource settings.
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13. Wiarsih W, Sahar DJ, Nursasi AY. A qualitative study: Interprofessional collaboration practice in Indonesian primary healthcare. Nursing Management. 2023;54(5S):13-8.
doi: 10.1097/nmg.0000000000000010.
14. Rai SS, Peters RMH, Syurina EV, Irwanto I, Naniche D, Zweekhorst MBM. Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia. International Journal for Equity in Health. 2020;19(1):206. doi: 10.1186/s12939-020-01318-w.
15. Eman A, Hassanat A-A, Soad A. Medication adherence and its influencing factors in community-dwelling older adults with chronic illnesses in a rural area. Nursing Practice Today. 2023;10(3):250-60.
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16. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open. 2016;2:8-14. doi: 10.1016/j.npls.2016.01.001.
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19. Gray LM, Wong-Wylie G, Rempel GR, Cook K. Expanding qualitative research interviewing strategies: Zoom video communications. The Qualitative Report. 2020;25(5):1292-301.
doi: 10.46743/2160-3715/2020.4212.
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21. Moon MD. Triangulation: A Method to Increase Validity, Reliability, and Legitimation in Clinical Research. Journal of Emergency Nursing. 2019;45(1):103-5. doi: 10.1016/j.jen.2018.11.004.
22. Apaydin E. Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews. Sage Open. 2020;10(1). doi: 10.1177/2158244019899092.
23. Carron T, Rawlinson C, Arditi C, Cohidon C, Hong QN, Pluye P, et al. An overview of reviews on interprofessional collaboration in primary care: Effectiveness. International Journal of Integrated Care. 2021;21(2):31. doi: 10.5334/ijic.5588.
24. Akpor OA, Akingbade TO, Olorunfemi O. Lack of adequate equipment for healthcare – the agony of patients and nurses: A review. Indian Journal of Continuing Nursing Education. 2023;24(1):7-10. doi: 10.4103/ijcn.ijcn_96_21.
25. Ansbro É, Issa R, Willis R, Blanchet K, Perel P, Roberts B. Chronic NCD care in crises: A qualitative study of global experts’ perspectives on models of care for hypertension and diabetes in humanitarian settings. Journal of migration and health. 2022;5(100094). doi: 10.1016/j.jmh.2022.100094.
26. Rawlinson C, Carron T, Cohidon C, Arditi C, Hong QN, Pluye P, et al. An overview of reviews on interprofessional collaboration in primary care: Barriers and facilitators. International Journal of Integrated Care. 2021;21(2):32.
27. Al Hasani S, Al Ghafri TS, AlHarthi AS, Gibson E, Al Harthi MS. Perceptions of Primary Care Providers on Public Health Services in Primary Care in Oman: A Qualitative Study. Cureus. 2023;15(7):e42208. doi: 10.7759/cureus.42208.
28. Grant A, Kontak J, Jeffers E, Lawson B, MacKenzie A, Burge F, et al. Barriers and enablers to implementing interprofessional primary care teams: A narrative review of the literature using the consolidated framework for implementation research. BMC Primary Care. 2024;25(1):25. doi: 10.1186/s12875-023-02240-0.
29. Vasconcelos J, Probst LF, Silva JAMd, Costa MVd, Higashijima MNS, Santos MLdMd, et al. Factors associated with interprofessional collaboration in primary health care: A multilevel analysis. Ciencia & Saude Coletiva. 2024;29(1):e10572022. doi: 10.1590/1413-81232024291.10572022.
30. Ana Q, Manuela E, Manuel M, Isabel O. Transformational leadership and nurses’ satisfaction with their team: A cross-sectional study. Nursing Practice Today. 2022;9(3):243-50. doi: 10.18502/npt.v9i3.10226.
31. Herawati E, Sofiatin Y. Socio-cultural aspects of noncommunicable disease prevention in three villages in West Java. Masyarakat, Kebudayaan dan Politik. 2021;34(3):340-54. doi: 10.20473/mkp.V34I32021.340-354.
32. Ferreira-Batista NN, Postali FAS, Diaz MDM, Teixeira AD, Moreno-Serra R. The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas. Economics & Human Biology. 2022;46(101143). doi: 10.1016/j.ehb.2022.101143.
33. Arthur M, Patrícia B, Bruna C, Emerson Lucas Junio Silva C, Carla V. Global health diplomacy in nursing, reinforcing challenges and benefits: A scoping review. Nursing Practice Today. 2024;12(1):28-37. doi: 10.18502/npt.v12i1.17523.
34. Garchitorena A, Ihantamalala FA, Révillion C, Cordier LF, Randriamihaja M, Razafinjato B, et al. Geographic barriers to achieving universal health coverage: evidence from rural Madagascar. Health Policy and Planning. 2021;36(10):1659-70.
doi: 10.1093/heapol/czab087.
2. Shu J, Jin W. Prioritizing non-communicable diseases in the post-pandemic era based on a comprehensive analysis of the GBD 2019 from 1990 to 2019. Scientific Reports. 2023 Aug 16;13(1):13325. doi: 10.1038/s41598-023-40595-7.
3. World Health Organization. Noncommunicable Diseases Country Profiles 2018. Switzerland: World Health Organization; 2018.
4. Siswati T, Kasjono HS, Olfah Y. "Posbindu PTM": The Key of Early Detection and Decreasing Prevalence of Non-Communicable Diseases in Indonesia. Iranian Journal of Public Health. 2022;51(7):1683-4.
doi: 10.18502/ijph.v51i7.10105.
5. Ministry of Health of the Republic of Indonesia. Survei Kesehatan Indonesia Tahun 2023 [Indonesia Health Survey 2023]. Jakarta: Health Development Policy Agency Ministry of Health of the Republic of Indonesia; 2024.
6. Akbar MA, Juniarti N, Yamin A. The Roles of Community Health Nurses’ in Covid-19 Management in Indonesia: A Qualitative Study. International Journal of Community Based Nursing & Midwifery. 2022;10(2):96-109. doi: 10.30476/ijcbnm.2021.90884.1739.
7. Cini KI, Wulan NR, Dumuid D, Nurjannah Triputri A, Abbsar I, Li L, et al. Towards responsive policy and actions to address non-communicable disease risks amongst adolescents in Indonesia: insights from key stakeholders. The Lancet Regional Health- Southeast Asia. 2023;18(100260):1-13. doi: 10.1016/j.lansea.2023.100260.
8. President of the Republic of Indonesia. Peraturan Presiden Republik Indonesia Nomor 63 Tahun 2020 Tentang Penetapan Daerah Tertinggal Tahun 2020-2024 [Presidential Regulation Of The Republic Of Indonesia Number 63 Of 2020 On The Determination Of Underdeveloped Regions In 2020-2024] Jakarta: Minister of Law And Human Rights Of The Republic Of Indonesia; 2020. Available from: https://peraturan.bpk.go.id/Details/136563/perpres-no-63-tahun-2020.
9. Minister of Health of the Republic of Indonesia. Peraturan Menteri Kesehatan Republik Indonesia nomor 19 tahun 2024 tentang Penyelenggaraan Pusat Kesehatan Masyarakat [Regulation of the Minister of Health of the Republic of Indonesia number 19 of 2024 About Community Health Centers] Jakarta: Ministry of Health of the Republic of Indonesia; 2024. Available from: https://peraturan.bpk.go.id/Details/312837/permenkes-no-19-tahun-2024.
10. Oktaria V, Mahendradhata Y. The health status of Indonesia's provinces: the double burden of diseases and inequality gap. The Lancet Global Health. 2022;10(11):e1547-e8.
doi: 10.1016/S2214-109X(22)00405-3.
11. Akbar MA, Sahar J, Rekawati E, Sartika RAD, Gupta P. The Effect of Community Based Intervention on People with Type 2 Diabetes Mellitus: Systematic Review. Public Health of Indonesia. 2025;11(S1):39-51.
doi: 10.36685/phi.v11iS1.884.
12. Arsyad DS, Hamsyah EF, Qalby N, Qanitha A, Westerink J, Cramer MJ, et al. The readiness of public primary health care (PUSKESMAS) for cardiovascular services in Makasar City, Indonesia. BMC Health Services Research. 2022;22(1):1112. doi: 10.1186/s12913-022-08499-w.
13. Wiarsih W, Sahar DJ, Nursasi AY. A qualitative study: Interprofessional collaboration practice in Indonesian primary healthcare. Nursing Management. 2023;54(5S):13-8.
doi: 10.1097/nmg.0000000000000010.
14. Rai SS, Peters RMH, Syurina EV, Irwanto I, Naniche D, Zweekhorst MBM. Intersectionality and health-related stigma: insights from experiences of people living with stigmatized health conditions in Indonesia. International Journal for Equity in Health. 2020;19(1):206. doi: 10.1186/s12939-020-01318-w.
15. Eman A, Hassanat A-A, Soad A. Medication adherence and its influencing factors in community-dwelling older adults with chronic illnesses in a rural area. Nursing Practice Today. 2023;10(3):250-60.
doi: 10.18502/npt.v10i3.13434.
16. Bengtsson M. How to plan and perform a qualitative study using content analysis. Nursing Plus Open. 2016;2:8-14. doi: 10.1016/j.npls.2016.01.001.
17. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: A synthesis of recommendations. Academic Medicine. 2014;89(9):1245-51.
doi: 10.1097/ACM.0000000000000388.
18. Creswell JW. Research design: Qualitative, quantitative, and mixed methods approaches. Fourth ed. London: Sage Publications; 2016.
19. Gray LM, Wong-Wylie G, Rempel GR, Cook K. Expanding qualitative research interviewing strategies: Zoom video communications. The Qualitative Report. 2020;25(5):1292-301.
doi: 10.46743/2160-3715/2020.4212.
20. Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches. Fourth ed. London: Sage Publications; 2014.
21. Moon MD. Triangulation: A Method to Increase Validity, Reliability, and Legitimation in Clinical Research. Journal of Emergency Nursing. 2019;45(1):103-5. doi: 10.1016/j.jen.2018.11.004.
22. Apaydin E. Administrative Work and Job Role Beliefs in Primary Care Physicians: An Analysis of Semi-Structured Interviews. Sage Open. 2020;10(1). doi: 10.1177/2158244019899092.
23. Carron T, Rawlinson C, Arditi C, Cohidon C, Hong QN, Pluye P, et al. An overview of reviews on interprofessional collaboration in primary care: Effectiveness. International Journal of Integrated Care. 2021;21(2):31. doi: 10.5334/ijic.5588.
24. Akpor OA, Akingbade TO, Olorunfemi O. Lack of adequate equipment for healthcare – the agony of patients and nurses: A review. Indian Journal of Continuing Nursing Education. 2023;24(1):7-10. doi: 10.4103/ijcn.ijcn_96_21.
25. Ansbro É, Issa R, Willis R, Blanchet K, Perel P, Roberts B. Chronic NCD care in crises: A qualitative study of global experts’ perspectives on models of care for hypertension and diabetes in humanitarian settings. Journal of migration and health. 2022;5(100094). doi: 10.1016/j.jmh.2022.100094.
26. Rawlinson C, Carron T, Cohidon C, Arditi C, Hong QN, Pluye P, et al. An overview of reviews on interprofessional collaboration in primary care: Barriers and facilitators. International Journal of Integrated Care. 2021;21(2):32.
27. Al Hasani S, Al Ghafri TS, AlHarthi AS, Gibson E, Al Harthi MS. Perceptions of Primary Care Providers on Public Health Services in Primary Care in Oman: A Qualitative Study. Cureus. 2023;15(7):e42208. doi: 10.7759/cureus.42208.
28. Grant A, Kontak J, Jeffers E, Lawson B, MacKenzie A, Burge F, et al. Barriers and enablers to implementing interprofessional primary care teams: A narrative review of the literature using the consolidated framework for implementation research. BMC Primary Care. 2024;25(1):25. doi: 10.1186/s12875-023-02240-0.
29. Vasconcelos J, Probst LF, Silva JAMd, Costa MVd, Higashijima MNS, Santos MLdMd, et al. Factors associated with interprofessional collaboration in primary health care: A multilevel analysis. Ciencia & Saude Coletiva. 2024;29(1):e10572022. doi: 10.1590/1413-81232024291.10572022.
30. Ana Q, Manuela E, Manuel M, Isabel O. Transformational leadership and nurses’ satisfaction with their team: A cross-sectional study. Nursing Practice Today. 2022;9(3):243-50. doi: 10.18502/npt.v9i3.10226.
31. Herawati E, Sofiatin Y. Socio-cultural aspects of noncommunicable disease prevention in three villages in West Java. Masyarakat, Kebudayaan dan Politik. 2021;34(3):340-54. doi: 10.20473/mkp.V34I32021.340-354.
32. Ferreira-Batista NN, Postali FAS, Diaz MDM, Teixeira AD, Moreno-Serra R. The Brazilian Family Health Strategy and adult health: Evidence from individual and local data for metropolitan areas. Economics & Human Biology. 2022;46(101143). doi: 10.1016/j.ehb.2022.101143.
33. Arthur M, Patrícia B, Bruna C, Emerson Lucas Junio Silva C, Carla V. Global health diplomacy in nursing, reinforcing challenges and benefits: A scoping review. Nursing Practice Today. 2024;12(1):28-37. doi: 10.18502/npt.v12i1.17523.
34. Garchitorena A, Ihantamalala FA, Révillion C, Cordier LF, Randriamihaja M, Razafinjato B, et al. Geographic barriers to achieving universal health coverage: evidence from rural Madagascar. Health Policy and Planning. 2021;36(10):1659-70.
doi: 10.1093/heapol/czab087.
| Files | ||
| Issue | Vol 12 No 2 (2025): Spring | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/npt.v12i2.18342 | |
| Keywords | ||
| noncommunicable disease; community health centers; healthcare disparities | ||
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How to Cite
1.
Akbar MA, Sahar J, Rekawati E, Sartika RAD. Challenges and barriers to noncommunicable disease management at community health centers in south Sumatera province, Indonesia: A qualitative study. NPT. 2025;12(2):190-201.
