A quality improvement approach to scaling up a complex health system intervention for the prevention and management of cardiovascular disease in rural Indonesia

Bibliographic Data

ID19593716
AuthorsThomas Gadsden (0000-0002-9371-420X, UNSW Sydney, corresponding author), Sujarwoto (0000-0003-4197-4592, University of Brawijaya, corresponding author), Sekar Aqila Salsabilla (0009-0003-4215-6089, University of Brawijaya, corresponding author), Asri Maharani (0000-0002-5931-8692, Manchester Academic Health Science Centre, corresponding author), Devarsetty Praveen (0000-0002-0973-943X, UNSW Sydney, corresponding author), Gindo Tampubolon (0000-0002-9081-2349, University of Manchester, corresponding author), Seye Abimbola (0000-0003-1294-3850, The University of Sydney, corresponding author), Anushka Patel (0000-0003-3825-4092, UNSW Sydney, corresponding author), Anna Palagyi (0000-0002-8127-9351, UNSW Sydney, corresponding author)
EditorsCollins Otieno Asweto (0000-0003-3514-9836)
Year2025
Volume5
Issue12
Pagese0005577
Publication date2025-12-04
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0005577
PMID41343592
OpenAlexW4417003873
LanguageEN
References cited24

Scaling up effective public health interventions is crucial for achieving universal health coverage, yet remains challenging. We report the use of the Plan-Do-Study-Act (PDSA) quality improvement model to support the iterative scale-up of a community-based cardiovascular disease risk management program in Malang District, East Java, Indonesia. A pragmatic implementation study comprising three PDSA cycles was conducted in 10 ‘test of scale-up’ villages between April 2021 and December 2022. Each cycle included: 1) the capture of quantitative outcomes, such as the number of new community members screened per month and diagnostic summaries with predicted risk status; and 2) semi-structured interviews and focus group discussions with health care workers, community members, and community health workers in each village to assess acceptability, adoption, adaptations and perceived effectiveness. Based on identified implementation barriers, local Technical Working Groups designed change strategies, which were implemented and evaluated in subsequent cycles. The COVID-19 pandemic disrupted program delivery in the first two PDSA cycles, reducing screening to an average of 112 and 7, respectively. In cycle 3, 463 community members were screened. Across the 10 participating villages, 42 interviews and 30 focus group discussions were conducted per PDSA cycle. Key barriers included difficulty reaching male community members, inadequate resourcing, limited essential medications and poor integration with existing health information systems. Change strategies included centralising screening activities, leveraging instant messaging platforms, additional activities to engage men and streamlined procurement processes. Each village demonstrated versatility in addressing implementation challenges. These findings highlight the utility of the PDSA model in supporting the iterative scale-up of a community-based cardiovascular disease risk management programs in real-world settings, even amid significant disruptions such as the COVID-19 pandemic

Community engagement · Community health · Focus group · Implementation research · PDCA · Psychological intervention · Public health · Quality management · Health Policy Implementation Science · Health Promotion and Cardiovascular Prevention · Primary Care and Health Outcomes