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All Journal Jurnal Kedokteran Syiah Kuala Jurnal Kedokteran Brawijaya Sari Pediatri Padjadjaran Journal of Dentistry Jurnal Ilmiah Mahasiswa Kedokteran Medisia Jurnal Penelitian dan Pengabdian Kepada Masyarakat UNSIQ Jurnal Sinaps Poltekita : Jurnal Ilmu Kesehatan Indian Journal of Forensic Medicine & Toxicology Narra J Journal of Social Research Journal of Medical Science; Jurnal Ilmu Medis Rumah Sakit Umum Daerah dr. Zainoel Abidin, Banda Aceh International Journal Of Public Health Media Penelitian dan Pengembangan Kesehatan
Rachmad Suhanda
Fakultas Kedokteran Universitas Syiah Kuala
Humanities Biochemistry, Genetics & Molecular Biology Computer Science & IT Decision Sciences, Operations Research & Management Dentistry Economics, Econometrics & Finance Education Environmental Science Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Nursing Public Health Social Sciences Other

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Multi-stakeholder perspectives on cervical cancer screening implementation in Indonesia: A qualitative study of cervical screening barriers in Banda Aceh Yolanda, Febrina; Dewi, Tgk. Puspa; Nainggolan, Sarah I.; Munawar, Munawar; Munizar, Munizar; Bulqini, Rijal; Suhanda, Rachmad; Rusnaidi, Rusnaidi
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3022

Abstract

Indonesia is committed to the WHO's cervical cancer elimination strategy through the National Action Plan (RAN) 2023–2030, targeting 75% screening coverage by 2030. However, current rates remain critically low at 7.02%. This study explores multi-stakeholder perspectives to identify implementation barriers and facilitators for policy enhancement. A qualitative descriptive case study was conducted in Banda Aceh (July-August 2025) involving 25 stakeholders: City Health Office Head, 11 puskesmas heads, 11 VIA coordinators and 2 community organization representatives. Thematic analysis using NVivo v.16 identified key implementation factors. Five major themes emerged: (1) Knowledge gaps—screening perceived necessary only when symptomatic despite available information; (2) Access paradox—excellent geographic access and flexibility undermined by limited examination rooms, insufficient midwives, and psychosocial barriers (shame, fear, lack of spousal support); (3) Financial sustainability—free services threatened by complex BPJS claims and low reimbursement affecting logistics; (4) Service quality variation—dependent on cross-sector collaboration and staff competency, with uneven training and limited cryotherapy (only 2 centers); and (5) Communication challenges—inconsistent digital media use necessitates face-to-face counseling and cadres, though reach remains limited. Implementation faces psychological barriers, capacity limitations, and uneven digital adoption despite strong infrastructure. Priority policy recommendations include: (1) HPV DNA self-sampling to overcome privacy barriers; (2) simplified BPJS claims with adequate reimbursement; (3) systematic competency-building and cryotherapy expansion; and (4) culturally-adapted education integrating local language and religious leaders. These evidence-based enhancements could accelerate Indonesia's RAN 2030 elimination targets.
Determinants of intrauterine device use among reproductive-age women in a province implementing Islamic Sharia law in Indonesia: An application of the theory of planned behavior Purnama, Dean R.; Dewi, Tgk. Puspa; Rusnaidi, Rusnaidi; Utami, Niken A.; Aditya, Rizka; Suhanda, Rachmad
Narra J Vol. 6 No. 1 (2026): April 2026
Publisher : Narra Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.52225/narra.v6i1.3025

Abstract

The utilization of the intrauterine device (IUD) in Indonesia remains low at 3.9%, despite its high effectiveness (99.4%) and designation as a national family planning priority, suggesting the presence of psychosocial barriers influencing contraceptive behavior among women of reproductive age. This study aimed to analyze psychosocial factors influencing IUD use behavior based on the theory of planned behavior, including attitudes, subjective norms, perceived behavioral control, actual behavioral control, and intention, in Banda Aceh—the only province in Indonesia implementing holistic Sharia law. A quantitative cross-sectional study was conducted among women of reproductive age from six urban public health centers using cluster random sampling. Data were collected through face-to-face interviews using a structured TPB-based questionnaire validated for reliability. Statistical analyses included linear regression and binary logistic regression with a significance level set at p<0.05. A total of 442 women were included in the final analysis. Attitude toward IUD use, subjective norms, and perceived behavioral control were all significantly associated with intention to use an IUD, all had p<0.001. Attitudes toward IUD use (B=0.410; p<0.001; R²=0.213), subjective norms (B=0.552; p<0.001; R²=0.413), perceived behavioral control (B=0.273; p<0.001; R²=0.255), and actual behavioral control (B=0.273; p<0.001; R²=0.255) were all significantly associated with IUD use behavior. Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.780; p<0.001; R²=0.566). Intention to use an IUD emerged as the strongest predictor of IUD use behavior (B=0.78; p<0.001; R²=0.56). This study highlights that all intention was shaped by positive attitudes, strong subjective norms, and a high level of behavioral control. Efforts to increase IUD use should therefore focus on educational interventions, strengthening partner and social support, and improving the accessibility and quality of long-acting contraceptive services.
Co-Authors Aditya, Rizka Adnyana, I Gde Hary Eka Agung Pranata Aini, Zahratul Atika, Siti Azka Muda Adri Bulqini, Rijal Chairunas Chairunas Cut Fauziah Dessy R. Emril Dewi, Tgk. Puspa Dian Lestari, Nova Djazuly Chalidyanto Dwi Susanti, Nurhayani ENDANG MUTIAWATI, ENDANG Evrillisa, Ghina Alya Fadhlia Farida Farida Febrina Yolanda FIRDAUSA, SARAH Fitria, Sova Geumpana, Teuku A. Hasan, Desi Salwani Hendra Zufry, Hendra Irwan Saputra Ismy, Dewi Purnama Sari Juwita Kurnia , Benny Kurnia Fitri Jamil Laurentina, Yoriko Liza Meutia Sari M. Yogi Riyantama Isjoni Machillah, Nurul Maimun Syukri, Maimun Marty Mawarpury Mellazulfa, Dhea Sofiana Mulkan Azhari Munadi Munadi Munawar Munawar Munizar Munizar, Munizar Mustaqiem Isda Nainggolan, Sarah I. Nurfianto, Sigit Nurjannah Nurjannah Oktaria Denantika Purnama, Dean R. Refani, Priska Renaldi, Teuku Rima Novirianthy Rovy Pratama, Rovy Rusnaidi Said Usman Sembiring, Thyrister Nina Asarya Setiani, Lily Sinta, Gian Salsabila Soehartati Gondhowiardjo Sukri Ekadamayanti, Agustia T. Maulana Tristia Rinanda Ummu Balqis Usman Hadi Utami, Niken A. Wardhana Sucipto, Krishna Widodo J. Pudjirahardjo Winda Yulia Yeni Yeni Yuarta, Ferina Agustia Yus, Teuku Muhammad Zainul Abidin, Siti Nur Nabihah Zakaria, Iskandar Zulkarnain Zulkarnain