This research is a collaborative study between Indonesia's Strategic Development Initiatives (CISDI), Knowledge Partnership Platform Australia - Indonesia (KONEKSI), Center on Child Protection and Wellbeing (PUSKAPA), and Center for Development Economics and Sustainability at Monash University. This study is a part of the PN PRIMA research universe, which is a program lead by CISDI with a focus of strengthening the primary healthcare facilities of Indonesia, known as Integrated Health Posts (Posyandu). This project supports the Ministry of Health's (MoH) flagship program: the Integrated Primary Health Care Services (ILP). This study aims to evaluate the impact of implementing a digital mHealth app, called the PN PRIMA app, in enhancing the work quality of Community Health Workers working in Posyandu, known as Kader. This study specifically improve the PN PRIMA app from a web-based platform to a mobile application. We aim to improve data quality, streamline service delivery workflows, and enhance decision-making support for community health workers. The enhanced version incorporates new features and Gender Equality, Disability, and Social Inclusion (GEDSI) framework to strengthen primary health care delivery. Impact evaluation of the study will be conducted through a three-arm parallel cluster randomized controlled trial. Posyandu will be the unit in which randomization will occur. The primary outcomes focuses on the improvements of Kader Posyandu performance in delivering follow-up home visits and how the app effectively support Kader in delivering nutrition interventions for children under five years of age. The study will be conducted in the Puskesmas PN PRIMA catchment area, located in Kabupaten Bekasi and Kota Depok, focusing the intervention at the Posyandu level. In total, 38 Posyandu out of 12 health centers (Puskesmas) across the two areas will be recruited to take part in this study.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
DOUBLE
Enrollment
1,030
Apps PRIMA (posyandu monitoring tools) is delivered using a web-based app accessible through web browsers with basic core functionalities
Enhancement of Apps PRIMA delivered using a standalone mobile app. Enhanced core functionalities include the looping system of children measurements, automatic charts, and GEDSI-sensitive features
Additional training to address vulnerabilities in communities and empathetic service from CHWs to caregivers. The training is a follow-up training from a basic GEDSI materials already delivered to CHWs
Puskesmas Sukmajaya
Depok, West Java, Indonesia
Puskesmas Abadijaya
Depok, Indonesia
Puskesmas Baktijaya
Depok, Indonesia
Puskesmas Cinangka
Depok, Indonesia
Puskesmas Limo
Depok, Indonesia
Puskesmas Sukatani
Depok, Indonesia
At least one visitation completed
The proportion of U5 children's visitation cycles in which CHWs completed at least the one required home visitation according to the app-generated schedule. For each cycle, a score of 1 is coded if the assigned CHW completes at least one visitation session within the scheduled time window, and 0 if none of the scheduled visitation was delivered. The final proportion is calculated as the number of cycles coded 1 in proportion to the total number of visitation cycles assigned to the CHW.
Time frame: From intervention roll-out to the end of intervention period in 6 months
Proportion of on-time and completed visitation
The measure captures the proportion of required visits that were completed on time for each child's visitation cycle. Within each cycle, visits conducted within the recommended time window were assigned a score of 1. The total number of on-time visits for each child was calculated by summing the score. The final proportion was calculated by dividing the score of actual on-time visits by the total number of required visits.
Time frame: Every visitation conducted by CHW during the intervention period, marked by 6-month after the first use of app after training
Knowledge and Attitude of CHWs
Kader's knowledge on children's nutritional needs and status, and attitudes toward vulnerable population
Time frame: Measured in baseline (pre-intervention; maximum 1 months before training intervention) and endline (post-intervention; minimum 6 months intervention implementation)
Caregiver's knowledge and attitude
Parents/caregivers knowledge on children's nutrition and primary care services, and attitudes towards primary healthcare services
Time frame: Measured in baseline (pre-intervention; maximum 1 months before training intervention) and endline (post-intervention; minimum 6 months intervention implementation)
Caregiver's satisfaction on healthcare
Parents/caregivers satisfaction towards primary healthcare services
Time frame: Measured in baseline (pre-intervention; maximum 1 months before training intervention) and endline (post-intervention; minimum 6 months intervention implementation)
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