Situational analysis and development of SMARThealth Climate Indonesia: a digital primary healthcare intervention with an integrated early warning system for non-communicable disease management
1
Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom
2
Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
3
School of Public Health, Imperial College London, London, United Kingdom
4
Faculty of Public Administration, Universitas Brawijaya, Malang, Indonesia
Popul. Med. 2026;8(Supplement Supplement 1):A870
ABSTRACT
BACKGROUND:
Household plastic burning and ambient air pollution contribute to cardiovascular and respiratory morbidity in Indonesia, yet primary health care (PHC) systems have limited capacity to integrate environmental risk information into routine NCD care. Evidence is needed to inform the development of climate-responsive PHC interventions that are feasible and contextually appropriate.
METHODS:
We conducted a two-phase mixed-methods situational analysis to support the development of a digital PHC intervention, SMARThealth Climate in Malang and Banyuwangi districts, East Java. Phase 1 comprised a rapid evidence synthesis and policy analysis of national and sub-national documents. Phase 2 involved a field assessment of facility readiness across macro, meso, and micro health system levels. Quantitative data were collected from 24 staff across 16 primary care providers. Qualitative data were generated through 64 in-depth interviews and 12 focus group discussions with policymakers, health professionals, community health workers (CHWs), patients, and village officials (n=112). Informed by the situational analysis, the intervention was co-designed with healthcare professionals and piloted over two months for further refinement. Data were analysed thematically and triangulated across sources.
RESULTS:
Despite high community awareness of air pollution and its health effects, environmental risk is not incorporated into routine NCD care. Only 20% patients diagnosed with high CVD risk and COPD reported regular follow-up at PHCs. Health workers expressed demand for actionable, locally relevant air quality alerts to support counselling and risk stratification. However, concerns included workload, digital readiness, and clinical accountability. Facility assessments revealed substantial variability in workforce capacity, diagnostics, and digital infrastructure. SMARThealth Climate was co-created to address this, which includes clinical decision support systems and an integrated air quality warning system.
CONCLUSIONS:
Integrating air quality warning systems into digital primary health care has the potential to strengthen NCD management in resource-constrained settings; however, addressing system-level barriers is essential for interventions to succeed.
Household plastic burning and ambient air pollution contribute to cardiovascular and respiratory morbidity in Indonesia, yet primary health care (PHC) systems have limited capacity to integrate environmental risk information into routine NCD care. Evidence is needed to inform the development of climate-responsive PHC interventions that are feasible and contextually appropriate.
METHODS:
We conducted a two-phase mixed-methods situational analysis to support the development of a digital PHC intervention, SMARThealth Climate in Malang and Banyuwangi districts, East Java. Phase 1 comprised a rapid evidence synthesis and policy analysis of national and sub-national documents. Phase 2 involved a field assessment of facility readiness across macro, meso, and micro health system levels. Quantitative data were collected from 24 staff across 16 primary care providers. Qualitative data were generated through 64 in-depth interviews and 12 focus group discussions with policymakers, health professionals, community health workers (CHWs), patients, and village officials (n=112). Informed by the situational analysis, the intervention was co-designed with healthcare professionals and piloted over two months for further refinement. Data were analysed thematically and triangulated across sources.
RESULTS:
Despite high community awareness of air pollution and its health effects, environmental risk is not incorporated into routine NCD care. Only 20% patients diagnosed with high CVD risk and COPD reported regular follow-up at PHCs. Health workers expressed demand for actionable, locally relevant air quality alerts to support counselling and risk stratification. However, concerns included workload, digital readiness, and clinical accountability. Facility assessments revealed substantial variability in workforce capacity, diagnostics, and digital infrastructure. SMARThealth Climate was co-created to address this, which includes clinical decision support systems and an integrated air quality warning system.
CONCLUSIONS:
Integrating air quality warning systems into digital primary health care has the potential to strengthen NCD management in resource-constrained settings; however, addressing system-level barriers is essential for interventions to succeed.
| eISSN: | 2654-1459 |
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