Fidelity and Acceptability of Posbindu-Posyandu Keluarga Integration for Diabetes Mellitus Early Detection at Sumbawa, West Nusa Tenggara

Listyati Budi Utami, dr. Vicka Oktaria, MPH., Ph.D, FRSPH; dr. Ahmad Watsiq Maula, MPH

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Diabetes Melitus (DM) merupakan salah satu penyakit tidak menular utama penyebab kematian di dunia, terutama di negara berpendapatan rendah dan menengah. Di Kabupaten Sumbawa, prevalensi DM meningkat dari 9,64% tahun 2022 menjadi 10,45% tahun 2023. Program Posbindu-Posyandu Keluarga diintegrasikan untuk meningkatkan deteksi dini DM, namun cakupan skrining masih di bawah target Standar Pelayanan Minimal (SPM). Penelitian ini bertujuan mengevaluasi fidelity dan acceptability implementasi integrasi Posbindu-Posyandu Keluarga untuk deteksi dini DM.

Metode: Penelitian ini menggunakan metode kualitatif deskriptif dengan pendekatan riset implementasi, dilaksanakan di Desa Nijang dan Desa Kerato wilayah kerja Puskesmas Unter Iwes, Sumbawa, NTB pada Maret-Mei 2025. Subjek penelitian dipilih secara purposive, mencakup stakeholder (manajer tingkat atas dan menengah) serta implementer (petugas kesehatan dan kader). Pengumpulan data dilakukan melalui telaah dokumen, observasi, wawancara mendalam, dan diskusi kelompok terarah (FGD). Data dianalisis menggunakan thematic analysis.

Hasil: Hasil penelitian mengidentifikasi beberapa hambatan utama dalam aspek fidelity seperti ketidakjelasan kebijakan, keterbatasan pelatihan kader, serta rendahnya kepatuhan implementasi SOP oleh petugas dan kader. Aspek acceptability menunjukkan bahwa kader memiliki persepsi positif terhadap efektivitas program, namun merasa terbebani oleh kurangnya insentif serta dukungan lintas sektoral yang minim.

Kesimpulan: Fidelity dan acceptability implementasi integrasi Posbindu-Posyandu Keluarga belum optimal. Strategi fasilitasi seperti pelatihan rutin, peningkatan insentif kader, serta perbaikan koordinasi lintas sektor diperlukan untuk meningkatkan efektivitas deteksi dini DM di komunitas.

Background: Diabetes Mellitus (DM) is among the leading non-communicable diseases causing mortality worldwide, particularly in low- and middle-income countries. In Sumbawa Regency, DM prevalence increased from 9.64% in 2022 to 10.45% in 2023. The Posbindu-Posyandu Keluarga program was integrated to enhance early DM detection; however, screening coverage remains below the Minimum Service Standard (SPM) target. This study evaluates the fidelity and acceptability of Posbindu-Posyandu Keluarga integration for DM early detection.

Methods: This descriptive qualitative study applied an implementation research method in Nijang and Kerato villages, Puskesmas Unter Iwes, Sumbawa, West Nusa Tenggara, from March to May 2025. Purposive sampling identified stakeholders (top and mid-level managers) and implementers (health workers and cadres). Data collection methods included document reviews, observations, in-depth interviews, and Focus Group Discussions (FGD). Data were analyzed through thematic analysis.

Results: Findings indicated primary barriers to fidelity, such as unclear policy guidelines, insufficient cadre training, and low adherence to standard operating procedures among health workers and cadres. Acceptability analysis revealed that cadres positively perceived program effectiveness but experienced a significant burden due to inadequate incentives and minimal intersectoral support.

Conclusion: Fidelity and acceptability in implementing Posbindu-Posyandu Keluarga integration remain suboptimal. Enhanced facilitation strategies, such as regular training, improved cadre incentives, and strengthened intersectoral coordination, are essential for optimizing early DM detection in the community.

Kata Kunci : Diabetes mellitus, early detection, implementation fidelity, acceptability, Posbindu-Posyandu Keluarga, Sumbawa, West Nusa Tenggara