The Context, Mechanisms, and Outcomes of The Cervical Cancer Early Detection Program Using VIA Method at Puskesmas Mlati II: A Realist Evaluation

Denada Jihan Dampi, Prof. Dr. dr. Mubasysyir Hasanbasri, MA ; dr. Vicka Oktaria, MPH., PhD

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Kanker serviks merupakan salah satu penyakit penyebab kematian tertinggi pada perempuan di dunia. Tingginya angka kesakitan dan kematian akibat kanker serviks disebabkan oleh rendahnya cakupan skrining. Rendahnya cakupan skrining ini dipengaruhi oleh pelaksanaan program serta penerimaan yang kurang baik dari pembuat maupun penerima program, sehingga diperlukan upaya untuk memastikan program dapat berjalan secara optimal. Tujuan: Mengidentifikasi konteks dan mekanisme yang memengaruhi akseptabilitas dan keberlanjutan program deteksi dini kanker serviks dengan metode IVA di Puskesmas Mlati II. Metode: Penelitian ini bersifat kualitatif dengan menggunakan pendekatan realist evaluation. Penelitian dilaksanakan di Puskesmas Mlati II dengan metode pengumpulan data berupa observasi menggunakan daftar checklist, wawancara mendalam, dan FGD terhadap responden. Hasil: Pelaksanaan skrining kanker serviks dengan metode IVA di Puskesmas Mlati II telah didukung oleh infrastruktur yang memadai, bidan terlatih, serta akses layanan yang gratis. Namun, ketiadaan dokter yang terlatih dalam krioterapi menjadi tantangan besar bagi keberlanjutan program. Hambatan utama partisipasi masyarakat meliputi stigma, rasa malu, ketakutan, kurangnya kesadaran, serta ketidakmerataan akses informasi. Evaluasi program memang dilakukan secara rutin, namun belum sepenuhnya mencakup upaya promosi kesehatan yang komprehensif. Meskipun prosedur IVA tergolong sederhana, cakupan program secara keseluruhan masih belum optimal. Kesimpulan: Program skrining IVA di Puskesmas Mlati II masih menghadapi tantangan terkait akseptabilitas masyarakat dan keberlanjutan program. Penguatan edukasi kesehatan, peningkatan strategi promosi, pemenuhan sumber daya manusia yang memadai, serta kolaborasi lintas sektor sangat diperlukan untuk memperluas cakupan, meningkatkan penerimaan masyarakat, dan mendukung keberlanjutan program dalam jangka panjang.

Background: Cervical cancer is one of the diseases that causes the most deaths in women in the world. The high morbidity and mortality rates from cervical cancer are caused by low screening coverage. The low screening coverage that occurs is caused by program implementation and poor program acceptance among program makers and recipients so that action is needed to ensure this program can be implemented optimally. Objective: To identify what are the contexts and mechanisms that can affect to acceptability and sustainability of cervical cancer early detection program with the VIA method at Puskesmas Mlati II. Method: This research is qualitative in nature using realist approach to evaluation. This research was carried out at the Puskesmas Mlati II. The data collection method is carried out by observation checklist, in-depth interview, and FGD against the respondent. Result: The implementation of cervical cancer screening using the VIA method at Puskesmas Mlati II has been supported by adequate infrastructure, trained midwives, and free access to services. However, the absence of a cryotherapy- trained doctor remains a significant challenge to the sustainability of the program. The main barriers to community participation include stigma, shame, fear, lack of awareness, and unequal access to information. Although program evaluations are conducted regularly, they have not yet fully encompassed comprehensive health promotion efforts. While the VIA procedure is relatively simple, the overall coverage of the program remains suboptimal. Conclusion: The VIA screening program at Puskesmas Mlati II continues to face challenges related to community acceptance and program sustainability. Strengthening health education, enhancing promotional strategies, ensuring adequate human resources, and fostering cross-sectoral collaboration are essential to increase coverage, improve community acceptance, and support the long-term sustainability of the program.

Kata Kunci : Cervical Cancer, Early Detection, VIA method, Screening program, Realist evaluation