Hypertensive disorders of pregnancy (HDP) management pathways: results
of a Delphi survey to contextualise international recommendations for
Indonesian primary care settings
Abstract
Objectives: To reach consensus on evidence-based recommendations to
develop HDP management pathways for Indonesian primary care. Design: A
three-round Delphi survey Setting: N/A Population: Maternal health
practitioners and experts, including GPs, midwives, nurses and health
policy researchers from Indonesia and international background. Methods:
Participants were asked to rate their agreement on whether each of 125
statements about HDP and HDP managements extracted from international
guidelines were feasible in Indonesian primary care settings in a mix of
quantitative and qualitative questions in three-rounds Delphi survey. A
minimum of 70% agreement among participants was needed for a statement
to be included for the HDP pathways that the pathways drafts were
presented at the third-round survey. The participants’ free text
questions responses and suggestions were analysed thematically. Main
Outcome Measures: Agreement scores of the statements. Results: A total
of 52 participants participated, 48, 45, and 37 of them completed the
first, second and third-round survey respectively. The consensus was
reached for 115 of the 125 statements on HDP definition, screening,
management and long-term follow-up. The agreement scores ranged from
70.8-100.0% and potential implementation barriers were also identified.
Drafts of HDP management pathways were also agreed upon and received
suggestions from the participants. Conclusions: Most evidence-based HDP
management recommendations achieved consensus represented in the
developed HDP management pathways can be implemented in Indonesian
settings. Further investigations are needed to explore the acceptability
and feasibility of the pathways in practice.