Indonesian Midwives’ Readiness to Upscale the Secondary Prevention of Cervical Cancer within Primary Health Clinics: A Qualitative Study of Midwives Across Three Provinces

Wilopo, Siswanto Agus; Harisaputra, Rosalia Kurniawati; Hadati, Rahmah S; Mustikaningtyas, Mustikaningtyas; Setyawan, Althaf; Eka Putri, I. Gusti Agung Paramitha; Frans, Sandra Olivia; Bennett, Linda Rae

doi:10.31557/APJCP.2026.27.5.1671

Indonesian Midwives’ Readiness to Upscale the Secondary Prevention of Cervical Cancer within Primary Health Clinics: A Qualitative Study of Midwives Across Three Provinces

Document Type : Research Articles

Authors

¹ Department of Biostatistics, Epidemiology, and Population Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.

² Center for Reproductive Health, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.

³ Ministry of Population and Family Development / Representative Office of National Population and Family Planning Board in the Special Region of Yogyakarta, Yogyakarta, Indonesia.

⁴ Nossal Institute for Global Health, The University of Melbourne, Melbourne, Australia.

10.31557/APJCP.2026.27.5.1671

Abstract

Objective: This article analyzes the readiness of Indonesian midwives for the rapid scale-up of secondary prevention of cervical cancer, in line with Indonesia’s National Plan for Cervical Cancer Elimination (2023–2030). Methods: Data were collected via a mixed-methods study conducted in 2024. We analyzed a subset of qualitative data from semi-structured interviews with 24 midwives, sampled from 13 primary health clinics (PHCs) in Kupang City, Purworejo Regency, and Palu City. Thematic analysis revealed four key themes relevant to determining midwives’ readiness: knowledge; technical training and confidence in performing visual inspection with acetic acid (VIA); communication skills; and motivation. Result: Midwives’ knowledge of causation and risk factors was high, underpinning their high perception of cervical cancer risk and subsequent strong motivation to provide screening. However, inconsistent knowledge existed regarding screening targets, intervals, and clinical indications for screening. Training coverage was low, with only half of the midwives having received training. Multiple midwives viewed their training as inadequate for establishing competency in the interpretation of VIA results, negatively impacting their motivation. Midwives reported high confidence in communication skills but noted a lack of health communication materials for patient education and raised concerns over the suitability of PHC information systems for enabling follow-up. Conclusion: The proportion of Indonesian midwives receiving training in cervical screening and provider-administered HPV DNA testing needs to increase significantly. Training in cervical cancer prevention should receive greater attention in the core curriculum for midwifery accreditation. The content should be more comprehensive, addressing knowledge gaps, low confidence in interpreting VIA results, and the transition to HPV DNA testing. A train-the-trainer program for senior midwives to enable high-quality peer education would be a strategic investment. Critical system-level changes such as adequate budgets, provision of health communication materials, and improvements to the design and use of health information systems are also required.

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