Project Line 1: Diabetes and Hypertension Screening Uptake
Project Line 2: Barriers to Hypertension and Diabetes Screening Uptake
Project Line 3: Protective Health Behavior against COVID19

     When:          2019 and 2020
     Where:         Banda Aceh and Aceh Besar, Aceh, Indonesia
     Who:            2.006 individuals aged 40 - 70 years
     Sampling:    Two-stage, stratified random sampling procedure

Abstract: As cardiovascular diseases (CVD) become the leading cause of death in low- and middle-income countries (LMICs), this raises new challenges for health systems. Regular screening is a key measure to manage CVD risk, but the uptake of such services remains low. We conducted a randomized controlled trial in Indonesia to assess whether personalized and targeted text messages increase the usage of public screening services for diabetes and hypertension in the at-risk population. Our intervention increased screening uptake by 6.6 percentage points. We show that text messages can be effective in the context of a relatively new disease burden in LMICs, where population responses may still be shaped by low salience and missing screening routines.

Publication:  Marcus ME, Reuter A, Rogge L, Vollmer S (2024): The Effect of SMS Reminders on Health Screening Uptake: A Randomized Experiment in Indonesia. Journal of Economic Behavior & Organization

Background: Diabetes and hypertension are major global health crises, yet Indonesia is lacking behind in achieving care outcomes compared to other middle income countries. We examined barriers to screening uptake, a key care entry point, in 40-70 year-old adults in Aceh, Indonesia. 
Methods: We combined two data sources on diabetes and hypertension screenings in Banda Aceh and Aceh Besar in 2019-2020. Using two-stage random sampling, we collected survey data on 2,080 adults that are indicated for, but had not undergone diabetes screening as per WHO PEN guidelines. Additionally, we collected administrative records on the Posbindu screening program in 459 villages. Using this, we analyzed 1) screening indication, 2) disease-related knowledge, attitude, practices, 3) socioeconomic associations using multivariable linear and logistic regression, and 4) COVID-19 related distruptions to Posbindu. 
Findings: TBA - in submission process

Abstract: The COVID-19 pandemic shapes the lives of people around the globe – at the same time, people themselves have the power to shape the pandemic. By employing protective health behaviour, the population can alleviate the severity of an outbreak. This may be of particular importance whenever health systems or populations are vulnerable to shocks, as is frequently the case in low- and middle-income settings. Therefore, understanding the underlying drivers of protective action against COVID-19 is urgently needed for policy responses. We investigate the individual-level determinants of disease knowledge and behaviour in the context of the COVID-19 pandemic in Aceh, Indonesia. We use data from a representative sample of 40–70-year-olds, mainly obtained from telephone interviews between March and May 2020. We employ linear probability models that account for a comprehensive set of factors that were previously found to influence knowledge and practice during pandemics. We find that both knowledge and uptake of protective health behaviour are relatively high. Knowledge is the largest explanatory driver of protective health behaviour, while socioeconomics and economic preferences are minor determinants. However, knowledge itself is strongly shaped by socioeconomic gradients. On this basis, we show that policies need to disseminate information in an equitable way.

Publication: Chavarría, E., Diba, F., Marcus, M. E., Marthoenis, Reuter, A., Rogge, L., & Vollmer, S. (2021). Knowing Versus Doing: Protective Health Behaviour Against COVID-19 in Aceh, Indonesia. The Journal of Development Studies, 1-22.