Engaging primary care physicians in approaching adolescents for early prevention of NCDs

Adolescence is a period of life when the adoption of healthy or unhealthy habits will significantly contribute to health in adulthood. Adolescents have greater autonomy and responsibility for physical activity and eating habits than younger children, but do not automatically develop the skills and behaviours that support healthy choices. Primary care physicians (PCPs) play major roles in tackling adolescent health, as they are the health care providers that adolescents are most likely to visit. However, adolescent visit rates in Indonesia are still low and very few programs are available to support PCP involvement in adolescent health.

This project aimed to develop an acceptable and feasible educational initiative program for early prevention of non-communicable disease (NCDs) in adolescents. PCPs and related stakeholders in primary care were involved. This program was also embedded into the existing and well-known community and school working groups on adolescent health called ‘Dokter Kecil’ and ‘Pos Bindu’. It is expected that the program could, in time, become sustainable because these two initiatives are fully supported by the Indonesian Department of Health and the Department of Education.

The objectives of this project were:

• To undertake a needs analysis of GPs and medical students about their self-perceived knowledge and skill gaps with adolescents, and to train them in undertaking a dietary and needs assessment, building relationships, communicating sensitively and dealing with adolescents from early adolescence (elementary-school children) to high school.
• To create, together with GPs and medical students, an educational initiatives program consisting of three educational initiative modules for early prevention of NCDs in adolescence.
• To pilot and evaluate the educational initiatives program with fifth grade students via a ‘Dokter Kecil’ program, and with 11th grade students via a ‘Pos Bindu’ program, in one elementary school and one high school in South Yogyakarta remote regency.

This project implemented action research principles in which key stakeholders (i.e. end users consisting of GPs, medical students, and adolescents) were involved in the development of the educational initiative program. This strategy is anticipated to enhance acceptability and applicability of the program. Furthermore, the educational programs were embedded into existing and well-known community and school working groups ‘Dokter Kecil’ and ‘Pos Bindu’. 

Kolb’s experiential learning style theory was applied in the development of the educational modules. The theory is typically represented by a four-stage learning cycle: concrete experience, reflective observation of the new experience, abstract conceptualisation, and active experimentation. At the concrete experience, the key stakeholders (GPs, medical students, and SD/ SMK health cadres) are expected to have insight before developing the educational modules in preventing NCDs.

Findings

Two modules on NCD prevention for both elementary and high school students were developed, consisting of the healthy lifestyle and smoking cessation modules. These modules were accepted by GPs and the local health department. Some suggestions have been made on follow-up developments, such as combining the activities under both the health and education departments, and involving cadres in primary care settings. There are also suggestions for future modules’ development to include other issues in primary care, such as mental health, infectious diseases and trauma prevention.

Recommendation

A scaling-up study is needed to appropriately implement the modules in schools. The involvement of health cadres is desirable to provide more comprehensive implementation in the community. The future development of the modules should also cover the topics of mental health, injury and prevention of infectious diseases.