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 lagging 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 assessed individual-level data on diabetes and hypertension screenings in Banda Aceh and Aceh Besar in 2019. Using two-stage random sampling, we collected survey data on 2080 adults that are indicated for, but had not undergone diabetes screening as per World Health Organization’s Package of Essential Noncommunicable Disease Intervention guidelines. Using this, we adjusted the data for complex survey design to describe (1) the share of respondents with screening indication and presence of risk factors; (2) disease-related knowledge, attitude, and practices, as well as (3) estimate associations of screening with socioeconomic characteristics, knowledge, and attitudes using multivariable linear and logistic regression.
Results: We found that while respondents were aware of diabetes and hypertension, a majority lacked knowledge about leading risk factors, the conditions’ potentially asymptomatic nature, and screening needs. About 41% of respondents never had any blood pressure or glucose check, the primary reason reported being not feeling ill. Blood glucose checks were rarely conducted. We found rural location and lower education to be associated with lower disease-related knowledge, and lower wealth with lower knowledge and screening uptake.
Conclusions: Barriers to screening uptake in Aceh, Indonesia, include misconceptions around hypertension and diabetes, provider-specific challenges especially around the provision of glucose testing, and socioeconomic gradients.

Publication: Marcus ME, Reuter A, Rogge L, Diba F, Marthoenis, Vollmer S (2025):  Hypertension and diabetes screening uptake in adults aged 40–70 in Indonesia: a knowledge, attitudes, and practices study. BMC Global and Public Health

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.