Improving Medication Management in Indonesian Aged Care Homes: Research Priority Setting With Stakeholders

ABSTRACT

Indonesia and other Southeast Asian nations are experiencing rapidly aging populations. The Indonesian Government recently announced a national initiative of aged care homes to support older people not able to live independently or receive family care. Medication‐without‐harm is the topic of the World Health Organization Third Global Patient Safety Challenge. The objective of this study was to prioritize research questions for improving medication management in public and private aged care homes in Indonesia. In April 2025, a 20‐person expert consensus panel was convened comprising general practitioners, geriatricians, neurologists, nurses, pharmacists, physiotherapists, nutritionists, public health practitioners, aged care home managers, Ministry of Health representatives, ASEAN organization representatives, and a family caregiver. The panel used modified nominal group technique to identify and prioritize research for improving medication management in aged care homes in Indonesia. The panel identified 47 research priorities that were consolidated into 15 policy and 20 practice priorities for voting. The highest ranked policy priorities focused on necessary regulations and clinical guidelines; essential medication lists for older people; and policies to support development and use of drug formulations acceptable for residents of aged care homes. The highest ranked practice priorities emphasized digital health technologies; medication safety monitoring; and enhancing communication among families, aged care home staff, and prescribers. The findings lay the groundwork for a culturally‐ and context‐specific research roadmap for improving medication management in Indonesian aged care homes. This will guide researchers and research funding organizations in aligning future studies with policy and practice priorities.

1. Introduction

Like many other Southeast Asian countries, Indonesia is experiencing a rapid population aging. Indonesia is the world's fourth most populous country, with the number of people aged 60 years and older projected to increase from 26 million in 2019 to 74 million in 2050 [1]. This demographic shift necessitates exploring different models for providing aged care as traditional family structures evolve. While filial piety (the cultural expectation that adult children have a moral responsibility to care for and support their aging parents) continues to be a cultural cornerstone in many Southeast Asian countries, the expectation for family‐based care is increasingly challenged by smaller family sizes, different employment patterns, and longer life expectancies [2].

Indonesia's National Strategy on Aging outlines the government's commitment to strengthening social protection, improving access to health services, and supporting community‐based care. Opportunities exist to further strengthen the formal aged care sector in Indonesia. Most older people continue to rely on informal family‐based support, with residential aged care remaining relatively limited [3, 4]. Aged care in Indonesia has historically been centered on family and community support, with residential aged care services (panti werdha or Panti Sosial Tresna Werdha) representing only one component of a broader long‐term care system [5]. These aged care homes are operated by government, private, faith‐based, and charitable organizations and provide varying levels of health and social care rather than continuous nursing care. The term “aged care homes” is more reflective of the Indonesian context than the term “nursing homes” because the latter term may imply routine provision of 24‐h nursing care. Healthcare for residents is commonly provided through collaboration between caregivers and visiting or facility‐based healthcare professionals, including medical doctors, nurses, pharmacists, physiotherapists, and nutritionists, depending on the type of facility and locally available resources [6]. The 2018 National Standards for Social Aged Care Homes of Older People highlight issues related to infrastructure, workforce competency, and quality assurance mechanisms [7]. In 2024 the Indonesian Government announced a program of aged care homes to provide special health services to older adults not able to be cared for by their own families [8]. This initiative draws inspiration from similar programs in neighboring Malaysia and Singapore, and acknowledges the need for care culturally appropriate for the Indonesian context.

The 2024 World Health Organization (WHO) Long‐term Care for Older People Report recognizes the value of routine screening for unnecessary, ineffective, or duplicated medications [5]. A systematic review of international literature reported 40% of older adults experience polypharmacy, with a higher prevalence in aged care homes [9]. The WHO Third Global Patient Safety Challenge aimed to reduce severe, avoidable medication‐related harm by 50% [10]. This initiative addressed key areas such as polypharmacy, high‐risk situations, and transitions of care with the key focus to promote safer medication practices and minimize medication errors, which are a leading cause of avoidable harm in healthcare systems globally [11]. Indonesia's rapidly aging population has high rates of multimorbidity and polypharmacy. More than one in 12 hospital inpatients aged 60 years and older use 10 or more regular medications [12]. Patients in a hospital geriatric ward had a median of 4 comorbidities and 10 regular medications [13]. High levels of polypharmacy increase the risk of adverse drug events (ADEs) [14]. ADEs disproportionately impact those who are older and frailer. Rizka et al. [15] reported that frailty was prevalent in 46.5% of aged care home residents.

There are scant data on polypharmacy prevalence in Indonesian aged care homes, with currently no peer‐reviewed research. Existing data from emergency departments, inpatient settings [12], or community settings [16], do not reflect the context of aged care homes, as they do not capture the chronic and clinically complex nature of aged care homes. A study in six aged care homes in Jakarta and Banten Provinces reported up to 42% of residents have hypertension, 22% diabetes, and 20% cognitive impairment [15]. These conditions are often associated with complex medication regimens and the need for caregiver support for medication administration. Medications often overused in low and middle‐income countries include antimicrobials, psychotropic medications, proton‐pump inhibitors, and antihypertensives [17]. The consequences of medication overuse may be more severe in low and middle‐income rather than high‐income countries. Recent qualitative research identified opportunities to improve multidisciplinary collaboration to enhance care for older people in Indonesian aged care homes [6]. A second qualitative study reported the importance of new staff orientation, training, and infrastructure improvements for improving safety culture in public and private aged care homes [18]. However, there remains no stakeholder‐informed research agenda to guide future studies addressing medication‐related harm, optimization of pharmacotherapy, and implementation of evidence‐based medication management practices in Indonesian aged care homes. Identifying these priorities is an important first step toward informing future pharmacotherapy research, implementation strategies, and policy development that support safer and more appropriate medication use among older adults.

Therefore, the objective of this study was to prioritize research questions for improving medication management in public and private aged care homes in Indonesia, with the aim of informing future research on medication safety, geriatric pharmacotherapy, implementation science, and health policy.

2. Methods

2.1. Study Design

The study employed a modified nominal group technique (NGT). This is a structured approach for identifying and ranking research priorities. This method yields more priorities compared to conventional group discussions and helps mitigate the influence of individuals with an interest in particular outcomes (Figure 1) [19]. The study methods and results are reported according to the Reporting Guideline for Health Research Priority Setting with Stakeholders (REPRISE) [20].

FIGURE 1.

Modified nominal group technique.

2.2. Setting

The NGT session took place in April 2025 at South Tangerang, Banten, Indonesia. This was a national‐level priority‐setting exercise focused on Indonesia. The priorities were intended to guide research agendas over the short (0–4 years) to medium‐term (5–10 years), with a view to revisiting and updating the priorities as policies, clinical practices, and the demographic context evolve. Participants contributed a diverse range of clinical, research, and policy expertise from across Indonesia, providing a rich exchange of insights and perspectives during the session (see Table 1).

TABLE 1.

Characteristics of stakeholders.

Stakeholder	Gender	Age range (years old)	Profession(s)/role(s)	Years of professional experience b
1	Female	30–60	Geriatrician a	10–20
2	Female	30–60	Pharmacist	< 10
3	Female	30–60	Physiotherapist	< 10
4	Female	< 30	General practitioner	< 10
5	Male	30–60	Pharmacist a	< 10
6	Female	30‐60	Neurologist a	10–20
7	Male	30–60	Nurse and aged care home provider	20–30
8	Male	30–60	Aged care home provider	< 10
9	Male	30–60	Physiotherapist	10–20
10	Female	30–60	Family caregiver and a pharmacist	30+
11	Male	< 30	General practitioner	< 10
12	Male	30–60	Aged care home provider and public health practitioner	< 10
13	Male	30–60	Government representative (Ministry of Health) and a medical doctor	20–30
14	Female	30–60	Nutritionist a	30+
15	Female	30‐60	Nurse and aged care home providers	10–20
16	Male	30–60	International organization	20–30
17	Male	< 30	Public health practitioner and caregiver	< 10
18	Female	< 30	Pharmacist	< 10
19	Female	30–60	Geriatrician a	10–20
20	Female	30–60	International organization	< 10

^a Those who also hold academic/research roles.

^b Years since professional registration or years in a professional role.

2.3. Stakeholder Identification

We invited the stakeholder organizations to nominate participants. GW and YS identified aged care institutions and organizations in Indonesia. We sought to ensure balanced representation of different professional organizations (physicians, nurses, pharmacists, physiotherapists and nutritionists). We also invited the Ministry of Health and Ministry of Social Welfare to nominate at least one representative each. We explored whether the stakeholders had other aged care related roles, that is, representative of professional organization and family caregiver. We sought to achieve age and gender balance. The stakeholders were invited by email and followed up via WhatsApp. If stakeholders did not respond or confirm attendance after two reminders, we replaced the potential participant by inviting a representative from another similar institution. No financial honorarium was provided for stakeholders; however, stakeholders were given a modest transportation allowance for their attendance.

2.4. Stakeholder Workshop

The 4‐h workshop was facilitated by three members of the research team. These were a physician, pharmacist, and gerontologist with extensive research and clinical expertise in Indonesia and Australia. The lead moderator guided the discussions, while the other two moderators took field notes and transcribed information on whiteboards. The moderator posed the question: “What are the research priorities for improving medication management in public and private aged care homes in Indonesia?” Participants worked in pairs to identify priorities based on clinical and policy needs informed by their clinical and professional experience. This was to ensure the priorities reflected important clinical and real‐life issues from diverse perspectives. The workshop was audio recorded via Zoom and audio and written records were retained.

2.5. Identification of Research Priorities

We modified the traditional NGT methodology by substituting the silent generation of priorities with discussion in pre‐allocated mixed‐discipline pairs. This fostered a broader range of priorities through enhanced interaction and engagement among stakeholders. Previous studies have implemented similar modifications, particularly in contexts involving a larger number of stakeholders (n = 17) compared to standard NGT sessions [21]. Stakeholders collaborated in pairs to create a comprehensive list of initial priorities for further discussion. Each pair was provided with sticky note paper and marker pens to document their identified priorities.

The initial priorities were presented to the wider group in round‐robin fashion until all initial priorities were documented on the whiteboard. The priorities were discussed collectively to clarify their meaning and identify overlapping concepts. Following the workshop, three investigators (Y.M.S., J.S.B., and G.W.) independently reviewed all priorities, and overlapping concepts were merged while preserving their original intent. The wording of several priorities was refined to improve clarity and consistency, but no priority was removed solely on the basis of its perceived importance. Any disagreements regarding the consolidation or wording of priorities were resolved through discussion until consensus was reached.

2.6. Ranking of Research Priorities

Three investigators (Y.M.S., J.S.B., and G.W.) thematically categorized the consolidated priorities into two domains for voting: policy and practice. Voting occurred after the workshop using an online survey in Qualtrics. The survey was pilot tested for face validity by a convenience sample of two independent researchers. The survey was sent to all stakeholders via email and WhatsApp within 2 working days of the workshop. Stakeholders were instructed to rank their top five priorities in each domain according to the perceived importance, feasibility, and potential equity impact. Rankings were converted into weighted scores, whereby the highest‐ranked priority received five points, the second‐ranked priority four points, the third‐ranked priority three points, the fourth‐ranked priority two points, and the fifth‐ranked priority one point. Total scores were summed across all participants to determine the final ranking of priorities.

2.7. Final Written Evaluation

We emailed the results of the voting to all the stakeholders in Bahasa Indonesia (18 stakeholders) and in English (2 international organization stakeholders). The stakeholders were given two weeks to review the results and provide additional written feedback, with reminders sent via email and WhatsApp.

3. Results

3.1. Stakeholder Characteristics

Twenty of the 23 potential stakeholders who were approached provided written informed consent to participate (three were unavailable or declined). Stakeholders included representatives of consumer/caregiver (n = 1), general practitioners, geriatricians, and neurologists (n = 6), aged care home managers (n = 4), pharmacists (n = 4), nurses (n = 2), physiotherapists (n = 2), nutritionists (n = 1), public health practitioners (n = 2), and representatives from the Ministry of Health and ASEAN organizations (n = 3). Several stakeholders held more than one role, reflecting the diverse expertise and perspectives within the group. Several stakeholders had clinical and academic/research roles (n = 5). Nineteen stakeholders participated in person while one stakeholder attended online. Stakeholders ranged in age by 49 years (Table 1).

3.2. Research Priorities

A total of 47 research priorities were identified during the stakeholder workshop (Supporting Information Appendix 1), These 47 priorities were then consolidated to be 35 research priorities. The list of priorities was categorized into the policy domain (15 priorities) and practice domain (20 priorities). All 20 stakeholders completed the voting survey, ranking their research priorities within two focus areas.

For the policy domain, the top three priorities were: (i) “What policies, regulations and guidelines are needed to support better medication management in aged care homes (e.g., national clinical guidelines for appropriate medication use in aged care homes)?” (Total score 37, Figure 2, Supporting Information Appendix 1); (ii) “Which medications should be included in an essential medication list and national formulary for older people in aged care homes” (total score 31); and (iii) “What policies are needed to support development and use of drug formulations that are more acceptable for residents in aged care homes (e.g., controlled release, combination products)?” (Total score 28).

FIGURE 2.

Policy‐related research priorities.

In the practice domain, the top three priorities were: (i) “What digital health technologies can be used to support clinicians and caregivers to manage medications in aged care homes?” (Total score 28, Figure 3, Supporting Information Appendix 1); (ii) “How to monitor medication safety (e.g., side effects, drug‐drug and drug‐supplement interaction, medication dosage)?” (Total score 27); and (iii) “How to improve communication between families, nursing home staff and prescribers about the need for psychotropic (antidepressant, antipsychotic, benzodiazepine) and dementia medications?” (Total score 27). It is important to note that the second and third priorities received identical scores, highlighting their equal significance in this context.

FIGURE 3.

Practice‐related research priorities.

3.3. Final Written Evaluation

Sixteen stakeholders provided written evaluation. This was predominantly to agree with the results of the voting. Two stakeholders commented on the preferred Bahasa Indonesia term for aged care home (“panti werdha”). One stakeholder provided published evidence related to prioritized research questions. One stakeholder highlighted the importance of considering digital literacy of users and the accessibility of digital devices. One stakeholder suggested the need for a comprehensive field study that included integrated health posts (posyandu lansia) held by primary healthcare centers for older adults.

4. Discussion

This study generated 35 consolidated research priorities for improving medication management in public and private aged care homes in Indonesia. The highest‐ranked priorities focused on developing policies, regulations, and guidelines to support better medication management in aged care homes and digital health technologies to support clinicians and caregivers to manage medication use.

Beyond the highest‐ranked priorities, the 35 research priorities collectively highlight several interconnected themes that can guide future medication management research in Indonesian aged care homes. These priorities align with the reality of the lack of appropriate evidence for medication management and geriatric pharmacotherapy in Indonesia [12, 16, 22]. Current evidence on medication review, deprescribing, psychotropic use, and care transitions comes almost entirely from high‐income countries with on‐site nurse and pharmacist staffing models [9, 23]. Whether these interventions are effective, feasible, or appropriately designed for settings where care is delivered primarily by non‐clinical caregivers with visits from healthcare professionals remains untested. Thus, this study provides a roadmap for generating context‐specific evidence, which in turn can inform understanding of how care models moderate intervention effectiveness. Rather than proposing new pharmacological interventions, most of the proposed research priorities relate to the adaptation, implementation, and evaluation of established interventions—medication review, ADE monitoring, medication reconciliation at care transitions, and digital medication management systems—in a family‐ and caregiver‐centered long‐term care system. This is unique and well‐suited to Indonesian culture, where care for family members is centered on family and significant others. Therefore, future evidence describing implementation outcomes (such as feasibility, fidelity, acceptability, and sustainability) alongside treatment and clinical outcomes is needed and can leverage established implementation frameworks to examine how workforce composition, resource constraints, and caregiver engagement shape service delivery. In addition, these identified practical priorities align with WHO Global Patient Safety and will ultimately contribute reciprocally to the international evidence base on the safe use of medicines for older adults in aged care homes.

Several priority research areas have direct implications for geriatric pharmacotherapy and drug safety in Indonesia, particularly as Indonesia's pharmacovigilance system is still in its development: dedicated regulation was first introduced for the pharmaceutical industry in 2011, substantially revised in 2022 (Peraturan BPOM No. 15/2022), and replaced again in 2026 (Peraturan BPOM No. 4/2026). Residents of aged care homes are particularly vulnerable to medication‐related harms: nearly 40% of older adults worldwide experience polypharmacy, with residency in a care facility independently associated with a higher prevalence [9], and potentially inappropriate prescribing is common in nursing homes [24]. In this context, developing an essential medicine list tailored to the conditions of nursing homes in Indonesia could help create a medication selection system with more appropriate criteria for older Indonesians. Strengthening medication safety monitoring and reporting systems would establish a structured ADR detection framework that underpins pharmacovigilance in an environment where residents' symptoms are often first observed by lay caregivers rather than healthcare professionals; structured monitoring tools have been shown to identify a significant number of previously undiagnosed medication‐related problems in nursing homes [25]. Improving communication during care transitions addresses recognized high‐risk points for medication discrepancies and preventable adverse events, in line with the WHO Treatment Without Harm priority area [11], while evaluation of psychotropic medication use targets medication classes associated with falls, fractures, cerebrovascular events, and death in aged care populations [26].

The highest policy‐related research priority related to the need for policies, regulations and guidelines to support better medication management in aged care homes. These policies may complement umbrella policies already outlined in the National Action Plan for Pharmaceutical Services 2020–2024 [27]. The National Action Plan outlines efforts needed to improve medication management and reduce polypharmacy. However, its implementation among older people in primary care settings remains limited, especially in rural or under‐resourced areas. The need for research into guideline implementation in aged care homes was also identified by study stakeholders. A number of other Asia‐Pacific countries have produced national policies and guidelines to support better medication management in aged care homes, including the 2022 Australian Government Guiding Principles for Medication Management in Residential Aged Care Facilities [28]. The Australian Guiding Principles address a number of the priorities identified in this study, including communicating about medications, medication review, continuity in supply, incident reporting, and safe storage and disposal.

The second highest policy‐related research priority concerned the establishment of an essential medicines list for older people. WHO updates its Model List of Essential Medicines biennially and has published a dedicated list for children since 2007 [29]. No equivalent list exists for older people, despite the rapidly aging population in many regions of the world. Several governments in the Asia‐Pacific have adapted their national essential medicines lists to address the needs of older people, particularly through chronic disease and palliative care medicines. Thailand and Australia have each developed specific palliative care lists. Thailand issued long‐term and palliative care policy (2014) with explicit criteria to identify potentially inappropriate medications in older people; and Australia established the National Core Community Palliative Care Medicines List comprising clonazepam, haloperidol, hyoscine butylbromide, and morphine. The Australian list is supported by an educational mobile application to aid prescribing and dispensing in community settings [30].

The highest practice‐related research priority related to digital health technologies to support clinicians and caregivers. However, this finding may reflect stakeholder perceptions, consistent with a rapid increase in access to smartphones and other technologies [31], rather than demonstrated effectiveness, highlighting the need for future evaluation of digital interventions to improve medication management in Indonesian aged care homes. Smartphone apps have been developed to support managing complex medication regimens and to provide access to medication information at the point‐of‐care. Australia's electronic National Residential Medication Chart (eNRMC) is one example of an established digital medication management system that facilitates real‐time communication among prescribers, pharmacists, and nursing staff, supporting safer medication management in residential aged care [32, 33]. Such systems may provide useful insights for the future development of digital medication management solutions in Indonesia. Canadian and Australian research has centered on the use of mobile phone applications to support direct caregiving in dementia, demonstrating their potential to improve care quality [32]. While assistive and social robots have been introduced in countries such as Japan, South Korea, and Australia to help with various tasks, including companionship, some literature suggests that they may inadvertently increase caregiver workload and reduce meaningful human interaction [34]. In Indonesia, the effectiveness of digital health technologies for aged care should be interpreted as a stakeholders' pragmatic response to the need for well‐documented features of the Indonesian health system only [35]. Whether digital health technologies can deliver comparable benefits for medication management in aged care homes therefore remains an empirical question that any future research should address.

The priority to support caregivers is consistent with the WHO Long‐term Care for Older People Package of Universal Health Coverage which includes domains related to social care and support, person‐centered integrated processes and education and training [13]. Both the WHO Package and this research highlight the need for flexible and culturally appropriate training for caregivers who perform increasingly complex medication‐related tasks with little or no formal training. The second highest practice‐related priorities included improving communication between families, aged care home staff and prescribers. The need to improve coordination of care through multidisciplinary collaboration and sharing of medication information was prioritized highly. This was consistent with the findings of a recent qualitative study in a Jakarta nursing home [36].

We identified the need for frameworks to promote age‐appropriate products and formulations. This included a practice‐related emphasis on simplifying complex medication regimens. Dose forms are often modified for people with frailty or dementia for the purpose of flexible dosing (e.g., dose reduction in renal impairment) or to aid administration by people with limited dexterity or swallowing difficulties. Such modifications can be burdensome for caregivers and increase the risk of medication errors. Similar concerns are evident elsewhere in the Western Pacific. Japan's Geriatrics Society guidelines introduced STOPP‐J and the Ministry of Health has issued guidance on polypharmacy and, more recently, the Japanese Anticholinergic Risk Scale (J‐ARS) [37] to quantify anticholinergic burden (ACB) and reduce risks of cognitive decline, falls, and delirium. Australia has integrated the Drug Burden Index [38] and ACB [28] assessment into aged‐care standards, with pharmacists mandated to review sedative and anticholinergic load, supported by national toolkits. Evidence for simplification of complex regimens is growing: a cluster randomized trial in Australian aged‐care facilities demonstrated its feasibility, and the Japanese Society of Geriatric Pharmacy has recently recognized its value [39]. The broader trend toward deprescribing is also reflected in disease‐specific guidelines, though this has yet to be consistently extended to people who are older, frail, or living with dementia across Asia‐Pacific countries. These findings resonate with the high prevalence of dementia in Indonesian aged‐care homes, underscoring the urgency of strategies to reduce medication burden [40].

Other practice‐related research priorities were identified but attracted less votes. Research questions related to medication management in frailty and malnutrition were not highly prioritized despite frailty and malnutrition being reported in 47% and 58% of aged care home residents in Jakarta and Banten [15]. Similarly, the importance of end‐of‐life medication management was identified but not highly prioritized. Palliative care is described as a core intervention in the WHO Long‐term Care for Older People Package of Universal Health Coverage [11]. Stakeholders identified the need for research into medication incident reporting and management. This was consistent with previous research calling for clear guidelines on the handling, reporting, and documenting incidents in Indonesian aged care homes [40].

The research priorities identified in this study provide a foundation for improving medication management in Indonesian aged care homes. Future efforts should focus on co‐designing national medication management guidelines, undertaking pilot implementation studies, and applying implementation science approaches to support their adoption. These efforts should be supported by workforce training, evaluation of implementation outcomes, and collaboration among government, professional organizations, researchers, and aged care providers.

4.1. Strengths and Limitations

A major strength of this study was the inclusion of diverse stakeholders, including geriatricians, neurologists, general practitioners, pharmacists, aged care home managers, caregivers, representatives of professional organizations, and policy makers. This multidisciplinary representation facilitated a comprehensive exploration of medication management practices and challenges from clinical, policy, research, and service delivery perspectives.

Several limitations should be acknowledged. First, only one family caregiver participated, and no aged care home residents were involved in the priority‐setting process.

Consequently, the identified priorities may primarily reflect professional and policy perspectives. Priority‐setting research in other settings has shown that patients and caregivers often rank priorities differently from professionals, emphasizing quality of life, treatment burden, and easy‐to‐understand information over clinical and system‐level issues [41]. The dynamics of this difference may operate differently in Indonesia, where the lifestyle and choices of residents, particularly those with less agency, often rely on their extended family and traditional communities [42]. However, their absence may have contributed to a lack of prioritization regarding expectations about caregiver capacity, differences in health literacy levels, and caregiver agency in providing eldercare [43]. Second, most stakeholders worked in the greater metropolitan area of Jakarta, where aged care homes are better resourced and have greater access to health professionals. The predominantly metropolitan‐based sample might partly explain why research related to polypharmacy in higher‐ and lower‐resource settings was not prioritized higher. This means the priorities are most directly applicable to urban settings; their transferability to rural and remote regions should be tested in future research rather than assumed.

5. Conclusions

This study provides a crucial foundation for developing a comprehensive roadmap for medication management research tailored to Indonesia's unique cultural and contextual landscape. The identified priorities establish a platform for future research aimed at reducing medication‐related harm, optimizing pharmacotherapy, and supporting implementation of evidence‐based medication management practices for older adults living in aged care homes. By aligning research initiatives with the identified priorities, future studies can contribute meaningfully to improving the quality of care for older adults in Indonesia. This will enhance medication safety and promote better health outcomes and quality of life for individuals in aged care settings in Indonesia.

Author Contributions

Yulisna Mutia Sari: conceptualization, methodology, data curation, writing – original draft, writing – review and editing, visualization, project administration, formal analysis. J. Simon Bell: conceptualization, methodology, supervision, writing – review and editing, writing – original draft, validation, software, visualization. Surya Adhi: writing – review and editing, data curation. Uswa Alhamid: data curation, writing – review and editing. Esthika Dewiasty: data curation, writing – review and editing. Annisa Dhanira: data curation, writing – review and editing. Clara M. Kusharto: data curation, writing – review and editing. Evi Dwi Novriany: data curation, writing – review and editing. Dion Notario: data curation, writing – review and editing. Imran Pambudi: data curation, writing – review and editing. Rocksy Situmeang: data curation, writing – review and editing. Sri Soenarti: writing – review and editing, data curation. M. Rizky Widodo: data curation, writing – review and editing. Grace Wangge: conceptualization, methodology, funding acquisition, writing – original draft, writing – review and editing, data curation, formal analysis, supervision, validation, resources, software.

Funding

This study was funded through a Monash University 2025 Incubator Grant to Monash University Indonesia, Malaysia, and Australia received by Grace Wangge, Yulisna Mutia Sari, and Simon Bell. Monash University awards Incubator Grants to Monash University staff/researchers to address global challenges through interdisciplinary collaboration between Monash University researchers and international partners.

Ethics Statement

Ethics approval was obtained from the Monash University Human Research Ethics Committee (MUHREC), Project ID: 46265, and the Health Research Ethics Committee, National Research and Innovation Agency of Indonesia (Badan Riset dan Inovasi Nasional—BRIN), No: 128/KE.03/SK/05/2025.

Consent

All participants provided written informed consent.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Supporting Information: Appendix 1. All 47 research questions identified by stakeholders.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.