Evidence map›Paper›PMID 33020133›Full record

ArticleBMJ open diabetes research & care2020

Change in clinical knowledge of diabetes among primary healthcare providers in Indonesia: repeated cross-sectional survey of 5105 primary healthcare facilities.

Dorit T Stein, Nikkil Sudharsanan, Shita Dewi, Jennifer Manne-Goehler, Firman Witoelar, Pascal Geldsetzer

Abstract read
In one paragraph

Article in BMJ open diabetes research & care, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Bridging the diagnostic gap in diabetes.Bulletin of the World Health Organization · 2026
    Article
  3. Article
  4. Article
  5. Article
  6. Article
  7. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Dorit T SteinDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA dorittalia@gmail.com.ORCID 0000-0001-9938-3272
Nikkil SudharsananInstitute of Global Health, Heidelberg University, Heidelberg, Baden-Württemberg, Germany.
Shita DewiCenter for Health Policy and Management, Universitas Gadjah Mada, Yogyakarta, Daerah Istimewa Yogyakart, Indonesia.
Jennifer Manne-GoehlerDivision of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA.
Firman WitoelarCrawford School of Public Policy, Australian National University, Canberra, Australian Capital Territory, Australia.ORCID 0000-0001-8286-861X
Pascal GeldsetzerInstitute of Global Health, Heidelberg University, Heidelberg, Baden-Württemberg, Germany.

Funding

PROGRAM FOR AIDS CLINICAL RESEARCH TRAINING (PACRT)T32AI007433 · NIAID · MASSACHUSETTS GENERAL HOSPITAL · PI MARK J SIEDNER · 1992 to 2026
$11.4M
Institutional Career Development Core (KL2)KL2TR003143 · NCATS · STANFORD UNIVERSITY · PI ASCH, STEVEN M. · 2019 to 2023
$8.7M
NCATS NIH HHS KL2 TR003143NIAID NIH HHS T32 AI007433
6 · The paper itself

Abstract

introductionIndonesia is experiencing a rapid rise in the number of people with diabetes. There is limited evidence on how well primary care providers are equipped to deal with this growing epidemic. This study aimed to determine the level of primary healthcare providers' knowledge of diabetes, change in knowledge from 2007 to 2014/2015 and the extent to which changes in the diabetes workforce composition, geographical distribution of providers, and provider characteristics explained the change in diabetes knowledge. RESEARCH DESIGN AND

methodsIn 2007 and 2014/2015, a random sample of public and private primary healthcare providers who reported providing diabetes care across 13 provinces in Indonesia completed a diabetes clinical case vignette. A provider's diabetes vignette score represents the percentage of all correct clinical actions for a hypothetical diabetes patient that were spontaneously mentioned by the provider. We used standardization and fixed-effects linear regression models to determine the extent to which changes in diabetes workforce composition, geographical distribution of providers, and provider characteristics explained any change in diabetes knowledge between survey rounds, and how knowledge varied among provinces.

resultsThe mean unadjusted vignette score decreased from 37.1% (95% CI 36.4% to 37.9%) in 2007 to 29.1% (95% CI 28.4% to 29.8%, p<0.001) in 2014/2015. Vignette scores were, on average, 6.9 (95% CI -8.2 to 5.6, p<0.001) percentage points lower in 2014/2015 than in 2007 after adjusting for provider cadre, geographical distribution, and provider experience and training. Physicians and providers with postgraduate diabetes training had the highest vignette scores.

conclusionsDiabetes knowledge among primary healthcare providers in Indonesia decreased, from an already low level, between 2007 and 2014/2015. Policies that improve preservice training, particularly at newer schools, and investment in on-the-job training in diabetes might halt and reverse the decline in diabetes knowledge among Indonesia's primary healthcare workforce.

Indexed as

Diabetes MellitusHealth PersonnelCross-Sectional StudiesHumansIndonesiaPrimary Health Carediabetes mellitushealth services researchprimary healthcarequality of healthcaretype 2

Identifiers

PMID33020133
PMCPMC7536835

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.