Preventive Governance in Premarital Health Screening: Integrating Guidance and Counseling within Local Public Health Services
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Abstract
Premarital health screening is widely promoted as a preventive strategy to improve maternal and child health; however, its implementation is often embedded within administrative procedures rather than preventive public health governance. Existing studies predominantly frame premarital screening as either a clinical intervention or a bureaucratic requirement, leaving a conceptual gap between governance practices and preventive counselling functions. This study addresses this gap by introducing the concept of preventive governance to examine how premarital health screening operates as preventive guidance and counselling within local public service delivery. Using a qualitative intrinsic case study in Kotawaringin Barat Regency, Indonesia, data were collected through in-depth interviews with health officials, religious affairs officers, health workers, and prospective couples, supported by observation and document analysis. Thematic analysis revealed a structural pattern characterized by procedural transparency, administrative accountability, and compliance-based participation. Although counselling and reproductive education were formally integrated into the screening process, participants largely perceived the service as an administrative prerequisite for marriage registration. Accountability mechanisms emphasized medical records and reporting systems, yet lacked longitudinal monitoring of preventive outcomes. Institutional coordination between health centres and the Office of Religious Affairs improved service access but remained constrained by workload pressures and the absence of integrated monitoring systems. These findings demonstrate a governance gap where premarital screening functions procedurally but has not fully evolved into preventive governance capable of fostering sustained preventive awareness and reproductive health literacy. This study contributes theoretically by conceptualizing preventive governance as an analytical framework that integrates governance principles, preventive health objectives, and counselling practices within local public services. Practically, the study highlights the need for outcome-oriented monitoring, strengthened preventive health literacy, and enhanced counselling capacity to transform administrative compliance into sustainable preventive health behaviour.
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References
Alemu, A. A., Bitew, M. S., Zeleke, B. G., et al. (2021). Knowledge of preconception care and its association with family planning utilization among women in Ethiopia: Meta-analysis. Scientific Reports, 11, 10909. https://doi.org/10.1038/s41598-021-89819-8.
Andrews, M., Pritchett, L., & Woolcock, M. (2017). Building state capability: Evidence, analysis, action. Oxford University Press.
Angrosino, M. V. (2016). Naturalistic observation. Routledge.
Ansell, C., & Gash, A. (2008). Collaborative governance in theory and practice. Journal of Public Administration Research and Theory, 18(4), 543–571. https://doi.org/10.1093/jopart/mum032
Ayele, A. D., Belay, H. G., Kassa, B. G., et al. (2021). Knowledge and utilisation of preconception care and associated factors among women in Ethiopia: Systematic review and meta-analysis. Reproductive Health, 18, 78. https://doi.org/10.1186/s12978-021-01132-9.
Barbazza, E., & Tello, J. E. (2014). A review of health governance: definitions, dimensions and tools to govern. Health Policy, 116(1), 1–11. https://doi.org/10.1016/j.healthpol.2014.01.007
Behn, R. D. (2001). Rethinking democratic accountability. Brookings Institution Press.
BKKBN. (2022). Peraturan Badan Kependudukan dan Keluarga Berencana Nasional Republik Indonesia.
Bovens, M. (2007). Analysing and assessing accountability: A conceptual framework 1. European Law Journal, 13(4), 447–468. https://doi.org/10.1111/j.1468-0386.2007.00378.x
Bovens, M. A. P., Goodin, R. E., & Schillemans, T. (2014). The Oxford handbook public accountability. Oxford handbooks.
Bowen, G. A. (2009). Document analysis as a qualitative research method. Qualitative Research Journal, 9(2), 27–40. https://doi.org/10.3316/QRJ0902027
Chan, K. S., Wan, E. Y. F., Chin, W. Y., Cheng, W. H. G., Ho, M. K., Yu, E. Y. T., & Lam, C. L. K. (2021). Effects of continuity of care on health outcomes among patients with diabetes mellitus and/or hypertension: A systematic review. BMC Primary Care, 22, 145. https://doi.org/10.1186/s12875-021-01493-x.
Dean, S. V, Lassi, Z. S., Imam, A. M., & Bhutta, Z. A. (2014). Preconception care: closing the gap in the continuum of care to accelerate improvements in maternal, newborn and child health. Reproductive Health, 11(Suppl 3), S1. https://doi.org/10.1186/1742-4755-11-S3-S1
Denzin, N. K., & Lincoln, Y. S. (2011). The Sage handbook of qualitative research. sage.
Duan-Porter, W., Ullman, K., Majeski, B., Miake-Lye, I., Diem, S., & Wilt, T. J. (2022). Care coordination models and tools—Systematic review and key informant interviews. Journal of General Internal Medicine, 37(6), 1367–1379. https://doi.org/10.1007/s11606-021-07158-w.
Emerson, K., & Nabatchi, T. (2015). Collaborative governance regimes. Georgetown. Georgetown University Press, Public management and change series.
Fukuyama, F. (2013). What is governance? Governance, 26(3), 347–368.
Gaffney, H. J., & Hamiduzzaman, M. (2022). Factors that influence older patients' participation in clinical communication within developed country hospitals and GP clinics: A systematic review of current literature. PLOS ONE, 17(6), e0269840. https://doi.org/10.1371/journal.pone.0269840.
Glanz, K., Rimer, B. K., & Viswanath, K. (2015). Health behavior: Theory, research, and practice. John Wiley & Sons.
Greer, S., Wismar, M., & Figueras, J. (2015). Strengthening health system governance: better policies, stronger performance. McGraw-Hill Education (UK).
Guest, G., Namey, E. E., & Mitchell, M. L. (2020). Collecting qualitative data: A field manual for applied research. Sage.
Halfon, N., & Hochstein, M. (2002). Life course health development: an integrated framework for developing health, policy, and research. The Milbank Quarterly, 80(3), 433–479. https://doi.org/10.1111/1468-0009.00019
Hernández-Leal, M. J., Pérez-Lacasta, M. J., Feijoo-Cid, M., Ramos-García, V., & Carles-Lavila, M. (2021). Healthcare professionals’ behaviour regarding the implementation of shared decision-making in screening programmes: A systematic review. Patient Education and Counseling, 104(8), 1933–1944. https://doi.org/10.1016/j.pec.2021.01.032.
Israel, M., & Hay, I. (2016). Research ethics for social scientists. Sage Publications.
Javadivala, Z., Allahverdipour, H., Jafarabadi, M. A., et al. (2021). Improved couple satisfaction and communication with marriage and relationship programs: Are there gender differences?—A systematic review and meta-analysis. Systematic Reviews, 10, 178. https://doi.org/10.1186/s13643-021-01719-0.
KemenkesRI. (2020). Profil kesehatan indonesia 2022.
Khatri, R., Endalamaw, A., Erku, D., Wolka, E., Nigatu, F., Zewdie, A., & Assefa, Y. (2023). Continuity and care coordination of primary health care: a scoping review. BMC health services research, 23(1), 750. https://doi.org/10.1186/s12913-023-09718-8
Kickbusch, I., & Gleicher, D. (2012). Governance for Health in the 21st Century. Denmark: WHO Regional Office for Europe: Copenhagen.
Klijn, E., & Koppenjan, J. (2016). Governance Networks in the Public Sector. Routledge. Routledge.
Kvale, S., & Brinkmann, S. (2015). Interviews: Learning the craft of qualitative research interviewing. Sage Publications.
Lassi, Z. S., Dean, S. V, Mallick, D., & Bhutta, Z. A. (2020). Preconception care: delivery strategies and packages for care. Reproductive Health, 11(Suppl 3), S7. https://doi.org/10.1016/S2214-109X(19)30502-5
Lassi, Z. S., Kedzior, S. G. E., Tariq, W., Jadoon, Y., Das, J. K., & Bhutta, Z. A. (2021). Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low- and middle-income countries: A systematic review. Campbell Systematic Reviews, 17(2), e1156. https://doi.org/10.1002/cl2.1156.
Lincoln, Y. S., & Guba, E. G. (1985). Naturalistic inquiry. Sage Publications.
Miles, M. B., Huberman, A. M., & Saldana, J. (2014). Qualitative data analysis: A methods sourcebook. (3rd ed.). Sage Publications.
Muscat, D. M., Shepherd, H. L., Nutbeam, D., Trevena, L., & McCaffery, K. J. (2021). Health literacy and shared decision-making: Exploring the relationship to enable meaningful patient engagement in healthcare. Journal of General Internal Medicine, 36(2), 521–524. https://doi.org/10.1007/s11606-020-05912-0.
Nowell, L. S., Norris, J. M., White, D. E., & White, D. E. (2017). Thematic Analysis: Striving to Meet the Trustworthiness Criteria: Striving to Meet the Trustworthiness Criteria. International Journal of Qualitative Methods, 16(1). https://doi.org/10.1177/1609406917733847
Nutbeam, D. (2008). The evolving concept of health literacy. Social Science & Medicine, 67(12), 2072–2078. https://doi.org/10.1016/j.socscimed.2008.09.050
OECD. (2023). Integrating care to prevent and manage chronic diseases: Best practices in public health. OECD Publishing. https://doi.org/10.1787/9acc1b1d-en.
Painter, M., & Peters, B. G. (2018). Administrative Traditions in Comparative Perspective: Families, Groups and Hybrids. Oxford University Press.
Patton, M. Q. (2015). Qualitative research & evaluation methods. (4th ed.). Sage Publications.
Pollitt, C., & Bouckaert, G. (2017). Public management reform: A comparative analysis. (4th ed.). Oxford University Press.
Richter, R., Jansen, J., Bongaerts, I., Damman, O., Rademakers, J., & van der Weijden, T. (2023). Communication of benefits and harms in shared decision making with patients with limited health literacy: A systematic review of risk communication strategies. Patient Education and Counseling, 116, 107944. https://doi.org/10.1016/j.pec.2023.107944.
Shonkoff, J. P., Garner, A. S., Benjamin S. Siegel, Dobbins, M. I., Earls, M. F., Pascoe, A. S. G. L. M. J., & Wood, D. L. (2021). The Lifelong Effects of Early Childhood Adversity and Toxic Stress. Pediatrics, 129(1), e232–e246. https://doi.org/10.1542/peds.2011-2663
Sørensen, K., Pelikan, J. M., Röthlin, F., Ganahl, K., Slonska, Z., Doyle, G., … Consortium, on behalf of the H.-E. (2012). Health literacy and public health. BMC Public Health, 25(6), 1053–1058. https://doi.org/10.1093/eurpub/ckv043
Stake, R. E. (2010). Qualitative research: Studying how things work. Guilford Press.
Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. The Milbank Quarterly, 83(3), 457–502. https://doi.org/10.1111/j.1468-0009.2005.00409.x
Stephenson, J., Heslehurst, N., Hall, J., Schoenaker, D. A. J. M., Hutchinson, J., Cade, J. E., … Mishra, G. D. (2018). Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. The Lancet, 391(10132), 1830–1841. https://doi.org/10.1016/S0140-6736(18)30311-8
Waddell, A., Lennox, A., Spassova, G., et al. (2021). Barriers and facilitators to shared decision-making in hospitals from policy to practice: A systematic review. Implementation Science, 16, 74.
WHO. (2013). Preconception care: Maximizing the gains for maternal and child health. Geneva: WHO. Geneva: WHO.
WHO (2021). Health promotion glossary of terms 2021. World Health Organization.
WHO. (2022). Global health estimates 2022: Mortality and burden of disease. WHO Press.
WorldBank. (2017). World development report 2017: Governance and the law. https://doi.org/10.1596/978-1-4648-0950-7
Yavuzer, Y., & Doğanülkü, H. A. (2024). Development of a systemic premarital counselling programme and evaluating its impact on young adults' couple relationships: A pilot study. Current Psychology, 43, 5179–5192. https://doi.org/10.1007/s12144-023-04715-w.
Yin, R. K. (2018). Case study research and applications: Design and methods. (6th ed.). Sage Publications.