Determinants of Routine Follow-Up Adherence among Stroke Patients in Indonesia: Analysis of the 2023 Indonesian Health Survey

Abstract

Stroke is a non-communicable disease with the highest disability and mortality burden in Indonesia. Routine follow-up adherence to health facilities is a key determinant of successful secondary prevention, yet its determinants from a health administration and service management perspective remain underexamined using nationally representative data in Indonesia. The study aims to analyze factors associated with routine follow-up adherence among stroke patients and to identify the most dominant factor. This quantitative cross-sectional study used secondary data from the 2023 Indonesian Health Survey (Survei Kesehatan Indonesia/SKI), individual and household modules, merged by household identity. The eligible population comprised 5,621 individuals ever diagnosed with stroke by a physician. The outcome was routine follow-up status (routine vs. non-routine). Analyses included chi-square testing at the bivariate level and binary logistic regression with backward elimination based on likelihood ratio tests at the multivariate level. A total of 2,740 respondents (48.7%) adhered to routine follow-up. At the bivariate level, 14 of 16 variables were associated (p<.25) and were entered as multivariate candidates. The final model retained six independently significant variables: age group, education level, urban/rural residence, the type of facility most frequently used by the household, hospital availability in the district/city, and perceived congruence of services with patient expectations. The most dominant factor was higher education (Adjusted OR=2.33; 95% CI 1.91–2.84; p<.001), followed by hospital use as the primary facility (Adjusted OR=2.06; 95% CI 1.76–2.39; p<.001). Routine follow-up adherence among stroke patients is shaped by an interaction between individual predisposing factors (education) and structural enabling factors (utilization of and access to referral facilities), indicating the need for layered interventions at both the individual and health-system levels.