# Challenges for a Maternal-Care Health Recommender System in Indonesia: Formative Preimplementation Qualitative Study

## TL;DR

This study explores challenges in implementing a maternal-care health recommender system in Indonesia, emphasizing the need for user involvement and system reliability.

## Contribution

The study identifies six major challenges in preimplementation of a maternal-care health recommender system through stakeholder interviews in Indonesia.

## Key findings

- Six major challenges were identified, including skill, accuracy, completeness, timeliness, cost, and standardization.
- User involvement in system design is emphasized to meet healthcare professionals' and patients' needs.
- Technical advancements and adherence to regulatory standards are critical for successful implementation.

## Abstract

Maternal evaluation during routine antenatal care visits may reduce maternal morbidity and mortality by identifying and addressing issues early on. A health recommender system could help health professionals and pregnant women monitor daily health parameters, provide tailored recommendations, and support timely antenatal care.

This study aims to qualitatively analyze challenges in the preimplementation of health recommender system for maternal care in Indonesia as perceived by multiple stakeholders, including health care providers, patients, health system managers, government officers, and technology vendors.

The methodology used a qualitative approach, where qualitative data were obtained from interviews of 37 respondents from multiple stakeholders, consisting of 15 health workers and 15 patients from private and government health care facilities, 4 officers from government health offices, 2 directors of health application vendors, and 1 manager from a private health clinic. These semistructured interview results were analyzed using thematic analysis.

This qualitative study identifies key challenges in implementing a health recommender system for maternal care in Indonesia across the people, process, infrastructure, and policy dimensions. Intercoder reliability for the coding process demonstrated almost perfect agreement (Cohen κ=0.90), supporting the consistency of the coding process. Six major challenges were revealed, mostly regarding skill, accuracy, completeness, timeliness, cost, and standardization. These 6 major challenges were mentioned 96 times, accounting for 64.43% of all codes extracted from the interviews. These findings emphasize the value of user involvement in system design to meet health care professionals’ and patients’ needs, technical advancements to foster trust and support effective decision-making, as well as enhanced data accuracy, reliable and timely service delivery, cost management, and clear regulatory standards.

This formative, preimplementation qualitative study highlights the importance of involving users in system design and future implementation to meet the needs of health care professionals and patients. Reducing input errors and improving system reliability are critical to building trust and supporting effective point-of-care decision-making and, in later phases, facility-level monitoring as part of public health surveillance. Adherence to regulatory standards and the establishment of standardized guidelines will be key to enabling broader implementation. Further usability, feasibility, and pilot studies are required before any evaluation of effectiveness.