{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:23:18Z","timestamp":1783520598762,"version":"3.55.0"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":56,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"University of Padjadjaran"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Women's Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cervical cancer remains a major public health concern in Indonesia despite ongoing national efforts toward elimination. While policy initiatives have expanded screening and treatment services, limited evidence exists regarding women\u2019s lived experiences during the early stage of cervical cancer care. Understanding women\u2019s perspectives is essential to strengthening a national care strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To explore women\u2019s experiences during the early stage of cervical cancer care in Indonesia, from symptom recognition and abnormal screening results to diagnosis and initiation of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative descriptive study was conducted in a national tertiary referral center in West Java, Indonesia. Eighteen women diagnosed with cervical cancer were recruited using purposive sampling to capture diverse clinical and experiential backgrounds. Data were collected through in-depth, semi-structured interviews between August and October 2025. Interviews were transcribed verbatim and analyzed using Braun and Clarke\u2019s thematic analysis framework. Trustworthiness was ensured through member checking, audit trails, and collaborative theme validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three themes emerged: (1) women\u2019s experiences in accessing care services, (2) difficulties and coping mechanisms, and (3) unmet informational and psychosocial needs. Participants described normalization of early symptoms, misinterpretation at primary care level, fragmented referrals, and inconsistent staging information, contributing to diagnostic uncertainty and emotional distress. Although national health financing covered treatment costs, indirect financial burdens persisted. Women actively sought simplified explanations through digital platforms to compensate for communication gaps. Many entered treatment with limited preparation and inadequate counseling regarding side effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Initiation of care represents a critical bottleneck within Indonesia\u2019s cervical cancer elimination efforts. Strengthening early clinical recognition by healthcare providers, referral continuity, structured counseling, early palliative care integration, and digital navigation systems is essential to bridge the policy-implementation gap and support achievement of the WHO cervical cancer elimination target of treating 90% of women diagnosed with cervical disease.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12905-026-04493-0","type":"journal-article","created":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T01:35:44Z","timestamp":1778636144000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Women\u2019s experiences toward cervical cancer care at the initiation of care: a qualitative study closing the gap policy and implementation in Indonesia"],"prefix":"10.1186","volume":"26","author":[{"given":"Tuti","family":"Pahria","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hartiah","family":"Haroen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hana Rizmadewi","family":"Agustina","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Citra Windani Mambang","family":"Sari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Windy","family":"Natasya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gatot Nyarumenteng Adhipurnawan","family":"Winarno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sidik","family":"Maulana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerico","family":"Franciscus Pardosi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"4493_CR1","doi-asserted-by":"publisher","first-page":"1811","DOI":"10.1016\/S0140-6736(25)01917-8","volume":"406","author":"M Naghavi","year":"2025","unstructured":"Naghavi M, Kyu HH, Aalipour AB, Aalruz MA, Ababneh H. Global burden of 292 causes of death in 204 countries and territories and 660 subnational locations, 1990\u20132023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406:1811\u201372. https:\/\/doi.org\/10.1016\/S0140-6736(25)01917-8.","journal-title":"Lancet"},{"key":"4493_CR2","doi-asserted-by":"publisher","first-page":"889","DOI":"10.1016\/S0140-6736(13)60022-7","volume":"382","author":"EJ Crosbie","year":"2013","unstructured":"Crosbie EJ, Einstein MH, Franceschi S, Kitchener HC. Human papillomavirus and cervical cancer. Lancet. 2013;382:889\u201399. https:\/\/doi.org\/10.1016\/S0140-6736(13)60022-7.","journal-title":"Lancet"},{"key":"4493_CR3","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1016\/S0140-6736(07)61416-0","volume":"370","author":"M Schiffman","year":"2007","unstructured":"Schiffman M, Castle PE, Jeronimo J, Rodriguez AC, Wacholder S. Human papillomavirus and cervical cancer. Lancet. 2007;370:890\u2013907. https:\/\/doi.org\/10.1016\/S0140-6736(07)61416-0.","journal-title":"Lancet"},{"key":"4493_CR4","doi-asserted-by":"publisher","first-page":"2058","DOI":"10.3892\/ol.2020.11754","volume":"20","author":"R Hull","year":"2020","unstructured":"Hull R, Mbele M, Makhafola T, Hicks C, Wang S-M, Reis RM, et al. Cervical cancer in low and middle-income countries. Oncol Lett. 2020;20:2058\u201374. https:\/\/doi.org\/10.3892\/ol.2020.11754.","journal-title":"Oncol Lett"},{"key":"4493_CR5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1186\/s12916-025-03897-3","volume":"23","author":"L Zhou","year":"2025","unstructured":"Zhou L, Li Y, Wang H, Qin R, Han Z, Li R. Global cervical cancer elimination: quantifying the status, progress, and gaps. BMC Med. 2025;23:67. https:\/\/doi.org\/10.1186\/s12916-025-03897-3.","journal-title":"BMC Med"},{"key":"4493_CR6","unstructured":"WHO. Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020. https:\/\/www.who.int\/publications\/i\/item\/9789240014107. Accessed 13 Feb 2026."},{"key":"4493_CR7","doi-asserted-by":"publisher","first-page":"147","DOI":"10.3802\/jgo.2012.23.3.147","volume":"23","author":"L Nuranna","year":"2012","unstructured":"Nuranna L, Aziz MF, Cornain S, Purwoto G, Purbadi S, Budiningsih S, et al. Cervical cancer prevention program in Jakarta, Indonesia: See and Treat model in developing country. J Gynecol Oncol. 2012;23:147\u201352. https:\/\/doi.org\/10.3802\/jgo.2012.23.3.147.","journal-title":"J Gynecol Oncol"},{"key":"4493_CR8","unstructured":"Kemenkes. National Cervical Cancer Elimination Plan for Indonesia 2023\u20132030. 2023. https:\/\/kemkes.go.id\/id\/national-cervical-cancer-elimination-plan-for-indonesia-2023-2030. Accessed 14 Feb 2026."},{"key":"4493_CR9","doi-asserted-by":"publisher","first-page":"486","DOI":"10.1186\/s12905-022-02043-y","volume":"22","author":"Z Petersen","year":"2022","unstructured":"Petersen Z, Jaca A, Ginindza TG, Maseko G, Takatshana S, Ndlovu P, et al. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health. 2022;22:486. https:\/\/doi.org\/10.1186\/s12905-022-02043-y.","journal-title":"BMC Womens Health"},{"key":"4493_CR10","doi-asserted-by":"publisher","unstructured":"Laksono AD, Wulandari RD, Rohmah N, Rukmini R, Tumaji T. Regional disparities in hospital utilisation in Indonesia. BMJ Open. 2023;13:e064532. https:\/\/doi.org\/10.1136\/bmjopen-2022-064532. a cross-sectional analysis data from the 2018 Indonesian Basic Health Survey.","DOI":"10.1136\/bmjopen-2022-064532"},{"key":"4493_CR11","doi-asserted-by":"publisher","first-page":"100697","DOI":"10.1016\/j.gore.2021.100697","volume":"35","author":"JA Hern\u00e1ndez Vargas","year":"2021","unstructured":"Hern\u00e1ndez Vargas JA, Ram\u00edrez Barbosa PX, Valbuena-Garcia AM, Acu\u00f1a L, Gonz\u00e1lez-Diaz JA. Factors associated with delays in time to treatment initiation in Colombian women with cervical cancer: A cross-sectional analysis. Gynecologic Oncol Rep. 2021;35:100697. https:\/\/doi.org\/10.1016\/j.gore.2021.100697.","journal-title":"Gynecologic Oncol Rep"},{"key":"4493_CR12","doi-asserted-by":"publisher","first-page":"2881","DOI":"10.1186\/s12889-025-23783-0","volume":"25","author":"J Fang","year":"2025","unstructured":"Fang J, Cheng Y, Liu Y, Yang Q. How delays in seeking medical care for cervical cancer patients are affected by their health-seeking behaviour: a qualitative study. BMC Public Health. 2025;25:2881. https:\/\/doi.org\/10.1186\/s12889-025-23783-0.","journal-title":"BMC Public Health"},{"key":"4493_CR13","doi-asserted-by":"publisher","unstructured":"Liang J, Mvemba A, Swanson M, Hsu I-C (Joe), Alvarez E, Chapman J Delay to timely treatment in locally advanced cervical cancer, et al. editors. insurance inequities in access to gynecologic oncology. American Journal of Obstetrics & Gynecology. 2025;233:186.e1-186.e9. https:\/\/doi.org\/10.1016\/j.ajog.2025.02.032","DOI":"10.1016\/j.ajog.2025.02.032"},{"key":"4493_CR14","unstructured":"IARC. Elimination Planning Tool: Advancing Towards Cervical Cancer Elimination Indonesia. 2025."},{"key":"4493_CR15","doi-asserted-by":"publisher","first-page":"102004","DOI":"10.1016\/j.gore.2025.102004","volume":"63","author":"M Gross","year":"2025","unstructured":"Gross M, Wang JY, Goff BA, Ma TM, Kang KH, Doll KM, et al. Treatment delay and prolongation in locally advanced cervical cancer. Gynecol Oncol Rep. 2025;63:102004. https:\/\/doi.org\/10.1016\/j.gore.2025.102004.","journal-title":"Gynecol Oncol Rep"},{"key":"4493_CR16","doi-asserted-by":"publisher","first-page":"101325","DOI":"10.1016\/j.gore.2024.101325","volume":"51","author":"BA Tjokroprawiro","year":"2024","unstructured":"Tjokroprawiro BA, Novitasari K, Saraswati W, Yuliati I, Ulhaq RA, Sulistya HA. The challenging journey of cervical cancer diagnosis and treatment at the second largest hospital in Indonesia. Gynecol Oncol Rep. 2024;51:101325. https:\/\/doi.org\/10.1016\/j.gore.2024.101325.","journal-title":"Gynecol Oncol Rep"},{"key":"4493_CR17","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.ygyno.2020.10.006","volume":"160","author":"P Hung","year":"2021","unstructured":"Hung P, Zahnd WE, Brandt HM, Adams SA, Wang S, Eberth JM. Cervical cancer treatment initiation and survival: The role of residential proximity to cancer care. Gynecol Oncol. 2021;160:219\u201326. https:\/\/doi.org\/10.1016\/j.ygyno.2020.10.006.","journal-title":"Gynecol Oncol"},{"key":"4493_CR18","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1097\/ACM.0000000000000388","volume":"89","author":"BC O\u2019Brien","year":"2014","unstructured":"O\u2019Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for Reporting Qualitative Research: A Synthesis of Recommendations. Acad Med. 2014;89:1245. https:\/\/doi.org\/10.1097\/ACM.0000000000000388.","journal-title":"Acad Med"},{"key":"4493_CR19","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3:77\u2013101. https:\/\/doi.org\/10.1191\/1478088706qp063oa.","journal-title":"Qualitative Res Psychol"},{"key":"4493_CR20","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/ev.1427","volume":"1986","author":"YS Lincoln","year":"1986","unstructured":"Lincoln YS, Guba EG. But is it rigorous? Trustworthiness and authenticity in naturalistic evaluation. New Dir Program Evaluation. 1986;1986:73\u201384. https:\/\/doi.org\/10.1002\/ev.1427.","journal-title":"New Dir Program Evaluation"},{"key":"4493_CR21","doi-asserted-by":"publisher","unstructured":"Sebi EP, Tejanaik P, Narendiran V. Healthcare Provider-Related Factors in the Diagnostic Delay of Cervical Cancer: A Cross-Sectional Study. Cureus 16:e61865. https:\/\/doi.org\/10.7759\/cureus.61865","DOI":"10.7759\/cureus.61865"},{"key":"4493_CR22","doi-asserted-by":"publisher","unstructured":"Bhatia RK, Rayne S, Rate W, Bakwenabatsile L, Monare B, Anakwenze C, et al. Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana. J Glob Oncol. 2018;4. https:\/\/doi.org\/10.1200\/JGO.18.00088. JGO.18.00088.","DOI":"10.1200\/JGO.18.00088"},{"key":"4493_CR23","doi-asserted-by":"publisher","unstructured":"Dereje N, Addissie A, Worku A, Assefa M, Abraha A, Tigeneh W, et al. Extent and Predictors of Delays in Diagnosis of Cervical Cancer in Addis Ababa, Ethiopia: A Population-Based Prospective Study. JCO Glob Oncol. 2020;6. https:\/\/doi.org\/10.1200\/JGO.19.00242. JGO.19.00242.","DOI":"10.1200\/JGO.19.00242"},{"key":"4493_CR24","doi-asserted-by":"publisher","unstructured":"Farajimakin O. Barriers to Cervical Cancer Screening: A Systematic Review. Cureus 16:e65555. https:\/\/doi.org\/10.7759\/cureus.65555","DOI":"10.7759\/cureus.65555"},{"key":"4493_CR25","doi-asserted-by":"publisher","first-page":"e770","DOI":"10.1016\/S2214-109X(23)00064-5","volume":"11","author":"A Asante","year":"2023","unstructured":"Asante A, Cheng Q, Susilo D, Satrya A, Haemmerli M, Fattah RA, et al. The benefits and burden of health financing in Indonesia: analyses of nationally representative cross-sectional data. Lancet Global Health. 2023;11:e770\u201380. https:\/\/doi.org\/10.1016\/S2214-109X(23)00064-5.","journal-title":"Lancet Global Health"},{"key":"4493_CR26","doi-asserted-by":"publisher","first-page":"e017133","DOI":"10.1136\/bmjgh-2024-017133","volume":"10","author":"TA Kitaw","year":"2025","unstructured":"Kitaw TA, Tilahun BD, Zemariam AB, Getie A, Bizuayehu MA, Haile RN. The financial toxicity of cancer: unveiling global burden and risk factors \u2013 a systematic review and meta-analysis. BMJ Glob Health. 2025;10:e017133. https:\/\/doi.org\/10.1136\/bmjgh-2024-017133.","journal-title":"BMJ Glob Health"},{"key":"4493_CR27","doi-asserted-by":"publisher","first-page":"166","DOI":"10.21037\/atm.2018.03.28","volume":"6","author":"G Tran","year":"2018","unstructured":"Tran G, Zafar SY. Financial toxicity and implications for cancer care in the era of molecular and immune therapies. Ann Transl Med. 2018;6:166. https:\/\/doi.org\/10.21037\/atm.2018.03.28.","journal-title":"Ann Transl Med"},{"key":"4493_CR28","doi-asserted-by":"publisher","unstructured":"Gichoya JW, Mwavu R, Minja F, Kaonga N, Purkayastha S, Newsome J. Leveraging digital technologies to reduce cancer disparities in low-income and middle-income countries. Lancet Digit Health. 2025;7. https:\/\/doi.org\/10.1016\/j.landig.2025.100937.","DOI":"10.1016\/j.landig.2025.100937"},{"key":"4493_CR29","doi-asserted-by":"publisher","first-page":"107798","DOI":"10.1016\/j.ypmed.2023.107798","volume":"179","author":"CA Bravo","year":"2024","unstructured":"Bravo CA, Walker MJ, Papadopoulos A, McWhirter JE. Social media use in HPV-, cervical cancer-, and cervical screening-related research: A scoping review. Prev Med. 2024;179:107798. https:\/\/doi.org\/10.1016\/j.ypmed.2023.107798.","journal-title":"Prev Med"},{"key":"4493_CR30","doi-asserted-by":"publisher","first-page":"e23350","DOI":"10.2196\/23350","volume":"23","author":"AH Rossman","year":"2021","unstructured":"Rossman AH, Reid HW, Pieters MM, Mizelle C, von Isenburg M, Ramanujam N, et al. Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research. J Med Internet Res. 2021;23:e23350. https:\/\/doi.org\/10.2196\/23350.","journal-title":"J Med Internet Res"},{"key":"4493_CR31","doi-asserted-by":"publisher","first-page":"e1828","DOI":"10.1016\/S2214-109X(25)00310-9","volume":"13","author":"A Hyatt","year":"2025","unstructured":"Hyatt A, Canfell K, Moodie R, Aranda S. Achieving cervical cancer elimination: an ecological assessment of global determinants using a policy determinant model. Lancet Global Health. 2025;13:e1828\u201336. https:\/\/doi.org\/10.1016\/S2214-109X(25)00310-9.","journal-title":"Lancet Global Health"},{"key":"4493_CR32","unstructured":"WHO. Global cervical cancer elimination forum commitments 2025. https:\/\/www.who.int\/initiatives\/cervical-cancer-elimination-initiative\/cervical-cancer-forum\/commitments-2025. Accessed 14 Feb 2026."},{"key":"4493_CR33","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1186\/s12904-025-01737-y","volume":"24","author":"H Haroen","year":"2025","unstructured":"Haroen H, Maulana S, Harun H, Mirwanti R, Sari CWM, Platini H, et al. The benefits of early palliative care on psychological well-being, functional status, and health-related quality of life among cancer patients and their caregivers: a systematic review and meta-analysis. BMC Palliat Care. 2025;24:120. https:\/\/doi.org\/10.1186\/s12904-025-01737-y.","journal-title":"BMC Palliat Care"},{"key":"4493_CR34","doi-asserted-by":"publisher","first-page":"28","DOI":"10.25259\/IJPC_153_2022","volume":"29","author":"MSN Gautama","year":"2023","unstructured":"Gautama MSN, Damayanti A, Khusnia AF. Impact of Early Palliative Care to Improve Quality of Life of Advanced Cancer Patients: A Meta-Analysis of Randomised Controlled Trials. Indian J Palliat Care. 2023;29:28\u201335. https:\/\/doi.org\/10.25259\/IJPC_153_2022.","journal-title":"Indian J Palliat Care"},{"key":"4493_CR35","doi-asserted-by":"publisher","first-page":"e13620","DOI":"10.1111\/ecc.13620","volume":"31","author":"B Huo","year":"2022","unstructured":"Huo B, Song Y, Chang L, Tan B. Effects of early palliative care on patients with incurable cancer: A meta-analysis and systematic review. Eur J Cancer Care. 2022;31:e13620\u201313620. https:\/\/doi.org\/10.1111\/ecc.13620.","journal-title":"Eur J Cancer Care"},{"key":"4493_CR36","doi-asserted-by":"publisher","unstructured":"Haroen H, Maulana S, Harlasgunawan AR, Rahmawati S, Riansyah A, Musthofa F et al. Barriers and Facilitators of Early Palliative Care in the Trajectory of People Living with Chronic Condition: A Mini Review Using Socio-ecological Framework to Inform Public Health Strategy. Journal of Multidisciplinary Healthcare. 2024;17 null:4189\u201397. https:\/\/doi.org\/10.2147\/JMDH.S473457","DOI":"10.2147\/JMDH.S473457"},{"key":"4493_CR37","doi-asserted-by":"publisher","first-page":"e161","DOI":"10.1016\/S2214-109X(20)30459-9","volume":"9","author":"D Stelzle","year":"2021","unstructured":"Stelzle D, Tanaka LF, Lee KK, Khalil AI, Baussano I, Shah ASV, et al. Estimates of the global burden of cervical cancer associated with HIV. Lancet Global Health. 2021;9:e161\u20139. https:\/\/doi.org\/10.1016\/S2214-109X(20)30459-9.","journal-title":"Lancet Global Health"},{"key":"4493_CR38","doi-asserted-by":"publisher","first-page":"e293","DOI":"10.1016\/S2352-3018(25)00011-6","volume":"12","author":"A Uusk\u00fcla","year":"2025","unstructured":"Uusk\u00fcla A, Tisler A, DeHovitz J, Murenzi G, Castle PE, Clifford G. Prevention and control of HPV-related cancers in people living with HIV. Lancet HIV. 2025;12:e293\u2013302. https:\/\/doi.org\/10.1016\/S2352-3018(25)00011-6.","journal-title":"Lancet HIV"}],"container-title":["BMC Women's Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12905-026-04493-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-026-04493-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12905-026-04493-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T14:03:36Z","timestamp":1783519416000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12905-026-04493-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,13]]},"references-count":38,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4493"],"URL":"https:\/\/doi.org\/10.1186\/s12905-026-04493-0","relation":{},"ISSN":["1472-6874"],"issn-type":[{"value":"1472-6874","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,13]]},"assertion":[{"value":"22 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Health Research Ethics Committee of Universitas Padjadjaran (Approval No. 709\/UN6.KEP\/EC\/2025). All the participants provided written informed consent.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"339"}}