Development and Expert Validation of a Hospital-to-Home Care Pathway for Preterm Infants in Indonesia: A Qualitative...

The transition of preterm infants from hospital to home requires coordinated care across hospital, primary care, community, and family settings. This study aimed to develop and validate a Hospital-to-Home Care Pathway for preterm infants in Indonesia.

A sequential exploratory qualitative-Delphi consensus design was used. This study was conducted in Bandung, West Java, Indonesia, from May 2025 to November 2025. Stage 1 involved 70 stakeholders, including mothers, healthcare providers, community health volunteers (cadres), managers, hospital leaders, and health office representatives. Data were collected through focus group discussions, in-depth interviews, observations, and document review and analyzed using inductive thematic analysis. Stage 2 used three Delphi rounds with seven experts to refine and validate the pathway.

Stage 1 identified fragmentation across care settings beyond parental knowledge gaps. Synthesized findings yielded six pathway needs: parental readiness, information continuity, hospital-community coordination, defined roles for community health volunteers and primary care providers, community follow-up, and monitoring, evaluation, and referral feedback. Stage 2 confirmed expert consensus. Round 1 agreement ranged from 85.7% to 100%. In Round 2, item-level content validity ranged from 0.86 to 1.00, with scale-level content validity index based on average agreement (S-CVI/Ave) = 0.99 and scale-level content validity index based on universal agreement (S-CVI/UA) = 0.90. Round 3 confirmed final consensus and response stability. The final pathway comprised a visual care flow and an operational table specifying care settings, components, activities, responsible providers, and documents.

This study produced an expert-validated Hospital-to-Home Care Pathway for preterm infants in Indonesia. The pathway integrates discharge planning, community follow-up, family education, documentation, and referral feedback. As a pre-implementation output, the pathway should be evaluated further through feasibility, acceptability, fidelity, and effectiveness testing before claims about clinical or health-system impact are made.