An Implementation Fidelity Index for Nurse-Led Integrated Primary Care in Indonesia: Evidence from Planning, Early Detection, Nursing Care, Community Empowerment, and Reporting

Background/Objective: Nurses play a central role in operationalizing integration through coordination, screening, nursing care processes, community empowerment, and reporting. This study to examine the empirical distribution of an Implementation Fidelity Index (IFI) for nurse-led integrated primary care in Indonesia, grounded in five core domains: planning and coordination, early detection, nursing care processes, community education and empowerment, and reporting. Methods: We conducted a cross-sectional, facility-based online survey in 2025 among registered nurses working in Indonesian primary health care facilities (Puskesmas) and involved in integrated primary care activities. Implementation was measured using a structured 28-item questionnaire across five domains: planning/coordination, early detection, nursing care processes, community education/empowerment, and reporting (Likert 1–5). Domain scores were calculated as the mean of items within each domain; the overall Implementation IFI was calculated as the mean across all items and as the summed total score (range 28–140). We summarized domain and overall distributions (mean, SD, range) and examined inter-domain associations using Spearman correlations. Results: A total of 252 nurses completed the survey with no missing item responses. Overall IFI (item-mean) was 3.99 (SD 0.92; range 1.04–5.00), corresponding to a total score mean of 111.84 (SD 25.90; range 29–140). Domain means were highest for nursing care processes (4.28, SD 0.91) and early detection (4.09, SD 0.94), and lowest for community education/empowerment (3.75, SD 1.10). Using mean ±1 SD thresholds, 12.3% of nurses were categorized as low implementers, 71.8% moderate, and 15.9% high, indicating substantial heterogeneity. Inter-domain correlations were consistently positive and moderate-to-strong (ρ≈0.54–0.80; p<0.001). Conclusions: Nurse-led integrated primary care implementation in Indonesia was moderate-to-high overall but uneven across nurses and domains, with comparatively weaker performance in community empowerment and reporting.