Table 2 Summary of the realist evaluation domains: context, mechanism and outcome for the cervical cancer screening in Indonesia

a. Current screening modalities, including VIA and Pap smear, are cost-effective and widely available.

b. Applied screening programs are part of public health efforts, targeting sexually active women in reproductive ages.

c. Perceived challenges in implementing cervical cancer screening include the COVID-19 pandemic, limited national insurance reimbursements, and government regulations.

d. Uneven distribution and lack of awareness of the HPV-DNA test nationwide.

a. Stakeholders acknowledge the potential benefits of the HPV-DNA test, including higher sensitivity, specificity, and self-sampling capabilities.

b. Training and capacity building for healthcare professionals, especially general practitioners, in cervical cancer screening, including HPV-DNA tests.

c. Cross-sectoral collaboration and integrating cervical cancer screening into other healthcare visits (e.g., during contraceptive visits) to improve participation and coverage.

a. Mass screening improved cervical cancer screening coverage and detection rates, potentially reducing the burden of cervical cancer in Indonesia.

b. Increased awareness and utilisation of HPV-DNA tests as a screening modality, leading to more accurate and screening of cervical cancer cases.

c. Implementation of HPV-DNA testing as a standard screening modality, contingent upon overcoming barriers such as lack of awareness, uneven distribution, and government regulations.