Governance of access to basic services for persons with disabilities in Indonesia: a three-city mixed-methods study protocol using the Gender Equality, Disability and Social Inclusion (GEDSI) framework

Study design

This three-city mixed-methods study uses a participatory governance approach to examine how governance arrangements shape access to basic services for persons with disabilities in Indonesia. The study will generate baseline quantitative profiles of service-provider readiness, lived experience of access, and facility accessibility, while also producing qualitative explanations of governance mechanisms through document and policy analysis and participatory reflection and action planning with key stakeholders, including Disabled People’s Organisations (Bowen, 2009; Creswell and Plano Clark, 2018; Patton, 2015).

The mixed-methods logic combines structured baseline measurement with explanatory qualitative and participatory components. Quantitative streams provide cross-city and cross-sector baseline profiles, while qualitative and participatory streams clarify mechanisms, contextual factors, and implementation processes that may not be fully captured through surveys alone (Creswell and Plano Clark, 2018; Patton, 2015). Integration will be undertaken through triangulation across data sources and through joint displays that synthesise city- and sector-specific findings into coherent meta-inferences to support actionable governance recommendations. An overview of the study design, core components, units of analysis, and expected outputs is provided in Table 1.

Study setting and period

The study will be conducted in three Indonesian cities: Bogor, Makassar, and Banjarmasin. Sites were selected purposively to capture variation in local service and governance contexts while preserving feasibility for cross-city comparison and participatory implementation.

The planned study period runs from December 2025 to September 2026. The planned phases are: preparation and instrument finalisation, including ethics administration (December 2025–January 2026); initial formative focus group discussion in Bogor City (23 February 2026); quantitative data collection and facility accessibility audits across the three cities (March–May 2026); participatory processes and any required qualitative clarification (June–July 2026); mixed-methods analysis and integration (June–July 2026); manuscript drafting (July 2026); and dissemination of stakeholder materials and accessible summaries (August–September 2026). The implementation phases and indicative timeline are summarised in Table 2.

Units of analysis and participant groups

The study includes four primary units of analysis: (1) service providers in the education, health, and employment sectors; (2) persons with disabilities, including adolescents aged 15–17 years; (3) facilities or service points audited for accessibility; and (4) governance actors and stakeholders involved in planning, implementation, oversight, or participatory validation.

Participant groups are therefore organised as follows: service providers for the readiness survey; persons with disabilities for the self-report survey; facilities for the accessibility audit; and local government, sectoral, and DPO stakeholders for document review input, validation, and participatory action planning.

Recruitment and eligibility

Recruitment will use three complementary channels: coordination with relevant government agencies and regional offices; recruitment through facility and service networks in the education, health, and employment sectors; and collaboration with local DPO partners for community outreach and accessible recruitment of persons with disabilities (National Institute for Health and Care Research, 2021; Staniszewska et al., 2017).

For the readiness survey, eligible participants are individuals working in the relevant sector and study site, including teachers, health workers, and workplace staff or human resource personnel, who are willing and able to provide written informed consent. For the self-report survey, eligible participants are persons with disabilities who reside in or access services in the study sites and are able to participate with reasonable accommodations where needed. Adolescents aged 15–17 years will be included using written parental or guardian consent together with written adolescent assent. For participatory and institutional components, eligible participants are local officials or key actors with roles in planning, implementation, or oversight of relevant services.

To support inclusive participation, the study will provide reasonable accommodations and supported decision-making where needed and feasible, including plain-language or easy-read information materials, communication support, additional time, assistance from trusted supporters where appropriate, and accessible procedures during recruitment, consent or assent, and data collection (Republik Indonesia, 2020; Council for International Organizations of Medical Sciences, 2016).

Sampling and sample size rationale

Sample sizes were defined a priori to support baseline description across three cities and three sectors and to enable the planned measurement-property work for the readiness instruments, drawing on general sample-size guidance for health studies and on recommendations relevant to survey and psychometric analysis (Lwanga and Lemeshow, 1991; Bartlett et al., 2001; Wolf et al., 2013).

For the service-provider readiness survey, the study will recruit 240 respondents per sector per city across education, health, and employment. This yields 720 respondents per city and 2160 respondents overall. This sample will support sector-specific descriptive analyses and the planned evaluation of internal structure, internal consistency, and related measurement properties of the readiness instruments, while any cross-city comparability analyses will be treated as exploratory and feasibility-oriented.

For the self-report survey among persons with disabilities, the target is 20 adults and 10 adolescents aged 15–17 years per city, yielding a total of 90 respondents across the three cities. This component is designed to provide structured baseline descriptions of lived experiences, barriers, and priorities rather than population-representative prevalence estimates.

For the facility accessibility audit, facilities will be selected purposively to reflect cross-sector service pathways and feasibility within each city. Per city, the audit will cover eight facilities: two inclusive junior high schools, two inclusive senior high schools or vocational schools, two primary healthcare centres, and two workplaces or employers. The purpose of this component is to produce structured facility-level and city-level accessibility profiles rather than probabilistic estimates.

Where qualitative interviews or focus group discussions are conducted beyond the planned participatory workshops, these will be limited to DPO representatives and governance stakeholders rather than service users with disabilities, and will use purposeful sampling to maximise informational relevance across roles, sectors, and cities. The participant groups, observational units, and planned sampling targets across study components are summarised in Table 3.

Study components and measures

The study comprises five main components.

Instrument development, validation, and freezing

The study uses a structured and documented development pathway for the readiness instruments and other measurement tools. Constructs and domains are derived from the GEDSI framework and accessibility domains, then translated into measurable indicators. Draft instruments will undergo expert-informed refinement, DPO-informed review for accessibility and relevance, and limited piloting where needed. Prior to main data collection, the final instrument versions will be frozen and archived, and any post-freeze changes will be documented in change logs and deviation records.

For the readiness instruments, measurement-property work is planned on internal structure and internal consistency, with exploratory assessment of cross-city comparability where feasible. Reporting of the measurement-property component in future outputs will draw on relevant COSMIN guidance (de Arruda et al., 2024; de Arruda et al., 2025; Mokkink et al., 2020).

Data collection procedures

Data collection will follow standard operating procedures and component-specific quality controls. For document review, metadata, eligibility decisions, and extracted content will be recorded in a structured extraction matrix. For the readiness survey, field teams will use standard administration procedures, scripted explanations, completeness checks, and coded scoring rules. For the self-report survey, data collection procedures will be adapted to participant needs through accessible formats and reasonable accommodations, with the aim of supporting both inclusion and data quality. For the facility accessibility audit, auditors will use a shared operational guide and pre-specified scoring rules, with ambiguous observations resolved through documented decision rules. For participatory workshops, facilitators will use standard templates for documentation while minimising unnecessary identifiers.

Outcomes

The study is designed to generate baseline evidence rather than evaluate a discrete intervention. The primary outcomes are therefore baseline governance-related outputs and profiles.

Primary outcomes

Secondary outcomes

Data analysis plan

Quantitative analysis will begin with data preparation and quality checks, including completeness review, range validation, internal consistency checks, and documented cleaning decisions. Descriptive statistics will summarise readiness scores, self-reported access experiences, and facility accessibility scores by city and sector.

For the readiness survey, measurement-property analysis will include exploratory and/or confirmatory factor-analytic procedures where justified, model-fit evaluation, internal consistency estimation, and item-performance diagnostics. Any cross-city comparability analyses, including measurement invariance where feasible, will be conducted as exploratory and feasibility-oriented analyses rather than as confirmatory tests.

Qualitative analysis will include structured document analysis and thematic interpretation of governance arrangements, procedures, coordination mechanisms, and accountability structures. Where thematic coding is applied to workshop or interview material, the analysis will draw on established thematic analysis procedures (Braun and Clarke, 2006). Outputs from GEDSI SAT and VRAP workshops will be analysed thematically to identify prioritised issues, hypothesised root causes, responsible actors, agreed actions, and enabling or constraining conditions. The interpretation of themes will be conducted reflexively and iteratively during analysis (Braun and Clarke, 2019). If any additional interviews or focus groups are conducted, they will be limited to DPO representatives and governance stakeholders and analysed thematically using explicit analytic steps.

Mixed-methods integration will be carried out through triangulation, joint displays, and meta-inferences. Findings across surveys, audits, document analysis, and participatory outputs will be compared to identify convergence, complementarity, and divergence, with integration decisions documented in an audit trail. A summary of the analyses and intended outputs for each study component is presented in Table 6.

Data management and quality assurance

All study data will be managed under the approved ethics protocol with safeguards to protect confidentiality and reduce re-identification risk, particularly for qualitative and small-subgroup data. Identifiers will be separated from analytic datasets and stored in restricted-access linkage files. Quantitative datasets will be supported by codebooks documenting variable names, labels, response options, derived variables, and scoring rules.

Quality assurance will include training and supervision of field teams, completeness and consistency checks, scripted administration, standard scoring rules, inter-rater guidance for audits, traceable coding procedures for document analysis, and standard templates for participatory outputs (Bowen, 2009; Boateng et al., 2018; Chambers and Tzavella, 2022).

Patient and public involvement

Persons with disabilities and DPOs are involved in the planning of this study and will continue to be involved in implementation, interpretation, and dissemination (National Institute for Health and Care Research, 2021; Staniszewska et al., 2017). DPO partners support recruitment and outreach, advise on accessible formats and reasonable accommodations, and contribute to the contextualisation and validation of findings through participatory governance processes.

Public involvement is planned across multiple stages. Before main data collection, DPO input is used to improve accessibility and acceptability of consent materials and questionnaires. During data collection, DPO partners may assist outreach and advise on accommodation needs. During analysis and integration, participatory workshops using GEDSI SAT and VRAP will include DPOs and other stakeholders to refine interpretation and co-prioritise actions. During dissemination, DPO partners will advise on the format and accessibility of outputs such as policy briefs, feedback materials, and plain-language summaries. All such processes will be documented so that later outputs can report public involvement transparently.

Dissemination

Findings will be disseminated through peer-reviewed publications, city-level policy briefs, stakeholder feedback sessions, and accessible outputs such as plain-language summaries developed with DPO input (National Institute for Health and Care Research, 2021; Council for International Organizations of Medical Sciences, 2016). The dissemination strategy is designed for both academic audiences and applied governance stakeholders. Policy-oriented outputs will emphasise actionable recommendations for local government, service providers, and partner institutions. Community-oriented outputs will prioritise accessibility, readability, and practical usefulness.

Subject to ethical approval and confidentiality safeguards, quantitative datasets, codebooks, and analysis scripts are planned for future archiving in the study repository. Qualitative raw data will not be fully shared because of the risk of participant re-identification, particularly in context-specific and small-group participatory settings. Any shared materials will therefore be governed by confidentiality protections, access conditions, and data-minimisation principles.

Study status

At the time of protocol submission, the full three-city main data collection had not yet commenced. The protocol was prospectively preregistered to strengthen transparency regarding planned objectives, design, instruments, and analysis before the availability of primary results (Chambers and Tzavella, 2022). Preparation of instruments, ethics administration, and protocol registration had been completed. Ethical approval was obtained from the Komite Etik Penelitian yang Melibatkan Subjek Manusia, IPB University, and the protocol was prospectively preregistered on the Open Science Framework on 15 January 2026.

An initial formative focus group discussion was conducted in Bogor City on 23 February 2026 to inform early understanding of barriers, solutions, and stakeholder expectations. Main quantitative data collection and facility accessibility audits across Bogor, Makassar, and Banjarmasin are scheduled for March–May 2026, followed by participatory validation and action-planning processes and mixed-methods integration.