The Effectiveness of Psychoeducation in Improving Psychological and

Emotional Health Patients with Chronic Diseases (Tuberculosis): A

Systematic Review

Nurul Khoirun Nisa, Soedarsono

and Makhfudli

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Psychoeducation, Psychological and Emotional Health, Chronic Disease Patients, Tuberculosis.

Abstract: Background: individuals suffering from chronic disease were 2.6 times greater risk for an emotional mental

disorder. Tuberculosis (TB) is a chronic and infectious disease, caused by Mycobacterium tuberculosis that

affects the lungs and can affect not only physical health but also psychological and social conditions.

Psychically and socially perceived by clients due to TB-related stigma and changing attitudes of people

around it, thus requiring the right method to know and handle it. the aim of this study was to describe the

patient's psychological and emotional health, especially patients with chronic diseases. Methods: this

systematic review using PICO frameworks on some databases to searching international scientific articles

such as Pro Quest, Ebscho, Pubmed, Science direct bounded from 2006 until 2017. The searching with the

keyword found 1,124 articles, Those articles are identified in accordance to the inclusion criteria, which got

7 articles. The search results are identified further to have critical appraisal to the stage of making

systematic review. Results: In general, all the journals conducted by the review provide results that

psychoeducation provides positive benefits as a medical handling strategy in improving the psychological

and emotional health of the patient in terms of decreasing levels of anxiety and stress as well as providing

good emotional support to the patient. Conclusions: Psychoeducation give an effective method that is

beneficial in providing a positive effect and good emotional support to the patient. This effect occurs in the

decline of good psychological health conditions, and increased levels of patient satisfaction to nurse.

1 BACKGROUND

Tuberculosis (TB) has become a health problem in

the world, a chronic and contagious infectious

disease, the third cause of death and ranks first for

infectious diseases class. The situation of

Tuberculosis in the world is getting worse, the

number of TB cases is increasing and many which is

not successfully cured, especially in countries

grouped in 22 countries with high burden countries.

TB caused by Mycobacterium tuberculosis that

affects the lungs and can affect not only physical

health but also psychological (mental) and social

conditions. Physically, the patient will have a long

cough with coughing up blood, breathing difficulties,

weight loss, night sweats, and fever, while

psychologically and socially sensed patients are due

to TB-related stigma and changes in the attitude of

those around them. The impact of pulmonary TB can

affect many aspects of life and lead to a deterioration

in the quality of life of the patient (Jannah, 2016).

Tuberculosis therapy has a positive effect on the

physical condition, but there are other effects

obtained after tuberculosis patients completed

treatment and microbiologically declared cured, the

quality of life of patients with tuberculosis

significantly worse than the healthy population, in

terms of physical health (physical function, physical

health status, overall body pain, general health view)

and mental health (vitality of life, health effects on

living activity, restriction by mental health status,

general mental health) (Guo et al., 2009).

One form of therapy to reduce the psychological

impact is with psychoeducation. Psychoeducation is

the development and provision of information in the

form of community education as information related

to simple psychology that affects the psychosocial

well-being of society (Supratiknya, 2011). With the

provision of psychoeducation therapy, is expected to

increase knowledge and ability in self care, self

management in patients with chronic diseases

undergoing therapy.

734

Nisa, N., Soedarsono, . and Makhfudli, .

The Effectiveness of Psychoeducation in Improving Psychological and Emotional Health Patients with Chronic Diseases (Tuberculosis): A Systematic Review.

DOI: 10.5220/0008331907340737

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 734-737

ISBN: 978-989-758-336-0

Provision of education has been shown to

increase therapeutic satisfaction, especially in the

comfort, social and quality of life domains,

especially in the domain of treatment satisfaction

(Mustikanigtyas, 2013). The results of the Yuni

study (2016) also show that there is a significant

relationship between knowledge of the disease and

medication adherence. Education is one of the

indicators that determine the success of treatment.

Patients with low education will be difficult to

receive treatment, where treatment takes a long time,

with more toxic drugs, more expensive with a very

large effect (WHO, 2013).

The study of psychoeducation therapy on anxiety

in chronic disease patients, ever done by Espahbodi,

Hosseini, Mirzade, & Beygom, 2015 entitled Effect

of Psycho Education on Depression and Anxiety

Symptoms in Patientson Hemodialysis said that the

results showed Psychoeducation decreased

depression score and total score HADS. However, it

is not enough to conclude the effect of

psychoeducation therapy on anxiety in patients with

renal failure who underwent hemodialysis.

The purpose of this study is to conduct a

systematic review of psychoeducation therapy on

improving the psychological and emotional health of

patients with chronic diseases. It is expected to

facilitate the provision of nursing interventions and

ultimately reduce the level of anxiety / psychological

and emotional impacts on chronic disease patients

undergoing therapy as well as other cases that allow

this therapy to be given.

2 METHODS

The method used in Systematic review begins with

topic selection, then the keyword is determined to

search the journal using English through several

databases such as Science Direct, Ebscho, Pro Quest,

Google Scholar, e-resources, and Pub Med.

Keywords used are "psychoeducation", "health

psychological", "emotional", "chronic disease",

"TB/Tuberculosis". This search is bounded from

2006 until 2017. Journals were selected for review

based on studies that fit the inclusion criteria. The

inclusion criteria in this systematic review is

psychoeducation performed on patients with chronic

diseases. The searching with the keyword found

1,124 articles, Those articles are identified in

accordance to the inclusion criteria, which got 7

articles, then be observed and done Critical

Appraisal.

3 RESULTS

This systematic reviews 7 journals. All journals

discuss about the influence of psychoeducation to

improve the psychological and emotional health of

patients with chronic illness.

Martin's research (2017) suggests that there is a

better improvement in sickle cell disease level

knowledge and self-efficacy for adolescents and

young adults who participate in SCD interventions

than those who participate in control conditions

(medication as usual). Further analysis revealed that

participants in psychoeducation interventions proved

significantly greater improvement in the subscale

outcomes of medical treatment and handling

strategies compared to those who participated in

control conditions.

This results were supported by research

conducted by Hemdi and Daley (2017) that

improvements were found in T2 (postintervention)

for stresses (F = 234.34, p = 0.00, and d = -1.52) and

depression (F = 195.70, p = 0.00, and d = -2.14) but

not anxiety, and these results are maintained in

T3(follow up 8 weeks). Changes in child behavior

problems were limited to hyperactive improvement

in T2 (F = 133.66, p = 0.00, and d = -1.54). Despite

the statistically significant changes in stress and

depression, changes to normal clinical levels are

limited to depression. None of the participants had

recovered after the intervention (Mother Stress Index

Short Form stress score), while 23 mothers (71.87%)

in the intervention group had recovered at T2 and 22

(68.75%) in T3 (Hospital of Anxiety and Depression

Scale depression score).

Similar research was also conducted Khanal et al

(2017) revealed that behavioral changes proved to

assist individuals in identifying appropriate changes

in levels of practice and policy. The findings of this

study emphasize the need for psycho-social support

tailored to work on simple aspects of psychological

support for the general population can be used easily

for use with people with MDR-TB.

The results were supported by Montoya (2013)

in the results of his qualitative study obtained

analysis of participants' answers to different

questions from semistructured interviews of patients

in identifying major categories of self-beliefs' 'To

realize that life is short' 'and requires active support

from the surrounding environment.

Chan (2006) also describes Psychoeducation

interventions that contain education, relaxation and

effective group support in improving outcomes from

the care provided, while also providing a positive

effect and good emotional support to the individual.

The Effectiveness of Psychoeducation in Improving Psychological and Emotional Health Patients with Chronic Diseases (Tuberculosis): A

Systematic Review

735

Research conducted Hosseini (2012) in Iran J Jid

Kidney Dis explained that Psychological training

and citalopram therapy useful in reducing symptoms

of anxiety and depression of patients undergoing

hemodialysis.

A similar study by Al-Rishawi (2015) proves

that there is a relationship between anxiety and

depression levels with socio-demographic

characteristics in clients with renal failure. The

results of this Psycho-educational program are

suggested to improve the client's psychological and

emotional status

4 DISCUSSION

In general, all journals conducted by the review

provide results that psychoeducation provides

positive benefits as a medical handling strategy in

improving the psychological and emotional health of

patients viewed from the aspect of decreasing the

level of anxiety and stress as well as providing good

emotional support there are patients.

Patients suffering from chronic diseases are

prone to psychological problems. Through the

research of Al-Rishawi, M.K.dan Al-Juboori, A.K.

(2015) suggests that the variant levels of anxiety and

depression in hemodialysis patients are associated

with sex, age, and occupation. The difference of

variant of psychological pressure with education

level showed significant result according to HADS

scale. Psychoeducation is therefore expected to

improve psychological function and emotional

status.

Psychoeducation significantly affects stress

levels, anxiety and depression is demonstrated

through research conducted by Rahimipoour et al

(2015) through educational therapy hope to reduce

depression, anxiety, and stress levels in patients

undergoing hemodialysis. There were significant

results on the average score of depression, stress, and

anxiety in the treatment group. Through hope-

therapy education, individuals will have more

realistic goals and get rid of despair that can damage

self-confidence. So it is possible that the individual

is more resistant to negative events. In addition, hope

is a kind of feeling that enlarges the possibility of

future behavior or fun events.

The reseach An Gyeong-Ju's (2011) study also

showed that e-mail education decreased the stress

score, epinephrine and cortisol serum lower than the

control group after the 6-week e-mail education

program. The content and encouragement given in

the e-mail education program psychologically

supports elderly hemodialysis patients.

Psychological pressure is known to be greater than

physical stress. However, e-mail patient education

does not affect the limitations of time for face-to-

face and space.

In Research of Montoya (2013) nurses are

expected to reduce the impact of terminal illness on

clients, not only by controlling the symptoms but

also supporting the patient's health, by increasing the

sense of satisfaction in life, providing honest and

accurate information, building the patient's thoughts

on realistic health , and facilitate patients and

families in effective and quality communication).

Research conducted by Khanal (2017) also

indicates that with behavioral changes proven

helpful in identifying appropriate changes in attitude

and decision making. This study describes the need

for psycho-social support appropriate to the patient's

condition. Recent research on simple psychological

support packages for the general population can be

used easily for use with MDR-TB. Good

psychological support is expected to improve

attitudes and ways of making decisions in

determining therapy so that the success of therapy

will be more optimal.

Some studies do not statistically show significant

results regarding the influence of psychoeducation in

reducing stress, anxiety, or depression. In the

Espahbodi study (2015), psychoeducation affects

anxiety, depression and total HADS levels. Total

HADS is a combination of HADS depression and

HADS anxiety scores. Total depression and HADS

levels in decline significantly after educational

treatment, but, in women, psychoeducation effects

can only be seen in depression scores. Although

psychoeducation reduces an anxiety HADS score, it

is statistically insignificant. This may be due to the

duration of education as well as follow-up with a

short period of time. In addition, special skills taught

such as muscle relaxation require continuous

practice and require a fairly long duration.

Similar results were also raised by Hosseini

(2012) in his research. There were no significant

differences between citalopram groups and

psychological education groups on depression,

anxiety and total HADS scores. However,

psychological-social interventions for depression in

dialysis patients suggest that psychological

interventions added to routine medical therapy may

decrease depression in ESRD patients

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

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5 CONCLUSIONS

Psychoeducation can be an effective method useful

in giving positive effects and good emotional

support to Patients. This effect occurs in the decline

of good psychological health conditions, and

increased levels of patient satisfaction to nurse.

REFERENCES

Al-Rishawi, M., Al-Juboori, A.K., 2015, ‘Anxiety and

Depression Symptoms of Renal Failure Patients

undergoing Hemodialysis at Al Sadder Teaching

Hospital in Al Amarah City’, Kufa Journal for

Nursing Sciences, vol. 5, no. 2.

An, Gyeong-Ju, 2011, ‘ Effect of e-mail education on

stress and compliance in Korean elderly on

hemodialysis’, Hong Kong Journal of Nephrology, vol

13, Hal. 68-73

Chan, Carmen W.H., 2006, ‘Psychoeducational

Intervention : A Critical Review Of Systematic

Analyses’, Research Gate, DOI:

10.1016/j.cein.2006.08.011

Espahbodi, F., Hosseini, H., Mirzade, M. M., & Beygom,

A. (2015). Effect of Psycho Education on Depression

and Anxiety Symptoms in Patients on Hemodialysis.

Psychiatry Behaviour Science, 9(1), 1–5.

https://doi.org/10.17795/ijpbs227 Original

Guo N, Fawziah M, & Carlo AM., 2009, ‘Measuring

Health-Related Quality Of Life In Tuberculosis: A

Systematic Review’, Biomed Central, vol. 7, no. 14,

hal. 1-10.

Hemdi A. & Daley D., 2017, ‘The Effectiveness of a

Psychoeducation Intervention Delivered via

WhatsApp for Mothers of Children with Autism

Spectrum Disorder (ASD) in the Kingdom of Saudi

Arabia: A Randomized Controlled trial’, Child Care

Health Dev, vol. 43, no. 6, hal. 933-941.

Hosseini, S.H., Espahbodi, F., Goudarzi, 2012,

‘Citalopram Versus Psychological Training For

Depression And Anxiety Symptom In Hemodialysis

Patients’, Iran J Kidney Dis, vol. 6, no. 6, hal. 441-

451.

Jannah, Ana Miftahul, 2016, Faktor-Faktor Yang

Mempengaruhi Kualitas Hidup Pasien Tuberkulosis

Paru Di Poli Rawat Jalan Rumah Sakit Paru Jember.

Thesis, Universitas Jember.

Khanal, Sudeepa, Helen Elsey, Rebecca King, Sushil C.

Baral, Bharat Raj Bhatta & James N. Newell, 2017,

‘Development of a Patient-Centred, Psychosocial

Support Intervention for Multi-Drug-Resistant

Tuberculosis (MDR-TB) Care in Nepal’, Plos One,

vol. 12 no. 1 : 0167559

Martin, Gweneth M,- , The Effect Of Psychoeducational

Intervention On Improving Psychosocial Functioning

And Disease Management Of Adolescent And Young

Adults With Sickle Cell Disease, diakses 3 Oktober

2017

Montoya-Juarez R., Garcia-Caro MP., Compos-Calderon

C., Schmidt-RioValle J., Gomez-Chica A., Marti-

Gracia C., Cruz-Quintana F., 2013, ‘Psychological

Responses Of Terminally Ill Patients Who Are

Experiencing Suffering: A Qualitative Study’, Int J

Nurs Stud, vol. 50, no. 1, hal. 53-62

Mustikaningtyas, Ika. 2013. Pengaruh Pemberian Edukasi

Secara Berkelompok Terhadap Kepuasan Terapi Dan

Kualitas Hidup Pasien Deabetes Mellitus. Thesis,

Universitas Gadjah Mada, Yogyakarta

Rahimipour, M., Shahgholian, N., Yazdani, M. 2015.

Effect of happiness educational program on the level

of stress, anxiety and depression of the cancer

patients’ nurses. Iranian Journal of Nursing and

Midwifery Research .vol. 20, no. 6

Supratiknya, 2011. Merancang Model Dan Modul

Psikoedukasi Edisi Revisi, Yogyakarta: Universitas

Sanata Dharma

WHO. 2013. Defenition and Diagnosis Of Pulmonolgy

Tuberculosis. Diakses dari

https://mdgsgoals.com.who.int/sree/ pada tanggal 15

November 2016.

Widakdo, Giri & Besral, 2013, ‘Efek Penyakit

Kronis Terhadap Gangguan Mental Emosional’,

Jurnal Kesehatan Masyarakat Nasional, vol. 3,

no. 7.

Yuni, I Dewa Ayu Made Arda, 2016, ‘Hubungan Fase

Pengobatan TB Dan Pengetahuan Tentang MDR TB

Dengan Kepatuhan Pengobatan Pasien TB’, Jurnal

Berkala Epidemiologi, vol. 4, no. 3, hal. 301-312.

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Systematic Review

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