Family Support Perceived among Pulmonary Tuberculosis (TB)

Patients in Medan, Indonesia

Siti Zahara Nasution

,Reni Asmara Ariga

, Cholina Trisa Siregar

, Muhammad Ridha Haykal Amal

Faculty of Nursing, Universitas Sumatera Utara, Prof. Maas Street No. 3 Kampus USU, Medan, Indonesia

Faculty of Law, Universitas Medan Area, Medan, Indonesia

Keywords: Family support, Pulmonary TB

Abstract: Tuberculosis (TB) is an infectious disease caused by the Mycobacterium tuberculosis bacteria, which can

attack various organs, especially the lungs. This disease if untreated or treatment is incomplete can cause

dangerous complications to death. Family is an important factor in providing support for people with

pulmonary TB. The existence of family support will increase self-confidence and motivation to deal with

problems. The purpose of the study was to identify patients with pulmonary TB in the city of Medan

Indonesia. In this study using a descriptive design with a study population of pulmonary TB patients in the

Medan City of Indonesia and the number of research samples were 250 samples carried out by probability

method with cluster sampling type. Data collection uses a questionnaire. The results of the study found that

family support in emotional, informational, material, and reward aspects were classified as good. This

research is expected to be the initial reference material for conducting further research related to family

support for other patients.

1 INTRODUCTION

Pulmonary Tuberculosis (Pulmonary TB) is an

infectious disease caused by Mycobacterium

tuberculosis and commonly found in the lungs but

can affect other organs. About 75% of pulmonary

TB patients are the most economically productive

age group. Being one of the global concerns because

of the high cases of pulmonary TB can have a broad

impact on the quality of life, social and economic

and even threaten human life (Ministry, 2018).

Based on (WHO, 2013), TB prevalence is

estimated at 169 cases per 100,000 population, the

incidence of pulmonary TB is 122 cases per 100,000

population and the mortality rate is 13 cases per

100,000 population. Then the cure rate reached a

target of 83.7% (minimum target of 85%) and the

treatment success rate in 2013 reached a target of

90.3% (minimum target of 85%), from these data

making Indonesia the 4th most country after India,

China and South Africa.

Data from (Benerjee et al., 2016) contained

197,000 new cases of positive smear pulmonary TB,

namely 117,000 men and 80,000 women. Then the

data of Riau Provincial Health Office in 2012 the

number of Pulmonary TB patients in Riau Province

is still high compared to Java-Bali, which is only

160 people out of 100 thousand. Positive patients

with pulmonary TB in Riau Province were 2,968

people from 5,538,367 residents of Riau Province.

Targeted discovery coverage is 70%, the rate of

discovery of pulmonary TB patients in new cases

with Acid Resistant Basil (BTA) is positive, Case

Detection Rate (CDR) for 2011 is 2,880 cases

(33.9%) increased compared to 2010 (26, 6% of the

cases of 2,205) and in 2007 of 2,003 cases (21.8%)

(Pekanbaru, 2012). The number of Pulmonary TB

patients in Sidomulyo Public Health Center with 59

cases of Pulmonary TB, with 39 smear positive

smear, negative smear with 15 positive x-rays, 1

extra lung (EP) 1 person and 4 patients who relapsed

soul. Sidomulyo Health Center is one of the health

centres in Pekanbaru that uses the DOTS strategy

(Directly Observed Treatment, Short course

Chemotherapy) in tackling Pulmonary TB and is an

exemplary Community Health Centre throughout

the City of Pekanbaru in 2011 (Brittain, et al., 2012).

Phenomenon found in Sidomulyo Public Health

Center in 2012 is the percentage proportion of

pulmonary TB cure rate has only reached 33 people

(84.61%) of 39 pulmonary TB patients have not

reached the target of treatment success, the

minimum recovery that must be achieved by the

188

Nasution, S., Ariga, R., Siregar, C. and Amal, M.

Family Support Perceived among Pulmonary Tuberculosis (TB) Patients in Medan, Indonesia.

DOI: 10.5220/0008788701880195

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 188-195

ISBN: 978-989-758-438-1

Community Health Center is > 85 % (Celik &

Yunus, 2014).

Community Lung Health Centers (BKPM) are

one of the health agencies that use the DOTS

strategy in tackling pulmonary TB. Based on data

from BKPM Semarang, data in 2011 showed that the

number of smear-positive TB patients was 550

people, 37 of them (6.7%) was relapsed patients, and

in 2012 the number of smear-positive TB patients

were 641 people, 39 of them (6.08%) were relapse

patient (Brittain et al., 2012). In 2016, in Medan the

number of new BTA + cases were 2,829 cases,

compared to the new BTA + cases found in 2015 as

many as 3,111 cases and in 2014 there were 3,047

cases, the number of cases decreased.

This is due to the increasing TB health services

carried out by the Medan City Health Office and

also through cross-sector programs that care about

the incidence of TB in Medan City. According to

gender in 2016, cases of BTA + in men were higher

than in the case of BTA + women. Gender plays a

role in determining whether a person is more

susceptible to TB or not. The number of male

sufferers is more likely due to mobility and higher

activity than women. Moreover, smoking habits

have a significant effect on the increased risk of

developing TB. With these factors, men are believed

to be more susceptible to exposure to TB-causing

bacteria, while women and children who also

contribute to the high number of those who are

included in the vulnerable lifestyle are also those

who are closely related to tuberculosis sufferers.

Factors that influence the risk of transmission

Pulmonary tuberculosis are those who have close

contact with someone who has active pulmonary

tuberculosis, immunosuppressive individuals

(including the elderly, patients with cancer, those on

corticosteroid therapy or those who are infected with

HIV), users of IV drugs and alcoholics, individuals

who have pre-existing medical disorders, age and

sex, malnutrition or lack of calories, protein,

vitamins, iron and others that will affect a person's

immune system so that they are susceptible to

pulmonary tuberculosis, individuals who living in

institutions (for example: long-term care facilities,

psychiatric institutions, prisons, those who live in

dense housing, slums and poor sanitation.

Family support is the most important factor in

helping individuals solve problems, family support

will increase self-confidence and motivation to deal

with problems and improve life satisfaction.

In this case, the family must be involved in

educational programs so that families can meet the

needs of patients, knowing when families should

seek help and support adherence to treatment.

Factors that affect the health of both individuals,

groups and communities are grouped into 4, namely:

environment (including physical, social, cultural,

political, economic, and so on), behaviour, health

services, and offspring. These four factors in

influencing health do not stand alone, but each

affects each other. Environmental factors other than

directly affecting health also affect behaviour, and

reverse behaviour also affects the environment.

The source of transmission is a positive smear

tuberculosis patient when coughing or sneezing, the

patient spreads germs to the air in the form of

droplets (sputum). Some factors that cause the

spread of the disease are bad habits of pulmonary

tuberculosis patients who spit carelessly. Family

support for the elderly who have pulmonary TB

disease is very important, the family can be a very

influential factor in determining individual health

beliefs and values. From Stuart and Sundeen

(Tamher, 2009), that family support is the most

important element in helping individuals solve

problems. The existence of family support will

increase self-confidence and motivation to deal with

problems. Therefore it can be concluded that family

is an important factor in providing support for

routine pulmonary TB patients in their treatment.

2 METHODS

This study used a descriptive research design, which

is a simple description of the phenomenon of

pulmonary TB patients in Medan Indonesia. This

study uses a measuring instrument in the form of a

questionnaire. This study aims to identify patients

with pulmonary TB in Medan, Indonesia. Research

sampling technique with Probability technique.

Sampling in the study using Cluster Sampling

technique. This study was conducted on the elderly

population suffering from pulmonary TB in Medan,

Indonesia. The number of samples was 250 samples.

3 RESULT

Table 1: Characteristic Frequency Distribution in

Patients with Pulmonary TB in Medan City,

Indonesia

Characteristic

Genre

Man

163

65,2

Woman

34,8

Religion

Muslim

211

84,4

Chatolic

3,2

Protestant

9,6

Family Support Perceived among Pulmonary Tuberculosis (TB) Patients in Medan, Indonesia

189

Buddhist

1,2

Hindu

1,6

Ethnic

Mandailing

108

43,2

Javanese

35,6

Batak Toba

12,4

Batak Karo

2,4

Tionghoa

1,2

Nias

0,8

Aceh

2,8

Tamil

1,6

Education

Elementary

School

33,6

Secondary School

101

40,4

High School

20,8

Bachelor

5,2

From the table above, the results of demographic

data were the majority of male sex as many as 163

respondents (65.2%). The majority of respondents

were Islam, namely 211 respondents (84.4%). Most

tribes are the Mandailing tribe, which were 108

respondents (43.2%). Then the final education of the

average respondent in this study was secondary

school, as many as 101 respondents (40.4%).

Table 2. Distribution of Frequency of Family

Support for Pulmonary TB Patients in Medan,

Indonesia

Family Support

Good

157

62,8

Enough

20,8

Slump

16,4

From the table above, the results of the frequency

distribution of family support for pulmonary TB

patients in Medan, Indonesia are good as many as

157 respondents (62.8%).

Table3. Frequency Distribution of Emotional Family

Support in Pulmonary TB Patients in Medan City

Family Support

Emotional

Good

198

79,2

Enough

17,2

Slump

3,6

From the table above, we found the results of the

frequency distribution of emotional family support

for pulmonary TB patients in the city of Medan,

namely as many as 198 respondents (79.2%).

Table 4. Distribution of Frequency of Informational

Family Support in Pulmonary TB Patients in Medan

City

Family support

Informational

Good

142

56,8

Enouhg

16,8

Slump

26,4

From the table above, we get the results of the

frequency distribution of informational family

support for pulmonary TB patients in the city of

Medan, that is as good as 142 respondents (56.8%).

Table 5. Frequency Distribution Family Support

Award for Pulmonary TB Patients in Medan City

Family Support

Appreciation

Good

126

50,4

Enough

29,2

Slump

20,4

From the table above, the results of this study were

related to the frequency distribution data of family

support awards for pulmonary TB patients in

Medan, namely 126 respondents (50.4%).

4 DISCUSSION

Tuberculosis (TB) is an infectious disease caused by

Mycobacterium tuberculosis, which can attack

various organs, especially the lungs. If this disease is

not treated completely can cause dangerous

complications even cause death. TB is estimated has

been existed in the world since 5000 BC, but the

progress in the discovery and control of TB has only

occurred in the last two centuries. The main

symptoms of pulmonary TB are a cough with

phlegm for two weeks or more, additional symptoms

of sputum mixed with blood (coughing up blood),

shortness of breath, weakness, malaise, decreased

appetite, weight loss, dry at night without physical

activity, fever more than one month. In extra-

pulmonary TB, symptoms, and complaints depend

on the affected organ, such as neck stiffness on

tuberculous meningitis, chest pain in pleural TB

(pleuritic), superficial lymph node enlargement in

tuberculous lymphadenitis and spinal deformity

(gibbous) in tuberculous spondylitis and others -

others.

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

190

Tuberculosis is a direct infectious disease caused by

Mycobacterium Tuberculosis

TB transmission method.

a. The source of transmission is a positive smear

TB patients through sputum released.

However, that does not mean that TB patients

with negative smear examination results do not

contain germs in their sputum. This could have

happened because the number of germs

contained in the test sample was 5.000 out of

5,000 sputum/cc so that it was difficult to

detect through direct microscopic examination.

b. TB patients with negative smear also still have

the possibility of transmitting TB. The rate of

transmission of positive smear TB patients was

65%, negative smear TB patients with positive

culture results were 26% while TB patients

with negative culture results and positive

thorax photos were 17%.

c. The infection will occur if other people breathe

air containing the infectious sputum.

d. When coughing or sneezing, patients spread

germs into the air in the form of sputum

(droplet nuclei). Once a cough can produce

about 3000 sputum (Dinas, 216).

Risk of transmission

a. The risk of contracting depends on the level of

exposure with sputum.

Pulmonary TB patients with positive smear

give a risk possibility

Transmission is greater than pulmonary TB

patients with a negative smear.

b. The risk of transmission every year is indicated

by the Annual Risk of Tuberculosis Infection

(ARTI), which is the proportion of the

population at risk of TB infection for one year.

ARTI is 1%, meaning that 10 (ten) people out

of 1000 people are infected every year.

c. ARTI in Indonesia varies between 1-3%.

d. TB infection is proven by the change in the

negative tuberculin reaction to positive

(Gleeson et al., 2016).

Conditions in the home environment can show that

the average home condition of research subjects has

not met the requirements of a healthy home and is

very risky for the occurrence of pulmonary

tuberculosis, because based on the results of

observations or measurements it is known that the

condition of some research subjects' homes is in

risky conditions, because:

a. Some of the residential densities of research

subjects did not meet the requirements.

b. The average room temperature is 32.11 0C so it

is said to not meet the requirements of a

healthy home, this is because research subjects

rarely open the windows of the house every

day, and some tiles do not use glass tiles, so

that sunlight does not enter the house.

c. The average lighting is 21.7 lux, so it is said

that it does not meet the requirements of a

healthy home, it is affected because the

research subjects do not open the house

window every day, and the location of the vent

is not strategic so that sunlight cannot enter the

house (Li & Ke, 2017).

There are several tips to help maintain and prevent

TB disease to friends and family from germ

infections: Stay at home. Don't go to work or school

or sleep in a room with someone else for the first

few weeks of treatment for active TB

a. Ventilate the room. TB germs spread more

easily in small enclosed spaces where the air is

not moving.

b. If the room ventilation is still lacking, open the

window and use a fan to blow air in the room

outside.

c. Shut up using a mask. Use a mask to cover

your mouth at any time, this is a step to prevent

TB effectively. Do not forget to remove masks

regularly.

d. Spit should be in a certain place that has been

given disinfectant (soapy water).

e. BCG immunization is given to infants aged 3-

14 months.

f. Avoid cold air.

g. Try sunlight and fresh air to enter enough into

the bed.

h. Drying mattresses, pillows, and beds especially

in the morning.

i. All items used by the patient must be separated

as well as washing and should not be used by

others.

j. Foods must be high in carbohydrates and high

in protein.

Family support

a. Family Definition

The family is an association of two or more

individuals who are bound by blood relations,

marriage, or adoption, and each family member

always interacts with each other.

b. Family support

Family support is the attitude, actions, and

acceptance of the family towards the family

members who are supportive always ready to

Family Support Perceived among Pulmonary Tuberculosis (TB) Patients in Medan, Indonesia

191

give help and assistance if needed. In this case,

the family support recipient will know that there

are other people who pay attention, respect and

love him

c. Form family support

families have several types of support, namely:

1. Instrumental support namely the family is a

source of practical and concrete help.

2. Information support is the family functions as

a collector and disseminator (the cause of

information).

3. Assessment support is the family acting as

feedback, guiding and mediating problem-

solving and as a source and validator of

family identity.

4. Emotional support is as a safe and peaceful

place for rest and recovery and helps

mastery of emotions.

5. Financial support, financial stress usually

affects the family system and results in the

destruction of the family.

6. Spiritual support, in fact, trust in God and

prayer are identified by the family as the

most important cam for the family to

overcome a thing (American, 2017).

Family role

The role of the family describes a set of

interpersonal behaviour, traits, activities related to

individuals in certain positions and situations. The

role of individuals in the family is based on the

expectations and patterns of behaviour of families,

groups, and communities. One of the roles of the

family is to form other family members while facing

health problems.

Family Function.

In a family there are several family functions that

can be run, namely:

a. Biological function is a function to carry on

offspring, nurture, and raise children, and fulfil

family nutrition needs.

b. The psychological function is to provide love

and a sense of security for the family, giving

attention to the family, giving maturity to the

personality of family members, and giving

identity to the family

c. The function of socialization is to foster

socialization with children, establish

behavioural norms according to their respective

levels of development and carry on cultural

values

d. The function of socialization is a function that

develops the process of interaction in the

family that starts from birth and the family is

an individual place to learn to socialize

e. The economic function is to look for sources of

income to meet current family needs and save

to meet the needs of the family in the future

f. The economic function is a family function to

meet the needs of all family members including

clothing, food, and shelter

g. The function of education is to send children to

provide knowledge, skills, shape children's

behaviour in accordance with their talents and

interests, prepare children for an adult life that

will come in fulfilling their role as adults and

educating children according to their level of

development (David, 2008).

Family support, emotional support, informational

support, and appreciation support:

1. Family support for patients with pulmonary TB

in Medan City, Indonesia. In this study, it was

found that family support for pulmonary TB

patients was good (62.8%). Family support is

an encouragement, motivation, encouragement,

and advice that comes from family members in

the home that build one's character. Family

support can be obtained through verbal or

nonverbal. The majority of the sexes in this

study were men where men usually became

leaders in a family, so when they fell ill they

were very much cared for by the family. Family

support is also influenced by economic and

social and environmental factors. Family

support is very important when a person is

affected by illness because family support

provided can prevent the development of

problems due to the pressure faced. Family

support plays an important role in making good

interpersonal relationships. In TB patients

require iron supplementation to prevent

anaemia, in general, TB patients suffer from

anaemia (Dolan et al., 2006). Perceived

benefits, perceived barriers and family support

related to adherence to iron supplementation;

thus, developing a good perception and family

support must be promoted well. Patients with

pulmonary TB experience stress during the

treatment process, therefore pulmonary TB

sufferers need more support from the family in

the form of social support, family competence,

and adequate family resources (Sangian et al.,

2017). Social support, family competency, and

family resource adequacy have a direct effect

on parenting stress in the family and, the

adequacy of family resources mediates and

moderates the influence of social support and

family competencies in parenting stress.

SKIC-MHS 2018 - The 2nd Syiah Kuala International Conference on Medicine and Health Sciences

192

2. Emotional family support for pulmonary TB

sufferers in this study, it was found that

emotional family support in pulmonary TB

patients was good (79.2%). Emotional family

support is the presence of emotions, feelings in

providing support to families such as giving

praise, strengthening families who are

experiencing problems such as illness or

accident. Emotional support includes

expressions of empathy, care and attention of

the people concerned to family members who

experience health problems such as feedback

and affirmation from family members.

Emotional family support serves as a place to

restore feelings and help in mastering emotions.

In the study of good emotional family support

supported by the respondent's family related to

pulmonary TB sufferers due to good family

relationships and also the good support given

by the family in the family. Family support

related to health problems is proven to increase

satisfaction for sufferers in aspects of provider

decisions and compliance during the treatment

process (Sianturi, 2014). Based on the results of

the study, practitioners must regularly assess

family support and CRC beliefs with African-

American patients. This can increase

satisfaction sharing patient-provider decisions

and compliance with CRC screening among

African American patients. In patients with TB

often need moral support from the family

because TB patients experience routine

treatment for 6 months accompanied by

medication side effects (Sumantra, 2017). In

Studies 1a and 1b, we find that individuals who

engage in prior moral actions provide less

family support than those who were not

involved in previous moral actions. In Study 2,

we found that the indirect effects of engaging in

previous moral actions on providing family

support as mediated by individual

counterfactual thinking were observed only

when situational severity was low (Triharini et

al., 2018). There is a connection between

Family Emotional Support and Self-Acceptance

in the Elderly in the village of Watutumou III.

Based on data obtained through research on 60

respondents showed that respondents who had

good family emotional support amounted to 33

respondents with a percentage of 55%.

3. Informational family support for pulmonary TB

sufferers in Medan, Indonesia

In this study, the results of informational family

support in pulmonary TB patients were good

(56.8%). Informational family support in the

form of families always provides information

related to something either about health or

other general matters. In the family exchanging

information is very important and reasonable to

do because then the communication between

family members can run well so that the

relationship between family members is also

good. Therefore, it will affect when there is one

family member who is sick or afflicted by a

disaster, the other family members will care

about the family members who are affected by

the disease or the disaster. Informational family

support is a collection of advice, advice,

guidance and providing information that is

useful to suppress stressors. Although in this

study the majority of respondents' last

education was a junior high school the

respondents had good family support and good

family communication so that the informational

family support could be well established.

Information support from families related to the

compliance of pulmonary TB patients in

consuming drugs that must be consumed

routinely by pulmonary TB sufferers for 6

months (Sumantra et al., 2017). Good family

informative support with medication adherence

in elderly hypertension as many as 29

respondents (72.5%). Informative family

support that is the Family functions as a

collector and disseminator of information on

the emergence of a stressor because the

information provided can contribute to

suggestions that are specific to individuals. The

aspects of this support are advice, suggestions,

instructions and information.

4. Family support Material for pulmonary TB

sufferers in Medan City, Indonesia

In this study, the results of maternal family

support in pulmonary TB patients were good

(60.8%). Material family support can be in the

form of providing facilities for families such as

when the family is sick and will be taken to the

nearest health service. In this study, a family

support obtained from respondents is therefore

good for material family support, where

families are very sensitive and help each other

and meet the needs of other family members

when other family members are affected or ill.

Family support in the form of competency-

based education and training support in the

form of the use of more modern technology can

make it easier to connect and get patients even

non-family members (Behera, 2010). The use

of digital technology has revolutionized and

shaped the modern world. The use of cellular-

based applications can help parents to develop

their knowledge and beliefs. Cameras and

videos can help parents to keep in touch with

vulnerable babies even when they are not next

Family Support Perceived among Pulmonary Tuberculosis (TB) Patients in Medan, Indonesia

193

to their loved ones. Family economic status can

increase the family support provided by

families to TB sufferers (Nasution, 2007).

Researchers described that living with

biological parents, parents' level of education,

high family income levels and having a

disabled sibling increased the perceived family

support score. Therefore, it is estimated that

supporting and strengthening these individuals

in terms of these characteristics can increase

the level of perceived family support.

5. Family support Award for pulmonary TB

sufferers in Medan City, Indonesia

In this study, the results of family support were

obtained in the form of rewards for pulmonary

TB patients, namely good (50.4%). Where

family support can be in the form of praise,

reward, and encouragement. Family support

awards can act as feedback guidance, guide and

influence problem-solving. This support can be

realized through expressions of respect or

providing positive reinforcement for the family.

Award support is generally given by the family

in the form of attitudes and attention. In this

study, the majority of respondent religions are

Islam, where in Islam itself it is recommended

to strengthen and help one another when one of

the other Muslims is facing a problem.

5 CONCLUSIONS

The results of this study found that family support in

emotional, informational, material, and reward

aspects was classified as good. Whereas a whole the

family plays a role in supporting during the healing

and recovery process of the patient. Most families in

Medan, Indonesia have good family support this is

allegedly due to the relationship of a family caring

very much about each other.

ACKNOWLEDGEMENTS

The author would like to thank the Ministry of

Research and Technology Higher Education of the

Republic of Indonesia, Prof. Dr. Runtung, SH,

M.Hum as the Rector of the University of Sumatra

Utara, Drs. Mahyuddin K. M. Nasution, M.I.T.,

Ph.D. as Vice Rector III of North Sumatra

University, Prof. Dr. Ir. Dr. Erman Munir, M.Sc as

Chairman of Research Institute of the University of

North Sumatra. This research is financed by

TALENT USU of the 2018 Year.

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