Relationship of Family Empowerment with Prevention of

TB Transmission on Patients

in Area of Puskesmas Siabu Mandailing Natal, Indonesia

Saleh Usman

, Arlinda Sari Wahyuni

, Nurmala Sari

, Cholina Trisa Siregar

, Reni Asmara Ariga

Department of Public Health Institute Deli Husada, Indonesia

Department of Public Health/Community Medicine Faculty of Medicine, Universitas Sumatera Utara, Indonesia

Department of Medical Surgical Nursing, Faculty of Nursing Universitas Sumatera Utara, Indonesia

Keywords: Knowledge, Information, Communication, Participation, Prevention of Tuberculosis Transmission

Abstract: The Role of family empowerment in decreasing causes TB is very important. Family empowerment

program of TB family is always called as supervisor of taking medicine. Tuberculosis (TB) is a chronic

infectious disease, the caused by the Mycobacterium tuberculosis. Results of a preliminary study conducted

in Puskesmas Siabu found that new TB cases in 2016 reached 112 cases and 135 cases of TB in 2017, it had

Increased. One factor that the caused to the high number of new TB cases every year in controlled is the

transmission of TB cases that are not controlled. The study is the quantitative research with cross-sectional

analytic to analyze the empowerment family with the prevent, transmission of TB in the work area

Puskesmas of Siabu. The relation was determined the value of the ratio of prevalence (RP). The sample of

this study is 61 the empowerment of the family of patients who have TB. Sample examined in the

consecutive sampling of data, analysed used Chi-square test and logistic regression performed with real α =

0.05 standard. The result of the research show that knowledge (p = 0.00; p <0.05; RP.14,5), communication

(p = 0.04; p <0.05; RP.5,81), information (p = 0.040; p <0.05; RP.11,1), participation (p = 0.030; p <0.05;

RP.8,26). From the analysis it can be concluded that there is a relationship of knowledge, information,

communication, spreading with Tb infection precautions on family empowerment.

1 INTRODUCTION

Tuberculosis (TB) is a chronic infectious disease

caused by the Mycobacterium tuberculosis. Based

on data from the World Health Organization (WHO)

in 2013 there were 9 million people worldwide have

been infected with the TB germ. In 2014 there were

9.6 million people worldwide have been infected by

TB (WHO, 2014). The highest number of cases of

pulmonary tuberculosis were in the African region

(37%), South East Asian region (28%), and the

Eastern Mediterranean (17%) (WHO, 2015).

In North Sumatra in 2012, TB cases found to be

still relatively high in as many 15 614 cases. Based

on data from a national pulmonary tuberculosis,

North Sumatra until the third quarter of 2012 came

in seventh with the highest number of pulmonary

tuberculosis patients after Gorontalo, Maluku,

northern Sulawesi, Southeast Sulawesi, Bangka

Belitung and Jakarta (Riskesdas, 2013).

Based on data from the Health Profile of North

Sumatra Provincial Health Office in 2015 showed

that the number of patients with pulmonary

tuberculosis in 2013 and then declined as much as

21 954 cases in 2014 to 19 062 cases, and increased

again in 2015 to 23 002 cases. The cure rate of

treatment cases in 2013 by 91%, decreased in 2014

by 87.1%, 87.9% in 2015 and has met the targets set

by the government in the amount of 85% (provincial

health office. Sumatra, 2015).

In Mandailing Natal, the number of pulmonary

tuberculosis patients from year to year the figures

show increases. The number of patients with

pulmonary TB in Mandailing Natal in 2013

amounted to 2623 cases, as many as 2886 cases in

2014 and 2015, 2992 cases (Profile Mandailing

Natal, 2015). While the cure rate of TB in the same

time period (2013-2015) in a row is estimated at

2086 cases, 2011 cases and 2244 cases.

According to Bomar (2014) family duties in the

health sector among others, is to know family health

104

Usman, S., Wahyuni, A., Sari, N., Siregar, C. and Ariga, R.

Relationship of Family Empowerment with Prevention of TB Transmission on Patients in Area of Puskesmas Siabu Mandailing Natal, Indonesia.

DOI: 10.5220/0008789101040108

In Proceedings of the 2nd Syiah Kuala International Conference on Medicine and Health Sciences (SKIC-MHS 2018), pages 104-108

ISBN: 978-989-758-438-1

issues, determine an appropriate action to care for

family members who are experiencing health

problems, modify environment that supports health

and wellness facilities can utilize. Family members

need to be empowered (empowerment) in carrying

out the task of family health in order to avoid

mistakes in the care of patients at home and

therefore do family empowerment by involving

health professionals and supporting systems of

patients with pulmonary tuberculosis.

Helpless means the ability to achieve the goals

set. Helpless means a person has the competence,

access, participation, and communicate well to

achieve the goals that have been set (Woodall, 2010)

Results of research Fred (2014) found that a lack

of knowledge and access to information causes a

person has limited knowledge about the behavior of

TB prevention in the family and society. Lack of

knowledge and information leads to lack of

motivation in preventing transmission of TB.

Results of a preliminary study conducted in

Puskesmas Siabu found that new TB cases in 2016

reached 112 cases with a cure rate of 78%. The

incidence of these TB cases, in 2017 increased to

135 cases, an increase of 31.2% from 2016. When

compared with the target level of recovery treatment

of TB cases in Indonesia by 85%, the cure rate of

TB cases in Puskesmas Siabu still below national

target figures. One of the factors that led to the high

number of new TB cases from year to year is the

transmission of TB cases that are not controlled.

According to the CDC (2013) the higher

transmission TB cases in the population due to

patient non-compliance with the treatment and the

high drop-out rates of TB patients who are

undergoing treatment. In Indonesia, in 2013 the

dropout rate case is estimated to reach 4 to 4.1%

(Riskesdas, 2013). In the city of Medan, in Indonesia

TB (2009) dropout rate reached 14.3%..

The aim of this study to correlate empowerment

families (competence or knowledge, the source

information, participation, and communication) with

prevention of TB transmission on patients in

Puskesmas Siabu.

2 METHOD

This research is quantitative research, analytical and

cross-sectional approach to analyze the relationship

between family empowerment with precaution

transmission of TB in Puskesmas Siabu Mandailing

Natal on February until Mei 2018. The samples in

this research are 61 adult TB patient. The sampling

in this research is done by using purposive sampling

technique. This study used a family empowerment

questionnaire who have been validated.

The family empowerment relationship with TB

preventive action is determined by the value of the

prevalence ratio (PR) and analysed by chi-square

test and logistic regression.

3 RESULTS

Table 3.1. Distribution of Family Empowerment:

Knowledge, Communication, Information, Participation

and Action in Puskesmas at 2018.

Variables

n %

Knowledge

Good

Less

63.9

36.1

Communication

Good

Less

77.0

23.0

Information

good access

less access

39.3

60.7

Participation

Good

Less

67.2

32.8

Precautions

Transmission of

Good

Less

70.5

29.5

Table 3.2 Relationship between the Knowledge with TB

Transmission Precautions in Puskesmas Siabu 2018.

Characterist

ics

Preventive Measure Amount

Good Less

n % N % n p RP

Knowledge

Good 34 87.2 5 12.8 39 0.00 2.13 95%

Less 9 40.9 15 59.1 22 (1.2

3.57)

Based on the above table it can be seen that the

transmission of tuberculosis prevention measures

found to be higher in good knowledge of 34 of 39

from Family member as a TB Drug observer (TB

Family PMO) (87.2%) compared with less

knowledge is equal to 9 out of 22 TB Family PMO

(40.9 %). The test results showed the statistical

Relationship of Family Empowerment with Prevention of TB Transmission on Patients in Area of Puskesmas Siabu Mandailing Natal,

Indonesia

105

correlation with the knowledge of precaution

transmission of tuberculosis (p = 0.000) at the

significance level α = 0.05. The results also showed

the prevalence ratio = 2.13 (95% CI; 1.27 to 3.57).

Table 3.3. Relationship between Communication aspect

with to TB Transmission Precautions on TB Family PMO

in Puskesmas Siabu 2018.

Characteristics Preventive Measure

Good Less

n % n % n p RP

Communication

Good 38 80.9 9 19.1 47 0.05 2.26 95%

Less 5 35.7 9 64.3 14 (1.1 to

4.6)

From the table above it can be seen that the

transmission of tuberculosis prevention measures

both at TB Family PMO found to be higher in good

communication by 38 of 47 (80.9%) compared with

less communication pattern that is equal to 5 of

14TB Family PMO (35,7%). The results of

statistical tests indicate there is a communication

link with precaution transmission of tuberculosis (p

= 0.004). The results also showed the prevalence

ratio = 2.26 (95% CI; 1.1 to 4.6).

Table3.4. Relationship between Availability Information

with Transmission Tuberculosis Precautions On TB

Family PMO in Puskesmas Siabu 2018.

Characteristics Preventive Measure Amount

Good Less

n % n % n p RP

Information

Good 21 87.5 3 12.5 24 0.04 1.47 95%

Less 22 59.5 15 40.5 37 (1.08

1.99)

From the table above it can be seen that the

transmission of tuberculosis prevention measures

both found to be higher availability of easily

accessible information for 21 of the 24 TB Family

PMO (87.5%) compared PMO TB Family with less

access to information availability by 22 of 37 TB

family PMO (59.5%). The test results showed

statistical correlation information access relationship

with precaution transmission of tuberculosis was

statistically significant (p = 0.04) The results also

showed the prevalence ratio = 1.47 (95% CI; 1.08 to

1.99).

Table 3.5. Participation Distribution Transmission

Precautions According to the PMO Family TB in

Puskesmas Siabu 2018.

Characteristics Preventive Measure

Good Less

n % N % n p RP

Participation

Good 33 80.5 8 19.5 44 0.03 1.6 95% CI

Less 10 50.0 10 50.0 17 (1.01 to

2.56)

From the table above it can be seen that the TB

Family PMO with both tuberculosis infection

prevention measures are higher in TB family PMO

with good participation by 33 of the 44 (80.5%) than

in the TB Family PMO with less participation

amounting to 10 from 17 Family PMO TB (50.0%).

The results of statistical tests show the relationship

of participation with precaution transmission of

tuberculosis (p = 0.03). The results also showed the

prevalence ratio = 1.6 (95% CI; 1.01 to 2.56).

Table 3.6. Logistic Regression Analysis

Vari a bl es B p RP 95% CI

Lower Upp

Knowled

2,67 0,002 14.5 2.64 80.5

Communi

cation

1.76 0,047 5.81 1.02 33.1

Informati

2.41 0,023 11.1 1.38 89.3

Participat

ion

2.11 0,020 8.26 1.39 48.9

Constant

-5.10 0,000

From the above table can be seen there is a

relationship of knowledge with precaution

transmission of tuberculosis in TB Family PMO (p =

0.002) in the evident level α = 0.05. The analysis

also showed the value of RP = 14.5 and statistically

significant (95% CI = 2.64 to 80.5). This means that

a TB family PMO likely to take precautions TB

tuberculosis infection either 14.5 times greater in the

PMO friendly with a good knowledge of TB

compared to less aware of knowledge regarding TB.

There is the relationship patterns of communication

with tuberculosis infection precautions in TB Family

PMO. The analysis also showed the value of RP =

5.81 and statistically significant (95% CI = 1.02 to

33.1). This means that a TB family PMO likely to

take precautions TB tuberculosis infection either

5.81 times greater in TB Family PMO with good

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

106

communication system compared with TB Family

PMO less communication system. Other than that,

the availability of access to information is also

associated with tuberculosis infection precautions in

TB Family PMO (p = 0.023) on real standard α =

0.05, RP = 11.1 and statistically significant (95% CI

= 1.38 to 89.3). This means that a family PMO likely

to take precautions TB tuberculosis infection either

11.1 times greater in the PMO TB Families with

access to information compared with TB Family

PMO lack of access to information. Furthermore,

this analysis shows the correlation between

participation with precaution transmission of

tuberculosis in TB Family PMO (p = 0, 02) RP =

8.26 and statistically meaningful (95% CI = 1.39 to

48.9).

4 DISCUSSION

Results of research Fred (2014) found that a lack of

knowledge of family PMO TB causes limited

knowledge about TB prevention behaviors within

families and communities. Results of several studies

have found a strong relationship between knowledge

about tuberculosis with tuberculosis preventive

measures on family members. Likewise, the same

thing in his research on the influence of family

knowledge of tuberculosis preventive measures.

Knowledge of tuberculosis is a member family

or PMO knowledge about the causes, symptoms and

signs, treatment, transmission, and prevention

(WHO, 2014). Knowledge of a person cognition

relative element is attached and can be implemented

or reproduction in the face of a condition in the form

of a specific action (CDC, 2014). The family

member or PMO knowledge about tuberculosis is

essential considering the family members or the

PMO is the person most instrumental in providing

care for patients with tuberculosis. These actions can

be of assistance in TB patients such as preparing

meals, providing medicine, clean bedrooms, set diet,

and so forth.

The importance of communication between health

workers with patients from the aspect of openness,

empathy, being supportive and equality so that

nurtured relation indirectly support can create

positive reception of information in preventing

pulmonary TB in the family. The results of the same

study found Yulianingsih (2011); Linda (2011) in

his research found that the transmission of

tuberculosis preventive measures depends on the

form and frequency of communication established

between the health workers and the PMO.

According to the CDC (2014) deals with

information provider communication, and improve

knowledge of TB patients and families and make

them helpless in expressing needs and take action. In

the same way, encourage providers to more accept

the wishes and views of TB patients and family

members against TB services that are more

responsive to community needs. Efforts responsive

will be able to develop communication techniques

and effective education such as using words that are

simple, provide the necessary information over and

over again, listening to the feedback by way of

empathy, and build a harmonious interaction

between families, health care workers and people

with TB.

Relationships access to information with

tuberculosis infection prevention measures is

essential. In essence, the more information that was

obtained from PMO family, the higher the

knowledge to be possessed.

Notoadmodjo (2007) said information influence

on a person's knowledge. Even though a person has

a low level but if you get better access to

information from a variety of media such as a TV,

radio, or newspaper then it will be able to improve

one's knowledge. Facilities for obtaining information

may help expedite a person to acquire new

knowledge. Facility or facilities can also increase the

knowledge of a person based on resources from

newspapers, internet television and that today can

be easy to access.

According to the CDC (2024), information

provided healthcare workers to patients and families

regarding pathogenesis TB patients, the benefits of

treatment, side effects of medication, treatment

response, and prevention of disease transmission.

Information obtained from the assessment TB family

patients have to guide sustainable health education

efforts. Soon after health officials to cooperate with

the family of TB, it is important to askPMOwhat is

understood and believed about the disease and

prevention of TB. If the PMO does not understand

the reason for preventing the transmission of

tuberculosis, termination of transmission chain will

be difficult. If too much information is given at one

time,PMO may not remember everything. To avoid

than, the information provided should be organized

in order of importance.

PMO participation in tuberculosis prevention

measures is essential. Martin (2015) also found the

same thing on the importance of the participation of

family members in the prevention of tuberculosis

transmission. WHO (2005) has established a central

Relationship of Family Empowerment with Prevention of TB Transmission on Patients in Area of Puskesmas Siabu Mandailing Natal,

Indonesia

107

role in tackling the problem of TB family PMO of

tuberculosis in TB control strategy globally.

Participation in tuberculosis prevention is an

essential element in the process of preventing the

transmission of tuberculosis, especially in the sphere

of the family. Prevention of transmission cannot

simply be imposed on the patient itself for reasons of

a poor physical condition, fatigue, psychological

problems, coping with weak and low self-concept

(CDC, 2014). With such conditions, tuberculosis

patients in need of assistance in the prevention and

healing process. This assistance may include the

provision of information, reminding to take

medication, diet prepare, monitor behaviors that

increase risk, keeping environmental sanitation,

preparing rooms with good ventilation, and prepare

handkerchiefs and spittoon.

5 CONCLUSION

There is a relationship of knowledge,

communication, acces to information TB, and

paticipation with precaution transmission of

tuberculosis in the TB Family PMO. The most

dominant factor is Knowledge aspect from TB

family PMO, the prevalence ratio is 14,5 (95% CI,

2,64; 80,5).

REFERENCES

Bomar PJ, 2014. Promoting Healthin Families: Applying

Family Research and Theory to Nursing Practice.

Elsevier Health Sciences

CDC, 2013. Core Curriculum On Tuberculosis. National

Center for HIV/AIDS, Viral Hepatitis, STD, and TB

Prevention, Division of Tuberculosis Elimination

CDC, 2014; Managing TuberculosisPatients and

Improving Adherence.U.S. DEPARTMENT OF

HEALTH AND HUMAN SERVICES, Centers

forDisease Control and Prevention, National Center

for HIV/AIDS, Viral Hepatitis, STD, and TB

Prevention, Division of Tuberculosis Elimination.

Dinas Kesehatan Mandailing Natal, 2015; Profil

Kesehatan Kabupaten Mandailing Natal.

Dinas Kesehatan Sumatera Utara, 2015, Kasus

Penderita TB paru di sumatera utara, Dinkes Sumut,

Medan.

Fred J, Grede N,.Mehra D,. 2014; The Enabling Effect of

Food Assistance in Improving Adherence and/or

Treatment Completion for Antiretroviral Therapy and

Tuberculosis Treatment: A Literature Review.

Springer Science+Business Media New York

Dinas Kesehatan Mandailing Natal, 2015; Profil

Kesehatan Kabupaten Mandailing Natal.

DinasKesehatan Sumatera Utara, 2015,

KasusPenderitaTBparu di sumaterautara,

DinkesSumut, Medan.

Fred J, Grede N,.Mehra D,. 2014; The Enabling Effect of

Food Assistance in Improving Adherence and/or

Treatment Completion for Antiretroviral Therapy and

Tuberculosis Treatment: A Literature Review.

Springer Science+Business Media New York.

Linda, 2011. Hubungan Antara Sikap Dengan Perilaku

Keluarga Tentang Pencegahan Penyakit Menular

Tuberkulosis. Jurnal Keperawatan Tahun 2011.

Martin, L,. Williams, S,. Haskard, K,. DiMatteo, R,. 2015;

The Challenge of Patient Adherence, Department of

Psychology, La Sierra University, CA, USA; 2

Department of Psychology, University of California,

Riverside, CA, USA.

Notoatmodjo S, 2007 Pendidikan Kesehatan dan Ilmu

Perilaku. Cetakan Kedua. Jakarta; Rineka Cipta. 2007.

WHO, 2014. Global Tuberculosis Report 2014.

Switzerland

WHO, 2014; WHO Guidelines For The Programmatic

Management Of Drug-Resistant Tuberculosis. WHO,

Janeva

Woodall J, 2010. Empowerment And Health &Well-

Being, Centre for Health PromotionResearch,Leeds

Metropolitan University.

Yulianingsih, 2016. Pelaksanaan Pencegahan Penularan

Tuberkulosis Paru oleh Keluarga di UPTD Kesehatan

Puskesmas Sukamulya Kabupaten Ciamis Tahun

2016. Jurnal Kesehatan Stikes Muhammadiyah Ciamis

Tahun 2016.

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

108