Participatory Training Model Development in Increasing of

Competence Cadre Pulmonary Tuberculosis in Sumatera Utara

Reni Asmara Ariga

, Siti Zahara Nasution

, Cholina Trisa Siregar

, Muhammad Taufik

, Fajar

Amanah Ariga

and Sri Budi Astuti

Faculty of Nursing, Universitas Sumatera Utara. Medan, Indonesia

Chemistry Department, Faculty of Mathematic and Natural Science, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Participatory Training Model, Competence Cadre, Pulmonary TB.

Abstract: The high rates of morbidity and mortality of pulmonary TB patients can be caused by the low competency

of health cadres. This competence is obtained through participatory training models. The aimed to

determine the effect of participatory training models on tuberculosis cadre competence. The research used a

pre-posttest without control group Quasi-experiment design. The sample consisted of 44 respondents. The

instrument was a questionnaire form with a validity value of 0.89 and a test of Cronbach-alpha reliability

0.86. The results showed that differences before and after the intervention participatory training model,

namely knowledge before and after intervention occurred 9% increase, attitudes before and after

intervention increased 34%, actions before and after intervention increased 24.2%. This training model is

expected to become a habit of cadres when mentoring in the community and integrated with empowerment

programs for patients such as HORAS (Health belief model, Observation, Relaxation, Action, Supporting).

1 INTRODUCTION

Pulmonary tuberculosis (pulmonary TB) is a chronic

disease that is a health problem in the world

including Indonesia (Ministry of Health Indonesian,

2017). WHO states that pulmonary TB is now a

global threat. An estimated 1.9 billion people or one-

third of the world's population are infected with this

disease. Every year there are about 9 million new

patients with pulmonary TB with a death of 3

million people. It is estimated that 95% of

pulmonary TB cases and 98% of deaths due to

pulmonary TB in the world occur in developing

countries. Likewise, the death of women due to

pulmonary TB is more than deaths due to pregnancy,

childbirth and postpartum. As many as 10.4 million

people are estimated to suffer from pulmonary TB in

2015 with a total of 5.9 million male patients (56%),

women as many as 3.5 million people (34%) and

children as many as one million people (10%).

Furthermore, the World Health Organization (WHO)

noted in 2015 that 60% of all cases were contributed

by six countries namely India followed by

Indonesia, China, Nigeria, Pakistan and South Africa

(Ministry of Health Indonesian, 2017).

In Indonesia, the coverage of tuberculosis cases

between men and women was 298,128 cases in

2016, while in North Sumatra province the coverage

of tuberculosis cases between men and women was

17,798 cases in 2016 which is the province with the

most number 5 coverage Indonesia (Ariga & Reni,

2017).

About 75% of pulmonary TB patients are the

most economically productive age group (15-50

years old). Meanwhile, it is estimated that an adult

pulmonary TB patient will lose an average of 3 to 4

months of work time. This situation resulted in a

loss of annual household income of around 20-30%.

If he/she dies from pulmonary tuberculosis, then

he/she will lose about 15 years of income. Besides

being economically detrimental, pulmonary

tuberculosis also has other socially stigmatizing

adverse effects and it is even excluded by the

community (Ariga & Reni, 2017).

Tuberculosis Eradication Program Data (P2

pulmonary TB) in Indonesia showed an increase in

cases from year to year. Prevention and prevention

efforts that have been attempted still have not

succeeded in solving the existing problems, namely

reducing morbidity and mortality. One of the

problems encountered was the difficulty of finding

Ariga, R., Nasution, S., Siregar, C., Tauﬁk, M., Ariga, F. and Astuti, S.

Participatory Training Model Development in Increasing of Competence Cadre Pulmonary Tuberculosis in Sumatera Utara.

DOI: 10.5220/0010205100002775

In Proceedings of the 1st International MIPAnet Conference on Science and Mathematics (IMC-SciMath 2019), pages 469-474

ISBN: 978-989-758-556-2

469

smear (+) pulmonary TB patients, irregularity in

treatment and drop out of treatment. Cases of

untreated pulmonary TB will continue to be a source

of transmission3.

Family and community support have a major role

in improving medication adherence, with

supervision and encouragement of sufferers. The

role of the Drugs Supervisor (PMO) can come from

health workers, the community or the families of

patients. An important understanding of knowledge

about pulmonary TB for patients and families

through cadre empowerment4. The people who can

be involved in this activity are health cadre

(Kementerian Kesehatan RI Pusat Data dan

Informasi Kementerian Kesehatan RI, 2016).

Health cadres are people who are appointed by

the community who can help the community,

especially in health problems such as pulmonary

tuberculosis, health cadres should have the

competence so that in carrying out their duties in the

community, especially the prevention of pulmonary

TB6. This competency improvement can be done by

participatory model training. Where this training

provides the ability of knowledge, attitudes, and

skills to cadres in carrying out their roles in the

community, especially prevention and assistance in

the treatment of pulmonary TB.

2 METHOD

The Research on the development of a participatory

training model in improving cadre competency on

pulmonary TB in North Sumatra uses a quantitative

design with training methods consisting of three

stages: the first stage is the planning stage, which

includes identification of competencies, preparation

of objectives, establishment of training strategies,

preparation of training materials, apply the

andragogy principle and participatory techniques,

preparation of training planning. the second stage is

the implementation, which includes explaining the

concept and the third stage is the evaluation of

activities, namely the evaluation of the training

carried out.

The population and sample of this study were all

integrated service center cadres in Sari Rejo

Subdistrict, Medan Polonia Subdistrict who were

still active and willing to take part in this study as

many as 44 people. This research has been carried

out for 6 months starting from July to September

2016. The reason for the study was to choose Sari

Rejo Village, Medan Polonia Subdistrict as a place

of research because this location is a densely

populated area with pulmonary tuberculosis

residents, integrated service center and health

cadres. The community is active in community

activities and cooperates in the business of clean,

healthy living behavior and one of the fields of

nursing professional student practice in the USU

nursing faculty community. This research instrument

uses a demographic data questionnaire and

questionnaire to develop a participatory training

model in improving cadre competence about

pulmonary TB that has been tested for validity to

experts in the field of pulmonary TB obtained 0.89

The reliability test results obtained were 0.83.

Training is carried out 4 times a month for 3

consecutive months. The things that are done during

the training can be described as follows:

a. In July, training was conducted on the concept of

pulmonary tuberculosis, such as testing, causes,

signs and symptoms, prevention and mentoring

of pulmonary patients.

b. In the 2nd and 3rd month, all cadres simulate

prevention efforts carried out on TB patients,

namely preventing and mentoring pulmonary TB

patients, identifying the risk of pulmonary TB,

motivating the community to conduct treatment

programs

Implementation stage during the training process

1. First Stage

Explain the scope of the extension material that

is carried out. Describe the relevance and

benefits of the material to the cadre

2. Second stage

a. Outlines the material about the concept of

pulmonary TB

b. Do a simulation

3. Third Stage

Evaluate cadre competencies, including

cognitive, affective and psychomotor

Basic skills that cadres must possess

1. Questioning skills

a. Express questions in a short and clear

manner

b. Transfer of questions to all

participants

c. Give the time to pause thinking before

asking the answer to the cadre

2. Strengthening skills

a. Demonstrate verbal reinforcement like

the word: Right, good, right or very

good

IMC-SciMath 2019 - The International MIPAnet Conference on Science and Mathematics (IMC-SciMath)

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b. Demonstrate non-verbal reinforcement

such as expression and body

movements

c. Strengthening: warmth and

enthusiasm, avoiding negative

responses

3. Explaining skills

a. Cadre explained using simple/general

sentences about pulmonary TB

b. Cadres provide examples in providing

counseling

c. Cadres use clear sentences

4. Skills for making variations

a. Cadres provide variations in tone of

voice during counseling

b. The cadre gave expressions and

gestures at the time of counseling

c. Cadres provide a point of contact

during counseling

5. The skill of opening and closing lessons

a. Cadres attract audience attention

b. Cadre raises motivation

c. The cadre evaluates the material

presented

3 DISCUSSION

Demographic data of respondents includes age,

gender, occupation, and education. The results of the

demographic data research obtained an early adult

age of 29 respondents (66%), all respondents were

female (100%), high school 30 respondents (%).

Information can be seen in the table below (Table 1).

Table 1: Demographic characteristics.

Characteristic Frequency (f) Percent

(%)

Age

Early adult 29 66

Late adult 15 34

Genre

Male 0 0

Female 44 100

Education

Primary School 1 2,27

Secondary school 13 29,55

High School 30 68,18

Length of job experience

<5 Years (New) 14 32

>5 Years (Old) 30 68

The results of research related to knowledge

were obtained before the participatory model was

conducted, the majority of patients' knowledge was

in the category of 75%. After a participatory model,

the majority of patients' knowledge was in the good

category of 66%. Information can be seen in the

graph below (Figure 1).

Figure 1: Patients Knowledge.

The respondents data includes age, gender,

occupation, and education. The results of the

demographic data research obtained an early adult

age of 29 respondents (66%), all respondents were

female (100%), high school 30 respondents (%).

Information can be seen in the table below (Figure

2).

Figure 2: Patients Attitude.

The results of the research related to attitudes

were obtained before the participatory model was

carried out, the majority of patients' attitudes were in

Participatory Training Model Development in Increasing of Competence Cadre Pulmonary Tuberculosis in Sumatera Utara

471

the positive category of 66%. After a participatory

model, the majority of patients' attitudes were in the

100% positive category. Information can be seen in

the graph below (Figure 3).

Figure 3: Patients Action.

The results of the study related to the action were

obtained before the participatory model was used,

the majority of the patients' actions were in the 43%

less category. After a participatory model, the

majority of patients' actions were in the good

category of 67.2% (Ministry of Health Indonesian,

2017).

The results of the study obtained the knowledge

of cadres before taking action in the category of

enough as much as 75%. This is because the cadres

have never received training, so the cadre has not

assumed that the discovery of pulmonary TB

suspects is their duty that must be carried out as well

as possible for increasing cases. Pulmonary TB in

the area. The focus of cadre activities so far is only

on the implementation of Posyandu and is related to

the health of infants and toddlers, so that the cadres

assume that the task of finding suspected pulmonary

TB is only side lined. This condition encourages

cadres to be less enthusiastic in finding information

about the mechanism of finding pulmonary TB

suspects.

The same thing was found by Chatarina in her

research on efforts to achieve positive BTA targets

on Suspek TB Pulmonary in South Middle East

District of NTT Province, which revealed that the

performance of cadres who were not equipped with

sufficient knowledge and only in a simple way to

refer suspects to subdistrict community health centre

is the target (Chatarina, 2007).

The results of the study showed that the attitude

of cadres before the action was carried out in the

positive category was 66%. This is influenced by the

length of time of the cadre. The majority of cadres

have a working period of more than 5 years as much

as 68%. Long working periods make cadres have

sufficient experience in carrying out the

interventions. Individuals who have long work

problems can make individuals understand the

attitude to be taken6. Another opinion expressed by

Andira that the longer the working period of a cadre,

the more experience he has so that it can be used as

a basis for acting / making decisions. On the

contrary, novice cadres do not have much

experience and are foreign and hesitant. This

condition will hamper participation in an activity

(Mirowsky & Ross, 2017).

The results of the research showed that the

cadre's actions before being carried out in the less

category were 43%. This is influenced by the

majority of cadre knowledge is as much as 75%.

Individuals who have sufficient knowledge will tend

to be less focused on taking action6. Related parties

such as health centers have not involved cadres to do

prevention, find and assist pulmonary TB patients in

the cadre area. The cadre does not have much

knowledge about taking action directly into the

community to the importance of breaking the chain

of transmission of TB through a screening action

carried out as a cadre.

The results of the study obtained the knowledge

of cadres after the action in the good category as

much as 66%. Good knowledge in this study is

influenced by the frequency of training. The more

often training is carried out, it can increase cadre

knowledge and skills. Training is part of education

that involves the learning process to acquire and

improve skills outside the education system that

applies in a relatively short time with methods that

prioritize practice rather than theory. Training is

basically an effort to increase knowledge and skills

and the ability of individuals to be able to carry out a

task or work that is charged to him.

Another factor that influences good knowledge is

the length of service. The length of the work period

greatly affects the ability of participatory training,

where the longer the cadre profession goes the better

the performance. Andira suggested that work period

is one indicator of the tendency in jobs where the

longer a person works the higher the productivity

because the more experienced and skilled at

completing the task entrusted to him (Andira et al.,

2012).

The results of the study showed that the attitude

of cadres after doing the action in the positive

category was 100%. A positive attitude in this study

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can be caused by factors of knowledge and

experience. Knowledge influences the attitude of

cadres, good cadre knowledge influences cadre

competence in conducting participatory training. As

revealed by Eka's research, cadre knowledge has an

effect on cadre skills on what material is to be

conveyed. Cadre knowledge influences positive

attitudes, then forms good behavior when cadres

conduct counselling9. The more positive the attitude

of cadres will be to improve the practice and

behavior of cadres in conducting counselling which

is their responsibility (Notoatmodjo, 2012).

In addition to the knowledge factors positive

attitude of cadres because all cadres have realized

that they have a function, motivate and strive so that

residents in the environment are healthy and

prevented from various diseases specifically

pulmonary diseases. This is supported by the

opinion of Djafar, the more positive the attitude of

cadres will be to improve the practice and behavior

of cadres in conducting counselling which is their

responsibility (Djafar, 2014).

The results of the study showed that the cadre's

actions after being carried out in the category of

enough as much as 67.2%. Efforts to control TB

disease as a whole are still not ideal, because there

are some inappropriate actions carried out by cadres

(Kritiawati & Diyan, 2014). In conducting referral

TB suspects, the actions of cadres are still wrong,

because in making referrals do not use forms. This is

probably due to the cadre's ignorance of how to fill

in TB patient forms and the possibility of TB

patients who have been found coming to the

subdistrict community health centre without being

accompanied by cadres. However, the cadre's

actions in finding and conducting counselling are

good enough, this is because the cadre's knowledge

of TB disease, especially in recognizing the

symptoms of TB patients is good enough. So that

TB cadres can recruit TB suspects and provide

counselling to the public about TB at the integrated

system service.

4 CONCLUSION

The development of participatory training is suitable

for cadres in order to reduce morbidity and mortality

of TB in the community with the implementation of

this training model can be received by cadres.

Development with participatory training approach is

an innovative training model and effective in

improving the competence of health workers about

TB so it is necessary to be applied in other health

fields. This training model is expected to become a

habit of cadres when mentoring in the community

and integrated with empowerment programs for

patients such as HORAS (Horas believed model,

Observation, Relaxation, Action, Supporting).

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research is supported by Ministry of Research and

Technology and Higher Education Republic of

Indonesia.

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