Enferm Clin.

2020;30(S2):416---419

www.elsevier.es/enfermeriaclinica

The effect of patients’ perception about tuberculosis

(TB) against treatment compliance夽
Muh. Zainal S. a,∗ , Sapar a , Syafruddin a , Irwandy b

a
Faculty of Health, Agriculture and Marin, Universitas Muhammadiyah Palopo, South Sulawesi, Indonesia
b
Faculty of Public Health, Indonesia University, Indonesia

Received 29 May 2019; accepted 15 July 2019

KEYWORDS Abstract
Self-efficacy; Objective: This study was conducted to analyze the effect of patient perceptions regarding TB
Obedience; on medication adherence.
TB care community; Methods: This study used a quantitative approach with a cross-sectional survey method. The
Aisyiyah sample was determined by census technique in a total of 128 patients which from Makassar City
that covered up Panakkukang, Makassar, Rapoocini, and Tallo sub-Districts from February to May
2018. The data were analyzed in quantitative statistics (descriptive and statistical statistics).
Result: The outcome revealed that the patient’s medication adherence was classified as high,
which meant that TB patients were obedient during the treatment process. Patients’ percep-
tions about TB reflected by hindrance indicator and self-efficacy perceived by the patients
impacted significantly to TB patients’ treatment, and they were TB patients’ perceptions.
Conclusion: Treatment compliance for TB patients in Aisyiyah’s TB care community program in
Makassar City is relatively high. This means that TB sufferers adhere to the treatment process.
Patients’ perceptions about TB are reflected indicators of perceived resistance and self-efficacy
significantly affect treatment compliance.
© 2019 Elsevier España, S.L.U. All rights reserved.

夽 Peer-review under responsibility of the scientific committee of
the International Conference on Women and Societal Perspective on
Quality of Life (WOSQUAL-2019). Full-text and the content of it is
under responsibility of authors of the article.
∗ Corresponding author.
E-mail address: richoenal@gmail.com (Muh. Zainal S.).
Introduction
One of the intentions of sustainable development is to
ensure a healthy life and support the welfare of all com-
munity in any level of ages targeted in 2030 by closure
the epidemic of AIDS epidemic, tuberculosis, malaria, other
tropical diseases and also fight against hepatitis, water-
borne diseases and other infectious diseases. Tuberculosis

https://doi.org/10.1016/j.enfcli.2019.07.128
1130-8621/© 2019 Elsevier España, S.L.U. All rights reserved.
The effect of patients’ perception about tuberculosis
Table 1 Number and percentage of respondents ‘ratings of patients’ perceptions of TB.
Indicator Category
Vulnerability Low
perceived Medium
High
Severity perceived Low
Medium
High
Benefits perceived Low
Medium
High
Hindrance Low
perceived Medium
High
Self-efficacy Low
Medium
High
(TB) is an infectious disease caused by the Mycobacterium
tuberculosis bacterium customarily not only infects the
lungs but also affects other parts of the body. TB escalates
through the air for example by coughing.
Treatment adherence is influenced simultaneously by
socio-economic factors, health care systems, disease cha-
racteristics, factors related to patients and treatment of
disease. Improved medication adherence can be done by
solving problems related to each of these factors. A research
literature study examining TB treatment adherence found
that four main interrelated factors affecting TB treatment
adherence included: structural factors (including poverty
and gender discrimination), social context, health service
factors, and personal factors.
Study of the factors that prompt it, including the indi-
viduals and also the family who seek health support, covers
social factors, family support, economics, health care sys-
tem (including good communication), disease characte-
ristics, sufferers’ individuality, disease treatment.
While the factors that influence noncompliance of
the treatment include: the complexity of interactions
between health systems, personal (psychological) factors,
socio-cultural factors, incompatibility of belief systems
(health workers and patients), morbidity, economy (includ-
ing poverty), social stigma. This study aimed to analyze the
effect of patient perceptions regarding TB on medication
adherence.
Methods
This study employed a quantitative approach with cross-
sectional survey method. The sample was determined by
census technique in a total of 128 patients. The study was
conducted in Makassar City in the area of Panakkukang,
Makassar, Rapoocini, and Tallo sub-districts from February to
May 2018. The data collected over questionnaires and direct
observation at the study location. The data processed and
analyzed with quantitative statistical analysis (descriptive
and inferential statistics). To interpret the data, descrip-
tive analysis is used to provide information about the data
417
Frequency Percentage (%)
6 4.7
84 65.5
38 29.7
1 8
91 71.1
36 28.1
27 21.1
75 58.6
26 20.3
47 36.7
77 60.2
4 3.1
3 2.3
4 3.1
121 94.5
or phenomenon under study. Smart Partial Least Squares
(Smart PLS2.0) software assistance was adapted to examine
the study hypotheses and draw conclusions.
Results
Patients’ perceptions of TB
Patients’ perceptions about TB which were examined
included a vulnerability that caused the TB, TB severity, the
benefits of undergoing treatment processes, treatment pro-
cess hindrance, and self-efficacy in the treatment process. A
description of sufferers’ perceptions about TB is presented
in Table 1.
Table 1 displayed that sufferers’ perceptions of the vul-
nerability felt by TB patients are in the moderate category
(65.5%) which leaned toward the higher level. This meant
that TB patients considered their self quite vulnerable and
expose TB. The patient’s perception of the perceived seve-
rity aspect related to TB was in the moderate category
(71.1%) leading to high. This means that most TB sufferers
perceive the TB disease as a threat to their physical, psycho-
logical and family severity. The severity felt by TB patients at
the study site was generally: experienced a cough that lasted
a long time and was sometimes accompanied by phlegm,
night sweats and sometimes accompanied by fever, no or less
appetite, feeling weak and sometimes experiencing short-
ness of breath and the patient’s weight condition decreased.
Facts at the study site were also found by patients who
experienced severe severity and had to be treated in health
services (hospitals and health centers).
The benefits felt by patients during the TB treatment
process were in the moderate category (58.6%). This means
that most sufferers considered getting benefits that could
encourage healing treatment, such as the improvement of
their health condition gradually (body weight started to rise
again; appetite increased, had started to work normally and
started working again), and getting information about TB
both directly in health services (public health centers and
hospitals) or indirectly through families (wife and children).
418
Table 2 Number and percentage of respondents’ ratings of medication adherence.
Indicator Category
The frequency of taking the medicine Low
Medium
Doze suitability High
Low
Treatment schedule Medium
High
The barriers felt by TB sufferers are in the moderate ca-
tegory (60.2%) which means that most sufferers perceived
that they have fewer barriers to TB treatment. However, it
was found in several cases, the patients’ home is far away
from the health service center (public health center, hospi-
tals), felt bored in taking the medication, experience side
effects of drugs, large TB drug size, the number of drugs that
were heavily taken and not accompanied by TB cadres goes
to the health service to carry out the treatment process.
Self-efficacy is classified as high (94.5%) which means
that sufferers trusted and believed that they were able to
undergo the treatment process consciously as recommended
by health workers. The majority of TB sufferers were very
confident and optimistic that if they take TB medicine re-
gularly, they will heal. The high efficacy of TB sufferers was
also based on the desire to live a normal life again and earn
a living for their family.
Treatment compliance
Treatment adherence included: the frequency of taking the
drugs, the suitability of the dose and the examination sche-
dule of TB patients. A description of the sample distribution
presents in Table 2.
In general, the level of medication adherence of suffe-
rers of all indicators was in the high category. The frequency
of taking the medication was in the high category (92.2%).
Most of the sufferers took the medicine as recommended by
health officers (every day in the initial phase of treatment
and three times a week in the advanced phase), never forget
to take medication, and do deliberately not take medica-
tion.
Dosage suitability was in the high category (96.6%) which
means that most sufferers take medicine according to the
recommended dosage of health workers. The high dose
suitability was since most TB sufferers never reduced or
increased the number of anti-TB drugs, never replace anti-
TB drugs with other drugs or herbal medicines, and never
throw away anti-TB drugs.
Hindrance
perceived
TB Perception
Self-efficacy
Figure 1 Perception factors regarding TB influence TB treatment compliance.
Muh. Zainal S. et al.
Frequency Percentage (%)
118 92.2
10 7.8
124 96.9
4 3.1
109 85.2
19 14.8
The examination schedule was relatively high (85.5%)
which means that the patient follows the examination
schedule regularly and correctly according to the advice
of the health officers. The sufferers routinely visit health
services (public health centers or hospitals) for sputum re-
examination, lung re-examination and to take anti-TB drugs.
Patients’ perception affects treatment compliance
with TB patients
The results of the statistical analysis (Fig. 1) show that
patient perception factors regarding TB reflected indicators
of perceived inhibition and self-efficacy significantly affect
TB medication adherence. This means that the patient’s
internal factors (beliefs and awareness of sufferers to do
the treatment) played an important role in encouraging
medication adherence to achieve healing. Although, in the
process of treatment sufferers still experienced barriers,
especially psychological barriers, but sufferers were able
to get through it. However, other research findings in the
case of TB-HIV confection had found that perceptions of
TB-HIV co-infected patients could hurt HIV and TB testing,
thereby contributing to treatment delays especially the ini-
tial phase.1 While the perception and attitude of health
workers toward HIV and TB co-infected patients play an
important role related to how patients use health services.2
Patients’ perceptions about TB are reflected by two
indicators that are perceived obstacles and self-efficacy
(confidence). Perceived hindrances were the first indicator
that reflects sufferers’ perceptions of TB that affect treat-
ment compliance. Descriptive results of the indicator value
of the perceived hindrance were mostly in the medium ca-
tegory or lead to lows so that the perceived obstacles do
not cause TB sufferers to disobey treatment, in other words,
even though the sufferer felt there were still obstacles but
still adheres to treatment.
Self-efficacy was the second indicator reflecting the
perception of patients about TB that significantly affected
treatment compliance. This means that the better the
Treatment
2,669
obidiency
The effect of patients’ perception about tuberculosis
self-efficacy of TB patients, the more obedient the treat-
ment. Self-efficacy or belief, including the awareness of
TB sufferers to recover, it was very high, thus encouraging
sufferers to take medication regularly. Patients were sure,
belief and conscious will recover if treated regularly,
sufferers also have a high sense of optimism in undergoing
treatment even though sometimes they feel the side effects
of the drug. Including encouragement to be able to return
to normal activities and be able to work for a living again for
his family to make patients obedient to undergo treatment.
Discussion
This study showed that the role of sufferers’ perceptions of
TB reflected by indicators of perceived resistance and self-
efficacy play an important role in medication adherence.
Self-efficacy is one of the main components that lead a per-
son to do the treatment process and health behavior.3 There
was a direct and strong relationship between self-efficacy
and compliance with the treatment of TB patients in Iran.4
While low self-efficacy has an effect on non-compliance
with anti-retroviral (ART) HIV sufferers in Africa.5 There
is a self-efficacy relationship for compliance with hepati-
tis C treatment.6 The efficacy of self-efficacy mediates the
relationship between side effects and adherence in cases of
anti-retroviral treatment of HIV patients. Through mindful-
ness, interventions can improve self-efficacy and physical
independence of pulmonary TB patients in Magelang.7
Self-efficacy can be increased through verbal persuasion
(feedback and encouragement) that is instructive, clear, and
positive. Providing social support and using several different
communication models such as video, voice, and text can
also increase self-efficacy. Treatment self-efficacy is posi-
tively related to medication adherence.
The desire of adherent patients is the most important
determinant of adherence that begins with the decision
to seek medical bio-health care (as opposed to traditional
health care) shaped by knowledge and beliefs about TB
treatment and motivation for recovery. Obedient desire
helps patients to overcome perceived obstacles to compli-
ance such as socioeconomic difficulties.
An important and major factor encouraging adherent
patients to undergo anti-retroviral HIV/AIDS treatment
was an internal drive in this case self-awareness, self-
motivation, and self-confidence.8 Factors that influenced
the success of TB treatment were internal factors includ-
ing sufferers: sufficient knowledge about TB, how to treat,
nutritious food, adequate rest, regular living and not drink
alcohol or to smoke, maintaining personal hygiene and
the environment by not expelling phlegm carelessly, when
coughing closes mouth with a handkerchief, do not feel infe-
rior or despicable because of TB as well as awareness and
determination to recover.9 Strong desire from within your-
self is a spiritual dimension to be a major factor in the
high compliance of patients undergoing pulmonary TB drug
therapy.
419
Self-efficacy (self-efficacy) was formed from four main
sources of information include: (1) Mastery experience
(mastery of success experience) results achieved through
previous success that serves as an indicator of one’s
ability, (2) Vicarious experience (mastery of the expe-
rience of others) that changing beliefs through the
transmission of competence and comparison with the
achievement of others, (3) Verbal persuasion (verbal
persuasion) verbal ability approach was used to influ-
ence socially, (4) physiological and affective states to
assess their abilities, strengths and vulnerability to disor-
der.
Conclusion
Treatment compliance for TB patients in Aisyiyah’s TB care
community program in Makassar City was relatively high.
This means that TB sufferers adhere to the treatment pro-
cess. Patients’ perceptions of TB have reflected indicators
of perceived resistance and self-efficacy significantly affect
treatment compliance.
Conflict of interest
The authors declare no conflict of interest.
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