Increase Medicine Adherecence TB Patient with Ners-Short Message

Service Intervenstion (N-SMSI)

Reni Asmara Ariga

, Siti Zahara Nasution

, Rina Amelia

and Siti Saidah Nasution

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

Faculty of Medicine, Universitas Sumatera Utara, dr. Mansyur Street No. 5 Kampus USU, Medan, Indonesia

Keywords: Medicine Adherecence, TB Patient, Ners-Short Message Service Intervention (N-SMSI).

Abstract: The high rates of pulmonary TB incidence worldwide are common due to poor patient adherence. Drug

adherence is one of the important indicators in the successful treatment of a disease. The purpose of this

study was to determine the effect of Ners-Short Message Service Intervention (N-SMSI) on the adherence

of taking medication to patients with pulmonary tuberculosis. This research design is Quasi experiment pre-

post test desaiqn with control group. Samples are taken by Consecutive Sampling. The results of this study

found that there was a difference between control and intervention groups before and after Ners-Short

Message Service Intervention (N-SMSI), ie in the control group as much as 47.2% obedient and the

intervention group as much as 80.6% obedient. N-SMSI (Ners-Short Message Service Intervention) can

improve medication adherence of pulmonary tuberculosis patients. The action is so important that it is not

just adherence to taking medication, but to the behavior of patients or TB patients' habits. So increase the

cure rate and reduce the rate of transmission and ultimately improve the quality of life.

1 INTRODUCTION

Pulmonary tuberculosis is caused by Mycobacterium

tuberculosis. It has infected as many as one-third of

the world's population. Tuberculosis cases are

increasing and many are not successfully be cured,

especially in countries grouped in 22 countries with

major tuberculosis problems ( Badan Litbangkes

Kemenkes RI, 2011)

Pulmonary TB patients are estimated to be only

10 to 20 cases among the 100,000 population,

whereas the mortality rate ranges from 1 to 5 deaths

per 100,000 population in development countries.

Africa is estimated to reach 165 new cases among

100,000 populations, and in Asia 110 among

100,000 populations. Asian populations are more

than Africa, the number of pulmonary patient in

Asian 3,7 times more than Africa

Data on World Lung TB patients by 2015

according to the World Health Organization (WHO)

reached 10.4 million people, up from just 9.6

million. Indonesia is ranked second largest among

patients with pulmonary TB after India with a total

of 2.8 million cases, followed by Indonesia with

1.02 million cases and China with 918 thousand

cases (WHO, 2015)

The discovery of new cases of Pulmonary

Tuberculosis in Indonesia based on data from the

Ministry of Health 2011-2015, the number of new

cases of BTA positive Tuberculosis found in 2011

were 197,797 new cases, 202,301 in 2012, 2013 of

196,310 new cases, 2014 of 176,667 new cases and

2015 as many as 330,910 new cases (Ministry of

Health, 2015).

TB drop out rates are many factors that affect the

recovery of TB patients. Many factors that succeed

in TB programs such as pmo and cadres. The

training model for the development of participatory

training can improve the cadre's competence on TB

(Ariga & Zahara) .

The high rates of pulmonary TB incidence

worldwide are common due to poor patient

adherence (45%) (Viney, et al, 2011). Drug

adherence is one of the important indicators in the

successful treatment of a disease. The average

patient's adherence to long-term treatment of chronic

diseases varies greatly. In developed countries the

percentage of patient adherence to taking medication

is 50% while for developing countries the

percentage is only about 24% (WHO, 2015). Low

patient compliance in taking medication is a serious

health problem and this often occurs when patients

Ariga, R., Nasution, S., Amelia, R. and Nasution, S.

Increase Medicine Adherecence TB Patient with Ners-Short Message Service Intervenstion (N-SMSI).

DOI: 10.5220/0010076905190524

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

519-524

ISBN: 978-989-758-449-7

519

are confronted with long-term treatment of chronic

illness such as pulmonary TB disease (WHO, 2015).

Low medication adherence in patients with

pulmonary TB will slow the healing process of the

disease, increase the risk of morbidity, mortality,

and drug resistance to either one type of OAT

(mono-resistant), or more than one type of OAT

(poly resistant, multidrug resistant, extenly drug

resistant, or totally drug resistant) (Departement of

Health Indonesiam 2005). Low patient compliance

with OAT also causes patients to be a source of

transmission of resistant bacteria in the community,

which in turn will complicate the eradication of

pulmonary TB disease in Indonesia and exacerbate

the burden of the government (WHO, 2015).

Drug adherence is influenced by several factors

such as knowledge and attitude (Departement of

Health Indonesiam 2005). According to research

Tachfouti et al (2011) there is a real relationship

between knowledge and attitude with adherence to

taking anti-tuberculosis drugs in Morocco, Africa

(BPOM RI, 2006). According to research Avianty

(2005) knowledge and attitudes become factors that

affect the level of adherence of a person in taking

medicine (Widjanarko, Gompelman, Dijkers &

Werf). According to research Luluk at Health Center

Gatak Surakarta (2012) it is said that there is a

significant relationship between the knowledge of

adherence to taking medication of patients with

pulmonary tuberculosis (CAN, 2013).

Based on the above it can be assumed that there

are several factors that influence the level of patient

compliance in the treatment of pulmonary

tuberculosis such as knowledge and attitude of the

patient. Active care management of lung TB patients

at home can be done through telenursing.

Telenursing is defined as a process of providing

management and coordination of care and delivery

of health services through information technology

and telecommunications (Sholikhah, 2012)

According to Wulandari (2012), that the use of

telenursing can improve patient behavior in

prevention of transmission of pulmonary

tuberculosis. However, this method of telenursing is

quite expensive. Therefore, researchers are trying to

develop new, cheaper models through N-SMSI

(Ners-Short Message Services) (Wulandari, 2012).

N-SMSI is one form of community nursing

intervention, where community nurses send SMS to

Pulmonary TB patients. SMS contains reminder

messages of medication and nutrition, sent daily,

with frequency adjusted to the timing schedule for

taking TB lung medication. Website-built SMS,

hosted on an email provider, so this method does not

cost a lot. To overcome this problem, researchers

apply communication technology through

telenursing known as N-SMSI (Ners-Short Message

Service Intervention) by sending short messages to

patients in accordance with the time of taking the

drug. This study aims to increase the rate of healing

of pulmonary TB patients and reduce mortality by

increasing knowledge, making decisions and

improving patient compliance to take medication

independently. This study has the outcomes of

producing appropriate methods in improving the

adherence of taking pulmonary TB patients with N-

SMSI (Ners-Short Message Service Intervention).

2 METHOD

Ners-Short Message Service Intervention (N-SMSI)

study on improving medication adherence of

pulmonary TB patients in Medan using Quasi

Experiment method with pretest-posttest design with

control group, population of 72 people. 36 controls

and 36 intervention groups. Sampling technique

used in this research is non probability sampling

technique with total sampling approach that is

sampling technique by taking the whole sample

amount of research. The inclusion criteria in this

study were the new intensive phase intensive TB

patients expressed by the Johor Field Health Center

and the Medan Amplas Community Health Center,

the patients with tuberculosis aged 21-60 years, the

patients had mobile phones, were willing to be

respondents. Exclusion criteria include Pulmonary

TB patients with accompanying diseases, such as

HIV, cancer, and DM, Pulmonary TB patients who

refuse to be respondents.

This research was conducted for 2 months.

Starting from April to June 2018. The reason for the

study was to select the working area of Medan Johor

Health Center and Puskesmas Medan Amplas as a

research site because this location is a densely

populated location with TB patients and Puskesmas

have TB program. Instrument used in this research is

questionnaire of medication patient compliance level

of Lung TB patient with CVI value. Instruments

have been derived with crobaalfa value. The process

of collecting data is done by 1) the researcher fill out

the format of assessment of respondent

characteristics that include age, sex, occupation, and

education level, and patient's cellular contact

number; 2) The researcher evaluates the patient's

compliance rate before taking N-SMSI (pre-test) on

the first day; 3) Researchers conducted N-SMSI

implementation in coordination with patient and

family for 2 months by sending a short message

containing reminder of taking medicine 15 minutes

before taking medicine. SMS is given in the morning

at 07.00 WIB but pasa when the fasting month is

done 03.00 WIB. Researchers previously gave the

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

520

news at the time to make changes sms at the time of

fasting. SMS contains information on reminders for

taking medication as well as information on

tuberculosis, such as prevention of TB transmission,

drug side effects, cough etiquette and sneezing, the

importance of medication adherence 4) researchers

reevaluate the level of adherence of taking

medication to patients with lung TB (post test) using

questionnaires level of medication adherence of lung

tuberculosis patients. Analysis of this research data

is processed by using SPSS program.

3 RESULT

The result showed that demographic data, the

majority of age <40 years old were 43,1% (31),

66,7% (48) male majority, 54,2% (39) private

employees, the majority of private sector employees

occupy 54.2% (39), the majority of private

employment is 54.2% (39), the majority of private

employment is 54.2% (39), the majority live with

households with the wife as much as 48.6% (35), the

majority of home high humidity home conditions are

38.9% (28), the majority of high school education as

much as 62.5% (45), the majority of respondents had

contact with patients in contact with previous

patients as much as 54.2% (39). Description can be

seen in the table below.

Tabel 1. Characteristic Of Patient Demographic

Karakteristik Demo

rafi F %

Age

<40

31 43.1

40-60

33 45.8

>60 yea

8 11.1

Sex

Female 24 33.3

Male 48 66.7

Profession

Labor 7 9.7

Farmer 1 1.4

Civil Servant 6 8.3

emplo

e 39 54.2

Deale

19 26.4

Families live at home

Main Family (father,

mother, chidren)

13 18.1

Extended Family

(father, mother, children,

the other family)

10 13.9

House condition

In front of hi

htwa

17 23.6

o window 27 37.5

Stuff

house 28 38.9

Education

Elementary school 2

Junior Hi

h School 8

Senior Hi

h School 45

Diploma 10

Bachelo

History of contact with

tuberculosis patients

Yes 33

o39

Culture

Bata

Jawa 26

Minan

Get TB Informa

ion

Ya 66

Tida

Total 72

TB Resource

Television 41

ews paper/

azine

Flip Char

Total 57

The result of the study showed the

characteristics of medication adherence of TB

patients before and after intervention, ie before the

action in the control group of the majority of the

disobedient patients 58.3% and the intervention

group the majority of the patients did not obey

55.6%. After an action on the control group the

majority of patients did not adhere 52.8% and the

intervention group the majority of patients obedient

80.6%. Description can be seen on the graph below.

Figure 1. Patient medication adherence of Pre-Post TB

patients to Control Group

Increase Medicine Adherecence TB Patient with Ners-Short Message Service Intervenstion (N-SMSI)

521

Figure 2. Patient medication adherence of Pre-Post TB

patients to Intervention Group

The results showed that test results using Man

Whitney that there is influence of N-SMSI on

patient compliance in taking medicine p = 0,000

Tabel 2. Different of Patient Obediance Among Control

and Intervention Group

Group Mean Median Min Max P

Control 20,31 0 0 2 0,00

Invention 52,69 2 1 6 0,00

4 DISCUSSION

4.1 Characteristic of Patient

Based on Table 1. The results showed the

demographic data, the majority of age group <40

Years as much as 43.1% who suffer from TB

compared with other age groups. This is supported

by Mahpudin and Mahkota (2007) that the age

group 49 years and under has a higher proportion of

63.2% compared with age group 50 years and over

(Mahpudin & Mahkota, 2007). The age group is a

productive age group. The majority of sexes of

patients with TB are men as much as 66.7%. The

research conducted by Zerbini, Greco, Cisneros,

Colombo, Beltrame, Boncompain and Genero

(2017) that the majority of sex of adult TB patients

in Argentina are men by 65% and men 1.7 times

more at risk suffer from pulmonary tuberculosis

compared to women. Women are usually more

docile than men. This is because majority women

are more concerned with their health than men

(Zerbini, Grec, Estrada, Cisneros, Colombo

Beltrame, Boncompain & Genero, 2017)

The majority of patients' occupations are private

employment of 54.2%. This is because the location

of the patient's residence is an industrial area such as

a factory. Occupational and occupational factors can

also lead to the incidence of TB known as Work-

Dose Disease. The workplace is an environment

with a concentrated population at the same place and

time, so it is one of the potential environments in TB

transmission (Ministry of Health, 2015).

The majority live with households with wives as

much as 48.6%. this is in line with research

conducted by Rukmini and Chatarina (2011) that as

much as 54.4% is the head of the household. The

head of the household can not provide for the child

and his wife, infectious diseases to other family

members, the patient can feel HDR (Low Self-

Esteem) because they can not produce and provide

for their children. Gender is one of the risk factors of

TB. The majority of house high humidity house

condition is 38.9%. The condition of the room is

related to the incidence of pulmonary tuberculosis

where people with unqualified room conditions have

a chance of 1.18 times for contracting pulmonary TB

compared to a house with a qualified room

condition. Condition of the room is eligible if

ventilation is available> 10% floor area, windows

are opened every day, lighting is good enough in the

bedroom, kitchen or living room. Houses with good

lighting and ventilation will complicate the growth

of germs, because ultraviolet light can kill germs and

good ventilation causes air exchange thus reducing

the concentration of germs (Rukmini, 2011)

In fact, people spend more time indoors than

outdoors. The concentration of pollutants in

buildings / rooms can be higher than outdoors,

especially in big cities. This is further exacerbated

by the lack of ventilation in the house building. The

largest sources of air pollution in the room are

cigarette smoke, combustion products (fuel energy),

radon gas (derived from floor cement dust, walls,

etc.), chemical products (hair spray, room cleaners,

paint, and others) and biological pollutants (fungi,

bacteria, animal dander, etc.) (Ministry of Health,

2014). The majority of respondents had contact with

patient contact with previous patient as much as

54.2% (39). The results of Agustina and Wahyuni's

(2017) study that the patient's actions in preventing

the TB exclusion of the members at home-level

family members were 56% (Nurjanah, 2015).

4.2 Obedience before NSMS

Based on the results of the study of TB drug

treatment adherence prior to Ners-Short Message

Service Intervention (N-SMSI) in the control group

it was found that 58.3% were not adherent and in the

intervention group it was found that did not comply

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

522

as much as 55.6%. The patient's compliance can be

affected by several factors, one of which is patient

education. This is because the majority of TB

patients education is high school as much as 62.5%.

Nurjana (2015) study on the risk factors of

pulmonary tuberculosis in productive age in

Indonesia that the most influential factor is

education. This is because education will affect one's

perception and knowledge about pulmonary TB.

With good knowledge, there will be prevention and

treatment efforts if the pulmonary TB. Information

received, role needs to be improved. Role as a

family nurse. Nurse improvement needs to be done

through training. The role of families needs to be

improved through family empowerment of drug

control. With a skilled family, the patient is obedient

in the tuning. The condition of education is one

indicator that is often reviewed in measuring the

level of human development of a country (Nurjanah,

2015). Research Pasek et al (2013), found that in TB

patients with positive perceptions have the

possibility of adherence in the treatment of 21.41

times greater than those having a negative

perception. So it can be concluded that TB patient

compliance is related to behavioral role of illness in

which the role describes behavior that should be

shown by the patient to get healing (Pasek, Suryani

dan Murdani, 2013). Through knowledge, education

contributes to health behavior. Knowledge that is

influenced by the level of education is one of the

predisposing factors that play a role in influencing

one's decision to behave healthy (Departement of

Health Indonesia, 2009)

4.3 Obedience after NSMS

Based on the results of the study of TB patients' drug

adherence before Ners-Short Message Service

Intervention (N-SMSI) in the intervention group

found that obedient as much as 80.6% and in the

control group obedient as much as 47.2%. In this

study there were some non-adherent patients as

much as 19.4% in the intervention group. This is

because the patient does not visit the health center

regularly to take medicine. Patients do not visit the

clinic regularly to take drugs because patients are

busy with rutinasnya, such as patients are more

concerned with their work, the symptoms felt the

patient has been reduced so that the patient felt he

had recovered and ignored taking medicine

according to the rules. This is in line with research

conducted by Munro et al (2007) that patients

prioritize work and take medicine is a choice

between work and adherence, so patients feel

compelled to choose (Munro, Lewis, Smith,

Freitment dan Volmink, 2007). The government

through the program is very good.

Permasalahhannya sekang lies in puskesmas staff,

do or not the program launched by the government.

4.4 Effect NSMS for Obedience Patient

Man Whitney test results obtained values pvalue =

0.000. These results indicate that the pvalue <0.05

indicates that there is a difference between the

control group and NSMS intervention for TB drug

treatment adherence. A person's compliance is the

result of the person's decision-making process, and

will affect people's perceptions and beliefs about

health. In addition, beliefs and cultures also

determine the behavior of compliance. The value of

a person has a belief that health advice is considered

correct then respondents will be obedient to taking

medicine. Patients who received health counseling

from health workers were 4.19 times more likely to

be regular or obedient than those who did not

receive health education. N-SMSI is one form of

community nursing intervention, in which

community nurses send short messages via cell

phone (SMS) to Pulmonary TB patients. SMS

contains reminder messages for medicine and

nutrition, sent daily, with frequency adjusted to the

timing schedule for taking lung tuberculosis patients

and also to provide TB pulmonary information about

prevention of TB transmission, drug side effects,

cough and sneeze ethics, the importance of

medication adherence. The information is given

twice a week every Monday and Wednesday

4 CONCLUSIONS

NSMS (Ners-Short Message Service Intervention) is

a Nerser-Short Message Service Intervention

(NSMS) model of care to improve medication

adherence of Pulmonary TB patients. provide

benefits for patients will be obedient to take

medicine. The action is so important that it is not

just adherence to taking medication, but to the

behavior of patients or TB patients' habits.

Compliance of TB patients in taking medication is

very important. This is because if the patient is not

obedient in taking medicine or medication, then the

patient will repeat the treatment again. If this bears

repeated it will cause the bacteria to become

resistant to the drug. Resistant is a condition where

bacteria can not die with the drug hence intensive

treatment is required to be left higher health services

by referring to the hospital.

Increase Medicine Adherecence TB Patient with Ners-Short Message Service Intervenstion (N-SMSI)

523

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research is supported Ministry of Research and

Technology and Higher Education Republic of

Indonesia. The support is under the research grant

TALENTA USU of Year 2018.

REFERENCES

Agustina S, Wahjuni CU 2017 Jurnal Berkala

Epidemiologi. E-JURNAL UNAIR

Ariga, R. A. dan Siti Z. N. 2016 Procedding PHICO

Universitas Sumatera Utara

Badan Litbangkes Kemenkes RI 2011 Laporan

Akhir Riset Fasilitas Kesehatan tahun

BPOM RI 2006

CNA 2013

Departement of Health Indonesia 2005 Rencana

Strategi Departemen Kesehatan 2005

Departement of Health Indonesia 2009 Profil

Kesehatan Indonesia 2008

Mahpudin, AH, Mahkota, R, 2007 Kesmas Jurnal

Kesehatan Masyarakat Nasional 01 147 – 152

Ministry of Health Indonesia 2014

Ministry of Health Indonesia 2015

Munro SA, Lewin SA, Smith HJ, Freitheim M,

Volmink J 2007 Plos Med, Adherence to Anti-

TuberculosisTreatment04 1230-1245

Nurjana, MA 2015 Balai Litbang P2B2 Donggala,

Badan Litbang Kesehatan, Kesehatan Republik

Indonesia25 165-170

Pasek MS, Suryani N, Murdani P 2013 Jurnal

Magister Kedokteran Keluarga01 14-23

Rukmini, Chatarina UW 2011 Bulletin system

research Health14 320 – 331

Sholikhah, L F 2012 Fakultas Ilmu Kesehatan

Universitas Muhammadiyah Surakarta

Viney, K., et al, 2011 Information Action 11 1-5.

Widjanarko B, Gompelman M, Dijkers M, Werf M

2009 Patient Preference and Adherence03 231 –

238

World Health Organization (WHO) 2015

Switzerland

World Health Organization (WHO) 2015

Switzerland

Wulandari N, 2012 Thesis Universitas Airlangga

Zerbini E, Greco A, Estrada S, Cisneros M,

Colombo C, Beltrame S, Boncompain C, Genero

S 2017Medicina (B Aires)77 267 – 273

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

524