SMS Reminder Program to Improve Drug Adherence of Multi-drug

Resistant Tubeculosis (MDR-TB) Patients in Medan

Syarifah

, E Mutiara

and SN Lubis

Department of Health Education and Behavioral Science, Fakultas Kesehatan Masyarakat, Universitas Sumatera Utara,

Medan, 20155, Indonesia

Department of Population and Biostatistics Fakultas Kesehatan Masyarakat, Universitas Sumatera Utara, Medan, 20155,

Indonesia

Department of Epidemiology Fakultas Kesehatan Masyarakat, Universitas Sumatera Utara, Medan, 20155, Indonesia

Keywords: SMS Reminder, MDR-TB, Drug Adherence.

Abstract: SMS is a way to communicate through cellphone to send or receive short messages by all phone users. This

media can be alternative in health promotion to improve MDR – TB patients’ compliance in case of therapy.

This research aims to design reminder SMS to improve patients’ treatment compliance. This qualitatively-

designed research to create SMS content and design program with System Development Life Cycle

(SDLC). The informants are MDR – TB patients who are undergoing treatment and recovered patients.

Collected data to design reminder SMS, so the patients are complied to undergo treatment, analyzed by

content analysis. Results show the long format-designed SMS reminder, containing 27 messages delivered

everyday. Contents : the patients are complied to take medicine and injection until completion as prescribed

recommendation says, prevent transmission to family and surrounding environment and accept themselves

as MDR – TB patients. After implementation to the patients then qualitatively and generally the patients are

relieved, capable to encourage them to take medicines without psychological obstacle, nevertheless a small

part considers it normal but they still want to be reminded through the next messages. It is recommended

that SMS are delivered regularly, messages’ acceptance level is monitored and compliance level for therapy

is analyzed qualitatively.

1 INTRODUCTION

The average number of drug adherence of patients

with chronic disease with long-term therapy in

developed countries is only 50%, meanwhile in

developing countries the number is even lower

(WHO, 2003). Patient’s compliance is needed to

achieve a successful therapy, including MDR – TB

patients that needed long-term treatment. Patient’s

compliance requires a health promotion strategy.

Thus far, the emphasis of health promotion is done

through health education via newspaper, radio,

television, leaflet, newsletter, magazine, poster,

brochure, etc (Emilia, 2008). However, these media

are still limited and are not reachable for the MDR –

TB patient. Nowadays, the increase of MDR – TB

cases and the inadequate number of health worker

who can provide Komunikasi Informasi Edukasi

(KIE) to the patient needs an alternative strategy as a

promotion media through the utilization mobile

phone.

The opportunity of mobile phone utilization as

health promotion strategy is expected to improve the

degree of public health. This technology is able to

facilitate the delivery of information more closely,

and reach out to sick as well as healthy people who

have irregular contact with health services.

According to the data gathered by Asosiasi

Telekomunikasi Seluler Indonesia (ATSI), up until

the end of 2011 the number of penetration of mobile

phone utilization in Indonesia is around 250 million

or 110% from the total population of Indonesia

(Nugraha F, 2012). The optimalization of the

program becomes essential if being referred to the

data from Balitbang SDM Kemkominfo which is, the

proportion of population who own cell phones is

increasing from 14.79% in 2004 to 82.41% in 2009.

High flexibility and accessibility act as supporting

factor in the importance of mobile phone utilization

Syarifah, ., Mutiara, E. and Lubis, S.

SMS Reminder Program to Improve Drug Adherence of Multi-drug Resistant Tubeculosis (MDR-TB) Patients in Medan.

DOI: 10.5220/0010082714791485

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

1479-1485

ISBN: 978-989-758-449-7

1479

in increasing public health. SMS is a way of

communicating via a cell phone to send or receive

short messages by all mobile users (Saputra, 2013).

Indonesia ranked eighth with the most cases of

TB-RO in the world (Kemenkes RI, 2011). This case

is basically a man-made phenomenon, as a result of

inadequate TB treatment, which impacted on the

long-term treatment, the side effect of drugs is more

severe and with quite expensive cost. Medan is an

area with the highest number of TB-RO patients in

Sumatera Utara, until March 2018 there are 255

people are confirmed TB-RO, from that number

only 197 (77%) have been receiving the treatment,

the remaining have not yet received treatment, and

this number has been growing (Syarifah, Mutiara

and Novita, 2018). Out of those who have been

receiving treatment, there are only 99 patients

(50.2%) stay in treatment, the remaining are no

longer in treatment, such as 31 patients default

(15.72%), 11 patients failed (5.58%), and 25 patients

cured (12.69%) (e-TB Manager, 2018). The number

of default is higher than the tolerable number (5%).

Therefore, it is necessary to design the SMS for the

MDR – TB patient in Medan, the content of the

SMS is being mustered from the cured MDR – TB

patients and in-treatment MDR – TB patients, these

SMS are being delivered to improve patient’s

compliance in undergoing a therapy program.

2 RESEARCH METHOD

The research design is using qualitative approach to

design the content of the SMS and design program

with the Systems Development Life Cycle (SDLC)

method. This design is divided into three main

activities, which are: analysis, design, and

implementation (Ladjamudin, 2005).

The informants for the qualitative research are

MDR – TB patients who are undergoing a treatment

along with MDR – TB patients who have been

cured. The reason to interview the cured patients is

because they have generally experienced difficult

phases in the treatment process due to limited health

facility, health worker, drug, as well as various

matters regarding personal experience and the

surrounding environment which has little knowledge

on the disease so that often cause discrimination in

the society. The qualitative data is gathered to design

the drug adherence model of MDR – TB patient

through SMS Reminder, to remind the patient to

take the medicine regularly. An interview guideline

is developed, which included questions such as: for

the patient to take the medicine regularly and getting

the injection according to the recommendation, for

the patient to prevent transmission to the family and

the surrounding environment as well as accepting

themselves as MDR – TB patients. The qualitative

data gathering is transformed into a transcript which

covers overall data without making a conclusion,

and then content analysis is performed.

3 RESULT AND DISCUSSION

3.1 Qualitative Research Result

3.1.1 The Content of SMS for Patient to

Take Medicine Regularly

The qualitative research result includes the content

of SMS for drug adherence for 18-24 months and

getting injection for 6-8 months five days per week.

Cured informants showed the most important thing

to emphasize to the patient are the belief in medical

drug, such as the following informant’s statement:

“If the medicine is taken regularly then TB can

be cured. Disbelief in the medicine can lead to

failure” (Informant 1 PP).

This message needs to be emphasized because

there are a lot of patients who don’t take their

medicine regularly due to disbelief in the medicine,

especially if the amount of the medicine is quite a

lot and the treatment takes a long period of time.

Therefore to convince the patient, it is should be

emphasized that TB can be cured with the medicine

from the hospital. Next, as disclosed by the

informant, if the symptoms of coughing last more

than 2 weeks, then it is recommendable to seek

health care. The statement of the informant is as

follows:

“Do not hesitate if you have been infected with

TB, immediately seek a treatment” (Informant 1

PP).

Many people are trying to seek a traditional

medicine, initially it creates a good feeling for the

body, but the condition of lungs will worsen. Herbal

and traditional medicine have a temporary curative

effect, there are times when the patient’s body is

gaining weight thus they feel healthier, however the

TB germs within the body cannot be vanished with

traditional medicine, the germs are still within the

body in accordance to informant 2.

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

1480

“TB germs are only dormant within the body, if

the condition of the body decreases then the germs

will act up hence the disease will only get worse”

In accordance to the informant, the delay of the

treatment will worsen the disease, if the patients

only seek for treatment when their health condition

is severe, they would not be cured thoroughly.

Therefore even though the disease has been cured

the lungs had been damaged, hence the body will be

vulnerable and prompt to fatigue.

The content of the message is as follows:

1. Take medicine regularly, TB can be cured.

2. Disbelief in the medicine can cause failure.

3. Be courageous to take the medicine to be cured,

a belief to be cured should be established, and

believe that TB can be cured.

4. To convince the patient that TB can be cured by

the medicine from the hospital.

5. Do not postpone seeking treatment from the

hospital if the symptoms of MDR-TB have been

detected.

**The research result with the informants who

are undergoing treatment shows that the factor that

influence drug adherence is internal factor of family.

Currently the father of the informant was suffering

from light stroke and the informant is the only

daughter in the family. She is young and if she gets

sick, her mother will be in despair. Hence to be

cured she kept taking her medicine despite the side

effects. Other than that, self-motivation to be healed

is what causes her to not feel the side effects.

Although with external factor such as SMS will also

help to increase the drug adherence, thus she

revealed the context of SMS for the patient to take

medicine regularly as follows:

“The future is still long, not to mention you are

young. Take your medicine regularly, if you do not

take the medicine just for a day it will deteriorate

your condition”

The result shows that word revealed by the

informant such as “telaten” (persevering) is not the

local language of Medan, even though the informant

is from North Sumatera she has lived in Yogyakarta

and has finished her study there. She has suffered

from coughing, and encouraged by her parents to

come home. After several tests, it was found that she

is infected with TB-RO whereas she never suffered

from TB before. The informant was very

disappointed with her condition but has to be strong

and move forward by adhering to her treatment.

Related to 2 years period of treatment, there are a

lot of important things to be instilled in the patient in

order to avoid default, and considering the side

effects of the medicine is varying. It starts from

nausea, dizziness, vomiting, up to medium and

heavy side effects such as heavy feels in the ears,

numbness in the legs, and memory disorder as well

as hallucination. According to the informant the

thing that needed to be instilled in the mind is TB

can be cured by taking medication. So for the

patients who are still undergoing treatment they

usually are accompanied by Non-Governmental

Organization (Lembaga Swadaya Masyarakat)

Pejuang Sehat Bermanfaat (Pesat), it is a Non-

Governmental Organization of MDR – TB

companion originating from the cured MDR – TB

patients. This Non-Governmental Organization

receive many funds from Global Fun to accompany,

persuade, and supervise the patient to take their

medication regularly, regular visit depends on the

monthly condition and said that:

“The patient is increasing every day, and most of

them come from Medan.”

The data revealed that each member (Pesat) has a

considerable amount of companions meanwhile the

member of Pesat is insufficient, therefore an

alternative method is needed to enforce the drug

adherence to the patient. One of the stategies is

sending SMS Reminder which content is gathered

from the previous patient so the words will be more

patient-oriented. Previous research result indicated

sending SMS through cellphone is increasing the

level of Anti Retroviral Therapy (ART) on limited

sources (Lester, 2010). (Rodrigues, 2012) postulated

the sending of reminder text message via cellphone

will increase the drug adherence of HIV, the effect

will even last for six months after the intervention

has stopped. Sending a reminder text message via

cellphone is increasing the attendance in the health

center with lower cost than phone call (Car, 2012).

Moreover, sending a text message via cellphone is

proved to increase the drug adherence of Anti

Retroviral (ARV) on group with low income (Free.,

2013). This is certainly related to the problem of

MDR – TB patient, which generally come from low-

income family. SMS is proved to be useful to

convey health information and build the awareness

of the mother to do regular pregnancy check

(antenatal care) (Herlina, 2015).

To overcome the boredom then a strategy is

needed. As for the strategy perfomed by the

informant is as stated below:

“We used to share our story with other TB-RO

patients. Especially when it was time to take the

SMS Reminder Program to Improve Drug Adherence of Multi-drug Resistant Tubeculosis (MDR-TB) Patients in Medan

1481

medicine, we made a phone call to remind each

other (Informant 3, cured patient).”

Another activity than sharing is:

“We had a gathering so we do not feel alone.

Every week we usually went to some place together

so we do not feel lonely (Informant 3, cured

patient).”

3.1.2 The Content of SMS in Coping with

the Side Effect

The side effect of MDR – TB drug differs for every

individual starting from light, medium, to heavy side

effect. Therefore, it is required to nurture the

patient’s mind not to feel burdened by the amount of

the medication and the long period of treatment

which is 2 years or more. Consequently, this new

paradigm must be imprinted in the mindset of all the

patients as well as a behavior to prevent

transmission.

For that reason the words that needed to be

conveyed through SMS are:

1. If experience any severe side effects you should

immediately refer to the hospital.

2. All drugs have side effects.

3. If any side effects occur please consult to the

health center (Informant, Cured patient 1, 2)

Another informant revealed if any side effects

occur, then it is suggested to divert attention through

activities such as:

“Listening to music or watching TV, or calling a

friend before taking the medicine. Because the

patient needs to adapt to the medicine and accepts

their condition (Informant 3).”

3.1.3 The Content of SMS for the Patient to

Getting Injection Regularly

Injection for 6-8 months is an activity that needs to

be passed by a MDR – TB patient and it happens 5

days per week. This is a painful activity for the

patient, especially on early stage of the treatment. If

it can be imagined how painful when both thighs are

getting 5 injections in a week for 6-8 months until

there is no place available for the injection. From the

statement of cured informant it is found the words

that made them getting the injection regularly:

“Please follow the rules from the hospital. The

injection only hurts in the beginning, gradually it

feels better than taking medicine. Like the motto in

taking medicine, Be courageous to take the medicine

to be cured, a belief to be cured should be

established, and believe that TB can be cured

(Informant 1,4).”

Similarly a cured informant also stated:

“Do not think about the pain, think about being

cured. The pain is only temporary and all disease

can be cured. Follow the rules of treatment from the

hospital, because it is one package of oral

medication and injection. Since the sickness is not

permanent and this is can be cured, so why not just

abide the process.”

To overcome the pain, do some activities, such

as:

“Sharing some personal experience to motivate

TB patient, pain is only temporary, all disease can be

cured, just go with the flow.”

From the statement of an informant who is still

undergoing treatment, it is revealed the way to get

over the pain causes by the injection:

“It is scary at first, gradually we will get used to

it.”

So the core in overcoming the injection pain is

the will, if the patient has a strong will then it will be

less painful. Other than that, the informant is

overcoming the pain by:

“After getting an injection, I compress it with

warm water or balsam (usually I use Baljitot

balsam). If I do not compress, it the spot will harden

and cannot be injected next time.”

3.1.4 The Content of SMS in Preventing

Transmission

Prevention is important in controlling MDR – TB,

this is due to TB-RO patient can transmit MDR –

TB to other people, especially to the closest person

or the people they live with as well as their

surrounding environment, if a precaution is not

taken. The prevention of transmission can be

executed by using a mask, the ethics of coughing

and nutrition consumption. The content of SMS for

using the mask is as follows:

“Wear a mask actively, to prevent the

transmission and not getting exposed to the germs in

the surrounding environment. The mask is to prevent

yourself from other germs (Informant 2, Cured).”

“Wear a mask to protect yourself and other

people, all this time people believe wearing a mask

is to prevent transmission to other people, even

though mask is also to take care of yourself.

Especially if we are already infected with TB then

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

1482

our body is vulnerable. So we have to wear a mask

(Informant 1, 4, Cured).

An essential preventive measure to be performed

by the patient is related with the ethics of coughing

by giving education through SMS as disclosed by

the informant:

“Cover your mouth with your sleeve, tissue, or a

handkerchief. If the sleeve is being exposed to the

sunlight the germs will die immediately. If you are

using a tissue throw it out afterwards (Informant 3,

Cured).”

Next another informant revealed thing regarding

the place to dispose sputum:

“Sputum is to be disposed in a container of water

Lysol/Biclyne, the germs will then die , then dispose

it to a drain or a ditch (Informant 2, 3, Cured).”

3.1.5 The Content of SMS in to Mantain

Physical Fitness

For the patient to stay fit there are several things to

such as maintaining a good diet, taking plenty of

rest, and practicing clean and healthy behavior

pattern. As for the message to be conveyed is:

“Eat nutritious food, refrain from eating spicy and

greasy food, do not eat instant noodles, and drink

milk. There is no food prohibition for MDR – TB

patient, except for patient with diabetes mellitus

(DM). The point is live healthy, take plenty of rest,

sunbathe for 30 minutes every morning, exercise

lightly such as walking, no smoking and drinking

alcohol, and do not overwork as well as having a

positive mind, and patient in dealing with the health

worker (Informant 1, 2, 3, Cured).

From the results of the research above, the SMS

format that was developed was long messages,

containing as many as 27 messages every day

delivered the same message to all patients. The

message is delivered in the morning around 9:00

a.m. The SMS format used in several countries that

have used SMS reminder is different, in Kenya the

format used is long SMS and short SMS (Pop-

Eleches, 2011).

The contents of the message sent via text are 1)

Are you Mr / Mrs / Friends all taking medicine

today Remember the future is still long, take

medication regularly so that we can gather with the

family to see children and grandchildren married? 2)

Immediately seek treatment if MDR – TB is known,

do not be postponed before it's too late !! Love your

lungs before the lungs get damaged !! Lung damage

can cause coughing up blood. 3) Must Be Sure,

never get tired of taking medication as

recommended, Regular medication for a disease can

be cured. 4) The duration of taking MDR – TB

medication 2 years, and 8 months of injection. if you

are not diligently treated, the disease gets worse, it

can become TB XDR. 5) Just one day not taking

medication will make things worse. Bring medicine

wherever you go. 6) How not to get bored and bored

taking medication ??? Sharing experiences and

complaints with friends Calling each other at meal

time Remind each other for mutual healing. 7)

Injections are very painful but rest assured we can

recover. Come to health services to get a 5-day

injection in 1 week. Follow the recommendation of a

Doctor / Health Officer because of one package

injection and medication. 8) Don't think about the

pain, but think about getting well, getting sick only

temporarily and everything has a cure, just live it. 9)

How to reduce side effects Nausea and vomiting Do

not eat large portions. Eat small portions but more

often Eat and drink slowly. Avoid foods that are too

sweet, greasy or fatty. Take a break after eating don't

lie down. 10) How can we get well?

Medication packages from doctors are the only

drugs that can cure MDR – TB. Beyond the doctor's

medicine, makes the body feel good for a moment,

but the disease in the body cannot heal. 11) Non-

medical treatment is just tired and a waste of time.

Finally the disease gets worse. 12) Don't feel alone,

there are still many people who care about us Don't

be lazy to take medicine, so that you can get

healthier, so you can play again ... Pain is a sin, the

sign is that God still loves us. 13) Remember !!

check his health in the laboratory as recommended

by the doctor Remember !! do not forget to check

MDR – TB to the laboratory at the designated

hospital, routinely according to the doctor's

recommendation until it is declared cured. 14)

Communication with health workers If you

experience complaints or side effects, immediately

contact and discuss with a health worker / doctor.

Adhere to the advice of health workers on

medication and other examination schedules. 15)

Wear a mask to protect your health and that of

others. If you have TB TB, your body is susceptible

to illness, so you must use a mask. 16) Cover the

mouth with a tissue when coughing. Bring tissue

when traveling. Cover your mouth when coughing

with tissue and throw it in the trash that is exposed

to sunlight and then burnt. 17) Dispose of phlegm in

a place filled with Lysol / byclean Do not throw

sputum carelessly. Dispose of phlegm in a container

containing Lysol or byclean, then dispose of water

SMS Reminder Program to Improve Drug Adherence of Multi-drug Resistant Tubeculosis (MDR-TB) Patients in Medan

1483

drainage. 18) Eat nutritious foods Eat lots of fish,

drink juice every day, eat fruit, and drink milk. If

you do not eat, try to keep eating a little but

repeatedly. 19) Avoid drinks and foods that contain

milk, fat, soda or supplements (additional drinks)

with drugs.

So the drinks above should be less than 2 hours

before or after taking medication. 20) Accept

yourself as a MDR – TB patient (not ashamed, do

not be alone) Do not be shy if you have MDR – TB

disease and seek treatment immediately at the health

services provided (H Adam Malik Hospital, Haji

Hospital, Pirngadi Hospital) Do not assume that

MDR – TB disease is not can be healed, the spirit to

continue treatment until healed. 21) Keep in touch

with friends and family. Don't be alone, join your

family. Establishing good relationships with people

nearby can help speed up your health recovery. 22)

Rest. Get enough rest so that the body is always in

shape. Sleep at the same hour every night, and try to

wake up at the same time every day. 23) Don't take

sleeping pills except those prescribed by a doctor.

During sleep, avoid sounds that can disturb your

sleep comfort. 24) Try to sunbathe every morning

from 09.00 around 15 minutes. If you need a nap,

keep it not too long for 30-45 minutes. 25) Perform

light physical activities and avoid activities that can

aggravate the situation. Do exercise regularly, do not

exercise before bed time. Exercise at least three

hours before going to bed. 26) Don't smoke and

drink alcoholic beverages. 27) Pray regularly, the

sickness is a sin, it is a sign that God loves us,

because until now we are still given the opportunity

to do activities. So take medication regularly so that

you can continue to carry out daily activities.

3.1.6 SMS Program

The messages that have been compiled are sent via

SMS design using the SDLC program starting from

the input, process and output stages of Debi (2015).

The design of input on the SMS reminder service in

compliance with taking medicine for MDR – TB

patients in Medan city includes the identity of the

patient, the identity of the admin / admin, the

patient's medication schedule.

It is recommended that this sms be delivered to

the patient accurately and regularly every day, then

monitored how the patient receives the reminder

SMS messages and analyzes the SMS recipient

compliance in medical treatment after health

promotion is done through the SMS reminder that

has been designed.

4 CONCLUSIONS

Results show the long format-designed SMS

reminder, containing 27 messages delivered

everyday. Contents : the patients are complied to

take medicine and injection until completion as

prescribed recommendation says, prevent

transmission to family and surrounding environment

and accept themselves as MDR – TB patients. After

implementation to the patients then qualitatively and

generally the patients are relieved, capable to

encourage them to take medicines without

psychological obstacle, nevertheless a small part

considers it normal but they still want to be

reminded through the next messages.

ACKNOWLEDGEMENT

Thank you to the Directorate of Research and

Community Service, General Directorate of

Research Empowerment and Development, The

Ministry of Research, Technology, and Higher

Education as the source of research fund, DRPM

Kemenristekdikti with research scheme Applied

Superior University of Fiscal Year 2018 Number

168/UN5.2.3.1/PPM/KP-DRPM/2018.

REFERENCES

Alisjahbana AS. 2011 Laporan pencapaian tujuan

pembangunan Milenium di Indonesia. Jakarta:

Kementerian Perencanaan Pembangunan Nasional

atau Bapan Perencana Pembangunan Nasional

(BAPPENAS); 2011

Caroline Free, et al 2012 . The Effectiveness of Mobile-

Health Technologies to Improve Health Care Service

Delivery Processes: A Systematic Review and Meta-

Analysis,: January 15, 2013

https://doi.org/10.1371/journal.pmed.1001363

Debi Daryani . 2015 Perancangan Dan Implementasi

Layanan SMS Reminder Dalam Kepatuhan Minum

Obat Pasien Penyakit TBC di Puskesmas Terjun Kec.

Marelan Medan 2015 Skripsi Fakultas Kesehatan

Masyarakat USU 2015.

Emilia. Promosi Kesehatan dalam Lingkup Kesehatan

Reproduksi. Yogyakarta: Pustaka Cendekia.Press;

2008.

Ladjamudin A.B., 2005. Analisis dan Desain Sistem

Informasi. Edisi pertama Yogyakarta: Graha Ilmu

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

1484

Nugraha F. 2012 ; Jumlah Pelanggan Seluler di Indonesia

Hampir Mendekati Jumlah Penduduk Indonesia.

Jakarta: http://www.teknojurnal.com; 2012.

Pop-Eleches, Cristian. Thirumurthy, harsha.,

Habyarimana, James P., Zivin, Joshua G., Goldstein,

Markus P. 2011. Mobile phone technologies improve

adherence to antiretroviral treatmean in resources-

limited setting; a randomized controlled trial of text

message reminder. Diakses pada tanggal 03 juli 2018;

http://www.works.bepress.com/josh/_graffzivin/32

Ramadian, Okki., Riztriawan, Eky . 2010. Pengaruh Efek

Samping Anti Retroviral Linipertama Terhadap

apadherens pada ODHA di Layanan Terpadu HIV

RSCM. Jakarta. Kelompok studi khusus HIV/AIDS.

RSCM. Diakses pada 03 juli 2018.

http://www.aidsindonesia.or.id/repo/ARV-rscm.pdf

Saputra A., 2013. Step by Step Membangun Aplikasi

Bioskop dan SMS untuk Panduan Skripsi. Jakarta: PT

Elex Media Komputindo

Sri Herlina, Guardian Yoki Sanjaya, Ova Emilia 2018

Pemanfaatan Fasilitas SMS Telepon Seluler Sebagai

Media Promosi Kesehatan Ibu Hamil Di Daerah

Terpencil Seminar Nasional Sistem Informasi

Indonesia, 2 - 4 Desember 2013, SESINDO 2013.

Syarifah, Erna Mutiara, Sri Novita. 2018 Characteristics

of Multi-drug Resistant Tuberculosis (MDR-TB)

Patients in Medan City in 2015-2016, Indian Journal

of Public Health Research & Development, June 2018,

Vol. 9, No. 6

Yuniar, yuyun., Handayani, Rini Sasanti., Arsyantami, Ni

Ketut. 2010. Faktor- Faktor Pendukung Kepatuhan

Orang dengan HIV AIDS (ODHA) dalam Minum

Obat Antiretroviral di Kota Bandung dan Cimahi.

Bulletin Penelitiian Kesehatan. Vol.41.No.2.halaman

72-83. Diakses pada 03 juli 2018;

http://ejournal.litbang.depkes.go.id/index.php/BPK/art

icle/view/3154

WHO, 2003.Adherence To Long-Term Therapies

Evidence for action. Diakses pada 03 juli 2018;

http://www.who.int/chp/knowledge/publications/adher

ence_full_report.pdf

SMS Reminder Program to Improve Drug Adherence of Multi-drug Resistant Tubeculosis (MDR-TB) Patients in Medan

1485