Family Knowledge and Attitudes to Improve Medication Adherence

in Patients with Pulmonary Tuberculosis

Lailatun Nimah, Rini Sartika and Makhfudli

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

Keywords: Knowledge, Attitude, Family, Medication Adherence of Pulmonary Tuberculosis.

Abstract: Many Pulmonary Tuberculosis (TB) patients forget to take medication because of lack of support from their

families due to a lack of knowledge and attitude. This study aimed to analyze the relationship between the

knowledge and attitude of families and adherence to taking medication in patients with pulmonary

tuberculosis at Perak Timur Health Center. This is a cross-sectional study. The population of this study

comprised of the families of patients treated at Perak Timur Health Center. The number of research samples

was 110 respondents while for the inclusion criteria, consecutive sampling was used. The dependent

variables were knowledge and family attitude in patients of pulmonary TB, while the independent variable

was medication adherence in TB patients. Data were collected using questionnaires. The data were analyzed

using Spearman. Results indicated that a correlation between family knowledge and TB medication

adherence (p = 0,000) with contingency coefficient (C) = 0,655. Family attitudes and medication adherence

of pulmonary tuberculosis patients (p=0,000) with contingency coefficient (C) = 0.926. It can be concluded

that there is a relationship between the knowledge and attitude of families and compliance in taking

medication in patients of TB. Family knowledge and attitude is good in relation to medication adherence.

Researchers are further advised to examine the analysis of factors related to adherence in taking pulmonary

TB Medication. Suggestions can be made for education about pulmonary TB, especially regarding disease

transmission, accuracy in taking medication, and time to take medication for TB patients.

1 BACKGROUND

Tuberculosis (TB) is a contagious infectious disease

caused by the bacterium Mycobacterium

Tuberculosis that can attack various organs,

especially the lungs (Depkes RI, 2016). Pulmonary

tuberculosis (TB) is a curable disease but many

patients stop treatment prematurely. TB patients

often discontinue their own treatment if they feel the

symptoms of the disease have been lost or reduced.

Many factors that affect the success of TB treatment

include regular medicine taking, family support,

community, social stigma, level of knowledge, and

environment. Non-adherence to TB treatment is

significantly associated with unemployment, low

status occupation, low annual income and cost of

travel to the TB treatment facility (Ii & Urin, 2007).

Pulmonary tuberculosis problems are a challenge

for countries all over the world. TB incidences from

year to year are increasing (WHO, 2017). The World

Global Tuberculosis Report says Indonesia ranks

second with the highest number of tuberculosis cases

in the world. The number of pulmonary TB patients

in Indonesia by 2016 was 156,723 people, those who

completed treatment was 11,427 (6.1%) and those

who experienced successful treatment was 141,980

(75.4%) (WHO, 2017). The incidences of confirmed

pulmonary TB in Indonesia rose significantly from

7% in 1999 to 13% in 2003. This indicator decline

from 2003 to 2014 but by 2015 had increased again

to 14% (Depkes RI, 2016).

All patients who have not been treated

previously, and do not have other risk factors for

drug resistance, should receive a WHO-approved

first-line treatment regimen using quality assured

drugs. The initial phase should consist of two

months of isoniazid, rifampicin, pyrazinamide, and

ethambutol. The continuation phase should consist

of isoniazid and rifampicin given for four months.

Doses of antituberculosis drugs should conform to

WHO recommendations. Fixed-dose combination

drugs may provide a more convenient form of drug

administration (TB Care I & United States Agency

for International Development, 2014).

Nimah, L., Sartika, R. and Makhfudli, .

Family Knowledge and Attitudes to Improve Medication Adherence in Patients with Pulmonary Tuberculosis.

DOI: 10.5220/0008319900290032

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 29-32

ISBN: 978-989-758-336-0

The duration of treatment in patients with

pulmonary TB greatly affects adherence of patients

in taking the drug. Poor treatment, heavy financial

burden (Lei et al., 2016), illiteracy, being divorced

or widowed, lacking health insurance and being

migrants (Xu et al. 2009) are factors of non-

adherence therapy. Family support is indispensable

in the treatment of pulmonary TB patients. One

fundamental principle of the Family Health Strategy

is to build bonds between the health team and the

referred community and to maintain the care offered

to individuals and families over time, through a

proactive attitude in view of health-disease problems

(de Souza et al., 2010).

2 METHODS

The method used in this research is cross sectional

with the population being the families of lung

tuberculosis patients at Perak Timur Health Center.

The sample comprises of families of patients with

pulmonary TB, who were seeking treatment at Perak

Timur Health Center and undergoing treatment of

anti-tuberculosis drug from October 23 to November

11, 2017. Inclusion criteria are: 1. Families who care

for patients with pulmonary TB who are undergoing

anti-tuberculosis drug treatment; 2. Families, caring

for pulmonary TB patients, who can read and write;

3. Families who have become drug supervisors; 4.

Patients who have had pulmonary TB for more than

15 years; and 5. TB patients who can read and write.

Exclusion criteria are: 1. TB patients who have

accompanying diseases such as diabetes mellitus,

hypertension, and others; and 2. Patients’ family

members aged less than 18 years. Total sampling is

used for this research. The number of samples in this

study comprised of 110 respondents. Independent

variables are the knowledge and attitude of the

family. The dependent variable is medication

adherence in patients with pulmonary TB. The

ethical clearance was conducted at the Faculty of

Nursing of Airlangga University and was approved

on November 6, 2017 with the certificate number

553-KEPK.

Samples were collected using consecutive

sampling and data were collected using

questionnaires. Questions in the questionnaire were

in four parts: 1. Demographic data including age,

education and gender; 2. Family knowledge about

TB consisting of 12 closed questions; 3. Family

attitudes toward pulmonary TB patients comprising

12 questions; and 4. Patient adherence to taking

pulmonary TB drugs, comprising four closed

questions. Data analysis of the knowledge level and

attitude of family regarding medication compliance

was done using the Spearman Rank statistic test.

3 RESULTS

The table shows that most of the families that care

for patients include working women with their most

recent education in elementary school and aged

between 18 and 65 years. Characteristics of patients

based on Table 1 are mostly male with a recent

primary school education, all aged 18–65 years, and

mostly employed.

Table 1: Family and patient demographic

characteristic data.

Characteristic Famil

Gende

f %

Male 45 40.9

Female 65 59.1

Total 110 100

Last education f %

Elementar

School 45 40.9

Junior Hi

h School 21 19.1

Senior High School 44 40

Total 110 100

ef %

–

ears 110 100

–

ears 0 0

Total 110 100

Work f %

Employee 92 83.6

Unem

ment 18 16.4

Total 110 100

Patient

Gende

f %

Male 57 51.8

Female 53 48.2

Total 110 100

Last education f %

Elementary School 47 42.7

Junior High School 24 21.8

Senior High School 39 35.;5

Total 110 100

ef %

–

ears 101 91.8

–

79 years 9 8.2

Total 110 100

Work f %

ee 62 56.4

Unem

ment 48 43.6

Total 110 100

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

Table 2 shows that most families of TB patients

have sufficient knowledge about TB (as many as 68

people or 61.8%. Family attitudes to TB patients are

mostly good (as many as 70 people or 63.6%). For

medication adherence in patients with lung TB, there

are 73 respondents or 66.4%.

Table 3 shows that ‘much less’ family

knowledge in correlation with less medication

adherence equate to two respondents or 1.8%.

‘Enough’ family knowledge correlates with good

medication adherence at 50 respondents or 45.5%.

The Spearman Rank test showed p = 0.000 with

contingency α < 0.05.

Table 4 shows that ‘enough’ family attitude

correlates with ‘enough’ medication adherence with

30 respondents or 27.3%. A ‘good’ family attitude

correlated with ‘very good’ medication adherence

with just one respondent or 0.9%. The Spearman

Rank test shows p = 0.000 with contingency α <

0.05, at 0.926.

4 DISCUSSION

Family knowledge of pulmonary TB patients at

Perak Timur Health Center is largely adequate. The

compliance of treatment of pulmonary TB patients at

Perak Timur Health Center is good. Sufficient

family knowledge has good medication adherence.

The results of statistical tests show that family

knowledge has a strong relationship with the need

for taking medication in patients with pulmonary TB

at in Perak Timur Health Center.

Family attitudes towards of pulmonary TB

patients at the Perak Timur Health Center is mostly

good. The compliance of patients taking medicine at

Perak Timur Health Center attitudes of patients with

pulmonary TB makes the TB medication adherence

good. Good family attitudes are related to

medication adherence in patients with pulmonary

TB in East Perak Surabaya Public Health.

The success of pulmonary TB lung treatment is

not only the responsibility of the patient, but other

factors that influence family support and family

Table 2: Family knowledge about tuberculosis, family

attitude to TB patients, medication adherence in

patients with lung tuberculosis.

Variable Cate

f %

nowledge Much less 2 1.8

Less 16 14.5

Enough 68 61.8

Goo

24 21.8

Total 110 100

Attitude Less 6 5.5

Enough 34 30.9

Goo

70 63.6

Total 110 100

Medication

Adherence

Less 6 5.5

Enough 30 27.3

Goo

73 66.4

Very

goo

1 0.9

Total 110 100

Table 3: Relationship of family knowledge with medication adherence in pulmonary tuberculosis patients.

Family Knowledge Medication Adherence Total

Less Enou

hGoo

Ver

f % F % F % f % f %

Much less 2 1.8000000 2 1.8

Less 4 3.61210.90000 16 14.5

Enough 0 0 18 16.4 50 45.5 0 0 68 61.8

Goo

0 0 0 0 23 20.9 1 0.9 24 21.8

Total 6 5.5 30 27.3 73 66.4 1 0.9 110 100

earman Rank Test

=0.000, contin

enc

coefficient

(

)

= 0.655

Table 4: Relationship of family attitude with medication adherence in pulmonary TB patients.

Family Attitude Medication Adherence Total

Less Enou

hGoo

Ver

f % F % f % f % f %

Less 6 5.5 000000 6 5.5

Enough 0 0 30 27.3 4 3.6 0 0 34 30.9

Goo

0 0 0 0 69 62.7 1 0.9 70 63.6

Total 6 5.5 30 27.3 73 66.4 1 0.9 110 100

earman Rank Test

= 0.000, contin

enc

coefficient

(

)

= 0.926

Family Knowledge and Attitudes to Improve Medication Adherence in Patients with Pulmonary Tuberculosis

behavior during treatment must be considered.

Families with good knowledge encourage patients to

be obedient during treatment because they know the

consequences of non-compliance. Family knowledge

support is essential for the healing and recovery of

patients.

Family knowledge affects medication adherence

of patients with pulmonary TB because with good

knowledge a family can supervise medicine taking

to ensure the schedule and doses the patient is

drinking are appropriate. Good family knowledge

can also prevent transmission to other family

members and avoid drug withdrawal.

The results are in accordance with factors of

medication adherence in TB patients, such as lost

access to essential financial and practical support

over time, often because relatives and friends are

financially and socially exhausted by supporting

them (Sagbakken et al., 2008). Other research states,

that non-adherence in medication patients in

Pakistan was associated with stigma, experience of

direct observation, social support received from the

family, and reasons for stopping treatment early

(Khan et al., 2005). Personal situations, including

related factors to medication adherence, are

accommodation, unemployment, and nutritional

requirements; knowledge about tuberculosis

comprises of causes, treatment, and prevention,

which are crucial for adherence to treatment (Akeju

et al., 2017).

5 CONCLUSIONS

Most family members who regulate patients with

tuberculosis are women. This is because women are

more conscientious and more attentive to family

members. The age of family members who treat

patients with TB is a productive age, so the ability to

care for family members has more leverage. Most of

the educational levels of family members who care

for TB patients are elementary and high school. This

indicates the level of knowledge of family members.

There is a relationship between family

knowledge and medication adherence in patients

with pulmonary TB at East Surabaya Perak Health

Center. Family members who have a high level of

education improve patient compliance with TB

medication because family members understand the

impact if the patient does not fully take the medicine

and the risks of recurrence, transmission, and drug

resistance OAT will be higher.

There is a relationship between family attitudes

and medication adherence in patients with

pulmonary TB at East Surabaya Perak Health

Center. Family members who have a positive

attitude will provide support to patients with

tuberculosis regarding treatment. Family members

will accompany p in treatment and provide

motivation to TB patients.

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INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research