Perception and Self Care Behavior of Tuberculosis Patients

Based on Leventhal Theory

Zuliani, Muhammad Amin and Laily Hidayati

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

Keywords: Perception, Self-Care Behavior, Tuberculosis Patient

Abstract: Tuberculosis (TB) is an infectious disease, caused by Mycobacterium tuberculosis and mostly it will attack

the lung. Based on Leventhal theory the person’s beliefs or perception were influenced by basic

understanding about his disease, than the perception will lead person’s behavior. However, this case was

common among TB patients. The aim this study was to know the perception and behavior of self-care of

tuberculosis Patients based on Leventhal theory. This study used a descriptive research design. The

population of this study was tuberculosis patients who are getting treatment at Primary Health Care Center

in Jombang. About 50 respondents were selected by using simple random sampling. The data were collected

by using questionnaire. The data were collected by questionnaire. The results of the study showed that the

majority of respondents are male (72%) and almost half of those aged 26-45 years old (40%). More than

half of the participants working as private employment (62%) and less than half of those hold elementary

school level (38%). However, almost half of the participants still have negative perception about TB (46%),

and half of those were lack of self-care of TB (50%). From this study, we can concued that clear and right

information regarding TB disease was importance because the good knowledge will be influence

perceptions and self-care behaviour among TB patients.

1 BACKGROUND

Tuberculosis (TB) is a disease of lung infection

caused by Mycobacterium tuberculosis. World

Health Organization (WHO) estimates that one third

of the world's population is infected by

Mycobacterium tuberculosis and 10% of them are at

risk for illness. In 2012 there were 8.6 million cases

and 1.3 million died caused by the disease. The

biggest number of new cases occur in Asia (WHO,

2014).

However, if the TB disease untreated or

uncompleted treatment, it will give dangerous

complications, such as disfungtion of liver, kidney,

hearth and also can dead (Kemenkes RI, 2016).

Indonesia is second ranking countries with the

highest TB burden in the world and East Java was

the biggest province with TB cases, in 2013 about

101.82 per 100,000 people were infected TB and

1.83 per 100,000 the patients were died caused by

TB(Dinkes Jatim, 2014).

According to Jombang’s Public Health Service,

in 2016, TB cases were found at 1,327 cases, the

number of new cases in 2017 in first quarter at 319,

second at 330, the third quarter as 372 cases so at the

moment TB cases in Jombang 1,021 cases new TB.

The report TB act in 2016 in Jombang to the target

number of 1,335 cases, the value of the

achievements of 645 cases with a cure rate of 593 or

91.9%, of the total patients who underwent treatment

(Dinkes Jombang, 2017).

Moreover, with interview method, head of

Jombang TB was mentioned that in October 2017

many TB patients were dropped from medication

program in Health Care Center (PHC) and do

irregular TB treatment, this because some factors

such as the patients feels getting better after take

some medicine, very bussy for working so no have

time to go to PHC, bored to consuming medicine,

lack of motivation and weak behavior to prevent or

transmitted their disease. This also was related with

the data that not 100% of completed medication

program of TB.

Tuberculosis (TB) is a disease with a high risk of

transmission. One of the determinants of successful

management of tuberculosis treatment is patient

adherence to therapy. Non-compliance will lead to

treatment failure and relapse, so it appears resistance

292

Zuliani, ., Amin, M. and Hidayati, L.

Perception and Self Care Behavior of Tuberculosis Patients Based on Leventhal Theory.

DOI: 10.5220/0008324102920297

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 292-297

ISBN: 978-989-758-336-0

and continuous transmission of the disease. This can

increase the risk of morbidity, mortality and drug

resistance in patients and the community at large.

Consequences of non-compliance with the long-term

treatment is deteriorating health and increased

maintenance treatment costs (WHO, 2013).

Disobedience treatment pulmonary of tuberculosis

patients causes people with low cure rate, high

mortality and recurrence increased and more fatal is

the occurrence of bacteria resistant to several anti-

tuberculosis drug or multi-drug Resistance, so that

pulmonary tuberculosis disease is very difficult to

cure (Kemenkes RI, 2015).

The theory developed by Leventhal, illness or

illness perception representation determine a person

votes against disease and healthy behaviors that

accompany it (Aflakseir, 2013). Moreover, Morris

(2001), explained that cognitive and emotional will

affect coping of person. Illness perception that will

be used as a predictor in this study consisted of acute

chronic aspects of the timeline, timeline cyclical,

personal control, treatment control, illness

coherence, emotional representation.

Independent management and follow-up care at

home which is done by patients with chronic

diseases is the key in a comprehensive disease

management (Egwaga et al., 2009). Pulmonary of

tuberculosis done by patients in the treatment and

compliance is obtained if the individual has the

knowledge, skills and self-care behaviour in

managing TB and self-care at home. According

Wongsonton (2000), self-care behaviour of TB

patients include: 1) medical adherence, 2) prevention

of transmission, 3) compliance with nutrition.

The purpose of this study was to know the

perceptions and self-care behaviours tuberculosis

patients based on Leventhal theory.

2 METHODS

The design of this research is quantitative with

descriptive research design. Independent variable in

this study was self-regulation and dependent

variable isperception and self-care behavior.The

population of this study was tuberculosis patients

who are getting treatment at Primary Health Care

Center in Jombang district. The inclusion criteria:

new patients of pulmonary tuberculosis in the

intensive stage treatment (<2 months), can read and

write, cooperative. The exclusion criteria is a patient

of tuberculosis with complications that require

further treatment at the hospital. The sample in this

are 50 respondents using simple random sampling

and the instrument using questionnaire.

Questionnaire perception from Morris (2001)

and self-care behavior from Sukartini study (2014),

and have validity and reliability test with r> 0,619

This research was approved ethical board at Faculty

of Nursing Airlangga on 29 January 2018. Data were

analysed by using univariate test.

3 RESULTS

3.1 Characteristic of Respondent

The following table were describes characteristic of

respondent:

Table 1: Description of the contents of tuberculosis

patients in January - February 2018.

Characteristics of

respondents

Frequency

Percentage

(%)

Gender

Male

Female

Number

100

Age

17-25 Years

26-45 Years

46-65 Years

> 65Years

Number

100

Education level

not school

Elementary school

Primary school

Senior high school

Universitiy

Number

100

Employment

Not working

TNI/POLRI/PNS

Private

self -business

Other

Number

100

Gender respondents mostly male 36 people

(72%). Almost half of respondents aged 26-45 years

as many as 20 people (40%) and a small proportion

of respondents aged 17-25 years as many as 6 people

(12%). While Almost half of the respondents had

elementary education were 19 (38%) and a fraction

Perception and Self Care Behavior of Tuberculosis Patients Based on Leventhal Theory

293

as much as 3 college educated respondents (6%).

Works most of the private respondents as many as

31 people (62%) and a small part of the work of civil

servants sebnayak 1 (2%).

3.2 Perceptions of Disease

The following table describes the perception relating

tuberculosis disease:

Table 2: Description of the perception of

tuberculosis disease in January - February 2018.

Characteristics

of respondents

Frequency

Percentage (%)

Negative

Positive

Based on table 2, found that more than half of

the participants 27 (54%) had positive perception

about tuberculosis disease and about 23 (46%) of

participants had negative perception relating TB

disease.

3.3 Self-Care Behaviours

The following table describes self-care behaviors

relating TB disease:

Table 3: Description of behaviour of tuberculosis in

January - February 2018.

Characteristics of

respondents

Frequency

Percentage (%)

Less (28-37)

Medium(38-47)

Good (48-56)

Based on table 3, found that only 7 (14%) of the

participants had good self-care behavior and half of

the participants (50%) had less self-care behavior

relating TB disease.

4 DISCUSSION

Results of research showed that almost half of

respondents aged 26-45 years 20 people (40%) and

only 6 (12%) aged 17-25 years old. This results was

related also with other research, it was mentioned

that TB patients were attack in productive middle

age (Hayati, 2011). The same thing happened in

2005 where cases of pulmonary TB in Indonesia is

more common in childbearing age because in the

productive age people tend to have a high mobility

so it is likely to be exposed to TB germs bigger

(Ariel, 2002), besides adults are better able to

prevent the spread of blood-borne diseases, but the

ability to prevent lung disease on the wane in the

(Bam, 2006).

The results are consistent with previous studies

which stated that the age group of patients with

pulmonary tuberculosis are in the productive age

group. Results of research conducted by Puspita

(2016), For most age in patients with pulmonary

tuberculosis is of childbearing age (18-55) in 60

people (84.5%). Results of research conducted by

Arsin (2016), the largest age group are in the

productive age group of 25-44 years 56 people

(49.6%), while the age group> 64, 3 people (2.7%).

Another study conducted by Yunita Rahmawati

2009 in Surabaya obtained the highest number of

patients with pulmonary tuberculosis 43.25% were

in the age group 15-30 years. Later studies

conducted by Freddy in 2010 in his research note

were 35 (77.8%) are in the productive middle age

(18-59 years).

This study is also consistent with the statement

Depkes RI 2014, Tuberculosis control national

guidelines which state that as many as 75% of

individuals infected with TB germs are in the

productive age group (15-50 years). This is probably

due to the productive age group of patients would

spend more time outside the home to work and

interact with others. The risk of exposure becomes

greater because of the possibility of contact with

people suffering from pulmonary tuberculosis are

becoming more frequent.

The results also have shown that a large majority

of respondents Gender male 36 people (72%). This

is similar to research Pant (2009), which states that

70% of patients with pulmonary TB are male. The

high number of male patients allows transmission

spacious. This is because the group of men mostly

out of the house for a living, with a frequency out of

the house that allows the transmission of diseases of

pulmonary TB, 17 high mobility of the women that

are more likely, but it is the habit of smoking and

alcohol consumption in men can lower immunity so

easily affected by pulmonary tuberculosis.

Results were consistent with reports Department

of Gender and Women's Health World Health

Organization (WHO) states that the incidence and

prevalence of tuberculosis is more common in the

male gender of women. And globally there are more

than 70% of men with positive smear compared to

women (Lestari, 2004).

The results also have shown that nearly half of

respondents had elementary education were 19

(38%) and a fraction as much as 3 college educated

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

294

respondents (6%). Similar to the study conducted

Dwipayanti (2014), that a low educational

background and the patient did not work, patients

who have a low educational background will affect

the ability of diabetic patients in the management of

information.

The level of formal education is the foundation

of someone in doing something, create a better

understanding and grasp something, or accept and

reject anything. The level of formal education also

allows the distinction of knowledge and decision-

making. Based on the research mostly non-

compliant tuberculosis treatment is a patient with

low education. This proves that indeed one's

education level will affect the person's knowledge,

such as recognizing a qualified home health and

pulmonary TB disease knowledge, so that with

enough knowledge then someone will try to have a

clean and healthy lifestyle behaviors (Pratomo,

2012).

The results of the same study proposed by Yang,

et al. (2001), which revealed that knowledge is one

of the factors daily self care support (self care

behavior), Because with knowledge enough,

someone will understand physical conditionHer and

are expected to show self care behavior good to

support the efforts in maintaining health.

The study's findings are consistent with the

results of Health Research (Riskesdas) in 2007,

which found a prevalence of pulmonary tuberculosis

is four times higher among lower education than

higher education (Rukmini, 2011). Education affects

a person in receipt of health information. Through

education, an individual can understand more about

the disease. Level of education plays an important

role in public health. The higher the education level,

the higher the ability to receive health information.

Another factors were influence is the

respondents' knowledge level of education. The

higher education, one will easily accept new things

and easily adapt to the new one (Notoatmodjo,

2012). In this study, in addition to educational

factors that can affect the majority of the

respondents' knowledge was influenced by

information received both formally and informally.

According Notoatmodjo (2012), information

influence on a person's knowledge. Even though a

person has a low level, but if you get good

information from a variety of media such as a TV,

radio, books, or newspapers and it will be able to

improve one's knowledge. Facilities for obtaining

information may help expedite a person to acquire

new knowledge. The results support the research

Nasirudin (2014), which examines the relationship

between the level of knowledge and attitude to the

behavior of the prevention of transmission of

tuberculosis (TB) with the number of respondents 27

people most of the respondents have good

knowledge of as many as 17 people (63.0%).

Individual higher education will cause the

individual has a great ability to manage information.

In addition to setting the upper middle belakanag

individual will have the ability to access the

information more widely. Information obtained

through the right patient megetahui impact it will

have if it does not do a good TB management impact

on your personal life and social impact. So that it

can improve the perception and self-care behaviors

that underlie the behavior of the management of

tuberculosis.

That means not in line with the theory of

Bandura (1997) states that older individuals tend to

have a span of time and more experience in dealing

with a matter that occurred when compared with

younger individuals, which may still be a bit of

experience and a variety of events in his life. Older

individuals will be better able to overcome the

obstacles in his life than the experience that

individuals have a long life span. But in this study

showed a younger age better perception of the

disease and its behavior.

Although tuberculosis has more experience in the

management of the disease, if not supported by an

adequate educational background eat will affect the

behavior of patients in solving problems regarding

the disease.

The results also have shown that most of the

respondents private employment of 31 people (62%)

and a small part of the work of civil servants by 1

person (2%).

This is likely due to the work environment, as

noted previously often interact with others can affect

the rate of transmission. So the risk of exposure to

the bacteria mycobacterium tuberculosis bigger

(Hartono, 2012). According to the WHO report of

2003 as much as 90% of the world's tuberculosis

patient infects socioeconomic groups with weak or

poor. The relationship between poverty and

tuberculosis are reciprocal, tuberculosis is the cause

of poverty and poverty then the man had

tuberculosis (Rukmini, 2011).

Perceptions of disease tuberculosis big sebgain

positive perception many as 27 people (54%). This

study is in line with the Dwipayanti (2014), when

patients who have a low educational background

will affect the ability of diabetic patients in the

management of information, it causes disease

Perception and Self Care Behavior of Tuberculosis Patients Based on Leventhal Theory

295

patients perceive the negative impact on bad

behavior.

The results also have shown that self-care

behaviours in patients with tuberculosis half the

respondents behaved less as many as 25 people

(50%) and a small well behaved as many as 7 people

(14%).

According to researchers the value of self-care

behavior can be influenced by education level and

occupation of individuals, these factors will affect

one's understanding of the management of

information, and to access information about their

illness. Younger clients have better cognitive

abilities of people who are older, they have an

adequate understanding of the self-treatment of

tuberculosis (self care bahvior) and the benefits of

self-care in their daily lives. This is not in line

withstatement of Orem (2001), which revealed that

the self-care behaviors will increase effective with

age and ability. Increasing age, diminishing reliance

on self-care behavior and increasingly self sufficient

in the health maintenance efforts.

In research self-care behavior (prevention of

transmission, drug adherence, and nutrition).

Nutrition is not a factor that causes the occurrence of

tuberculosis, but the status is closely related to one's

immune system. When the immune system declines

then someone will be easily contracted tuberculosis,

preferably if the immune system in good condition it

will be helpful in the healing process with a

minimum time (6 months). Increased nutrition is

highly recommended and adds to the belief of the

respondents that good nutrition can have a positive

impact on the treatment process.

Nurses play an important role in changing the

behavior of patients and families, resulting in

balance and independence in self-care activities.

Orem (1971) in Tomey & Alligood (2010), has the

view that everyone has the ability to fulfill its basic

independently. Nurses are agents who are able to

assist clients in returning their role as self care

agency. Nurses as educators and counselors can

provide assistance in the form of a supportive-

educative system, aimed at improving the ability of

the patient in performing self-care and medication

adherence. Patient compliance with TB treatment is

essential for effective transmission control.

Treatment compliance is a complex problem

involving the health care system, the process of care,

the behavior of health personnel and the quality of

its communication with the patient, the attitude of

the community, and the behavior of the patient itself

(Jakubowiak et al., 2008).

Advanced and self-care at home by families with

chronic diseases is a key to comprehensive disease

management (Egwaga et al., 2009). Self-reliance and

treatment compliance occur when individuals have

the knowledge, skills, and self-efficacy to perform

TB management behaviors and home care. The

results of Lewis and Newell's (2009) study indicate

that improving communication between healthcare

providers and patients, individual empowerment,

and patient knowledge and understanding of

treatment programs can increase TB patients' self-

efficacy in care and treatment. The results of the

Kholifah et al (2012) study concluded that the

application of the Adaptive Conservation Model can

increase the knowledge of patients with TB and

family, increase the support of families, groups and

communities in patients with pulmonary

tuberculosis, nurse support on TB Lung treatment

compliance, and improve TB treatment adherence

Lungs.

5 CONCLUSIONS

Tuberculosis can occur at any age, gender, education

level, and any work. Perception is one's judgment

against the disease, when tuberculosis patients have

a positive perception of the patient is expected to

have a good behaviour in preventing transmission,

compliance with nutrition and medication

adherence, so that the treatment of OAT in patients

with tuberculosis successfully.

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