A Description of Cadre Motivation of Community TB-HIV Care

Aisyiyah in Sukoharjo and Sragen District

Mitoriana Porusia

, Desy Aulia Abshor

Public Health Department, Universitas Muhammadiyah Surakarta

Jl. A Yani Tromol Pos no 1 Pabelan Kartasura Sukoharjo, Indonesia

Keywords: Tuberculosis Suspects, Motivation, Cadre.

Abstract: Tuberculosis is a major cause of death in most countries. Community TB-HIV Care Aisyiyah is a non-

governmental organization of Muhammadiyah in Indonesia that actively seeks TB suspects. Cadres of the

Community TB-HIV Care Aisyiyah in Sragen and Sukoharjo regencies have not been able to meet the

target of 1000 TB suspects / semester. This study aims to describe the motivation of cadres of Community

TB-HIV Care Aisyiyah Sukoharjo and Sragen and the correlation between the motivation and TB suspect

finding. This type of research was analytic observational with cross sectional approach. The object of the

study was all cadres of Community TB-HIV Care Aisyiyah in Sragen and Sukoharjo. The data were

analyzed through description and Exact Fisher test. The results showed that the cadres are likely to do the

job sincerely. However, there is correlation between opinion of attractive reward and target achievement of

TB suspect finding. Reward in the form of money tends to be a motivation to achieve the target of TB

suspect finding. Therefore, it is suggested that principal member of the community can hold regular

recitations meeting to refresh the cadre’s motivation and consider to increase the reward to appreciate the

cadres of achieving the target of TB suspect finding.

1 INTRODUCTION

Tuberculosis (TB) is an infectious disease

caused by Mycobacterium tuberculosis which

attacks various organs or tissues of the body,

especially the lungs (Widoyono, 2011). According

to WHO, the number of tuberculosis case is higher

than HIV / AIDS. In 2016, it was estimated that

there were 10.4 million new cases of tuberculosis, or

142 cases / 100,000 populations. 60% of new cases

occurred in 6 countries: India, Indonesia, China,

Nigeria, Pakistan and South Africa (WHO, Global

Tuberculosis Report, 2017). In Indonesia, the

highest rate was reported in West Java with 23,774

people, East Java with 21,606 people and Central

Java with 14,139 people (Ministry of Health, 2016).

According to Widoyono (2011), the national strategy

of TB prevention refers to the DOTS recommended

by WHO. The discovery of TB patients in this

strategy is done passively (passive case-finding).

Directly observed treatment, short-course (DOTS) is

indeed a comprehensive step to tackle TB, but this

strategy did not run optimally, as evidenced by the

government's lack of targets in the efforts to

overcome the spread of TB cases. Alternative TB

eradication program with active case finding is to

capture suspected pulmonary TB by involving the

community organizations (Wahyudi, 2010). One

community organization under the Muhammadiyah

organization that is active in TB control is

Community TB-HIV Care Aisyiyah

Based on the Principal Recipient of TB-HIV

Care Aisyiyah in 2017, Aisyiyah established a

community that participates with the government in

the efforts to eradicate TB. The community is called

Community TB-HIV Care Aisyiyah and includes

secondary and primary fund managers from the

Principal Recipient (PR). The program of this

community has been implemented in several areas;

some of them are in Central Java Province,

particularly Sukoharjo and Sragen. The cadres of the

community in both regencies found 566 TB suspects

in 2017. The number reached 26% in Boyolali

Regency, 87% in Sragen Regency, 81% in

Karanganyar Regency, 38% in Sukoharjo Regency,

Porusia, M. and Abshor, D.

A Description of Cadre Motivation of Community TB-HIV Care Aisyiyah in Sukoharjo and Sragen District.

DOI: 10.5220/0008370500200023

In Proceedings of the 1st International Conference on Social Determinants of Health (ICSDH 2018), pages 20-23

ISBN: 978-989-758-362-9

and 44% in Klaten Regency. The number has not

fulfilled the target of 1.000 suspects per semester.

In fact, the finding depends on the performance

of the cadres in the community of TB-HIV Care

Aisyiyah in accomplishing several tasks. They

include counseling, finding the suspects, and

assisting the patients with MDR TB and TB-HIV

with DOTS strategy. However, the cadres have not

reached the target of TB suspect through active case-

finding. They only provided information to the

target community when there is an event. Indeed,

they did not take the initiative to do the counseling.

As a matter of fact, the cadres should be highly

motivated, especially in accomplishing the

counseling task. According to Porusia and Iswari

(2018), the cadres of community TB-HIV Care

Aisyiyah Surakarta are likely able to find more

suspects when they receive higher reward in the

form of money. However, this result was analyzed

from secondary data. Therefore, it is important to

look for the primary data by interviewing the cadres

about their motivation to find TB suspect. This

research aimed to describe the motivation of the

community cadres of TB-HIV Care Aisyiyah

Sukoharjo and Sragen and the correlation between

the motivation and TB suspect finding.

2 MANUSCRIPT PREPARATION

This type of research is analytical research with an

observational approach and uses cross sectional

study design. This study aims to describe the

motivation of the Community TB-HIV Care cadres

of Aisyiyah in seeking TB suspects and to

acknowledge their motivation in the discovery of TB

suspects in Sukoharjo and Sragen Regency. The

study was conducted in March-June 2018. The

population of this study included the cadres of TB-

HIV Care community Aisyiyah in Sukoharjo and

Sragen Regency which worked for 1 year starting

December 2016-December 2017 and attended

relevant training. By using total sampling method,

the research took 77 respondents. The measuring

instrument used is questionnaire that contains the

reasons, motivations of each cadre, and the target of

TB suspect. Univariate analysis was employed to

describe the cadres’ motivation while bivariate test

using Exact Fisher test was used to correlate the

motivation and the target of finding TB suspect.

Ethical approval was provided by the Ethical

Research Committee of Universitas Muhammadiyah

Surakarta.

3 RESULTS

Percentage of cadre characteristic is displayed

in the chart below.

Gambar 1. Characteristic of Cadre

There were 77 respondents participated in

this research. Most of them aged between 36-55

years old (40% middle-aged adults and 90%

women). Thirty seven respondents graduated from

high school and forty seven of the total numbers

were working. Most of them have been joining this

organization for more than 15 months. All of them

admitted that finding TB suspect is a tenet of

ISLAM religion that teaches them to help others and

98% of them confessed that they do the task

sincerely. However, 75% of the respondents felt that

the task interrupts their time. Eighty two percent of

the respondents felt that the reward was not

attractive and 98% of the respondents declared that

they do this activity apart from the award. Despite

the results, the target was achieved by the majority

of cadres (60 people or 78%).

Based on the correlation test using Exact

Fisher Test, there is a correlation between the

opinion of attractive reward and target achievement

of suspect finding (p=0.031, <0.05). On the other

hand, there is no correlation between sincerity to

find suspect and target achievement of suspect

finding (p=1, >0.05).

4 DISCUSSION

Aisyiyah is a branch organization of

Muhammadiyah that empower women as its

member. Thus, the cadres of the Community TB-

HIV Care Aisyiyah are mostly women. In

Muhammadiyah organization, the members believe

that ISLAM teaches its follower to do Amar Ma’ruf

100

A Description of Cadre Motivation of Community TB-HIV Care Aisyiyah in Sukoharjo and Sragen District

Nahi Munkar which means ‘enjoining good,

forbidding wrong’. It is recited from Quran surah

Luqman (17) “O my child, set up a prayer and tell

people to do good and prevent them from doing

wrong and be patient with what happens to you.

Indeed, those include things that are required”.

Therefore, Community TB-HIV Care Aisyiyah

empowers women to find and assist the TB suspects

as an effort to control Tuberculosis disease.

As mentioned earlier, most of the respondents

aged between 36-55 years old (middle-aged adults,

40%). Almost 60% of the respondents are working.

They voluntarily take part in the community even if

they are working. Seventy five percent of them felt

that the task was interrupting their time. Those who

have been in the community for more than 15

months tend to be highly motivated because they are

fully dedicated. It is proven by the research

conducted by Ardiani (2016) that the length of

service affects motivation.

The cadres, as much as 98%, admitted that

finding the TB suspect teaches them to help others.

According to Green theory, this belief is included

into predisposing factors, derived from the field of

public health which has been in the context of L. W.

Green's PRECEDE-PROCEED model of community

health promotion planning and evaluation (Green

and Kreuter, 1999). Green's PRECEDE-PROCEED

model group divides factors into three types:

predisposing, reinforcing, and enabling factors.

"Predisposing factors" are defined as factors that

exert their effects prior to occurring behavior, by

increasing or decreasing a person or population's

motivation to undertake particular behavior.

Predisposing characteristics were seen to include

demographic factors (gender and age), behavioral

intentions, and the psychological realm which

include people's knowledge, beliefs, attitudes, self-

efficacy, values, social structure, and existing skills.

In this research, the belief that helps others by

finding TB suspect as part of ISLAM tenet is

included into predisposing factor, in that all cadres

agreed to do this job. From religious aspect, the

cadres should participate voluntarily and sincerely.

However, it was found that there is no correlation

between sincerity and target achievement of suspect

finding (p=1, >0.05).

On the other hand, 98% respondents declared

that they do the job apart of the reward and 82%

respondents stated that the reward was not attractive.

In community TB-HIV Care Aisyiyah, the cadre is

given about Rp15.000 ($1) to find one TB suspect.

Each has a responsibility to reach find around 18-20

TB suspect per semester. The target of finding TB

suspect is achieved only by 60 people (78%).

However, based on the correlation test using Exact

Fisher Test, there is a correlation between the

opinion of attractive reward and target achievement

of suspect finding (p=0.031, <0.05). Besides, there is

enabling factor that make people change their

behavior. Enabling factor includes the accessibility

of the sources and accommodations, the educational

classes, the family support, and the skills (Green and

Kreuter, 1999). The reward in the form of money is

also considered as the enabling factors. It is assumed

that the money received by the cadre is to appreciate

their work.

When the research was conducted, the cadre said

that the purpose of their participation is in

accordance with the Islamic teaching Amar Ma'ruf

Nahi Munkar. Some cadres do not expect any

rewards because from the beginning they only want

to help the government in TB eradication programs.

However, the need for rewards for cadres helps to

build their motivation. According to Djuhaeni

(2010), incentives as part of external motivational

factors were not expected by the community.

Rewards can be in the form of certificates or gift

awarded to outstanding cadres, as it will be more

memorable. A person's motivation arises when given

the opportunity and feedback from what has been

done, therefore an award is needed so that someone

feels cared and guided when making an effort. This

is in line with Malayu's study (2005), stating that

incentives are additional remuneration given to

employees and this incentive is used to support their

work. This is reinforced by the research conducted

by Megawati (2004), who said that all cadres can get

incentives of varying amounts among cadres. Even

though they do voluntary job, but cadres may expect

some incentives. According to Porusia and Iswari

(2018), if incentives increase, the number of

suspected TB findings tends to increase. Although

the predisposing factor is fulfilled, which is the

sincerity as part of religion belief, the enabling

factor should be supported as well by giving the

appropriate reward in the form of money to the

cadres.

The cadres have been trained in the beginning of

recruitment process. However, this training should

be repeated periodically to give new information

related to TB. An important component that has a

direct effect on improving performance is

knowledge (Yaslis, 2001). Notoadmodjo (2007) said

that cadre behavior which is based on knowledge is

more significant compared to those that are not

based on knowledge. In addition, Wahyudi (2010)

said that there is correlation between knowledge of

health and TB suspect discovery. Adequate

knowledge about TB is likely to boost the cadres to

ICSDH 2018 - International Conference on Social Determinants of Health

find TB suspect. Wahyudi's research (2010)

mentioned that motivation is a driving factor for

someone to act. The stronger the motivation, the

easier it is for someone to move (p value = 0.012).

Therefore, it is suggested that the principal member

of Community TB-HIV Care Aisyiyah can hold

regular meetings to refresh the cadres’ motivation

and take a consideration to increase the reward in the

form of money to persuade the cadres to achieve the

target of TB suspect finding.

5 CONCLUSIONS

The results showed that most cadres participate

in TB suspect finding because of religion and they

admitted to be sincere. However, there is a relation

between money reward and target achievement of

suspect finding (p = 0.031, <0.05). It showed that

the cadres are likely to do this job sincerely.

Nevertheless, the money reward has become the

motivation to achieve the target of TB suspect

finding. Therefore, it is suggested that principal

member of Community TB-HIV Care Aisyiyah can

hold regular meetings or recitations to refresh the

cadres’ motivation and take a consideration to

increase the reward to persuade them to achieve the

target. It is recommended that the next researchers

conduct experimental research about the

performance of the cadres who received higher

reward and regular training in achieving the target of

TB suspect finding.

ACKNOWLEDGEMENTS

The author would express their gratitude to

Allah SWT for the blessing given. The authors

sincerely thank Universitas Muhammadiyah

Surakarta that has supported this research and also to

Hatif T Zulqisthi and Rayhan Y Zulqisthi for their

love.

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A Description of Cadre Motivation of Community TB-HIV Care Aisyiyah in Sukoharjo and Sragen District