JHE 7 (2) (2022)

Journal of Health Education

http://journal.unnes.ac.id/sju/index.php/jhealthedu

Medication Adherence of Tuberculosis Patients in Yogyakarta: A Cross Sectional

Study

Liena Sofiana, Suci Musvita Ayu, Diratul Amelia, Putri Adiningsih, Umi Sa’diyah, Nawwara
Putri, Anggi Rahmatul Azizah, Aqna Aulya Safitri
Universitas Ahmad Dahlan, Indonesia

Article Info Abstract

Article History: Background: Tuberculosis (TBC) is one of the infectious diseases that is a ma-
Submitted 21 September 2022
Accepted 25 October 2022
jor health problem in the world. The disease usually affects the lungs but can
Published 30 October 2022 also affect other sites. Treatment adherence is the most important component
in achieving treatment success. Medication compliance can also be interpreted
as the extent to which the patient consumes the drug following the provisions
Keywords:
attitude; knowledge;
that have been given by the doctor. This study was conducted to determine the
medication adherence; factors associated with adherence to treatment of TBC patients in the city of
related factors; tuberculosis Yogyakarta.
Methods: This research is an analytic observational study with a cross-sectional
DOI
https://doi.org/10.15294/jhe.
approach. The population in this study included all pulmonary TBC patients in
v7i2.60607 18 health centers in Yogyakarta and still undergoing treatment, a sample of 75
people was obtained. The data was collected using questionnaires. The data were
analyzed using a chi-square test with a significance value of £0,05.
Result: The results of this study indicate that factors related to medication
adherence in tuberculosis patients are knowledge (sig=0.016) and attitude
(sig=0.039), while the factors that are not related to medication adherence are
self-efficacy (sig=1.000), motivation (sig=0.375), family support (sig=0.700),
support for health workers (sig=0.353) and stigma (sig=0.754) with adherence
to treatment of TBC patients in Yogyakarta City.
Conclusions: Knowledge is the most related risk factor for medication adher-
ence in tuberculosis patients in Yogyakarta City.


Correspondence Address: p-ISSN 2527-4252
Email : [email protected] e-ISSN 2528-2905

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INTRODUCTION treatment. So there are as many as 366 cases

Tuberculosis (TBC) is one of the that have not received complete treatment. This
infectious diseases that is a major health is one of the causes of the low success rate of
problem in the world. Tuberculosis is listed as TBC treatment in Yogyakarta City. Treatment
one of the top 10 diseases that cause death in success can be achieved if many TBC patients
the world (WHO, 2020). Globally, in 2016 there of all types successfully recover and obtain
were 10.4 million incident cases of tuberculosis, complete treatment (Dinkes Kota Yogyakarta,
equivalent to 120 cases per 100,000 population. 2021). Based on the health profile of the City
Most of these cases occurred in Southeast Asia, of Yogyakarta in 2021, the success rate of TBC
which was 45% and in Africa, 25%. Based on treatment in the City of Yogyakarta in 2020
the overall incidence of tuberculosis in the has decreased compared to 2019 from 83% to
world, there are five countries with the highest 79.38% (Dinkes Kota Yogyakarta, 2021). So this
incidence including India, Indonesia, China, figure has not reached the target of treatment
the Philippines, and Pakistan. WHO also success that has been set in the Yogyakarta City
categorizes High Burden Countries (HBC) for Regional Action Plan (RAD) for 2017-2021.
TBC based on 3 indicators, namely TBC, TB/ The low success of treatment is related to
HIV, and Multidrug-Resistant Tuberculosis the behavior of patients who are less compliant
(MDR-TB). Based on these three indicators, in taking medication. To achieve successful
Indonesia is a country that is included in the treatment, regularity or patient compliance is
high burden list (HBC) for each category. needed in taking anti-TBC drugs. Compliance
Based on this, it means that Indonesia has big with taking anti-TBC drugs can be interpreted
problems in dealing with TBC (Kemenkes RI, as adherence to taking anti-TBC drugs
2018). according to the doctor's prescription. In
The incidence of tuberculosis in addition, compliance is also very important in
Indonesia in 2018 was 316 per 100,000 healthy living behavior and one of them can
population. Meanwhile, the death rate for TBC be influenced by behavioral factors (Tukayo
patients is 40 per 100,000 population. In 2019, et al., 2020). The low success of treatment of
the number of TBC cases found was 543,874 TBC patients in the city of Yogyakarta greatly
cases. This figure decreased when compared to affects the incidence of resistance which if
all cases of tuberculosis found in 2018 which left continuously will result in Multi Drugs
were 566,623 cases. The Case Detection Rate Resistance (MDR) (Pameswari et al., 2016).
(CDR) of tuberculosis cases in 2019 increased Every patient has the right to continue
compared to the previous 10 years, was 64.5%. or stop treatment. However, there is one factor
However, this figure is still far from the CDR that influences the behavior of patients in
recommended by WHO, which is 90%. making these decisions, namely social support.
Nationally, the success rate of tuberculosis one of the efforts that can be made to improve
treatment in 2019 has reached the target set medication adherence is by providing support
in the strategic plan of the Ministry of Health, by the community, social organizations,
which is 86.6% (Kemenkes RI, 2020). and health services. With the concern and
Based on the DIY Health Office Profile willingness of the people around, it can be used
in 2020, the highest number of all Regency/ as a form of social support for TBC patients
City TBC cases in 2019 occurred in the City to be obedient in carrying out treatment
of Yogyakarta, which was 1,178 cases. Then (Kemenkes 2014).
followed by Bantul Regency with 1,075 cases, Social support for medication adherence
Kulonprogo Regency with 1,048 cases, Sleman in TBC patients can be provided by families and
Regency with 481 cases, and Gunung Kidul health workers. Family support can be realized
Regency with 319 cases (Dinkes DIY, 2020). through the provision of medical expenses,
Based on the health profile of the City of providing information related to the disease
Yogyakarta in 2021, the number of registered suffered, as well as attention is given to family
and treated TBC cases was 659 cases. Of the members who suffer from TBC (Widiastutik et
659 cases, only 293 cases received complete al., 2020). Social support can also be provided

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by health workers. Health workers have roles with the aim of research to determine factors
as communicators, motivators, facilitators, and related to adherence to treatment in patients
counselors. Overall, this role is implemented with tuberculosis. tuberculosis in the city of
in the form of counseling, providing advice, Yogyakarta.
support, motivation, and attention to TBC
patients, as well as being a drug swallow METHODS
supervisor (Pengawas Menelan Obat/PMO) for This type of research is analytic
patients who do not have PMO (Widiastutik et observational with a cross-sectional
al., 2020). approach. This research was carried out in
Factors that exist within the individual Yogyakarta covering 18 health centers in
also affect medication adherence, namely the city of Yogyakarta namely Danurejan I,
good knowledge will raise awareness of TBC Danurejan II, Gedongtengen, Gondokusuman
sufferers to take treatment (Sutarto et al., I, Gondokusuman II, Gondomanan, Jetis,
2019; Sirait et al., 2020). A positive attitude of Kotagede I, Kotagede II, Kraton, Mantrijeron,
patients will also make it easier for them to Mergangsan, Ngampilan, Pakualaman,
carry out treatment (Gendhis, 2011). High self- Tegalrejo, Umbulharjo I, Umbulharjo II, and
efficacy can make the patient aware of taking Wirobrajan. The study was conducted in March-
the medication regularly and able to survive June 2022 the population in this study were
with the habit every day (Noorratri et al., 2016; all pulmonary TBC patients at 18 Puskesmas
Sutarto et al., 2019; Novitasari, 2017). The in Yogyakarta City who was still undergoing
patient's self-motivation factor can also create treatment during the study.
enthusiasm and increase discipline to comply The sample size used in this study was
with the treatment program (Febriyanto, 2016; calculated using the cross-sectional sample
Gurning & Manoppo, 2019). size formula, with a degree of confidence of
Environmental factors also affect 5%, absolute precision of 10%, a proportion
medication adherence in patients, one of of 50% and a population size of 133. we got as
which is the stigma in the environment around many as 75 people and all samples obtained
tuberculosis sufferers, the stigma that is widely were used in the analysis of this study. The
accepted by tuberculosis sufferers is that patients sampling technique was carried out using a
are often kept away because the transmission of purposive sampling technique. The purposive
the disease is very easy and fast to others, the sampling technique is a technique with a
impact of this environmental stigma makes subjective sample selection of respondents
Tuberculosis sufferers experience self-stigma who have information and meet the criteria
in the form of lack of confidence, shame, fear determined by the researcher. Determination
and stress on the surrounding environment and of respondents in this study using inclusion
do not want to meet people, this will then have and exclusion criteria. The inclusion criteria
an impact on the treatment process. Stigma in used were pulmonary tuberculosis patients
society must be removed so that tuberculosis who were still undergoing treatment at the
sufferers no longer feel ashamed of taking time of data collection, domiciled in the
treatment, if the stigma in the environment city of Yogyakarta at the time of the study,
changes, the patient will be consistent in his namely at least 6 months and ≥ 15 years of
treatment (Rizqiya, 2021). Environmental age, while the exclusion criteria were patients
stigma is related to medication adherence in who were not willing to become respondents,
tuberculosis patients (Muhardiani & Mardjan, had comorbidities based on medical records.
2017). Based on the problems found from the such as HIV/AIDS, diabetes mellitus, drug
results of previous studies and the decrease in resistance and hearing and vision impairments.
the success rate of tuberculosis treatment in Information about comorbidities suffered by
the city of Yogyakarta so that it has not met the tuberculosis patients was obtained from the
national target, the authors want to examine holder of the tuberculosis program by looking
the analysis of adherence to treatment for at medical record data. All respondent data in
tuberculosis patients in the city of Yogyakarta this study was kept confidential, referring to the

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ethical protocol issued by the Ahmad Dahlan (0.761), motivation ( 0.875), stigma (0.964).
University Ethics Commission (Number: The data obtained were then processed and
012203022) analyzed bivariate using the chi-square test and
Collecting data in this study using a multivariate analysis using logistic regression
questionnaire that has been tested for validity to determine the association between research
and reliability. The process of collecting data in variables. The level of confidence used in this
this study was assisted by six skilled and trained test is 95% (α = 0.05).
enumerators, and during data collection,
briefings were carried out and monitoring RESULTS AND DISCUSSIONS
of the completeness of the data. Cronbach's The results of the analysis between family
alpha scores from each questionnaire were as support variables and treatment adherence of
follows: medication adherence (0.773), family TBC patients in Yogyakarta are obtained the
support (0.752), health worker support (0.780), results in table 1 below:
knowledge (0.719), attitude (0.904), self-efficacy
Table 1. The association between knowledge, attitudes, self-efficacy, motivation, family support,
support from health workers, and environmental stigma and adherence to treatment of tuberculosis
patients in Yogyakarta City
Medication Adherence
Total RP
Variable Not Obey Obey Sig
(CI 95%)
n % n % n %
Knowledge
Negative 12 52.2 11 65.4 23 100.0 0.016 2.466
Positive 11 21.2 41 79.3 52 100.0 (1.282-4.746)
Attitude
Negative 7 58.3 5 41.7 12 100.0 0.039 2.450
Positive 15 23.8 47 76.2 63 100.0 (1.278-4.698)
Self-Efficacy
Low 11 31.4 24 68.6 35 100.0 1.000 1.048
High 12 30.0 28 70.0 40 100.0 (0.530-2.070)
Motivation
Low 13 37.1 22 62.9 35 100.0 0.375 1.486
High 10 25.0 30 75.0 40 100.0 (0.746-2.957)
Family Support
Poor 12 34.3 23 65.7 35 100.0 0.700 1,247
Good 11 27.5 29 72.5 40 100.0 (0.631-2.463)
Health Personnel Sup-
port 6 22.2 21 77.8 27 100.0 0.353 0.627
Poor 17 35.4 31 64.6 48 100.0 (0.281-1.400)
Good
Stigma
Yes 9 27.3 24 72.7 33 100.0 0.754 0.818
No 14 33.3 28 66.7 42 100.0 (0.405-1.652)

Table 2. Result of multivariate logistic regression analysis

CI 95%
Variable Koefisien S.E Wald df Sig OR
Min Max
Knowledge 1.330 0.566 5.529 1 0.019* 3.783 1.248 11.468
Attitude 1.173 0.696 2.838 1 0.092 3.232 0.826 12.652

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Knowledge about tuberculosis with adher- higher education when experiencing illness will
ence to treatment of tuberculosis patients increasingly need health facilities for treatment.
The results of the chi-square test that The more individuals have a higher level of
tested the association between knowledge education, the more they will realize that
about tuberculosis and adherence to health is an important thing in life so they are
tuberculosis treatment were obtained (sig= motivated to take medication adherence (Absor
0.016 and Prevalence Ratio= 2.466). Based on et al., 2020).
multivariate analysis using logistic regression, Another factor that has an association
knowledge is also the most related factor with between knowledge and medication adherence
medication adherence among other variables is age. The results of the analysis of the
with a value of sig= 0.019 and an Odds Ratio characteristics of the respondents obtained that
of 3.783 (95% CI: 1.248-11,468). These results 85.3% have a productive age, at this productive
indicate that statistically there is an association age someone has good knowledge because they
between knowledge and medication adherence. can find their information about the disease
These results indicate that statistically there they are suffering from. productive a person's
is an association between knowledge and age is, the better the knowledge they have and
medication adherence. This study is the the older a person is, the more mature they are
same as the research conducted by Utisman in thinking (Anita et al., 2018).
(2021) which shows that there is a significant
association between knowledge and adherence Attitudes about tuberculosis with adherence
to the treatment of tuberculosis patients. to treatment of tuberculosis patients
Knowledge relates to adherence to The results of statistical tests using the
treatment of tuberculosis sufferers because based chi-square test which tested the association
on the observations of researchers conducting between attitudes and adherence to tuberculosis
research in the field directly, it shows that most treatment obtained sig= 0.039 and the
respondents already have good knowledge Prevalence Ratio= 2.450 (95% CI: 1.278-4.698).
about tuberculosis, tuberculosis sufferers have These results indicate that there is a statistically
a good understanding of the disease they are significant association between attitude and
suffering from, this is supported by previous medication adherence.
research which states that if tuberculosis Attitudes are related to adherence to
sufferers believe in themselves to understand treatment of tuberculosis sufferers because
and apply knowledge well then this will affect based on the observations of researchers
the level of knowledge of a patient (Mientarini conducting research in the field directly, it
et al., 2018). Knowledge is important and needs shows that most of the respondents have positive
attention to live a better life. With knowledge, attitudes about tuberculosis such as a conscious
tuberculosis sufferers understand the disease attitude in carrying out routine treatment, an
they are suffering from so it is hoped that attitude that always takes their medicine. Have
knowledge about tuberculosis can increase good knowledge so that in taking a stand for
their adherence to treatment (Notoadmodjo, the illness he is suffering from is also good.
2012). respondents who have a positive attitude will be
One of the factors causing the association obedient in their treatment (Mientarini et al.,
can also be caused by the education of the 2018). respondents who have a positive attitude
respondent. The results of the analysis of the are in the compliance and identification stage.
characteristics of the respondents showed The compliance stage is the stage where an
that 49.3% had a high education, when individual obeys the suggestion without any
analyzed more deeply, patients who had higher self-awareness and obeys this recommendation
education had good knowledge that influenced for fear of the sanctions that will be obtained
the patient's understanding of tuberculosis. and the identification stage is the stage where
Education is an individual or community- an individual will obey something because
planned effort to be able to do what is taught they feel interested or admire a character so
by educational behavior, someone who has they want to imitate the character's actions

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(Alhamda, 2015). from both family and health workers so that

Attitude has an association with patients had a fear of not taking OAT. The role
medication adherence and is also caused by of health workers is very important in growing
other factors, namely family support, in this self-efficacy (Sutarto et al., 2019).
study family support owned by respondents had The results of the study also found that
good family support. An individual suffering some patients had high self-efficacy and were
from tuberculosis requires attention and obedient in treatment. Self-efficacy in social
affection during treatment so that tuberculosis cognitive theory is known to be the most
sufferers achieve success in treatment. The role dominant and significant determinant in
of the family is very important for tuberculosis increasing compliance (Holmes et al., 2014).
sufferers because it is able to provide enthusiasm Someone with a high level of self-efficacy will
and motivation to patients in their treatment have the confidence to recover. The high self-
(Marini et al., 2021). efficacy of tuberculosis sufferers will make
Attitude has an important role in the them aware of taking the medication regularly
treatment process, a positive attitude that and be able to survive with these habits every
a person has towards his illness will lead to day (Noorratri et al., 2016). High self-efficacy
positive behavior and actions as well so it is can foster self-confidence in responding to
hoped that this positive attitude will lead a something in getting help. Conversely, if self-
person to complete his treatment (Mientarini efficacy is low, a person will be anxious and
et al., 2018). Attitude is a reaction of a person unable to do so (Yusuf & Nurihsan, 2011).
close to a particular object, this reaction Self-efficacy encourages a person to behave in a
involves an opinion and emotion that will be healthy manner, someone who is not confident
used in response. Attitudes have several main in his ability to behave in a manner that supports
components, namely the first beliefs, ideas and health will tend to be lazy to try (Friedman &
concepts, the second emotional life and the Schustack, 2008 dalam Arzit et al., 2021).
third tendency to act (Notoadmodjo, 2012). Motivation with adherence to treatment of
Self-efficacy with adherence to treatment of tuberculosis patients
tuberculosis patients The results of statistical analysis showed
The results of the analysis obtained sig= that motivation did not have a significant
1,000 indicating that self-efficacy does not association with treatment adherence of
have a significant association with treatment tuberculosis patients in the city of Yogyakarta
adherence of tuberculosis patients in Yogyakarta and not necessarily people who have low
City with a Prevalence Ratio of 1.048 (95% CI: motivation will be at risk for non-adherence
0.530-2.070) indicating that people who have to treatment (sig= 0.375; Prevalence Ratio=
low self-efficacy are not necessarily at risk for 1.486; 95% CI: 0.746-2.957 ). Based on the
not adhering to treatment. The results of this observations of researchers in the field,
study are in line with previous studies that self- the possibility that there is no association
efficacy is not related to adherence to taking between motivation and medication adherence
advanced OAT in patients with pulmonary is influenced by the respondent's lack of
tuberculosis at Candi Lama Health Center knowledge about tuberculosis. In generating
(Suryani et al., 2021). motivation in a person, it is necessary to have
Based on the observations of researchers good knowledge of the intended object. The
in the field, it is known that there are some higher the knowledge a person has, the higher
respondents who feel the side effects of drugs self-awareness of health and motivation to
are unpleasant and disturbing so sometimes it recover (Sirait et al., 2020).
makes them feel that taking medicine makes Respondents' knowledge can be obtained
them sicker as a result they feel lazy to take from education, experience, health counseling,
medicine. The results of the study showed and information from health workers
that tuberculosis patients had low self-efficacy (Rahmiyanti et al., 2019). The higher a person's
but were obedient in treatment, it could be level of education, the easier it will be to
influenced by awareness and social support receive information as a result, the knowledge

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gained will be more and more (Atu et al., was no association between family support and
2017). In addition, it is known that some of the medication adherence in tuberculosis patients
respondents have started to feel bored and lazy in the city of Yogyakarta. The Prevalence Ratio
to take medicine because the treatment time value is 1.247 (95% CI = 0.631-2.463) which
is long and the medicine consumed is quite a means that family support is not necessarily
lot and has a bitter taste. This is supported by a risk factor for treatment adherence in TBC
the presence of 26 respondents who answered patients in the city of Yogyakarta. There is
"agree" and 4 respondents who answered no association between family support and
"strongly agree" on the statement item "Taking treatment adherence in TBC patients because
medicine continuously for a long time makes family support is not a strong reason for
me feel bored and lazy to take medicine". respondents to fully comply or not comply with
The longer the treatment time for treatment. The low adherence to treatment in
pulmonary tuberculosis, the less adherent to TBC patients is caused by other factors from TBC
treatment, and fewer patients with pulmonary patients that affect their treatment adherence.
tuberculosis who were recorded to be One of these factors is the inadvertence of TBC
compliant with treatment until completion. patients who delay taking medication so that
The length of time for pulmonary tuberculosis they eventually forget. This can be seen in the
treatment which takes 6 months makes people medication adherence instrument, especially in
with pulmonary tuberculosis feel bored to take the aspect of timeliness in taking medication,
drugs (Gunawan et al., 2017). Patients stopping there were still 21 TBC patients who answered
taking medication can be caused by several that they forgot to take their medication.
things, including the emergence of boredom Age is one of the factors that influence
due to a long treatment time, feeling healthy medication adherence in pulmonary
after receiving treatment for some time and tuberculosis patients. Based on the data
then cutting off treatment, lack of awareness obtained, most of the respondents fall into the
of the patient due to lack of knowledge about category of productive age. the number of the
pulmonary tuberculosis, distance from the productive age population is also higher than
patient's home to the place of service. distant the non-productive age population (BPS Kota
health (Yulisetyaningrum et al., 2019). Yogyakarta, 2022). In addition, the number of
The results of this study are in line with working population based on age also shows
previous studies that motivation is not related that most of the respondents who work are
to adherence to taking tuberculosis medication aged 15 years and over or are in productive age.
(Fitriani et al., 2019; Muna & Soleha, 2014). Productive age is an age with a period of high
Meanwhile, several other studies have stated activity and is exposed to the environment so
that motivation is related to medication that the intensity of meeting with other people
adherence (Angraini & Nofia, 2022; Alwi et is also getting bigger (Ulfah et al., 2018). age
al., 2021). The existence of differences in the a person has a high level of mobility and is
results of research from several researchers more concerned with activity than the disease
may be influenced by several factors that (Lasutri et al., 2021).Age was a determining
affect motivation. Several factors influence factor for patients' non-adherence to treatment.
motivation, which include internal factors and In old age, a person's medication adherence
external factors. Internal factors include the is higher because he is not busy with work so
desire from within the individual, individual he can seek treatment regularly (Budianto &
knowledge, education level, and age. While Inggri, 2015).
external factors include economic factors, Another factor that can affect the
religion, family support factors and nurses compliance of pulmonary TBC patients in
(Gurning & Manoppo, 2019). treatment is work status. Based on the data
Family support with adherence to treatment obtained, most of the pulmonary tuberculosis
of tuberculosis patients patients in the city of Yogyakarta are self-
The results of the analysis obtained a value employed. Entrepreneurship is one type of work
of sig= 0.700, meaning that statistically there that is mostly done outdoors. The type of work

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a person does affects his treatment adherence. provided by health workers about the possible
If workers work in a dusty environment, side effects of OAT. This is evidenced by the
exposure to particles will affect the occurrence respondent's answers to the health worker
of disorders of the respiratory tract. Exposure to support instrument regarding the side effects of
polluted air can increase morbidity, especially OAT. Based on this instrument, 9 respondents
the occurrence of symptoms of respiratory tract answered that health workers never explained
diseases and generally pulmonary tuberculosis the possibility of side effects of OAT. Inadequate
(Ulfah et al., 2018). Respondents who did information by patients makes it clear that
not work tended 4,736 times to comply with the failure of communication between health
pulmonary TBC treatment compared to workers and patients will have an impact on
respondents who worked. This is because when the form of compliance. This can be seen
a person works his time will decrease and the from the results of the analysis that 24 of 75
possibility to pay attention to his environment respondents stated that they had not received
tends to decrease (Lasutri et al., 2021). support in the aspect of good communication
The absence of an association between from health workers. Based on the results of
family support and medication adherence in interviews, respondents stated that there is
TBC patients in the city of Yogyakarta does still a lack of interpersonal communication
not mean that the effect of family support on between health workers and patients (Ulfah et
treatment adherence of TBC patients is not al., 2018). Interpersonal communication is very
considered. Family support must still be given important in establishing mutual trust between
so that TBC patients are more obedient in officers and patients
their treatment. family support is related to The role of health workers is not related
the compliance of tuberculosis patients. Good to drug adherence in pulmonary tuberculosis
social relations between family members have patients. The low adherence to treatment in
a significant effect on patient health outcomes, pulmonary TBC patients occurs due to less
especially for patients who are in the adaptation open communication between health workers
stage and the disease recovery process. The and TBC patients. The quality of interaction
family providing support can be in the form between TBC patients and health workers
of informational, instrumental, emotional, and is a determinant of the success of treatment
reward support (Putra, 2019) (Herawati et al., (Widiastutik et al., 2020). TBC patients who
2020). misunderstand the recommendations given by
Support of health workers with adherence to health workers cause patients to not comply
treatment of tuberculosis patients with their treatment (Sugiono, 2017).
The results of statistical analysis showed A health worker is someone who
that there was no association between the understands more about health, both regarding
support of health workers and adherence to the disease and the treatment of the disease.
medication for TBC patients in the city of Therefore, the absence of an association
Yogyakarta (sig= 0.353) with a Prevalence between the support of health workers and
Ratio value of 0.627 (95% CI= 0.281-1.400) adherence to the treatment of TBC patients in
which means that the support of health workers the city of Yogyakarta does not mean that the
is not necessarily a factor. risk of adherence support of health workers is not needed. the
to treatment of TBC patients in the city of role of health workers and family support in
Yogyakarta. This is because many other factors the level of adherence to taking medication in
affect the adherence to treatment of TBC pulmonary TBC patients, shows that there is an
patients. Other factors referred to can come association between the role of health workers
from the patient himself, such as a feeling of and the level of adherence to taking drugs for
fear with the long-term impact of taking anti- pulmonary TBC with a positive smear (Netty
TBC drugs regularly. So TBC patients choose et al., 2018).
to stop taking drugs that have been given Stigma with adherence to treatment of tuber-
by doctors or health workers. This feeling of culosis patients
fear can be caused by the lack of information The results of statistical tests using the

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chi-square test which tested the association environment and even those closest to them,
between stigma and adherence to tuberculosis with this condition many tuberculosis sufferers
treatment show a sig value= 0.754 and a do not want to seek treatment and even find
Prevalence Ratio= 0.818 (95% CI: 0.405- it difficult to make decisions for the disease
1.652). These results indicate that there is no they suffer. tuberculosis that has a stigma in
statistically significant association between the environment that is not compliant with
knowledge and medication adherence. Based treatment (Sari, 2018).
on the observations of researchers conducting
research in the field, some people with CONCLUSION
tuberculosis have a stigma in their environment Based on the results of research and
but sufferers do not care about the stigma that discussion that the most related factor to TB
society gives them because patients have the treatment adherence is knowledge. Tuberculosis
confidence to recover and have support from program staff are expected to continue to
their families so that the existing stigma does provide counseling to patients and their families
not reduce the patient's confidence in taking who are undergoing treatment. The counseling
treatment. It is until they healed. Another factor provided is related to the causes, transmission,
is also because of high education, in this study prevention, and treatment of TB disease as well
the respondents had a level of education, and the as counseling to TB patients to establish good
higher the education, the better the knowledge communication between health workers and
and attitudes possessed by tuberculosis sufferers TB patients. This outreach, it is hoped that it
which made the awareness to recover greater so will increase the adherence of TB patients to
that the stigma that existed in the environment treatment. The patient's family is expected to
did not affect compliance in treatment. continue to provide support to members who
Confidence in patients is very important in the are undergoing TB treatment to always comply
healing process for people with tuberculosis with their treatment by providing emotional,
and the stigma of society is influenced by one's instrumental, informational, and rewarding
education because education is one way to support.
increase one's knowledge (Astuti et al., 2019).
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