RELATED SOCIAL SUPPORT QUALITY OF LIFE IN PATIENTS WITH PULMONARY
TUBERCULOSIS (TB LUNG) IN LUNG DISEASE TREATMENT CENTER (BP4)
YOGYAKARTA UNIT Minggiran
Nita Yunianti Ratnasari
AKPER Giri Satria Husada Winton
INTRODUCTION
background
Tuberculosis (TB) is a chronic
disease that lung is still a public health problem in the world, including Indonesia. The WHO states that TB has now become a global threat. An estimated 1.9 billion people, or one third of the world's population infected with the disease occurs ini.Setiap year approximately 9 million new cases Tbdengan death of 3 million people. In developing countries deaths accounted for 25% of the cases, which could be prevented in connection with the discovery of the bacteria that causes TB has. Death is generally caused due to the detection of cases and failure pengobatan.Data Tuberculosis Eradication Program (P2 TB) in Indonesia showed an increase in cases from year to year. Mitigation and prevention efforts that have attempted still have not managed to solve the problem that there is a reduction in morbidity and mortality. Problem encountered is the difficulty of pulmonary tuberculosis case detection of smear (+), disorder treatment and drop out of treatment. Untreated TB cases will continue to be a source of transmission.
Humans as social beings can not
live alone without the help of others. Physical needs (food, clothing, shelter), social needs (interaction, recognition and psychological needs including curiosity, a sense of security, a feeling of religiosity), may not be fulfilled without the help of others. Especially if the person is facing the problem either mild or severe. At that point someone will seek social support from the people around him, so that he feels valued, cared for and loved.
So it is with people with chronic
diseases such as pulmonary TB should receive more social support, because with the support of these people can indirectly lower the psychological burden with respect to the disease which in turn will increase the body's resistance to physical condition is not
declining. Social support is important for
chronic illness because of social support can affect the behavior of individuals, such as decreased anxiety, helplessness and despair, which in turn can improve health status. Increased health status means it will improve the quality of life of patients. Family and community support has a big hand in improving treatment adherence, with supervision and encouragement to patients. Supervisory role Drink Drugs
(PMO) can be derived from health
workers, the public or the patient's family.
Quality of life is one of the main
criteria to determine the health care interventions such as morbidity, mortality, fertility, and disability. In developing countries in recent decades the incidence of chronic disease began to replace the dominance of infectious diseases in the community. Some people may live longer, but to carry the burden of chronic disease or disability, so the quality of life to the attention of health care. The phenomenon in today's society is still a family member who fear especially close to someone suspected of suffering from pulmonary tuberculosis, making it appear cautious attitude in excess, for example alienate people, reluctant to speak to, if close to the patient will soon cover the nose and so on. It will be very offensive to people. Patients will be depressed and feel isolated, so it can have an impact on the psychological condition and will ultimately affect the success of treatment. This means that social support is needed not gotten optimally.
Based on the consideration that
social support can improve the health status of the patient as well as the importance of attention to the quality of life of patients with chronic diseases, the researchers were interested in assessing both. Medical Center Pulmonary Disease (BP4) was chosen as the research data retrieval because besides being a potential treatment for pulmonary tuberculosis patients, BP4 as well as the right place to develop a variety of research related to the treatment of the disease. BP4 Minggiran unit is the administrative center and the discovery rate of new cases of pulmonary tuberculosis patients in the highest BP4 compared BP4 other units in Yogyakarta. In the period January to December 2003,
by 48%, patients with pulmonary TB
smear (+) recently discovered in Minggiran.
The purpose of this study was to
determine the relationship between social support and quality of life of patients with pulmonary tuberculosis, pulmonary tuberculosis patients characteristics, the amount of social support and the level of quality of life of patients with pulmonary tuberculosis treatment in Yogyakarta BP4 Minggiran Unit as well as the contribution of the characteristics of respondents to the quality of life of patients with pulmonary tuberculosis .
RESEARCH METHODS
This research is a quantitative nonexperimental descriptive method with
cross-sectional study design. The total sample size of 50 patients with pulmonary tuberculosis treatment in BP4 Minggiran Units that meet the specified criteria, namely: medical diagnosis of pulmonary TB smear (+), has gone through an intensive phase treatment program at least 2 months with OAT Category I, patients of childbearing age is between 15-55 years old, able to read and write. Data taken with the questionnaires by respondents from February to April 2004.Data analyzed descriptively to determine the relationship between social support and quality of life in patients with pulmonary tuberculosis by using correlation analysis test, Pearson Product Moment.
RESULTS AND DISCUSSION
1. Research
Pulmonary tuberculosis patients
who were respondents in this study were patients of childbearing age, the average age of 21-30 years as many as 26 people (52%). Age 31-40 years and 41-50 years of age respectively 8 (16%) and 7 (14%). The number of male patients and balanced women, men 27 people (54%), 23 women (46%). Education of respondents were 23 people (46%) graduated from high school, 14 people (28%) graduated from junior high school, while respondents with low education (no school, did not graduate or complete primary school each 3 people (6%). Job 14 student respondents (28%), did not work and labor of each 8 people (16%). History of treatment as many as 33 people (66%) of respondents said never seek treatment earlier
except in BP4, whereas 17 (34%) said that
they had to undergo another treatment before in BP4 Minggiran.
2. Social Support
The total score is the sum of the
social support and satisfaction of respondents giving support on the social support. A total of 18 people (36%) received social support with high category. For medium and low categories respectively by 22 people (44%) and 10 men (20%). Social support received by the patient is generally obtained from family, relatives and neighbors.
3. Quality of Life
Assessment of quality of life
includes 5 aspects: the level of activity, daily life, health, social support and hope. A total of 34 people (68%) can be normal activities, 14 people (28%) in the move need the help of others and 2 (4%) stated are not able to move. A total of 40 people (80%) able to perform daily life normally, 9 people (18%) in the conduct of life need the help of others, and 1 (2%) stated are not able to live a daily life at all. A total of 25 people (50%) felt well on most of the time, 21 people (42%) stated often feel lethargic, and 4 (8%) stated that the body is always a pain. Most of pulmonary tuberculosis patients received strong support from family and friends with 43 people (86%), patients who received limited support from the family as much as 6 people (12%) and only one (2%) stated rarely have the support of people around . A total of 40 people (80%) had positive expectations and can adapt to the circumstances surrounding environment. There are 9 people (18%) felt sad and only 1 (2%) really confused, very scared and anxious. Broadly speaking, as many as 34 people (68%) have a good quality of life, quality of life categories were 30% and only 1 respondent (2%) with the quality of life ugly.
4. Relationship Between Social Support
with the Quality of Life
From the analysis of the test
MomentPearson korelasiProduct obtained relationship between social support and quality of life in patients with pulmonary tuberculosis with r equal to 0.675; p <0.01. May imply that there is a significant relationship between social support and quality of life, which means the higher the social support received, the quality of life is also increasing. Interpretation of the strength of the relationship, including the high category.
Relationship Between Characteristics of
Respondents with Quality of Life
The results of the analysis with
Pearson correlation between respondent characteristics (age, gender, level of education, employment and medical history) with the quality of life of patients with pulmonary tuberculosis. Obtained results of the analysis: the variable age (r = 0.468; p <0.05), gender (r = 0.077; p = 0.593), education (r = 0.420; p <0.05), employment (r = 0.141; p = 0.330), history of treatment (r = 0.017; p = 0.906). From this analysis it is known that age and education variables have a correlation coefficient values were, respectively (r = 0.468 and r = 0.420), with a significance level of p <0.05. It showed no significant relationship between age and education with quality of life. While other variables: gender, occupation and medical history showed no significant correlation with quality of life.
The results of multiple regression
analysis between the characteristics of the respondents to the quality of life of patients with pulmonary tuberculosis, derived variables age ( = 0.519; p <0.05) and education ( = 0.378; p <0.05) contributed significantly to the quality of life. Other variables: gender ( = 0.260; p = 0.753), work ( = -0.155; p = 0.260) and treatment history ( = - 6.25; p = 0.417) did not contribute to the quality of life of patients with pulmonary tuberculosis .
DISCUSSION
The frequency of pulmonary tuberculosis
patients who undergo outpatient treatment program in Yogyakarta BP4 Minggiran
Unit majority are of childbearing age,
between 21-30 years, by 52%. The highest incidence of pulmonary TB usually affects young adults, between 15-44 years old. Approximately 95% of patients with pulmonary tuberculosis in developing countries, where 75% of whom are of childbearing age.
The number of male patients is
higher than women, amounting to 54%. This is consistent with the results of research on display radiological abnormalities in adults who stated that the men had kecenderunganlebih vulnerable to the risk factors of pulmonary tuberculosis. This is possible because men are doing more activities so that more often exposed to the cause of this disease.
Education is the most respondents
completed high school by 46%. It is assumed that people with higher education will be aware about healthy behaviors and treatment of disease. However, the results of this study indicate that the higher education yet
The individual would have a better
awareness of the disease than those who are less educated. This is in contrast with the results of case study research results of pulmonary tuberculosis treatment in 10 health centers in Jakarta from 1996 to 1999 which states that the low level of education will lead to a lack of knowledge in terms of hygiene and environmental health are reflected in the behavior of the majority of patients who still throw sputum and spit anywhere.
Most respondents as student jobs by 28%.
From interviews with the status of the
respondents found that most students come
from outside the area so they should outhouse. Living in dense residential neighborhood (like kos) effect on pulmonary TB transmission. This is consistent with the statement mengenaibeberapa thing to note in connection with the transmission of TB is related housing overcrowding or poor working conditions. Residential density negative effects on physical health, mental and social. Home or room that is too overcrowded to be deprived of O2 resulting in a lowering durability and facilitates the spread of disease.
History of treatment showed that
66% of patients had never previously sought treatment except in the BP4. Respondents had previously been undergoing treatment outside BP4 ultimately prefer to be treated in such institutions with cost considerations cheaper and affordable. It is closely related to patient compliance in completing the treatment program is for 6 months. Pulmonary TB treatment success rate is strongly influenced by patient adherence to treatment regimens given. Ministry of Health has established a policy with gratissehingga treatment delivery is expected to be an incentive for people that regularly treated in accordance with the schedule to achieve healing. But in practice many patients who do not diligently completed treatment.
Social support measurement results
obtained in this study 44% of all respondents receive social support moderate. This means that patients with pulmonary TB who were respondents in this study is quite get social support from people around the patient. Social support is important for people with chronic illness, because with such support will influence
the behavior of an individual, such as a
decrease in taste
9 Journal of Tuberculosis Indonesia, vol.8
anxiety, feelings of helplessness and
despair that can ultimately improve the health status of the patient.
Quality of life of patients with
pulmonary tuberculosis in BP4 Yogyakarta outpatient related activity on a relatively well last week. A total of 34 people (68%) patients stated that they can work or study with normal. Conversely, patients who declared unable to work or study in any circumstances by 4%. Pulmonary tuberculosis is a chronic inflammation. Symptoms common malaise (anorexia, decreased appetite, weight loss, headache, chills, muscle pain, and night sweats) and can reduce labor productivity patients.
Quality of life of patients with
pulmonary tuberculosis in BP4 Yogyakarta outpatient related daily life in the last week is a good one. By 80% of respondents said they can eat, wash, dress himself, taking public transportation without the help of others. The ability to perform daily activities, such as taking care of yourself as well as social functioning is one component in the quality of life related to functional capacity.
Quality of life of patients with
pulmonary tuberculosis in BP4 outpatient health related Yogyakarta on last week was a good one. A total of 25 people (50%) of respondents feel well on most of the time. Patients who feel unwell as much as 4 people (8%) is caused by chest pain, cough settled and feel tired. Cough with phlegm, chest wall pain, weight loss, fever and sweating, loss of appetite, shortness of breath and frequent colds.
Quality of life of patients with
pulmonary TB outpatient in Yogyakarta BP4 associated with support from family and friends was obtained by 43 people (86%) claimed to have good relationships with others and the powerful support of the members of the family or friends. Patients who lack the support of family and friends is mainly due to her illness. They have realized that it is easy to infectious pulmonary TB, so most feel better reduce contact with others. There is also where people around the patient intentionally limit contact with the patient, for fear of contracting. Conversely, strong support in patients mainly from the family would greatly help the healing process of pulmonary tuberculosis disease. For example related to medication adherence, which lasted for 6 months. Family and community support has a big hand in improving treatment adherence, with supervision in taking medicine and related support to the patient.
The life expectancy of patients
with pulmonary tuberculosis in BP4 outpatient quite good. A total of 40 people (80%) patients had positive expectations and be able to adjust to the circumstances surrounding environment. Most respondents have positive expectations have been convinced that despite the
relatively heavy but pulmonary TB disease
can be cured, provided that comply with treatment regimens that have been set. The existence of the PMO is someone who is trusted both by patients themselves or by the health workers, who will participate in supervising the patient to drink throughout the medicine is expected to greatly help people to behave so as to support the healing process.
In this research note that there is a
significant relationship between social support and quality of life (r = 0.675; p <0.01). Direction positive correlation indicates that the greater social support, the quality of life will increase. These results are consistent with the theory about the influence of social support, one of which is the indirect influence that social support can affect the stress faced by the individual, the social acceptance that can affect self-esteem. Self esteem will affect the mental health of a person.
The results of multiple regression
analysis between age and quality of life obtained a value of ( = 0.519; p <0.05). This means that age contributes significantly to the quality of life of patients with pulmonary tuberculosis. In general quality of life declines with increasing age.
In this research note sexes does not
contribute to the quality of life with the value ( = 0.260; p = 0.735). This is consistent with the results of research on Quality of Life of Patients with Terminal Renal Failure Undergoing Hemodialysis Kronikdi The dr. Sardjito which states that gender did not affect the quality of life of patients with terminal renal failure (GGT) undergoing chronic hemodialysis. It added that men have a worse quality of life than women.
The level of education contributes
significantly to the quality of life ( = 0.378; p <0.05). This is according to a statement that the level of education will affect the attitude of caring for themselves. The higher the level of education will be further spur towards progress, so expect these attitudes also affect health care. The results of multiple regression analysis between job with the quality of life gained ( = -0.155; p = 0.260). Means that the work does not contribute to the quality of life of patients with pulmonary tuberculosis. This is possible because the type of work the respondents in this study were taken only descriptively. More 50% of respondents are students and the rest were subdivided into 6 categories other kind of work, so that kind of work in this study can not be said to represent the profession. In this research note that there is no relationship between a history of treatment with the quality of life of patients with
pulmonary tuberculosis, a score ( = -6.25,
p = 0.417). History of treatment in this study related to patient adherence to treatment, with respect to the free treatment program of the government in the hope to reduce the number of drop out of treatment as low as possible.
CONCLUSION
There is a significant relationship
between social support and quality of life of patients with pulmonary tuberculosis. The higher the social support, the higher the quality of life. Age and education variables contributed significantly to the quality of life. Other variables, namely gender, occupation and medical history did not contribute to the quality of life of patients with pulmonary tuberculosis.