Study of Counseling on Knowledge, Attitude and Behavior of Drug

Supervisor (PMO) of Tuberkolosis Patient

Ade Irwansyah1, dr. H.Adenan, M.Kes2 dan Lenie Marlinae, SKM, MKL3
1
Student of Public Health Magister Program, 2Health Policy Management and Promotion Department,
3
Environmental Health Department Medical Faculty, Lambung Mangkurat University Indonesia
Correspondence : irwansyahade414@gmail.com

ABSTRACT

Tuberculosis (TB) is a contagious disease directly caused by tuberculosis

(mycobacterium tuberculosis). The three countries with the highest incidence of 9.8 million
cases of world TB are India (23%), Indonesia (10%) and China (10%) (WHO, 2014). The
Government of Indonesia through the National Control Program of TB has made various
efforts to tackle TB, with the strategy of Directly Observed Treatment Shortcourse (DOTS).
In order to support DOTS strategy, to reduce the number of cases and understanding of
PMO in doing supervision of taking medication in child tuberculosis patient, counseling
done by pharmacist at PMO of child tuberculosis patient. Giving counseling and information
to patients is very useful to improve patient knowledge. Knowledge is a predisposing factor
that affects attitudes and behavior according to Green Theory. Subsequent behavior becomes
one of the factors that play a role in influencing health status or healing based on H.L
Theory. Blum. Nutritional status is a measure of a person's body condition which can be seen
from the Anthropometric Index and is the ratio of one measurement to one or more
measurements or related to age and nutrient levels. This study aims to see the influence of
counseling on the level of knowledge, attitudes and behavior of PMO Patient TB Children, as
well as the nutritional status of TB children. This study uses 34 respondents who are PMO
TB Patients Children, which is divided into 2 groups of 17 people given counseling and 17
people not given counseling. The result of the research shows the value of sig. <0.05 based
on the Wilcoxon test test for the analysis of differences in effect on the level of knowledge,
attitude and behavior before and after counseling. The conclusion of this study is that there
are significant differences in influence on the level of knowledge, attitude and behavior
before and after counseling. And there are significant differences in the nutritional status of
children with TB before and after counseling.

Keywords: Tuberculosis, counseling, level of knowledge, attitude, behavior, nutritional

status, PMO

INTRODUCTION through the air (droplet nuclei) when a

patient with tuberculosis coughs and
Tuberculosis (TB) is a contagious
splashes of bacteria inhaled by others during
disease caused by tuberculosis
breathing1. Given the importance of TB, in
(mycobacterium tuberculosis), transmitted
1993 the World Health Organization (WHO)
has launched a Global Emergency against
TB disease. Data presented by WHO in
Global Tuberculosis Report 2015 states that
Indonesia occupies the second highest
position in TB cases after India. The three
countries with the highest incidence of 9.8
million cases of world TB are India at 23%,
Indonesia at 10% and China at 10% of the
total number of TB cases in the world2.
Data from the South Kalimantan
Provincial Health Office in 2015 showed
that the number of TB children infected in
Banjar district was the highest compared to
12 other districts in South Kalimantan
Province which was 1,175 cases of TB, of
which 421 were new cases of BTA+ and
120 cases of child TB, an increase when
compared to the number of cases in 2014
that only 888 cases of TB and 91 cases of
child TB. The occurrence of an increase in
the number of TB cases of children found in
Banjar District are 91 cases in 2014 to 120
in 2015 is serious, as it is not in accordance
with the target of decreasing incidence rate
according to the National TB Guideline of
2014 which should have a speed of shipment
of 3-4%3.
Counseling is part of the
pharmaceutical service aspect. An important
role of patient counseling is to improve the
quality of life of patients and provide quality
care for patients4. Providing counseling and
information to patients is helpful to improve
adherence and prevent the failure of patient
drug therapy5.
The results of Rina et al (2012)
showed that there was a significant
difference in the knowledge about the
adherence of patients receiving pulmonary
tuberculosis before and after getting
counseling, there were also significant
differences in attitudinal attitude toward TB
treatment before and after counseling. It can
be concluded that the effect of counseling on
knowledge, attitudes and compliance
treatment of pulmonary tuberculosis patients
in the work area of Samarinda Health
Office6. The same thing is also found in the
results of research Kangagung, et al (2013)
Obtained the results of significance value of
0.002 (p <0.05) on the evaluation of patient
understanding which means the
implementation of home care affects the
patient's understanding of pulmonary TB
disease7.
Material and Method
Design research or also called research
design is set with the aim that research can
be done effectively and efficiently. This type
of research is quantitative using quasi
experiment method with Pretest and Posttest
Control Group Design8. In this research
design the sample is divided into 2 groups observed data by way of Pretest and
(given counseling and which not given Posttest.
counseling). Then each sample will be
Findings

Table 1 Result of univariate analysis

No Variable Category Frequency %

Pre Post Pre Post
1. Knowledge of drug taking Good 4 12 23,53 70,59
supervisor (PMO) Child TB patient
in group given counseling Enough 10 5 58,82 29,41
Less 3 0 17,56 0
2. Knowledge of PMO TB child Good 5 6 29,4 35,3
sufferers in groups not given
counseling Enough 9 8 52,9 47,1

Less 3 3 17,6 17,6

3. Attitudes of PMO TB patients in Good 3 11 17,6 64,7

the group given counseling
Enough 9 6 52,9 35,3

Less 5 0 29,4 0

4. Attitudes of PMO TB patients in Good 4 6 23,5 35,3

the group who were not given
counseling Enough 8 6 47,1 35,3

Less 17 0 100 0
5. Behavior of PMO Child TB patient Good 7 12 41,2 70,6
in group given counseling
Enough 9 5 52,9 29,4

Less 1 0 5,9 0

6. Behavior of PMO child TB patient Good 5 6 29,4 35,3

in group not given counseling
Enough 8 9 47,1 52,9

Less 4 2 23,5 11,8

7. Nutritional status of TB patients Very thin 4 0 23,53 0
after receiving treatment in the
group receiving counseling Thin 6 0 35,29 0

Normal 7 16 41,8 94,12

Fat 0 1 0 5,88

8. Nutrition status of TB patients after Very thin 4 0 23,53 0

receiving treatment in groups that
did not receive counseling Thin 5 2 29,41 11,76

Normal 8 15 47 88,24

Fat 0 0 0 0

Based on Table 1 of 17 PMO before
being given counseling (pretest) most have
enough knowledge is 10 people (58,82%),
followed by PMO with good knowledge is 4
person (23,53%) and knowledge less is 3
person (17, 65%). After being given
counseling (Posttest), most of PMO
knowledge is good that is 12 people
(70,5%), followed by PMO with enough
knowledge about 5 people (29,41%). PMO
that is not given counseling on pretest most
is PMO which have enough knowledge that
is 9 people (52,9%), followed by PMO with
good knowledge that is 5 people (29,4%)
and knowledge less that 3 person (17,6% ).
After the most posttest is PMO with enough
knowledge that is 8 people (47,1%),
followed by good knowledge that is 6
people (35,3%) and less knowledge that is 3
person (17,6%).
PMO before getting counseling can be
seen less attitude is 5 people (29,4%) and
PMO which have good attitude is 3 person
(17,6%). After being given counseling
(Posttest) PMO attitudes are good that is 11
people (64,7%), followed by PMO with
enough attitude as many as 6 people
(35,3%). PMO that is not given counseling
on pretest most is PMO which have good
enough attitude that is 8 people (47,1%),
followed by PMO with less attitude that is 5
people (29,4%) and good attitude that is 4
person (23 , 5%). After the most posttest is
PMO with good attitude and enough that is 6
people (35,3%), followed by PMO with less
attitude that is 5 people (29,4%).
 The behavior of POM who received not given counseling on pretest, most have
counseling before giving counseling enough behavior is 8 people (47,1%),
(pretest) mostly had enough behavior was 9 followed by good behavioral behavior is 5
people (52,9%), followed by PMO with people (29,4%) and behavior is less 4 people
good behavior was 7 people (41,2%) and (23,5%). In Posttest, most of PMO behavior
less behavior was 1 person (5,9 %). After is enough that is 9 people (52,9%), followed
being given counseling (Posttest) PMO by PMO with good behavior that is 6 people
behavior is good that is 12 people (70,6%), (35,3%) and behavior less as much as 2
followed by PMO with enough behavior as person (11,8%).
much as 5 people (29,4%). PMO that was
Table 2.Bivariate Analysis
Variable Category Test of Normality Mean Rank Test crucified
(sig.) wallis
(Sig.)
Knowledge Counseling 0,000 21,44 0,010
No counseling 13,56
Attitude Counseling 0,000 20,88 0,030
No counseling 14,12
Behavior Counseling 0,000 21,24 0,013
No counseling 13,76
Nutritional status Counseling 0,000 16,06 0,086
No counseling 18,94

Based on the table 2 the results of the
average study of differences in the influence
of knowledge, attitudes and behavior of
PMO TB Patients in the group of counseling
is greater than the group not given
counseling, namely knowledge (21.44>
13.56), attitude (20, 88> 14,12), behavior
(21,24> 13,76) and (16,06> 18,94). The
result of crucified wallis test to see the
difference of influence of knowledge,
attitude, and behavior of PMO of TB Child
Patient is found that p-value value is 0,010
for knowledge, 0,030 for attitude, 0,013 for
behavior, 0,086 for nutrient status. From p-
value value in statistical test results Ho
decision was rejected (p <0,05), indicating
that there is influence giving counseling to PMO is given an explanation of TB disease,
knowledge, attitude, behavior of PMO and so that the PMO given the exact counseling
nutritional status of TB Child Patients. will have better knowledge than the PMO
that is not given counseling9.
Discussion
The results of this study are in line
The influence of counseling on
with research conducted by Loriana et al.
Knowledge of PMO was analyzed using
(2013) indicating that there is a significant
crucified wallis test with sig result. 0,024 or
effect of counseling on the knowledge of TB
Ho is rejected which means significant
sufferers in the work area of the Samarinda
influence counseling to the knowledge of
Health Office6.
PMO patient TB child. The result of pretest
The influence of counseling on the
and posttest in the control group that is not
attitude of PMO is analyzed using crucified
given counseling, that is the number of PMO
wallis test with p 0,030 or Ho rejected which
with good knowledge has increased, the
means there is influence of counseling to
number of PMO with sufficient knowledge
PMO attitude of TB child patient. The result
has decreased and the number of PMO with
of pretest and posttest in the control group
less knowledge does not change, but the
that is not given counseling, that is the
increase and decrease the number of PMO is
number of PMO with good attitude has
not significant. While the results of pretest
increased, the number of PMO with
and posttest in the group given counseling,
sufficiently decreasing attitude and the
the number of PMO with good knowledge
number of PMO with less attitude not
has increased significantly, the number of
change, but the increase and decreasing the
PMO with sufficient knowledge decreased
number of PMO is not significant. While the
significantly and the number of PMO with
pretest and posttest results in the group
less knowledge also decreased significantly.
given counseling, the number of PMO with
It shows that counseling has a significant
good attitude has increased significantly, the
effect on the knowledge of PMO of children
number of PMO with sufficient attitude
with TB. Drug counseling is one of the
decreased significantly and the number of
methods of facial education, is one form of
PMO with less attitude also decreased
pharmaceutical services in an effort to
significantly. This indicates that counseling
improve the knowledge and understanding
of patients in the use of drugs. In counseling,
has a significant effect on the attitude of
PMO TB Patients.
Several studies have also shown
similar results, one of which was Loriana et
al. (2013) indicating that there is a
significant effect of counseling on the
attitude of TB sufferers in the work area of
Samarinda Health Office4.
The influence of counseling on the
behavior of PMO is analyzed using Kruskal
Wallis Test with p 0,029 or Ho rejected
which means there is influence of
counseling on the behavior of PMO of child
TB patient. The results of pretest and
posttest in the control group that were not
given counseling, are the number of PMO
with good behavior has increased, the
number of PMO with behavior is quite
increased and the number of PMO with less
behavior decreased, but the increase and
decrease in the number of PMO is not
significant. While the pretest and posttest
results in the group given counseling, the
number of PMO with good behavior has
increased significantly, the number of PMO
with behavior quite decreased significantly
and the number of PMO with less behavior
also decreased significantly. This indicates
that counseling has a significant effect on
the behavior of PMO of children with TB.
The results obtained in accordance with
research conducted by Loriana et al (2013)
and Nurhamidah (2015) which explains that
there is a relationship providing counseling
to drug taking behavior in patients with TB.
The study by Wu et al (2011) explains that
there is a positive relationship between
attitude and behavior (p <0.001)6.
Ministry of Health Republic of
Indonesia (2016) stated that nutritional
status in children with TB will affect the
success of TB treatment. Nutrition status is a
measure of success in the fulfillment of
nutrition for children indicated by body
mass index (BMI) of children. To get IMT
each child tuberculosis patient is measured
body weight and height of patient at the
beginning and end of treatment. The results
of BMI measurements on 34 children with
TB of children showed that there was an
increase in nutritional status after receiving
TB treatment. In the counseling group,
children with tuberculosis patients who had
very thin nutritional status at the start of
treatment were 4 (23.53%) and decreased to
none (0%) of TB patients with very thin
nutritional status after TB treatment. Patients
with tuberculosis who had nutritional status
were thin at the beginning of TB treatment
as many as 6 people (35.29%) and decreased
to none (0%) of tuberculosis children who
have very thin nutritional status after
undergoing TB treatment. Furthermore,
children with TB who had normal nutritional
status at the beginning of treatment were 7
people (41.18%) who then increased to 16
people (94.12%) after receiving TB
treatment. And children with TB TB at the
beginning of treatment (0%) who had fat
nutritional status increased to 1 person
(5.88%) after receiving TB treatment.
Counseling on PMOs leads to increased
knowledge, attitudes and behavior of PMOs
that have an impact on improving adherence
to TB treatment for tuberculosis patients,
adherence to treatment has an impact on the
success of TB therapy as indicated by
improving the nutritional status of TB
children10.
Conclusion
1. There is a difference of influence on the
level of knowledge of the drug
controller (PMO) of child TB patients
before and after counseling
2. There is a difference of influence on the
attitude of drug taking supervisor
(PMO) of TB patients before and after
not given counseling.There is
difference of influence on the behavior
of drug control watchdog (PMO) of TB
patients before and after counseling.
3. There are differences in counseling
effect on the nutritional status of TB
patients before and after counseling.
4. There is influence of counseling to the
level of knowledge, attitude, behavior
of PMO and nutritional status of child
TB patient.
Ethical Clearance: this study approved and
received ethical clearance from the
Committee of Public Health Research Ethics
of Medical Faculty, Lambung Mangkurat
University, Indonesia. In this study we
followed the guidelines from the Committee
of Public Health Committee of Public
Health Research Ethics of Medical Faculty,
Lambung Mangkurat University, Indonesia
for etchical clearance and informed consent.
The informed consent included the research
tittle, purpose, participants’s right,
confidentiality and signature.
Source Funding: This study done by self
funding from the authors.
Conflict of Interest: The authors declare
that they have no conflict interest.
References
a 1. Widiyono. Penyakit Tropis:
Epidemiologi, Penularan, Pencegahan
dan Pemberantasannya, Jakarta:
Erlangga, 2008
2. WHO. Global Tuberculosis Report Penelitian Universitas Mulawarman,
2015, France: WHO Library 2012
Cataloguing-in-Publication Data. 2016 7. Kangagung C. P. dkk.,( 2013),
3. Dinas Kesehatan Provinsi Kalimantan Pengaruh Home Care Terhadap
Selatan. Laporan Tahunan. 2016 Pemahaman Dan Ketaatan Pada Pasien
4. Rantucci, M.J.,Komunikasi Apoteker- Tuberkulosis, Bali: Jurnal Penelitian
Pasien : Panduan Konseling Pasien, Universitas Udayana, 2013
diterjemahkan oleh Sani, A.N., edisi 8. Suyanto. Metodologi dan Aplikasi
kedua, Jakarta: Penerbit Buku Penelitian Keperawatan, Yogyakarta:
Kedokteran EGC, 2009 Nuha Medika, 2011
5. Monita. Evaluasi Implementasi Standar 9. Depkes RI. Pedoman Konseling
Pelayanan Kefarmasian di Apotek di Pelayanan Kefarmasian di Sarana
kota Padang, Yogyakarta: Tesis Kesehatan, Jakarta: Departemen
Program Pasca Sarjana Fakultas Kesehatan RI. 2006
Farmasi Universitas Gadjah Mada, 2009 10. Kemenkes RI. Profil Kesehatan
6. Rina L, dkk. Efek Konseling Terhadap Indonesia Tahun 2014, Jakarta:
Pengetahuan, Sikap Dan Kepatuhan Kementerian Kesehatan Republik
Berobat Penderita Tuberkulosis Paru Indonesia, 2015
DiWilayah Kerja Dinas Kesehatan Kota
Samarinda, Samarinda: Jurnal