Determinants of Treatment Adherence Among Pulmonary Tuberculosis Patients : A Health Belief Model Approach in Pariaman City, Indonesia / Faktor-faktor yang Memengaruhi Kepatuhan Pengobatan pada Pasien Tuberkulosis Paru: Pendekatan Health Belief Model di Kota Pariaman, Indonesia

Tuberculosis remains a major public health problem in Indonesia, and medication nonadherence continues to reduce treatment success despite the availability of effective therapy. The Health Belief Model (HBM) provides a framework for understanding treatment adherence based on patients' health beliefs. This study aimed to analyze determinants of treatment adherence among pulmonary tuberculosis patients using the Health Belief Model approach in Pariaman City, Indonesia. A mixed-methods study with an explanatory sequential design was conducted from August 2023 to June 2024. The quantitative phase employed a cross-sectional design involving 107 pulmonary tuberculosis patients selected through proportional random sampling. The sample size was determined using the Lemeshow formula, yielding a minimum of 97 participants, with an additional 10% included to account for potential dropouts, resulting in a final sample of 107 patients. Independent variables included perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and self-efficacy. The qualitative phase involved in-depth interviews with 12 purposively selected informants to explore program implementation related to treatment adherence. Poor perceptions were reported for susceptibility (43.9%), severity (41.1%), benefits (46.7%), barriers (44.9%), and self-efficacy (52.3%). Bivariate analysis showed that perceived severity (p=0.007) and perceived benefits (p<0.001) were significantly associated with treatment adherence. Multivariate analysis identified perceived benefits as the strongest determinant of treatment adherence (OR=5.103; 95% CI: 2.165-12.027; p<0.001). Qualitative findings revealed that limited human resources, funding constraints, and inconsistent patient education contributed to poor perceived benefits, supporting the quantitative finding that perceived benefits was the strongest determinant of adherence. Health authorities should strengthen patient education, ensure adequate human and financial resources, and implement standardized monitoring and counseling programs to improve treatment adherence and tuberculosis control outcomes.

Tuberkulosis masih menjadi masalah kesehatan masyarakat utama di Indonesia, dan ketidakpatuhan terhadap pengobatan terus menurunkan keberhasilan terapi meskipun pengobatan yang efektif telah tersedia. Health Belief Model (HBM) memberikan kerangka teori untuk memahami kepatuhan berobat berdasarkan keyakinan kesehatan pasien. Penelitian ini bertujuan menganalisis determinan kepatuhan berobat pada pasien tuberkulosis paru menggunakan pendekatan Health Belief Model di Kota Pariaman, Indonesia. Penelitian menggunakan metode campuran dengan desain explanatory sequential yang dilaksanakan pada Agustus 2023 hingga Juni 2024. Tahap kuantitatif menggunakan desain cross-sectional dengan melibatkan 107 pasien tuberkulosis paru yang dipilih melalui proportional random sampling. Besar sampel ditentukan menggunakan rumus Lemeshow dengan jumlah minimal 97 responden, kemudian ditambah 10% untuk mengantisipasi dropout, sehingga diperoleh total sampel sebanyak 107 responden. Variabel independen meliputi persepsi kerentanan, persepsi keparahan, persepsi manfaat, persepsi hambatan, dan efikasi diri. Tahap kualitatif dilakukan melalui wawancara mendalam terhadap 12 informan yang dipilih secara purposif untuk mengeksplorasi pelaksanaan program terkait kepatuhan berobat. Persepsi yang kurang baik ditemukan pada persepsi kerentanan (43,9%), persepsi keparahan (41,1%), persepsi manfaat (46,7%), persepsi hambatan (44,9%), dan efikasi diri (52,3%). Analisis bivariat menunjukkan bahwa persepsi keparahan (p=0,007) dan persepsi manfaat (p<0,001) berhubungan signifikan dengan kepatuhan berobat. Analisis multivariat menunjukkan bahwa persepsi manfaat merupakan determinan terkuat kepatuhan berobat (OR=5,103; IK95%: 2,165-12,027; p<0,001). Temuan kualitatif menunjukkan bahwa keterbatasan sumber daya manusia, kendala pendanaan, dan pendidikan pasien yang belum konsisten berkontribusi terhadap rendahnya persepsi manfaat, sehingga mendukung temuan kuantitatif bahwa persepsi manfaat merupakan determinan terkuat kepatuhan berobat. Otoritas kesehatan perlu memperkuat edukasi pasien, memastikan kecukupan sumber daya manusia dan pendanaan, serta menerapkan program pemantauan dan konseling yang terstandar untuk meningkatkan kepatuhan berobat dan keberhasilan pengendalian tuberkulosis.