ABSTRACT

Stigma remains a critical barrier to successful tuberculosis (TB) treatment adherence, particularly in primary health care settings. This study aimed to examine the influence of social stigma on TB treatment adherence and to evaluate the effectiveness of the FAST educational model (Familiné Andum Semangat Tumandhang) in reducing stigma and improving adherence. A quasi-experimental one-group pretest–posttest design was conducted among 40 pulmonary TB patients and their primary family supporters in community health centers in Kediri City, using purposive sampling. Data were collected using the Tuberculosis Stigma Scale and the Morisky Medication Adherence Scale (MMAS-8). Results indicated a significant reduction in stigma scores from 94.60 to 74.78 (t = 4.372; p < 0.001) and a significant improvement in adherence scores from 2.05 to 1.13 (t = 9.505; p < 0.001). The findings confirm that social stigma significantly influences treatment adherence. The FAST model effectively reduces stigma and enhances adherence through culturally and family-centered education. Integrating this model into routine TB care is recommended to support national TB control goals.

Keywords: Tuberculosis, FAST Educational Model, Treatment Adherence, Stigma, Family-Based Intervention, Primary Health Care

ABSTRAK

Stigma masih menjadi penghalang utama dalam keberhasilan kepatuhan pengobatan tuberkulosis, khususnya di layanan kesehatan primer. Penelitian ini bertujuan untuk menganalisis pengaruh stigma sosial terhadap kepatuhan pengobatan tuberkulosis serta mengevaluasi efektivitas model edukasi FAST (Familiné Andum Semangat Tumandhang) dalam menurunkan stigma dan meningkatkan kepatuhan. Desain penelitian yang digunakan adalah kuasi-eksperimen dengan pendekatan one-group pretest–posttest, melibatkan 40 pasien tuberkulosis paru yang menjalani terapi di puskesmas wilayah Kota Kediri, masing-masing didampingi oleh satu anggota keluarga sebagai pendukung utama. Teknik pengambilan sampel menggunakan purposive sampling. Pengumpulan data dilakukan dengan kuesioner Tuberculosis Stigma Scale dan Morisky Medication Adherence Scale (MMAS-8). Hasil penelitian menunjukkan adanya penurunan signifikan pada skor stigma dari 94,60 menjadi 74,78 (t = 4,372; p < 0,001) serta peningkatan signifikan pada skor kepatuhan dari 1,13 menjadi 2,05 (t = 9,505; p < 0,001). Sebagian besar peserta awalnya mengalami tingkat stigma sedang (50%) dan kepatuhan rendah (37,5%), yang keduanya meningkat setelah intervensi. Temuan ini menegaskan bahwa stigma sosial berperan penting sebagai determinan kepatuhan pengobatan. Model edukasi FAST terbukti efektif dalam menurunkan stigma dan meningkatkan kepatuhan melalui pendekatan edukasi berbasis keluarga dan budaya. Integrasi model FAST dalam program rutin perawatan TB direkomendasikan untuk mempercepat pencapaian target eliminasi TB nasional.

Kata Kunci: Tuberkulosis, Model Edukasi FAST, Kepatuhan Terapi, Stigma Sosial, Intervensi Keluarga, Layanan Kesehatan Primer.

Abraham, C., & Sheeran, P. (2014). The health belief model. Cambridge Handbook of Psychology, Health and Medicine, Second Edition, January, 97–102. https://doi.org/10.1017/CBO9780511543579.022

Abreu, A. L. A. (2024). Mitigating the stigma associated with tuberculosis. Revista Cientifica Multidisciplinar, 5(4). https://doi.org/https://doi.org/10.47820/recima21.v5i4.5110

Ace, S., Ainina, Ayu, R., Suratun., Pramita, I., Dewi, L., Wartonah, Santa, M., & Sumbara. (2023). Correlation of Knowledge and Family Support with Treatment Compliance of Tuberculosis Sufferers. https://doi.org/10.59183/aacendikiajon.v2i2.25

Artawan Eka Putra, I. W. G., Purnama Dewi, N. P. E., Probandari, A. N., Notobroto, H. B., & Wahyuni, C. (2023). The Implementation of Comprehensive Health Education to Improve Household Contacts’ Participation in Early Detection of Tuberculosis. Health Education and Behavior, 50(1), 136–143. https://doi.org/10.1177/10901981211001829

Aryantiningsih, D. S., Jalinus, N., & Rosalina, L. (2024). EduTB as an Effort to Improve Tuberculosis Treatment Adherence. Universal Journal of Public Health, 12(3), 441–459. https://doi.org/https://doi.org/10.13189/ujph.2024.120303

Ashaba, C., Musoke, D., Wafula, S. T., & Konde-Lule, J. (2021). Stigma among tuberculosis patients and associated factors in urban slum populations in Uganda. African Health Sciences, 21(4), 1640–1650. https://doi.org/10.4314/ahs.v21i4.18

Bresenham, D., Kipp, A. M., & Medina-Marino, A. (2020). Quantification and correlates of tuberculosis stigma along the tuberculosis testing and treatment cascades in South Africa: a cross-sectional study. Infectious Diseases of Poverty, 9(1), 1–13. https://doi.org/10.1186/s40249-020-00762-8

Chen, X., Wang, W., Hua, Q., Xu, H., Wang, F., Liu, K., Peng, Y., Chen, B., & Jiang, J. (2021). Persistent discrimination of TB in southeastern China: Results from four repeated population- based surveys during the period of 2006-2018. Risk Management and Healthcare Policy, 14, 2333–2344. https://doi.org/10.2147/RMHP.S311869

Dameria, D., Victor, Trismanjaya, H., Santy, Deasy, S., Putranto, M., & Frans, Judea, S. (2023). Improvement of Patients’ Knowledge, Attitude, and Practice on Tuberculosis Treatment Using Video and Leaflet. Jurnal Promosi Kesehatan Indonesia. https://doi.org/10.14710/jpki.18.2.79-88

Datiko, D. G., Jerene, D., & Suarez, P. (2020). Stigma matters in ending tuberculosis: Nationwide survey of stigma in Ethiopia. BMC Public Health, 20(1), 1–10. https://doi.org/10.1186/s12889-019-7915-6

Dinas Kesehatan Kabupaten Jember. (2021). Profil Kesehatan Kabupaten Jember Tahun 2020. Dinas Kesehatan Kabupaten Jember.

Dinas Kesehatan Provinsi Jawa Timur. (2022). Profil Kesehatan Jawa Timur 2021. Dinas Kesehatan Provinsi Jawa Timur.

Gero, S., & Sayuna, M. (2017). Prevention of Main TBC Diseases Started from Home Patients Pencegahan Penyakit Tbc Paru Yang Utama Dimulai Dari Rumah Penderita. Jurnal Info Kesehatan, 15(1), 1–9.

Huq, K. A. T. M., Moriyama, M., Krause, D. R., Shirin, H., Awoonor-Willaims, J. K., Rahman, M., & Rahman, M. M. (2022). Perceptions, Attitudes, Experiences and Opinions of Tuberculosis Associated Stigma: A Qualitative Study of the Perspectives among the Bolgatanga Municipality People of Ghana. International Journal of Environmental Research and Public Health, 19(22). https://doi.org/https://doi.org/10.3390/ijerph192214998

Kemenkes RI. (2020). Pedoman Nasional Pelayanan Kedokteran Tata Laksana Tuberkulosis. Kementerian Kesehatan RI.

Myburgh, H., Baloyi, D., Loveday, M., Meehan, S.-A., Osman, M., Wademan, D., Hesseling, A., & Hoddinott, G. (2023). A scoping review of patient-centred tuberculosis care interventions: Gaps and opportunities. Plos Global Public Health. https://doi.org/https://doi.org/10.1371/journal.pgph.0001357

Reyaan, I. B. M., Faustincia, I., & Zazuli, Z. (2023). Dampak Intervensi Edukasi dan Aplikasi Pengingat Minum Obat terhadap Pengetahuan dan Kepatuhan Pasien Tuberkulosis Paru di Puskesmas di Kota Bandung. Jurnal Manajemen Dan Pelayanan Farmasi. https://doi.org/https://doi.org/10.22146/jmpf.88408

Sinha, A., Renu, R., Kar, A., Karkhanis, P., Singarajipura, A., Adepu, R., Mishra, B. K., Basu, A., Potty, R. S., Kumaraswamy, K., Munjattu, J. F., Ranjan, R., Dias, M., Goswami, A., Swamickan, R., & Begum, R. (2023). Health-seeking behaviour, knowledge, and stigma around Tuberculosis: A mixed-method study with specific vulnerable population groups in India. https://doi.org/https://doi.org/10.21203/rs.3.rs-3083635/v1

Wahyuningsih, A., Probandari, A., & Artawan, I. W. G. (2025). Beyond the Stigma : Leveraging Education and Empathy for Effective Tuberculosis Care. 6(3), 492–503.

WHO. (2022). Global TB Report 2022 Factsheet. World Health Organization. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022