Association between Health Literacy and Medication Adherence among Pulmonary Tuberculosis Patients Using Four Domains of the Integrated Health Literacy Model in Jember Regency, Indonesia

Document Type : Original Article

Authors

1 Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand

2 Department of Family and Community Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand

Abstract

Background and Objective: Health literacy is one of the factors that can influence tuberculosis medication adherence. Due to inadequate health literacy, patients had not fully used the information received related to tuberculosis in their daily behavior to support recovery. This research analyzes the association between domains of health literacy and medication adherence among pulmonary tuberculosis patients.

Materials and Methods: This retrospective study analyzed the association between health literacy and medication adherence of 150 pulmonary tuberculosis patients in four primary healthcare units in Jember Regency. The participants were composed of; 1) adhere (had no history of interrupt medication > 1 month in 2021) and already recovered and 2) non-adhere (had a history of not taking medication for > 1 month in 2021). The prepared research assistants and health volunteers carried out the data collection. Descriptive statistics and the chi-square test were applied to analyze the data. Collection data held from October-November 2022.

Results: This study found that 128 participants adhered to and 22 did not adhere to tuberculosis medication. Forty-two percent of the participants (63 of 150) had a sufficient health literacy level. There was a significant association between health literacy level and medication adherence (p<.001).  All health literacy domains significantly associated with medication adherence with access (p=0.001), understand (p<0.001), appraise (p<0.001), and apply (p<0.001).

Conclusion: Most participants had sufficient health literacy and good skills in accessing, understanding, appraising, and applying tuberculosis-related information. Health workers can improve tuberculosis patients’ ability to appraise and apply tuberculosis health information by providing continuous health counseling. 

Keywords

Availability of data and materials: The anonymized datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.


Conflict of Interest statement: The authors have reported no conflicts of interest.


Consent for Publication; Not applicable


Ethical considerations: This study was carried out in accordance with the Helsinki Declaration. Clinical Ethical permission for the study had been obtained from the office of Khon Kaen University, Ethics Committee for Human Research (ECKKU), Thailand, under record reference number HE652156 with the date of approval 9th September 2022. All participants provided written informed consent.


Funding Statement: This research was supported by the KKU Scholarship for ASEAN and GMS Countries’ (Grant Number 751/220).


Author’s Contributions: Farida Nur Qomariyah,: Development of the concept and study design (proposal development), questionnaire development, ethical submission and approval, data collecting, data analysis, finding report, discussion, and recommendation provision, manuscript preparation. Lukawee Piyabanditkul: Development of the concept and study design (proposal development), questionnaire development, ethical submission and approval, data analysis, finding report, discussion, and recommendation provision, manuscript preparation

References

1- World Health Organization. Global Tuberculosis report 2022 [Internet]. 2022. Available from: tp://apps.who.int/bookorders.
 
2- Indonesia Ministry of Health. Indonesia Health Profile 2021. 2022.  
 
3- Indonesia Ministry of Health. G20 Side Event on TB: TB Elimination Funding in 2030 Increases to 20 Billion Dollars Per Year. Indonesia Ministry of Health [Internet]. 2022; Available from:https://www.kemkes.go.id/article/view/19093000001/penyakit-jantung-penyebab-kematian-terbanyak-ke-2-di-indonesia.html  
 
4. Rokom. This year, the Ministry of Health Plans a Massive TB Screening - Sehat Negeriku. Indonesia Ministry of Health [Internet]. 2022; Available from: https://sehatnegeriku.kemkes.go.id/baca/rilis-media/20220322/4239560/tahun-ini-kemenkes-rencanakan-skrining-tbc-besar-besaran/  
 
5. East Java Province Health Office. East Java Health Profile 2020. 2021.  
 
6. Tulchinsky TH, Varavikova EA. Communicable Diseases. In: The New Public Health [Internet]. Elsevier; 2014. p. 149-236. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9780124157668000045
https://doi.org/10.1016/B978-0-12-415766-8.00004-5
PMCid:PMC7171903  
 
7. Gebreweld FH, Kifle MM, Gebremicheal FE, Simel LL, Gezae MM, Ghebreyesus SS, et al. Factors influencing adherence to tuberculosis treatment in Asmara, Eritrea: a qualitative study. Journal of Health, Population and Nutrition. 2018;37:1-9.
https://doi.org/10.1186/s41043-017-0132-y
PMid:29304840 PMCid:PMC5756387  
 
8. Boru CG, Shimels T, Bilal AI. Factors contributing to non-adherence with treatment among TB patients in Sodo Woreda, Gurage Zone, Southern Ethiopia: A qualitative study. Journal of infection and public health. 2017;10(5):527-33.
https://doi.org/10.1016/j.jiph.2016.11.018
PMid:28189508  
 
9. World Health Organization. Global tuberculosis report 2021 [Internet]. 2021. Available from: https://www.who.int/publications/i/item/9789240037021  
 
10. Çalışkan C, Üner S. Disaster literacy and public health: a systematic review and integration of definitions and models. Disaster medicine and public health preparedness. 2021;15(4):518-27.
https://doi.org/10.1017/dmp.2020.100
PMid:32618555  
 
11. Cabellos-Garcia AC, Martinez-Sabater A, Castro-Sanchez E, Kangasniemi M, Juarez-Vela R, Gea-Caballero V. Relation between health literacy, self-care and adherence to treatment with oral anticoagulants in adults: a narrative systematic review. BMC Public Health. 2018;18:1-12.
https://doi.org/10.1186/s12889-018-6070-9
PMid:30286744 PMCid:PMC6172776  
 
12. Penaloza R, Navarro JI, Jolly PE, Junkins A, Seas C, Otero L. Health literacy and knowledge related to tuberculosis among outpatients at a referral hospital in Lima, Peru. Research and reports in tropical medicine. 2019:1-10.
https://doi.org/10.2147/RRTM.S189201
PMid:30881174 PMCid:PMC6400123  
 
13. Mukerji R, Turan JM. Exploring manifestations of TB-related stigma experienced by women in Kolkata, India. Annals of global health. 2018;84(4):727.
https://doi.org/10.29024/aogh.2383
PMid:30779523 PMCid:PMC6748300  
 
14. Vahedian-Shahroodi M, Jafari Y, Esmaily H, Shariati M, Tehrani H. Predictors of Health Literacy among Caregivers of Patients with Multiple Sclerosis: A Family-Centred Empowerment Approach. The British Journal of Social Work. 2023;53(1):334-48..
https://doi.org/10.1093/bjsw/bcac121  
 
15. Coskun S, Bagcivan G. Associated factors with treatment adherence of patients diagnosed with chronic disease: Relationship with health literacy. Applied Nursing Research. 2021;57:151368.
https://doi.org/10.1016/j.apnr.2020.151368
PMid:33092934  
 
16. Edyawati E, Asmaningrum N, Nur KRM. Relationship between the health literacy level with drug compliance among tuberculosis patients in Puskesmas of Ponorogo Regency. Artikel Penelitian Jurnal Keperawatan Sriwijaya. 2021;8(2):50-9.
https://doi.org/10.32539/JKS.V8i2.15302  
 
17. Shiratani KN. Psychological changes and associated factors among patients with tuberculosis who received directly observed treatment short-course in metropolitan areas of Japan: quantitative and qualitative perspectives. BMC Public Health. 2019;19:1-12.
https://doi.org/10.1186/s12889-019-8001-9
PMid:31805906 PMCid:PMC6896780  
 
18. Sorensen K. Health literacy: The Neglected European Public Health Disparity. 2013;(2013):1-266. Available from: http://digitalarchive.maastrichtuniversity.nl/fedora/get/guid:fec5580d-8b4e-4855-b023-a70b4d8decba/ASSET1  
 
19. Shi J, Mo X, Sun Z. Content validity index in scale development. Zhong nan da xue xue bao Yi xue ban= Journal of Central South University Medical sciences. 2012;37(2):152-5.  
 
20. Taber KS. The use of Cronbach's alpha when developing and reporting research instruments in science education. Research in science education. 2018;48:1273-96.
https://doi.org/10.1007/s11165-016-9602-2  
 
21. McHugh ML. Interrater reliability: the kappa statistic. Biochemia medica. 2012;22(3):276-82.
https://doi.org/10.11613/BM.2012.031
PMid:23092060 PMCid:PMC3900052  
 
22. Koo TK, Li MY. A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of chiropractic medicine. 2016;15(2):155-63.
https://doi.org/10.1016/j.jcm.2016.02.012
PMid:27330520 PMCid:PMC4913118  
 
23. Wong KK, Velasquez A, Powe NR, Tuot DS. Association between health literacy and self-care behaviors among patients with chronic kidney disease. BMC Nephrol. 2018;19(1).
https://doi.org/10.1186/s12882-018-0988-0
PMid:30081951 PMCid:PMC6091174  
 
24. Anggraini FDP, Aryani L, Nurmandhani R. Relationship between Tuberculosis Information Access and Health Literacy of Bandarharjo Public Health Center Officers in Semarang. Jurnal Dunia Kesmas. 2020;9(3):312-9.
https://doi.org/10.33024/jdk.v9i3.3205  
 
25. Santosa KS, Pratomo H. Factors Associated with Patient's Health Literacy Level for Family Medicine Services. PREPOTIF : Jurnal Kesehatan Masyarakat. 2021;5(2):681-92.
https://doi.org/10.31004/prepotif.v5i2.1798  
 
26. Arbuckle C, Tomaszewski D, Brown L, Schommer J, Morisky D, Parlett-Pelleriti C, et al. Exploring the relationship of digital information sources and medication adherence. Comput Biol Med. 2019;109:303-10.
https://doi.org/10.1016/j.compbiomed.2019.04.023
PMid:31100583  
 
27. Olayemi OM, Shola Abolarinwa T. Internet use and e-health literacy among tuberculosis patients in the Directly Observed Therapy Centre, Lagos State, Nigeria. Information Research: an international electronic journal. 2023;28(1).
https://doi.org/10.47989/irpaper951  
 
28. Maulina DI. The health literacy among tuberculosis patients in Bandarharjo primary health center Semarang 2015. 2015;fakultas I:1-4.  
 
29. Oscalices MIL, Okuno MFP, Lopes MCBT, Batista REA, Campanharo CRV. Health literacy and adherence to treatment of patients with heart failure. Revista da Escola de Enfermagem. 2019;53.
https://doi.org/10.1590/s1980-220x2017039803447
PMid:31314864  
 
30. Elisabeth Stømer U, Klopstad Wahl A, Gunnar Gøransson L, Hjorthaug Urstad K. Health Literacy in Kidney Disease: Associations with Quality of Life and Adherence. J Ren Care. 2020;46(2):85-94.
https://doi.org/10.1111/jorc.12314
PMid:31950601  
 
31. Meppelink CS, Smit EG, Fransen ML, Diviani N. "I was Right about Vaccination": Confirmation Bias and Health Literacy in Online Health Information Seeking. J Health Commun. 2019;24(2):129-40.
https://doi.org/10.1080/10810730.2019.1583701
PMid:30895889  
 
32. Pratiwi SH, Sari EA, Kurniawan T. Hemodialysis patients' health literacy at Hasan Sadikin hospital, Bandung. Jurnal Ilmiah Kesehatan Keperawatan. 2020 :11;16(2):125.
https://doi.org/10.26753/jikk.v16i2.364  
 
33. Thu S. Health literacy status and NSAIDS use among farmers in Naypyitaw territory , Myanmar a cross sectional analytical study. Khon Kaen University; 2018.  
 
34. Wolf MS, Serper M, Opsasnick L, O'Conor RM, Curtis L, Benavente JY, et al. Awareness, attitudes, and actions related to COVID-19 among adults with chronic conditions at the onset of the US outbreak: a cross-sectional survey. Annals of internal medicine. 2020;173(2):100-9.
https://doi.org/10.7326/M20-1239
PMid:32271861 PMCid:PMC7151355  
 
Journal of Health Literacy
Volume 8, Issue 3 - Serial Number 31
September 2023
Pages 9-21

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