Advancing Nursing Education and Practice for Future Global Health
Vol. 13 No. 4 (2025): Advancing Nursing Education and Practice for Future Global Health

The effectiveness of health belief model intervention on tuberculosis medication adherence in rural Indonesia: a pre-experimental study

Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 25 November 2025
188
Views
109
Downloads
1
HTML

Authors

Tuberculosis treatment non-adherence remains a significant challenge in rural Indonesia, with Kampar District reporting below-target success rates. Therefore, this study aimed to evaluate the effectiveness of a Health Belief Model (HBM) intervention on medication adherence among tuberculosis patients in rural Indonesia. A pre-experimental study with a one-group pretest- posttest design was conducted among 45 purposively sampled TB patients in Kampar District. Data were collected using the validated Health Belief Model Questionnaire and the Medication Adherence Rating Scale. The intervention consisted of a 3-month structured program including weekly sessions in the first month, bi-weekly sessions in the second month, and a monthly follow-up in the third month. Following the HBM intervention, significant improvements were observed in perceived benefits (31.33±4.447 to 32.80±4.341, p<0.001), perceived barriers (22.80±3.286 to 24.38±4.185, p=0.002), and perceived susceptibility (25.64±3.675 to 26.69±3.771, p=0.007). Moreover, medication adherence significantly improved from 5.40±1.156 to 6.20±0.944 (p<0.001). The HBM intervention effectively improved medication adherence through enhanced health beliefs among rural TB patients. Thus, integrating HBM-based interventions into TB treatment programs could improve treatment outcomes in resource-limited settings. However, further research with longer follow-up periods is recommended.

Downloads

Download data is not yet available.

Citations

1. World Health Organization. WHO consolidated guidelines on tuberculosis. Module 3: diagnosis–rapid diagnostics for tuberculosis detection. World Health Organization; 2024.
2. Cioboata R, Biciusca V, Olteanu M, Vasile CM. COVID-19 and tuberculosis: Unveiling the dual threat and shared solutions perspective. J Clin Med 2023;12:4784. DOI: https://doi.org/10.3390/jcm12144784
3. Surendra H, Elyazar IR, Puspaningrum E, et al. Impact of the COVID-19 pandemic on tuberculosis control in Indonesia: a nationwide longitudinal analysis of programme data. Lancet Global Health 2023;11:e1412–21. DOI: https://doi.org/10.1016/S2214-109X(23)00312-1
4. World Health Organization. Use of targeted next-generation sequencing to detect drug-resistant tuberculosis: rapid communication, July 2023. World Health Organization; 2023.
5. Fahdhienie F, Mudatsir M, Abidin TF, Nurjannah N. Risk factors of pulmonary tuberculosis in Indonesia: A case-control study in a high disease prevalence region. Narra J 2024;4:e943–e943. DOI: https://doi.org/10.52225/narra.v4i2.943
6. Etim NG, Mirabeau Y, Olorode A, Nwodo U. Risk Factors of Tuberculosis and Strategies for Prevention and Control. Int J Innovative Healthcare Res 2024;12:1–13.
7. Iskandar D, Suwantika AA, Pradipta IS, Postma MJ, van Boven JF. Clinical and economic burden of drug-susceptible tuberculosis in Indonesia: national trends 2017–19. Lancet Global Health 2023;11:e117–25. DOI: https://doi.org/10.1016/S2214-109X(22)00455-7
8. Harianto AV, Vitrianingsih Y, Issalillah F, Mardikaningsih R. Challenges and changes concerning national health development in Indonesia: legal perspectives, service access, and infectious disease management. Int J Service Sci Manag Engin Technol 2024;5:22–6.
9. Lasmaria R, Febrina N, Simanjutak AM. Characteristics of bacteriological pulmonary tuberculosis cases for the January–August 2021 period at Arifin Achmad Hospital, Riau Province. Jurnal Health Sains 2023;4:31–43. DOI: https://doi.org/10.46799/jhs.v4i12.1153
10. Yenti S, Mitra M, Abidin Z, et al. The effectiveness of health education through whatsapp on increasing knowledge and attitudes of TB patients in prevention of pulmonary TB transmission at the UPTD Puskesmas Tapung II. 2023.
11. Yuliyanti S. Beyond clinical outcomes: exploring the psychosocial and physical dimensions of quality of life in tuberculosis patients receiving outpatient care. Open Access Indonesian J Med Rev 2024;4:738–53. DOI: https://doi.org/10.37275/oaijmr.v4i4.636
12. Sialino L, Wijnhoven H, Van Oostrom S, et al. Perspectives of older women in the Netherlands: identifying motivators and barriers for healthy lifestyles and determinants of healthy aging. BMC Public Health 2023;23:664. DOI: https://doi.org/10.1186/s12889-023-15611-0
13. Dabitao D, Bishai WR. Sex and gender differences in tuberculosis pathogenesis and treatment outcomes. Sex Gender Differences Infect Treatments Infect Dis 2023;441:139–83. DOI: https://doi.org/10.1007/978-3-031-35139-6_6
14. Lazar M, Davenport L. Barriers to health care access for low income families: a review of literature. J Comm Health Nursing 2018;35:28–37. DOI: https://doi.org/10.1080/07370016.2018.1404832
15. Aibana O, Dauria E, Kiriazova T, et al. Patients’ perspectives of tuberculosis treatment challenges and barriers to treatment adherence in Ukraine: a qualitative study. BMJ Open 2020;10:e032027. DOI: https://doi.org/10.1136/bmjopen-2019-032027
16. Abdul Wahab NA, Makmor Bakry M, Ahmad M, et al. Exploring culture, religiosity and spirituality influence on antihypertensive medication adherence among specialised population: a qualitative ethnographic approach. Patient Prefer Adherence 2021;2249–65. DOI: https://doi.org/10.2147/PPA.S319469
17. Heckman BW, Mathew AR, Carpenter MJ. Treatment burden and treatment fatigue as barriers to health. Curr Opinion Psychol 2015;5:31–6. DOI: https://doi.org/10.1016/j.copsyc.2015.03.004
18. Raynor D. The influence of written information on patient knowledge and adherence to treatment. In: Adherance to Treatment in Medical Conditions. CRC Press; 2020. page 83–111. DOI: https://doi.org/10.1201/9781003072348-6
19. Anderson RM, Funnell MM. Patient empowerment: myths and misconceptions. Patient Educ Counsel 2010;79:277–82. DOI: https://doi.org/10.1016/j.pec.2009.07.025
20. Stang I, Mittelmark MB. Intervention to enhance empowerment in breast cancer self‐help groups. Nursing Inquiry 2010;17:47–57. DOI: https://doi.org/10.1111/j.1440-1800.2009.00465.x
21. Pradipta IS, Houtsma D, van Boven JF, et al. Interventions to improve medication adherence in tuberculosis patients: a systematic review of randomized controlled studies. NPJ Primary Care Respirat Med 2020;30:21. DOI: https://doi.org/10.1038/s41533-020-0179-x
22. Anuar H, Shah S, Gafor H, et al. Usage of Health Belief Model (HBM) in health behavior: A systematic review. Malaysian J Med Health Sci 2020;16:2636–9346.
23. Martela F, Hankonen N, Ryan RM, Vansteenkiste M. Motivating voluntary compliance to behavioural restrictions: Self-determination theory–based checklist of principles for COVID-19 and other emergency communications. Eur Rev Social Psychol 2021;32:305–47.
24. Iacobino A, Fattorini L, Giannoni F. Drug-resistant tuberculosis 2020: where we stand. Appl Sci 2020;10:2153.
25. Martela F, Hankonen N, Ryan RM, Vansteenkiste M. Motivating voluntary Adherence to behavioural restrictions: Self-determination theory–based checklist of principles for COVID-19 and other emergency communications. Eur Rev Soc Psychol 2021;32:305–47. DOI: https://doi.org/10.1080/10463283.2020.1857082
26. Iacobino A, Fattorini L, Giannoni F. Drug-resistant tuberculosis 2020: where we stand. Appl Sci 2020;10:2153. DOI: https://doi.org/10.3390/app10062153

How to Cite



The effectiveness of health belief model intervention on tuberculosis medication adherence in rural Indonesia: a pre-experimental study. (2025). Healthcare in Low-Resource Settings, 13(4). https://doi.org/10.4081/hls.2025.13966