Effects of the Family Empowerment Program on Medication Adherence and Treatment Success Among Adults with Pulmonary Tuberculosis: A Randomized Controlled Trial

Authors

  • Saowaluck Khakhong Faculty of Nursing, Chiang Mai University, Thailand.
  • Sumalee Lirtmunlikaporn Faculty of Nursing, Chiang Mai University, Thailand.
  • Akeau Unahalekhaka Faculty of Nursing, Chiang Mai University, Thailand.
  • Orn-anong Wichaikhum Faculty of Nursing, Chiang Mai University, Thailand.

DOI:

https://doi.org/10.60099/prijnr.2023.262115

Keywords:

Family empowerment, Medication adherence, Pulmonary tuberculosis, Randomized controlled trial, Treatment success

Abstract

         Unsuccessful treatment of pulmonary tuberculosis results from medication non-adherence. Family is a significant source of support for adults with pulmonary tuberculosis but has limited ability to continuously support in the first six months of treatments. This randomized controlled trial, a two-arm post-test-only design was utilized to investigate the effects of the family empowerment program on medication adherence and treatment success among adults with pulmonary tuberculosis. The sample comprised 64 family members caring for newly diagnosed adults with pulmonary tuberculosis who visited a tuberculosis clinic of a university hospital in central Thailand. The participants were assigned randomly to either the experimental arm (n = 32) to receive the program or the control arm (n = 32) to receive only usual care. Data were collected using the Demographic and Pulmonary Tuberculosis-related Characteristic Data Collection Form, Family Member’s Demographic Characteristic Data Collection Form, Tuberculosis Medication Adherence Scale, and criteria to identify tuberculosis treatment success of the World Health Organization. Data were analyzed using descriptive statistics, Pearson’s chi-square, Fisher’s Exact, and McNemar tests.
         The results showed that the experimental arm had significantly higher medication adherence at the 3rd and 19th weeks after the program ended than the control arm. The experimental arm had a significantly higher treatment success rate at the 19th week than
the control arm. The family empowerment program was effective in improving medication adherence and treatment success. Nurses need to be trained to empower family members in providing continuous support for adults with pulmonary tuberculosis. To fully assess the program’s effectiveness, additional research is required to investigate its performance in different contexts and with various samples.

References

World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization; 2021.

Ryan ET, Hill DR, Solomon T, Endy TP, Aronson N. Hunter’s tropical medicine and emerging infectious diseases. 10th ed. Edinburgh: Elsevier; 2019.

Division of Tuberculosis. National tuberculosis control programme guideline, Thailand, 2021. Bangkok: Aksorn Graphic and Design Publication; 2021.

World Health Organization. Definitions and reporting framework for tuberculosis-2013 revision: updated December 2014 and January 2020. 2023 [cited 2023 May 15]. Available from: https://www.who.int/publications/i/item/9789241505345

Rahimi BA, Rahimy N, Ahmadi Q, Hayat MS, Wasiq AW. Treatment outcome of tuberculosis treatment regimens in Kandahar, Afghanistan. Indian J Tuberc. 2020;67(1): 87-93. doi: 10.1016/j.ijtb.2018.10.008.

Charoensakulchai S, Limsakul M, Saengungsumalee I, Usawachoke S, Udomdech, A, Pongsaboripat A, et al. Characteristics of poor tuberculosis treatment outcomes among patients with pulmonary tuberculosis in community hospitals of Thailand. Am J Trop Med Hyg. 2020; 102(3):553-61. doi:10.4269/ajtmh.19-0564.

Somsong W, Lawpoolsri S, Kasetjaroen Y, Manosuthi W, Kaewkungwal J. Treatment outcomes for elderly patients in Thailand with pulmonary tuberculosis. Asian Biomed (Res Rev News). 2018;12(2):75-82. doi:10.1515/ abm-2019-0004.

World Health Organization. Global tuberculosis report 2019. Geneva: World Health Organization; 2019.

Choowong J, Tillgren P, Söderbäck M. Thai people living with tuberculosis and how they adhere to treatment: a grounded theory study. Nurs Health Sci. 2017;19(4):436-43. doi: 10.1111/nhs.12362.

Tola H, Holakouie-Naieni K, Tesfaye E, Mansournia MA, Yaseri M. Prevalence of tuberculosis treatment non-adherence in Ethiopia: a systematic review and meta-analysis. Int J Tuberc Lung Dis. 2019;23(6):741-9. doi: 10.5588/ijtld.18.0672.

Min J, Chung C, Jung SS, Park HK, Lee SS, Lee KM. Understanding illness perception in pulmonary tuberculosis patients: one step towards patient-centered care. PloS One. 2019;14(6):e0218106. doi:10.1371/journal.pone. 0218106.

Kristinawati B, Muryadewi A, Irianti AD. The role of family as a caregiver in caring for family members that are suffering from pulmonary tuberculosis. J Ners. 2019; 14(3si):362-66. doi: 10.20473/jn.v14i3(si).17214.

Wen S, Yin J, Sun Q. Impacts of social support on the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMJ Open. 2020;10(10): e036985. doi:10.1136/bmjopen-2020-036985.

Putra MM, Pratama AA, Adnyani NPN. Relationship between the level of knowledge and family support with self-efficacy in patients with tuberculosis. INJEC. 2019;4(1):61-5.

Bao Y, Wang C, Xu H, Lai Y, Yan Y, Ma Y, et al. Effects of an mHealth intervention for pulmonary tuberculosis self-management based on the integrated theory of health behavior change: randomized controlled trial. JMIR Public Health Surveill. 2022;8(7):e34277. doi:10.2196/ 34277.

Truzyan N, Crape B, Harutyunyan T, Petrosyan V. Family-based tuberculosis counseling supports directly observed therapy in Armenia: a pilot project. J Tuberc Res. 2018; 6:113-24. doi:10.4236/jtr.2018.62011.

Gibson CH. The process of empowerment in mothers of chronically ill children. J Adv Nurs. 1995;21(6):1201-10. doi: 10.1046/j.1365-2648.1995.21061201.x

Gibson CH. A concept analysis of empowerment. J Adv Nurs. 1991;16(3):354-61. doi: 10.1111/j.1365-2648. 1991.tb01660.x.

Ifansyah MN, Sukartini T, Hidayat AAA. The relationship between family empowerment and family independent in caring patients with lung tuberculosis in Banjar Regency, Indonesia. IJNHS. 2019;2(4):314–9. doi:10.35654/ ijnhs.v2i4.161.

Janprung A, Junprasert S, Rattanagreethakul S. Effects of empowerment on self-care behaviors and sputum examination of patients with tuberculosis. J Public Health Nurs. 2017;31(3):89-104 (in Thai).

World Health Organization. Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003.

Muzaini K, Yasin SM, Ismail N, Abdul Rani MF, Ismail AI, Razali A, et al. Determinants of tuberculosis treatment success among the working population in Malaysia Singapore Med J. 2023 Jan 31. doi: 10.4103/singaporemedj. SMJ- 2020-519.

Yusmaniar Y, Kurniawan AH. Medication adherence to successful tuberculosis treatment outcome among TB/HIV patient at Prof. Dr. Sulianti Saroso Infectious Disease Hospital. PCPR. 2020;5(3):98–105.

Lestari L, Triwibowo C, Nurhayati I, Lubis NA. Family empowerment with SEDAP method (sharing, education and practice) in improving the quality of life in lung tuberculosis patients. Health Notions. 2021;5(3):107-111. doi: 10.33846/hn50308.

Wardhani P, Dharma KK, Susito S. The effectiveness of family empowerment in the latent TB infection towards TB patients’ obedience and caregiver burden. J Nurs Care. 2021;4(1): 262-70. doi:10.24198/jnc.v4i1.25480.

Polit DF, Beck CT. Nursing research: generating and assessing evidence for nursing practice. 11th ed. Philadelphia: Wolters Kluwer; 2021.

Division of Tuberculosis. NTP: National tuberculosis control program guideline, Thailand, 2021. 2021[cited 2021 Jan 17]. Available from: https://ddc.moph.go.th/uploads/ publish/1253220220330064337.pdf (in Thai).

Chiangmai Provincial Public Health Office. Handbook of DMS aging screening. 2018 [cited 2021 May 9]. Available from: https://www.chiangmaihealth .go.th/cmpho_web/ main_section.php?info_id=4197(in Thai).

Yin X, Tu X, Tong Y, Yang R, Wang Y, Cao S, et al. Development and validation of a tuberculosis medication adherence scale. PloS One. 2012;7(12):e50328. doi:10.1371/journal.pone.0050328.

Brislin RW. Back-translation for cross-cultural research. J Cross-Cult Psychol. 1970;1(3):185-216. doi:10. 1177/135910457000100301.

Chen X, Du L, Wu R, Xu J, Ji H, Zhang Y, et al. The effects of family, society and national policy support on treatment adherence among newly diagnosed tuberculosis patients: a cross-sectional study. BMC Infect Dis. 2020;20(1):623. doi: 10.1186/s12879-020-05354-3.

Mukarsa S, Sumpowthong K. Effects of a health promotion program by applying the theory of empowerment in new smear positive pulmonary tuberculosis patients. J Med Health Sci. 2017;24(1):13-27 (in Thai).

Nezenega ZS, Perimal-Lewis L, Maeder AJ. Factors influencing patient adherence to tuberculosis treatment in Ethiopia: a literature review. Int J Environ Res Public Health. 2020;17(15):5626. doi: 10.3390/ijerph17155626.

Mahanggoro TP, Fajriyati NA, Permatasari IK. The factor of family support towards the success of tuberculosis therapy: a cohort study. Proceedings of the 1st International Conference on Science, Health, Economics, Education and Technology (ICoSHEET 2019); 2019 December 18; Semarang, Indonesia. Dordrecht, The Netherlands: Atlantis Press; 2020 [cited 2023 May 15]. p. 194-8. Available from: https://www. atlantis- press.com/proceedings/icosheet-19/125942154.

Abhicharttibutra K, Tungpunkom P. Association of structural and psychological empowerment with depersonalization and personal accomplishment among nurses: a systematic review. Pacific Rim Int J Nurs Res. 2019;23(4):398-413.

Akande PA. The effect of an educational intervention to improve tuberculosis infection control among nurses in Ibadan, south-west Nigeria: a quasi-experimental study. BMC Nurs. 2020;19:81. doi:10.1186/s12912-020-00474-2.

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Published

2023-09-28

How to Cite

1.
Khakhong S, Lirtmunlikaporn S, Unahalekhaka A, Wichaikhum O- anong. Effects of the Family Empowerment Program on Medication Adherence and Treatment Success Among Adults with Pulmonary Tuberculosis: A Randomized Controlled Trial. PRIJNR [Internet]. 2023 Sep. 28 [cited 2024 Dec. 22];27(4):654-70. Available from: https://he02.tci-thaijo.org/index.php/PRIJNR/article/view/262115