A Health Belief Model-Based Motivational Interviewing for Medication Adherence and Treatment Success in Pulmonary Tuberculosis Patients.

Ni Made Parwati,I Made Bakta,I Made Ady Wirawan,Pande Putu Januraga

doi:10.3390/ijerph182413238

Abstract

Medication adherence behavior plays a central role in the success of tuberculosis (TB) treatment. Conventional motivation is not optimal in strengthening long-term medication adherence. A motivational interviewing (MI) communication motivation model based on the Health Belief Model (HBM) was designed with the main objective of improving medication adherence and treatment success. This study used an experimental design with a randomized posttest-only control group design. The intervention and control groups consisted of 107 TB patients each, who were selected by random cluster sampling. The study was conducted from November 2020 to June 2021 at 38 public health centers in Bali Province. The HBM-based MI model intervention was given in seven counseling sessions, pill count percentages were used to measure medication adherence, and treatment success was based on sputum examination results. Logistic regression was used to assess the effect of the intervention on medication adherence and treatment success. Logistic regression analysis showed that MI-based HBM and knowledge were the most influential variables for increasing medication adherence and treatment success. Medication adherence was 4.5 times greater (ARR = 4.51, p = 0.018) and treatment success was 3.8 times greater (ARR = 3.81, p < 0.038) in the intervention group compared to the control group, while the secondary outcome of knowledge of other factors together influenced medication adherence and treatment success. The conclusion is that the HBM-based MI communication motivation model creates a patient-centered relationship by overcoming the triggers of treatment barriers originating from the HBM construct, effectively increasing medication adherence and treatment success for TB patients, and it needs further development by involving families in counseling for consistent self-efficacy of patients in long-term treatment.

Highlights

Tuberculosis is a global public health challenge
This study aims to evaluate medication adherence in terms of dose accuracy, time and duration of treatment, and the success of treatment based on negative results of acidresistant bacteria sputum examination after counseling with the motivational interviewing model approach based on the Health Belief Model
Adherence to medication was monitored with pill count percentages, and treatment success was based on the results of sputum examination in the second, fifth, and sixth months of treatment

Summary

Introduction

Tuberculosis is a global public health challenge. Medication adherence behavior plays a central role in the success of TB treatment [1]. In Indonesia, the Stop TB Strategy for the control of pulmonary TB with the directly observed treatment short course (DOTS). Community and health workers are trained with the aim of removing some of the barriers to medication adherence. In addition to interventions with conventional motivations that have not been optimally strengthened for long-term medication adherence, there were 9073 cases of multi-drug resistant (MDR). TB in 2018, confirmed to be the result of noncompliance, further resulting in suboptimal medical efforts, which endangered patient health and led to high morbidity and mortality rates [2]. Medication adherence and treatment success requires a multifaceted approach in order to help adapt, change, and maintain behavior due to the long treatment process of

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