The effects of acceptance and commitment therapy on psychosocial impact and adherence of MDR-TB patients.

Abstract

Background: The Worldwide resistance prevalence of the first-line tuberculosis drug, rifampicin, in 2017 was 7.4 per 100,000 population, and 82% of them experienced multidrugresistant tuberculosis (MDR-TB). Indonesia is the top 20 country with an MDR-TB burden, and its prevalence is 8.8 per 100,000 population. MDR-TB requires a long-time treatment and has accompanying side effects: biological and psychosocial effects. However, efforts to overcome the psychosocial impacts have not been conducted. This study aims to determine the effect of acceptance and commitment therapy (ACT) on anxiety, depression, suicidal ideation, and treatment adherence in MDR-TB patients.Design and methods: This research employed a quasi-experimental design with a pre-test three post-tests using total sampling. The pre-test was conducted before the standard nursing intervention, post-test 1 was after the standard nursing intervention, posttest 2 was after ACT session 1, and post-test 3 was after ACT session 2. Data were collected by the Hamilton Rating Scale for Anxiety, Beck Hopelessness Scale, a Scale for Suicide Ideation, and Morisky Medication Adherence Scale.Results: The standard nursing action and ACT reduce anxiety (p=0.002), reduced depression (p=0.0001), reduced suicidal ideation (p=0.008), and increased treatment adherence (p=0.0001).Conclusions: The standard nursing action and ACT reduce anxiety, depression, and suicidal ideation. They increase treatment adherence recommended for use in MDR-TB patients. Significance for public health Multidrug-resistant tuberculosis (MDR-TB) treatment need a long period, while biological, psychological, and social impacts require acceptance and commitment to treatment adherence. The MDR-TB treatment program focuses on treating disease and has not yet been treated for psychosocial problems. It is necessary to handle psychosocial problems in MDR-TB clients in the form of individual and family actions as a system thereby increasing adherence to taking medication, so that improve treatment success. Current and future healthcare professionals play an important role in psychosocial intervention in MDR-TB patients.