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RELATED SOCIAL SUPPORT QUALITY OF LIFE IN PATIENTS WITH PULMONARY

TUBERCULOSIS (TB LUNG) IN LUNG DISEASE TREATMENT CENTER (BP4)


YOGYAKARTA UNIT Minggiran

Nita Yunianti Ratnasari

AKPER Giri Satria Husada Winton

INTRODUCTION

background

Tuberculosis (TB) is a chronic


disease that lung is still a public health
problem in the world, including Indonesia.
The WHO states that TB has now become
a global threat. An estimated 1.9 billion
people, or one third of the world's
population infected with the disease occurs
ini.Setiap year approximately 9 million
new cases Tbdengan death of 3 million
people. In developing countries deaths
accounted for 25% of the cases, which
could be prevented in connection with the
discovery of the bacteria that causes TB
has. Death is generally caused due to the
detection
of
cases
and
failure
pengobatan.Data Tuberculosis Eradication
Program (P2 TB) in Indonesia showed an
increase in cases from year to year.
Mitigation and prevention efforts that have
attempted still have not managed to solve
the problem that there is a reduction in
morbidity
and
mortality.
Problem
encountered is the difficulty of pulmonary
tuberculosis case detection of smear (+),
disorder treatment and drop out of
treatment. Untreated TB cases will
continue to be a source of transmission.

Humans as social beings can not


live alone without the help of others.
Physical needs (food, clothing, shelter),
social needs (interaction, recognition and
psychological needs including curiosity, a
sense of security, a feeling of religiosity),
may not be fulfilled without the help of
others. Especially if the person is facing
the problem either mild or severe. At that
point someone will seek social support
from the people around him, so that he
feels valued, cared for and loved.

So it is with people with chronic


diseases such as pulmonary TB should
receive more social support, because with
the support of these people can indirectly
lower the psychological burden with
respect to the disease which in turn will
increase the body's resistance to physical
condition is not

declining. Social support is important for


chronic illness because of social support
can affect the behavior of individuals, such
as decreased anxiety, helplessness and
despair, which in turn can improve health
status. Increased health status means it will
improve the quality of life of patients.
Family and community support has a big
hand in improving treatment adherence,
with supervision and encouragement to
patients. Supervisory role Drink Drugs

(PMO) can be derived from health


workers, the public or the patient's family.

Quality of life is one of the main


criteria to determine the health care
interventions such as morbidity, mortality,
fertility, and disability. In developing
countries in recent decades the incidence
of chronic disease began to replace the
dominance of infectious diseases in the
community. Some people may live longer,
but to carry the burden of chronic disease
or disability, so the quality of life to the
attention of health care. The phenomenon
in today's society is still a family member
who fear especially close to someone
suspected of suffering from pulmonary
tuberculosis, making it appear cautious
attitude in excess, for example alienate
people, reluctant to speak to, if close to the
patient will soon cover the nose and so on.
It will be very offensive to people. Patients
will be depressed and feel isolated, so it
can have an impact on the psychological
condition and will ultimately affect the
success of treatment. This means that
social support is needed not gotten
optimally.

Based on the consideration that


social support can improve the health
status of the patient as well as the
importance of attention to the quality of
life of patients with chronic diseases, the
researchers were interested in assessing
both. Medical Center Pulmonary Disease
(BP4) was chosen as the research data
retrieval because besides being a potential
treatment for pulmonary tuberculosis
patients, BP4 as well as the right place to
develop a variety of research related to the
treatment of the disease. BP4 Minggiran
unit is the administrative center and the
discovery rate of new cases of pulmonary
tuberculosis patients in the highest BP4
compared BP4 other units in Yogyakarta.
In the period January to December 2003,

by 48%, patients with pulmonary TB


smear (+) recently discovered in
Minggiran.

The purpose of this study was to


determine the relationship between social
support and quality of life of patients with
pulmonary
tuberculosis,
pulmonary
tuberculosis patients characteristics, the
amount of social support and the level of
quality of life of patients with pulmonary
tuberculosis treatment in Yogyakarta BP4
Minggiran Unit as well as the contribution
of the characteristics of respondents to the
quality of life of patients with pulmonary
tuberculosis .

RESEARCH METHODS

This research is a quantitative nonexperimental descriptive method with


cross-sectional study design. The total
sample size of 50 patients with pulmonary
tuberculosis treatment in BP4 Minggiran
Units that meet the specified criteria,
namely: medical diagnosis of pulmonary
TB smear (+), has gone through an
intensive phase treatment program at least
2 months with OAT Category I, patients of
childbearing age is between 15-55 years
old, able to read and write. Data taken with
the questionnaires by respondents from
February to April 2004.Data analyzed
descriptively to determine the relationship
between social support and quality of life
in patients with pulmonary tuberculosis by
using correlation analysis test, Pearson
Product Moment.

RESULTS AND DISCUSSION

1. Research

Pulmonary tuberculosis patients


who were respondents in this study were
patients of childbearing age, the average
age of 21-30 years as many as 26 people
(52%). Age 31-40 years and 41-50 years of
age respectively 8 (16%) and 7 (14%). The
number of male patients and balanced
women, men 27 people (54%), 23 women
(46%). Education of respondents were 23
people (46%) graduated from high school,
14 people (28%) graduated from junior
high school, while respondents with low
education (no school, did not graduate or
complete primary school each 3 people
(6%). Job 14 student respondents (28%),
did not work and labor of each 8 people
(16%). History of treatment as many as 33
people (66%) of respondents said never
seek treatment earlier

except in BP4, whereas 17 (34%) said that


they had to undergo another treatment
before in BP4 Minggiran.

2. Social Support

The total score is the sum of the


social support and satisfaction of
respondents giving support on the social
support. A total of 18 people (36%)
received social support with high category.
For medium and low categories
respectively by 22 people (44%) and 10
men (20%). Social support received by the
patient is generally obtained from family,
relatives and neighbors.

3. Quality of Life

Assessment of quality of life


includes 5 aspects: the level of activity,
daily life, health, social support and hope.
A total of 34 people (68%) can be normal
activities, 14 people (28%) in the move
need the help of others and 2 (4%) stated
are not able to move. A total of 40 people
(80%) able to perform daily life normally,
9 people (18%) in the conduct of life need
the help of others, and 1 (2%) stated are
not able to live a daily life at all. A total of
25 people (50%) felt well on most of the
time, 21 people (42%) stated often feel
lethargic, and 4 (8%) stated that the body
is always a pain. Most of pulmonary
tuberculosis patients received strong
support from family and friends with 43
people (86%), patients who received
limited support from the family as much as
6 people (12%) and only one (2%) stated
rarely have the support of people around .
A total of 40 people (80%) had positive
expectations and can adapt to the
circumstances surrounding environment.
There are 9 people (18%) felt sad and only
1 (2%) really confused, very scared and
anxious. Broadly speaking, as many as 34
people (68%) have a good quality of life,
quality of life categories were 30% and
only 1 respondent (2%) with the quality of
life ugly.

4. Relationship Between Social Support


with the Quality of Life

From the analysis of the test


MomentPearson korelasiProduct obtained
relationship between social support and
quality of life in patients with pulmonary
tuberculosis with r equal to 0.675; p <0.01.
May imply that there is a significant
relationship between social support and
quality of life, which means the higher the
social support received, the quality of life
is also increasing. Interpretation of the
strength of the relationship, including the
high category.

Relationship Between Characteristics of


Respondents with Quality of Life

The results of the analysis with


Pearson correlation between respondent
characteristics (age, gender, level of
education, employment and medical
history) with the quality of life of patients
with pulmonary tuberculosis. Obtained
results of the analysis: the variable age (r =
0.468; p <0.05), gender (r = 0.077; p =
0.593), education (r = 0.420; p <0.05),
employment (r = 0.141; p = 0.330), history
of treatment (r = 0.017; p = 0.906). From
this analysis it is known that age and
education variables have a correlation
coefficient values were, respectively (r =
0.468 and r = 0.420), with a significance
level of p <0.05. It showed no significant
relationship between age and education
with quality of life. While other variables:
gender, occupation and medical history
showed no significant correlation with
quality of life.

The results of multiple regression


analysis between the characteristics of the
respondents to the quality of life of
patients with pulmonary tuberculosis,
derived variables age ( = 0.519; p <0.05)
and education ( = 0.378; p <0.05)
contributed significantly to the quality of
life. Other variables: gender ( = 0.260; p
= 0.753), work ( = -0.155; p = 0.260) and
treatment history ( = - 6.25; p = 0.417)
did not contribute to the quality of life of
patients with pulmonary tuberculosis .

DISCUSSION

The frequency of pulmonary tuberculosis


patients who undergo outpatient treatment
program in Yogyakarta BP4 Minggiran

Unit majority are of childbearing age,


between 21-30 years, by 52%. The highest
incidence of pulmonary TB usually affects
young adults, between 15-44 years old.
Approximately 95% of patients with
pulmonary tuberculosis in developing
countries, where 75% of whom are of
childbearing age.

The number of male patients is


higher than women, amounting to 54%.
This is consistent with the results of
research
on
display
radiological
abnormalities in adults who stated that the
men had kecenderunganlebih vulnerable to
the risk factors of pulmonary tuberculosis.
This is possible because men are doing
more activities so that more often exposed
to the cause of this disease.

Education is the most respondents


completed high school by 46%. It is
assumed that people with higher education
will be aware about healthy behaviors and
treatment of disease. However, the results
of this study indicate that the higher
education yet

The individual would have a better


awareness of the disease than those who
are less educated. This is in contrast with
the results of case study research results of
pulmonary tuberculosis treatment in 10
health centers in Jakarta from 1996 to
1999 which states that the low level of
education will lead to a lack of knowledge
in terms of hygiene and environmental
health are reflected in the behavior of the
majority of patients who still throw
sputum and spit anywhere.

Most respondents as student jobs by 28%.


From interviews with the status of the

respondents found that most students come


from outside the area so they should
outhouse. Living in dense residential
neighborhood (like kos) effect on
pulmonary TB transmission. This is
consistent
with
the
statement
mengenaibeberapa thing to note in
connection with the transmission of TB is
related housing overcrowding or poor
working conditions. Residential density
negative effects on physical health, mental
and social. Home or room that is too
overcrowded to be deprived of O2
resulting in a lowering durability and
facilitates the spread of disease.

History of treatment showed that


66% of patients had never previously
sought treatment except in the BP4.
Respondents
had
previously
been
undergoing treatment outside BP4
ultimately prefer to be treated in such
institutions with cost considerations
cheaper and affordable. It is closely related
to patient compliance in completing the
treatment program is for 6 months.
Pulmonary TB treatment success rate is
strongly influenced by patient adherence to
treatment regimens given. Ministry of
Health has established a policy with
gratissehingga treatment delivery is
expected to be an incentive for people that
regularly treated in accordance with the
schedule to achieve healing. But in
practice many patients who do not
diligently completed treatment.

Social support measurement results


obtained in this study 44% of all
respondents receive social support
moderate. This means that patients with
pulmonary TB who were respondents in
this study is quite get social support from
people around the patient. Social support is
important for people with chronic illness,
because with such support will influence

the behavior of an individual, such as a


decrease in taste

9 Journal of Tuberculosis Indonesia, vol.8

anxiety, feelings of helplessness and


despair that can ultimately improve the
health status of the patient.

Quality of life of patients with


pulmonary tuberculosis in BP4 Yogyakarta
outpatient related activity on a relatively
well last week. A total of 34 people (68%)
patients stated that they can work or study
with normal. Conversely, patients who
declared unable to work or study in any
circumstances
by
4%.
Pulmonary
tuberculosis is a chronic inflammation.
Symptoms common malaise (anorexia,
decreased appetite, weight loss, headache,
chills, muscle pain, and night sweats) and
can reduce labor productivity patients.

Quality of life of patients with


pulmonary tuberculosis in BP4 Yogyakarta
outpatient related daily life in the last week
is a good one. By 80% of respondents said
they can eat, wash, dress himself, taking
public transportation without the help of
others. The ability to perform daily
activities, such as taking care of yourself
as well as social functioning is one
component in the quality of life related to
functional capacity.

Quality of life of patients with


pulmonary tuberculosis in BP4 outpatient
health related Yogyakarta on last week was
a good one. A total of 25 people (50%) of
respondents feel well on most of the time.
Patients who feel unwell as much as 4
people (8%) is caused by chest pain, cough
settled and feel tired. Cough with phlegm,
chest wall pain, weight loss, fever and
sweating, loss of appetite, shortness of
breath and frequent colds.

Quality of life of patients with


pulmonary TB outpatient in Yogyakarta
BP4 associated with support from family
and friends was obtained by 43 people
(86%) claimed to have good relationships
with others and the powerful support of the
members of the family or friends. Patients
who lack the support of family and friends
is mainly due to her illness. They have
realized that it is easy to infectious
pulmonary TB, so most feel better reduce
contact with others. There is also where
people around the patient intentionally
limit contact with the patient, for fear of
contracting. Conversely, strong support in
patients mainly from the family would
greatly help the healing process of
pulmonary tuberculosis disease. For
example related to medication adherence,
which lasted for 6 months. Family and
community support has a big hand in
improving treatment adherence, with
supervision in taking medicine and related
support to the patient.

The life expectancy of patients


with pulmonary tuberculosis in BP4
outpatient quite good. A total of 40 people
(80%) patients had positive expectations
and be able to adjust to the circumstances
surrounding
environment.
Most
respondents have positive expectations
have been convinced that despite the

relatively heavy but pulmonary TB disease


can be cured, provided that comply with
treatment regimens that have been set. The
existence of the PMO is someone who is
trusted both by patients themselves or by
the health workers, who will participate in
supervising the patient to drink throughout
the medicine is expected to greatly help
people to behave so as to support the
healing process.

In this research note that there is a


significant relationship between social
support and quality of life (r = 0.675; p
<0.01). Direction positive correlation
indicates that the greater social support,
the quality of life will increase. These
results are consistent with the theory about
the influence of social support, one of
which is the indirect influence that social
support can affect the stress faced by the
individual, the social acceptance that can
affect self-esteem. Self esteem will affect
the mental health of a person.

The results of multiple regression


analysis between age and quality of life
obtained a value of ( = 0.519; p <0.05).
This means that age contributes
significantly to the quality of life of
patients with pulmonary tuberculosis. In
general quality of life declines with
increasing age.

In this research note sexes does not


contribute to the quality of life with the
value ( = 0.260; p = 0.735). This is
consistent with the results of research on
Quality of Life of Patients with Terminal
Renal Failure Undergoing Hemodialysis
Kronikdi The dr. Sardjito which states that
gender did not affect the quality of life of
patients with terminal renal failure (GGT)
undergoing chronic hemodialysis. It added
that men have a worse quality of life than
women.

The level of education contributes


significantly to the quality of life ( =
0.378; p <0.05). This is according to a
statement that the level of education will
affect the attitude of caring for themselves.
The higher the level of education will be
further spur towards progress, so expect
these attitudes also affect health care.
The results of multiple regression
analysis between job with the quality of
life gained ( = -0.155; p = 0.260).
Means that the work does not
contribute to the quality of life of patients
with pulmonary tuberculosis. This is
possible because the type of work the
respondents in this study were taken only
descriptively. More 50% of respondents
are students and the rest were subdivided
into 6 categories other kind of work, so
that kind of work in this study can not be
said to represent the profession.
In this research note that there is no
relationship between a history of treatment
with the quality of life of patients with

pulmonary tuberculosis, a score ( = -6.25,


p = 0.417). History of treatment in this
study related to patient adherence to
treatment, with respect to the free
treatment program of the government in
the hope to reduce the number of drop out
of treatment as low as possible.

CONCLUSION

There is a significant relationship


between social support and quality of life
of patients with pulmonary tuberculosis.
The higher the social support, the higher
the quality of life. Age and education
variables contributed significantly to the
quality of life. Other variables, namely
gender, occupation and medical history did
not contribute to the quality of life of
patients with pulmonary tuberculosis.