Artawan Eka Putra I Wayan Gede, Purnama Dewi Ni Putu Eka, Probandari Ari Natalia, Notobroto Hari Basuki, Wahyuni Chatarina
Universitas Udayana, Denpasar, Bali, Indonesia.
Health Office of Badung District, Mangupura, Bali, Indonesia.
Health Educ Behav. 2023 Feb;50(1):136-143. doi: 10.1177/10901981211001829. Epub 2021 Apr 8.
Lack of participation of household contacts is the main problem of early detection of tuberculosis (TB) in Indonesia. A comprehensive health education (CHE) program has been developed to encourage the participation of household contacts. This study aimed to assess the implementation of the CHE to improve participation of household contacts in early detection of TB. This was a quasi-experimental study conducted between November 2018 and June 2019 in Badung District, Bali, Indonesia. Twelve public health centers (PHCs) were randomly allocated to six PHCs implementing the CHE and six PHCs implementing standard health education (SHE). The CHE was developed through a pilot study using the health belief model supplemented with perceived stigma and social support to identify the factors that influence participation. The participation was measured using a TB register with a cross-check to the health care officer until 2 months after health education was provided. Four hundred and twenty-eight household contacts enrolled in this study-216 in the CHE group and 212 in the SHE group. The CHE group's participation was 28.2%, with 10 new TB cases found; in the SHE group, the participation was 15.6%, with 3 new TB cases found. The CHE increased the household contact participation by 1.83-fold (95% confidence interval [1.19, 2.81]) and case findings by 3.13-fold (95% confidence interval [0.85, 11.56]). The CHE implementation should be scaled up to other areas with a high level of TB transmission. The content and technique of the CHE could also be incorporated in contact investigation guidelines and materials for the TB campaign.
家庭接触者参与度不足是印度尼西亚结核病早期检测的主要问题。已制定了一项全面健康教育（CHE）计划，以鼓励家庭接触者参与。本研究旨在评估CHE的实施情况，以提高家庭接触者在结核病早期检测中的参与度。这是一项于2018年11月至2019年6月在印度尼西亚巴厘岛巴东县进行的准实验研究。12个公共卫生中心（PHC）被随机分为6个实施CHE的PHC和6个实施标准健康教育（SHE）的PHC。CHE是通过一项试点研究制定的，该研究使用健康信念模型，并辅以感知耻辱感和社会支持，以确定影响参与度的因素。参与度通过结核病登记册进行测量，并与医护人员进行交叉核对，直至提供健康教育后2个月。428名家庭接触者参与了本研究，其中CHE组216名，SHE组212名。CHE组的参与率为28.2%，发现10例新结核病病例；SHE组的参与率为15.6%，发现3例新结核病病例。CHE使家庭接触者的参与度提高了1.83倍（95%置信区间[1.19, 2.81]），病例发现率提高了3.13倍（95%置信区间[0.85, 11.56]）。CHE的实施应扩大到结核病传播水平较高的其他地区。CHE的内容和技术也可纳入结核病防治运动的接触者调查指南和材料中。
