Application of the Health Belief Model on Treatment Compliance in Multidrug-Resistant Tuberculosis Patients
DOI:
https://doi.org/10.37287/ijghr.v8i2.780Keywords:
Health Belief Model, multidrug-resistant tuberculosis, treatment complianceAbstract
Multidrug-resistant tuberculosis (MDR-TB) is a major health problem in Indonesia, with significant challenges in treatment adherence. The use of the Health Belief Model (HBM) can help explain factors influencing patient adherence to therapy. This study used a cross-sectional analytical design and was conducted at Dr. Soetomo General Hospital, Surabaya, from July to August 2025. The sample consisted of 36 MDR-TB patients on an 18-month regimen, selected using simple random sampling. The dependent variable was medication adherence, while the independent variables included perceptions of susceptibility, severity, benefits, barriers, cues to action, and self-efficacy. The research instrument was an HBM-based questionnaire. Data analysis was performed using linear regression. Multivariate analysis showed that perceived barriers significantly influenced treatment adherence (b = –0.15; 95% CI = –0.29 to –0.01; p = 0.041). Meanwhile, cues to action influenced treatment adherence, but were not statistically significant (b=0.04; 95% CI=-0.01 to 0.10; p=0.102). The regression model explained 18.9% of the variation in adherence. Perceived barriers have been shown to influence adherence in MDR-TB patients. Intervention efforts are needed to reduce perceived barriers in order to improve treatment adherence.
References
Aldurayhim JSE, Bawazir BA, Alharbi NO, Almutairi MG, Alowayqilah KM, Alanazi AZ, Mutairi RA, et al. (2023). Medication adherence strategies: Enhancing patient compliance and outcomes. Journal of International Crisis and Risk Communication Research, 6(1), 45–60. https://jicrcr.com/index.php/jicrcr/article/view/2045
Alinaitwe B, Shariff NJ, Madhavi Boddupalli B (2025). Treatment adherence and its association with family support among pulmonary tuberculosis patients in Jinja, Eastern Uganda. Sci Rep 15, 11150 (2025). https://doi.org/10.1038/s41598-025-96260-8
Arendse SM, Khoza-Shangase K (2025). A cross-sectional, descriptive qualitative study of information counselling during tuberculosis treatment in South Africa: Awareness of XDR-TB patients on ototoxic effects. International Journal of Environmental Research and Public Health, 22(1), 91. https://doi.org/10.3390/ijerph22010091
Bandura, A. (1997). Self-efficacy: The exercise of control. New York: Freeman.
Bhebhe LT, Van Rooyen C, Steinberg WJ (2014). Attitudes towards tuberculosis and treatment adherence in a community-based programme in the Free State province, South Africa. African Journal of Primary Health Care & Family Medicine, 6(1), 1–8. https://doi.org/10.4102/phcfm.v6i1.597
Chaiyachati KH, Ogbuoji O, Price M, Suthar AB, Negussie EK, Bärnighausen T. Interventions to improve adherence to antiretroviral therapy: a rapid systematic review. AIDS. 2014 Mar;28 Suppl 2:S187-204. doi: 10.1097/QAD.0000000000000252.
Cherry K (2021). Intimacy vs. isolation in psychosocial development. Verywell Mind. https://www.verywellmind.com/intimacy-versus-isolation-2795739
Fang XH, Shen HH, Hu WQ, Xu QQ, Jun L, Zhang ZP, Kan XH, Ma DC, Wu GC. Prevalence of and Factors Influencing Anti-Tuberculosis Treatment Non-Adherence Among Patients with Pulmonary Tuberculosis: A Cross-Sectional Study in Anhui Province, Eastern China. Med Sci Monit. 2019 Mar 14;25:1928-1935. doi: 10.12659/MSM.913510. PMID: 30869079; PMCID: PMC6429981.
Deutsch-Feldman M, Pratt RH, Price SF, Tsang CA, Self JL (2021). Tuberculosis - United States, 2020. MMWR Morb Mortal Wkly Rep. 70(12):409-414. doi: 10.15585/mmwr.mm7012a1.
Gebremariam RB, Wolde M, Beyene A. Determinants of adherence to anti-TB treatment and associated factors among adult TB patients in Gondar city administration, Northwest, Ethiopia: based on health belief model perspective. J Health Popul Nutr. 2021 Nov 27;40(1):49. doi: 10.1186/s41043-021-00275-6.
Glanz, K, Rimer BK, Viswanat K (2015). Health Behavior Theory, research, and practice. Jossey-Bass
Iribarren S, Beck S, Pearce PF, Chirico C, Etchevarria M, Cardinale D, Rubinstein F. TextTB: A Mixed Method Pilot Study Evaluating Acceptance, Feasibility, and Exploring Initial Efficacy of a Text Messaging Intervention to Support TB Treatment Adherence. Tuberc Res Treat. 2013;2013:349394. doi: 10.1155/2013/349394. Epub 2013 Dec 12.
Janz NK, Becker MH (1984). The Health Belief Model: A decade later. Health Education Quarterly, 11(1), 1–47. https://doi.org/10.1177/109019818401100101
Kementerian Kesehatan Republik Indonesia (2020). Laporan Situasi Tuberkulosis di Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia.
Kementerian Kesehatan Republik Indonesia (2022). Laporan Tahunan Tuberkulosis di Indonesia. Jakarta: Kementerian Kesehatan Republik Indonesia.
Khan M, Walley J, Witter S, Shah SK, Javeed S (2017). Tuberculosis patient adherence to direct observation: Results of a social study in Pakistan. Health Policy and Planning, 20(6), 354–365. https://doi.org/10.1093/heapol/czi047
Koirala S, Borisov S, Danila E, Mariandyshev A, Shrestha B, Lukhele N, et al. Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort. Pulmonology 2021. https://doi.org/10.1016/j.pulmoe.2021.02.006.
Maulina N, Hayati Z, Hasballah K, Zulkarnain Z, Waraztuty I, Defadheandra A (2024). Rifampicin Resistant Tuberculosis Among Presumptive Pulmonary Tuberculosis in Province Referral Hospital, Indonesia: Dynamic Cases of a 7-Year Report. J Res Health Sci. 24(1):e00601. doi: 10.34172/jrhs.2024.136.
McHorney CA, Tarlov AR (1995). Individual-patient monitoring in clinical practice: Are available health status surveys adequate? Quality of Life Research, 4(4), 293–307. https://doi.org/10.1007/BF01593882
Mekonnen HS, Azagew AW (2018). Non-adherence to anti-tuberculosis treatment, reasons and associated factors among TB patients attending at Gondar town health centers, Northwest Ethiopia. BMC Research Notes, 11, 691. https://doi.org/10.1186/s13104-018-3789-4
Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmin J. (2007). Patient adherence to tuberculosis treatment: A systematic review of qualitative research. PLoS Medicine, 4(7), e238. https://doi.org/10.1371/journal.pmed.0040238
Rosenstock IM (1974). The Health Belief Model and preventive health behavior. Health Education Monographs, 2(4), 354–386. https://doi.org/10.1177/109019817400200405
Schunk DH, DiBenedetto MK (2020). Motivation and Social Cognitive Theory. Contemporary Educational Psychology, 60, https://doi.org/10.1016/j.cedpsych.2019.101832
Sharma, S. K., et al. (2018). Factors associated with treatment adherence among patients with multidrug-resistant tuberculosis: a systematic review and meta-analysis. PLoS One, 13(10), e0205220.
Sirait N, Parwati I, Dewi NS, Suraya N. Validitas Metode Polymerase Chain Reaction GeneXpert MTB/RIF pada Bahan Pemeriksaan Sputum untuk Mendiagnosis Multidrug Resistant Tuberculosis. Maj Kedokt Bandung. 2013 Dec;45(4):234–9.
Soedarsono et al. (2024). Limited success and high attrition in the 9-month all-oral regimen for MDR-TB: Evidence from a tertiary care setting in Indonesia. [Manuscript]. Sub-pulmonology Department of Internal Medicine, Faculty of Medicine, Hang Tuah University.
Subbaraman R, de Mondesert L, Musiimenta A, Pai M, Mayer KH, Thomas BE, Haberer J. Digital adherence technologies for the management of tuberculosis therapy: mapping the landscape and research priorities. BMJ Glob Health. 2018 Oct 11;3(5):e001018. doi: 10.1136/bmjgh-2018-001018.
Tola HH, Tol A, Shojaeizadeh D, Garmaroudi G (2015). Tuberculosis Treatment Non-Adherence and Lost to Follow Up among TB Patients with or without HIV in Developing Countries: A Systematic Review. Iran J Public Health44(1):1-11. PMID: 26060770; PMCID: PMC4449995.
Yahaya JY (2025). Sociodemographic determinants of multidrug-resistant tuberculosis in Lesotho: A case-control study. PLOS Glob Public Health. 5(7):e0004075. doi: 10.1371/journal.pgph.0004075.
World Health Organization (2021). Global tuberculosis report 2021. Geneva: World Health Organization
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.








