Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.5
,
No
.2
,
Jun
e
2
016
, pp
. 16
4
~169
I
S
SN
: 225
2-8
8
0
6
1
64
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Model
of
Empowerm
ent t
o
Improve Aut
o
nomy Di
rectl
y
Observed Treatment (DOT)
Tub
e
rculosis Patients
Sya
m
ila
tul Kha
r
iroh
1
,
O
e
do
jo
So
ed
irh
a
m
2
, H
a
mid
a
h
3
,
En
da
ng
A
b
du
lla
h
1
1
School of
Nursing Hang
Tuah
Tanjungpin
a
ng,
Indonesia
2
Department of
Public He
alth
Science, Airlangg
a Un
iversity
, Surabay
a
, Indonesia
3
Department of
ps
y
c
holog
y
,
Air
l
a
ngga Univ
ersity
, Surabay
a
, Ind
onesia
Article Info
A
B
STRAC
T
Article histo
r
y:
Received Apr 15, 2016
Rev
i
sed
May 16
, 20
16
Accepted
May 26, 2016
Empowerment as not
y
e
t opt
imal health promotion
efforts done
to enhan
ce
the au
tonom
y
o
f
Directly
Observed
Tr
eatment (DOT), which
affect
th
e
success of the recover
y
of patients w
ith pulmonary
tub
e
rculosis.
The purpose
of research was to develop a m
odel empowerment based on Health
Promotion and Health
Literacy
with a
pproach to nursing interv
ention
in an
effort
enhan
c
e
the autonom
y
of
th
e
DOT
- pulmonar
y
TB patients.Th
e
method was an observationa
l analy
t
ic with
cross sectional appro
a
ch
.
Multistage r
a
nd
om
sa
m
p
ling was DOT-pulm
ona
r
y
tub
e
rculosis (
T
B) pati
ents
to decide the dis
t
rict and simple
ra
ndom sampling was assi
gned to choose th
e
participan
ts, a
to
tal of 253 DOT-
pulmona
r
y
TB patients new cas
e with acid
resistant b
aci
lli
positiveon
the
advanc
ed phas
e
in th
is stud
y.
The st
u
d
y
conducted in f
i
v
e
districts in Su
rabay
a
City
(
c
enter, north, south, east and
west). Data wer
e
collected b
y
q
u
es
tionnaire on
variab
les
namely
p
e
rsonal,
cognitiv
e and af
fect
ive, nursing
interv
ention
,
co
m
m
itm
ent, fam
i
l
y
supports,
heal
th li
ter
a
c
y
a
nd DOT- auton
o
m
y
.
Structural
Equation
Modeling (SEM)
with LISREL is used for constr
ucting
predictiv
e
model. This stud
y
found a
new model which was deve
loped
based on combination of Health
Promotion
Model (HPM)
and Health Literacy
(H
L)
. Statisti
ca
l result confirm
that
personal, cogn
itive and aff
e
ctive,
health literacy
and family
support
cons
idered
as
im
portant f
acto
r
s in improvin
g
DOT-autono
my
. DOT-
autonom
y
will i
m
p
rove by
consi
d
ering four m
a
in factors, personal, cogni
tiv
e
and affective, health lite
racy
, family
support. This model can b
e
adapted
b
y
Dis
t
rict He
alth
Office S
u
rab
a
ya Cit
y
as
the
m
a
in acto
r
reg
i
onal he
alth
developm
ent
.
In
addition
,
this m
odel m
a
y
bec
o
m
e
a referenc
e for other
district in
improving th
eir nu
rsing
i
n
te
rve
n
ti
on
i
n
c
o
mmuni
ty
se
t
ting.
Keyword:
Aut
o
n
o
m
y
DOT
o
f
TB Pa
tients
Em
powerm
e
nt
Health
Literacy
Heal
t
h
P
r
om
ot
ion
Copyright ©
201
6 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Sya
m
ila
tu
l Khariroh
,
Sch
ool
o
f
Nu
rs
i
ng Ha
ng
T
u
ah
Tan
j
un
g
p
i
n
a
n
g,
Jl
. B
a
r
u
KM
8
Tan
j
u
n
gpi
nan
g
Ti
m
u
r, R
i
au
Is
l
a
nd,
I
n
do
nesi
a
.
Em
a
il: k
h
a
riroh
65@g
m
ail.co
m
1.
INTRODUCTION
New
t
u
berc
ul
o
s
i
s
(TB
)
cases
gl
o
b
al
l
y
o
f
9.
6 m
i
ll
i
on pe
o
p
l
e
,
58
% are
i
n
S
o
ut
heast
A
s
i
a
an
d t
h
e
Western Pacifi
c.
India, Indonesia
an
d C
h
ina
ha
ve t
h
e large
s
t num
b
er of
T
B
cases with
t
h
e num
b
er
of each -
respect
i
v
el
y
23
%, 1
0
% a
nd
1
0
%
of t
o
t
a
l
ne
w TB
cases
gl
obal
l
y
o
f
9
.
6
m
i
ll
i
on.I
n
do
ne
si
a no
w ra
n
k
s
t
o
t
h
re
e
(3
) am
ong t
h
e 22 c
o
u
n
t
r
i
e
s i
n
t
h
e worl
d w
h
i
c
h has t
h
e hi
gh
est
bur
de
n of
TB
di
sease. Gl
obal
l
y
, t
h
e i
n
ci
den
c
e
o
f
MDR
-
TB (Mu
lti Drug
Resistan
ce Tub
e
rcu
l
o
s
is) 3
.
3
%
ca
m
e
fro
m
n
e
w TB cases and
20
%
o
f
TB cases h
a
s
been done
re-treatm
e
nt, an est
i
m
a
ted 190,000
p
e
op
le d
i
ed
of
MD
R
-
TB
in 2
014
[
1
].
East Jav
a
Pro
v
in
ce rank
s seco
nd
with
th
e l
a
rg
est
num
b
er of cases of T
B
(13%) in Indonesia. T
h
e
per
f
o
r
m
a
nce o
f
TB
co
nt
r
o
l
p
r
o
g
ram
s
i
n
20
11 s
h
owe
d
t
h
a
t
t
h
ere are
fi
ve
(5
) di
st
ri
ct
s i
n
East
Java wi
t
h
C
a
se
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Mod
e
l o
f
Empo
wermen
t to Imp
r
o
v
e Au
t
o
nomy
Directly
Ob
served
Trea
t
m
en
t (
DOT)
.... (S
yamila
tu
l K
h
a
r
iroh
)
16
5
Detection Rate
(CDR) <
7
0% and
Success
Rate (SR) <90%
, the city of Surabaya, Blitar,
Pacitan, Sidoa
r
j
o
a
nd
Sam
p
ang
has
not
reac
hed
t
h
e t
a
r
g
et
s set
by
t
h
e M
i
ni
s
t
ry
of
Heal
t
h
[
2
]
.
Di
rect
l
y
O
b
ser
v
e
d
T
r
eatm
e
nt
Sh
ort
c
ou
rse (
DOT
S)
has
be
com
e
an i
n
t
e
r
n
at
i
onal
st
a
n
d
a
rd i
n
t
h
e t
r
e
a
t
m
e
nt
of TB
.
The
pu
r
pose
o
f
usi
n
g
DOT
S is to re
ach
90%
TB t
r
eatm
e
nt success is m
easured
b
y
th
e
rate
o
f
cu
re and
treatmen
t co
m
p
leti
o
n
in
accorda
n
ce wi
th the progra
m
.
One approach use
d
to
op
tim
i
ze treatment outcom
es
is to identify directly
Obse
rved T
r
ea
tm
ent (DOT)
of eac
h TB
pat
i
ent
.
A
m
a
jor
ca
use o
f
of t
r
eat
m
e
nt
fai
l
u
re w
a
s due t
o
di
s
o
r
d
ere
d
patients takin
g
the
m
e
dicine. Irre
gula
r
ity
takin
g
m
e
dicatio
n d
u
e to the r
o
le of a D
O
T
was less effe
ctive.
R
e
sul
t
s
of rese
arch s
h
o
w
e
d
t
h
at
one ca
use of t
r
eat
m
e
nt
of pul
m
onary
TB
pat
i
e
nt
s dro
ppe
d o
u
t
beca
use o
f
a
lack of c
o
ntrol
by the
DOT
[3].
The
res
u
lts o
f
the s
u
rvey
at 2
5
(twe
nty
f
i
ve)
fam
i
ly
with o
n
e
fam
i
ly m
e
m
b
er suf
f
e
rin
g
fr
om
pul
m
onary
t
u
b
e
rcul
osi
s
s
h
o
w
ed t
h
at
t
h
e
DO
T r
o
l
e
ha
s
not
been
o
p
t
i
m
all
y
em
powere
d
t
o
co
nd
uct
s
u
per
v
i
s
i
o
n
an
d
care
o
f
p
a
t
i
en
ts with
p
u
l
m
o
n
a
ry TB. Th
e resu
lts of
the in
itial su
rv
ey
o
f
t
h
e ro
le of
th
e DOT sh
owed
th
at
6
5
% DOT are n
o
t
fam
iliar
with
TB d
i
sease co
rrec
tly, 8
5
%
DOT did
no
t un
d
e
rst
a
n
d
ho
w t
o
do
the
sup
e
r
v
i
s
i
o
n an
d care
of TB
p
a
t
i
e
nt
s du
ri
n
g
t
h
e co
ur
se o
f
T
B
t
r
eatm
e
nt
, 70% D
O
T
di
d
n
o
t
u
nde
rst
a
n
d
ho
w t
o
p
r
ev
en
t transmissio
n
t
o
fam
i
l
y
m
e
m
b
ers and h
ealth
im
p
r
ove
m
e
n
t
activ
e pu
lm
o
n
a
ry TB
patien
t
s.
R
e
ferri
ng t
o
t
h
e cri
t
e
ri
a set
by
t
h
e
WHO t
h
at
a di
rect
l
y
obs
er
ved t
r
eat
m
e
nt
i
s
so
m
e
one
wh
o i
s
ex
p
ected
to
h
a
v
e
th
e ab
ility
to
o
v
e
rsee th
e actio
n
s
o
f
p
a
tien
t
s to
ok
th
e d
r
ug
regu
larly,
m
o
tiv
ate, ed
ucate,
p
r
ov
id
e su
ppo
rt d
u
ring
th
e treat
m
en
t p
r
og
ram fo
r th
e t
r
eatmen
t
ad
h
e
ren
t
.A who
l
e activ
ity was related
to
the
streng
th
(po
w
er) own
e
d
b
y
th
e DOT. Such
cap
ab
ilities will d
e
v
e
lop o
p
tim
al
ly
if th
ere is a p
r
ocess o
f
em
powe
r
m
e
nt
at
t
h
e DOT. E
m
poweri
n
g D
O
T i
s
t
h
e act
s of gi
vi
n
g
t
h
e
vari
ous
fo
rces
on t
h
e
be
havi
o
r
an
d
encourage
the
DOT
have
self-control
ov
er t
h
e ev
en
ts and
critical situ
atio
ns in
h
i
m
an
d
h
i
s life [4
].
Nu
rses as
heal
t
h
care
pr
o
v
i
d
e
r
s and
n
u
rsi
ng
h
a
s not
bee
n
o
p
t
i
m
a
l
i
n
t
h
e D
O
T
em
powerm
e
nt
t
h
r
o
ug
h
health education as a key element of
h
ealth
p
r
o
m
o
tio
n
efforts in
th
e h
ealth
cen
ter to
in
crease th
e au
tono
m
y
o
f
DOT i
n
t
h
e m
oni
t
o
ri
n
g
an
d
t
r
eatm
e
nt
of p
u
l
m
onary
TB
pat
i
e
nt
s d
u
ri
ng
t
h
e t
r
eatm
e
nt
pr
og
ram
.
R
e
sul
t
s
of
in
terv
iews wit
h
n
i
n
e
nurses
th
at respon
sib
l
e to
TB
p
r
o
g
ram
s
fo
un
d
t
h
at ev
ery p
a
tien
t
who
tested
po
sitiv
e fo
r
suf
f
eri
n
g
f
r
om
p
u
l
m
onary
t
u
berc
ul
osi
s
sh
o
u
l
d
be a
ssi
st
ed
by
t
h
e
D
O
T
o
f
fam
i
l
y
m
e
m
b
ers t
o
b
e
gi
ve
n
co
un
seling
abou
t TB
d
i
sease,
th
e du
ty and the resp
on
si
b
ilit
y PMO
d
u
ring th
e treatm
e
n
t
p
r
og
ram
,
p
r
even
tio
n
o
f
infectio
n
and
th
e ti
m
e
p
e
rio
d
TB treatm
e
n
t
p
r
og
ram
.
Effo
rts to
im
p
r
o
v
e th
e k
n
o
w
ledg
e, sk
ills and
attitu
d
e
s
DOT
ove
rsi
g
ht
an
d ca
re
of
p
a
t
i
e
nt
s wi
t
h
p
u
l
m
onary
TB
i
s
n
o
t
do
ne
gra
d
ual
l
y
an
d c
ont
i
n
u
o
u
sl
y
t
o
i
m
pr
o
v
e
aut
o
nom
y
of
t
h
e DOT
.
T
h
e abse
nce of st
anda
r
d
ope
rat
i
n
g pr
oce
d
u
r
es (
S
OP
)
c
onc
er
ni
ng
heal
t
h
ed
uc
at
i
on
i
n
the DOT, s
o
not all of the
DOT and
the TB
patients
are given
i
n
form
ati
on
accordi
n
g
to established standa
rds
[5]
.
Health
p
r
o
m
o
t
io
n
m
o
d
e
l [6
] an
d
h
ealth
literacy [7
] is a t
h
eoretical
m
o
del th
at can
b
e
u
s
ed
fo
r t
h
e
devel
opm
ent
of DO
T em
pow
erm
e
nt
m
odel
i
n
an eff
o
rt
t
o
i
n
crease t
h
e au
t
o
n
o
m
y
of t
h
e m
oni
t
o
ri
ng a
n
d care
of
pat
i
e
nt
s
wi
t
h
pul
m
onary
T
B
, i
t
i
s
assum
e
d t
h
at
t
h
e a
p
p
r
oach
t
o
i
n
creas
e t
h
e a
u
t
o
nom
y
of
D
O
T
on
heal
t
h
pr
om
ot
i
on m
odel
wer
e
em
phasi
zed
o
n
as
pect
s o
f
c
ognition and affect
ive specifi
c i
n
di
cat
ors
ba
rri
e
r
s an
d
b
e
n
e
fits o
f
actio
n
s
tak
e
n
as well as self-efficacy. Th
eo
ry h
e
alth
literacy e
m
p
h
a
sis o
n
asp
ects o
f
the abilit
y o
f
indivi
duals to
seek, fi
nd a
nd
obtain
h
ealth inform
ation (ac
cess), the a
b
ility
to unde
rstand health inform
ation
(und
erstan
d), t
h
e ab
ility to
interp
ret, refin
e
,
assess an
d
ev
alu
a
te h
ealth inform
at
io
n
(appraise), th
e ab
ility to
del
i
v
er an
d us
e i
n
fo
rm
ati
on t
o
m
a
i
n
t
a
i
n
and
im
prove heal
t
h
(ap
p
l
y
) so t
h
at
t
h
e em
powe
r
m
e
nt
m
odel
b
a
sed
h
ealth
pro
m
o
tio
n
an
d
h
ealth
literacywas ex
pected
to
in
crease th
e au
ton
o
m
y o
f
th
e DOT in
th
e m
o
n
ito
rin
g
and
t
r
eatm
e
nt
of TB
pat
i
e
nt
s wi
t
h
n
u
rsi
ng act
i
ons s
u
c
h
as educat
i
o
nal
an
d
supe
rvi
s
i
on a
s
wel
l
as t
h
ei
r fam
i
l
y
su
ppo
rt, t
h
e DOT will h
a
v
e
th
e streng
th
(p
ower) an
d
t
h
e in
d
e
p
e
nd
en
ce o
f
sup
e
rv
isio
n
and
treatmen
t
in
pat
i
e
nt
s wi
t
h
p
u
l
m
onary
t
ube
rcul
osi
s
,
whi
c
h w
o
ul
d
ha
ve
an i
m
pact
on t
h
e i
n
c
r
ease i
n
t
h
e cu
re rat
e
o
f
TB
pat
i
e
nt
s, t
o
pre
v
ent
t
r
ansm
i
ssion
t
o
fam
i
ly
m
e
m
b
ers an
d i
n
crease
heal
t
h
y
beha
vi
o
r
s i
n
t
ube
rc
ul
osi
s
p
a
t
i
e
nt
s
an
d fam
ilies.
2.
R
E
SEARC
H M
ETHOD
Th
e
p
r
esen
t stud
y was
ob
servatio
n
a
l an
alytic with
cr
oss
sec
t
i
onal
ap
pr
oac
h
. T
h
er
e we
re
si
x va
ri
abl
e
s
wi
t
h
eac
h i
n
d
i
cat
or as l
i
s
t
e
d i
n
Tabl
e
1.
C
ont
e
n
t
an
d
co
nstru
c
t
v
a
lid
ity u
s
ed to
en
sure each
item
s
in
que
st
i
o
n
n
ai
re
was
val
i
d
a
n
d
rel
i
a
bl
e [
8
]
.
Fo
kus
G
r
ou
p
Di
scussi
o
n
wi
t
h
rel
e
va
nt
st
akeh
ol
de
rs a
n
d
n
u
rse
s
respon
sib
l
e
o
f
th
e TB
p
r
og
ra
m
in
Pub
lic
Health
Nu
rsi
n
g (
P
H
N
)
wa
s
d
one
t
o
co
nfirm
th
e
draf
m
o
d
e
l.
Inferen
tial an
alysis tech
n
i
q
u
es were u
s
e t
o
test th
e e
m
p
i
rical
m
o
d
e
l a
n
d
th
e
h
ypo
theses p
r
o
p
o
s
ed in
th
is
stu
d
y
. Th
e su
itab
ility o
f
th
e m
o
d
e
l tested
b
y
h
y
p
o
t
h
e
tical co
n
s
t
r
u
c
ts St
ru
ctural Equ
a
tio
n
M
o
d
e
li
n
g
(SEM)
whi
c
h wa
s ca
l
l
e
d t
h
e LI
SR
EL. St
r
u
ct
u
r
al
m
odel
co
ul
d
be e
v
al
uat
e
d
by
l
o
oki
ng a
t
t
h
e val
u
e
–
T
an
d
Esti
m
a
tio
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
16
4 – 1
6
9
16
6
2.
1.
Pa
rticipa
n
t a
n
d
Setting
To
get
a g
o
o
d
resul
t
of
SE
M
wi
t
h
m
a
xim
u
m
l
i
k
ehoo
d
m
e
t
hode,
sam
p
l
e
si
ze 2
5
3
re
spo
n
d
e
n
t
we
re
su
gg
ested
.
Th
e in
clu
s
i
o
n criteria of th
e respon
d
e
n
as fo
llowin
g
:
1)
Directly Observed Treatm
e
nt (DOT) L
u
ng
T
B
patients
2)
DOT of
TB p
a
t
i
en
ts of
n
e
w cases with acid
resistan
t b
acilli p
o
s
itiv
e on
t
h
e
ad
v
a
n
c
ed
p
h
a
se
3)
DOT
of TB
pat
i
ents treated at
health ce
nter
s
i
n
S
u
r
a
bay
a
C
i
t
y
, East
Ja
va,
In
do
nesi
a.
Mu
lti stag
e ran
d
o
m
sa
m
p
lin
g
was
u
s
ed
to select th
e p
a
rticip
an
ts’reg
ion
(d
istrict, sub
d
i
stric and
v
illag
e
). Th
ere were fi
v
e
d
i
stricts selected
to
co
ndu
ct
th
is stud
y n
a
mely Su
rab
a
ya
cen
ter,
no
rth,
so
u
t
h
,
east
a
nd
west
.
F
r
om
t
h
ese di
st
r
i
c, si
m
p
l
e
rand
om
sam
p
l
i
ng
DOT
t
o
ch
o
o
se
D
O
T
wh
o
re
pr
esent
s
eac
h
di
s
t
ri
ct
.
2.
2.
Vari
ables and
Indicators
Research
v
a
riab
les con
s
ist o
f
p
e
rson
al, nu
rsin
g
i
n
te
rv
en
tion, cog
n
ition
and affection
,
fam
ily su
p
p
o
r
t,
commitment and aut
o
nom
y
of the
DOT. Indicators
of each
vari
a
b
le can be
e seen in Ta
ble
1.
Tab
l
e
1
.
V
a
r
i
ab
les an
d ind
i
cato
r
s i
n
th
is study
Variables Indik
a
tor
(
X
1) Per
s
onal
X1.
1
Biologic
X1.2 Motivation
X1.3
Self Esteem
X1.4 Social-cultural
X1.5 Prior
experiences
(
X
2) Nur
s
ing
I
n
ter
v
ention
X2.
1
E
ducation
X2.2 Supervision
(X3)
Cognitionand affe
ction
X3.1
Perceived benefids to action
X3.
2
Per
ceived barr
ier
s
to action
X3.3
Self Efficacy
(
X
4) Fam
i
ly
suppor
t
X4.
1
Em
otional
X4
.2
In
stru
m
e
n
t
al
X4.3 Situational
influence
(X5) Co
mm
it
m
e
nt
X5.1
Intention
X5.
2
Awar
e
ness to a plan of action
(X6)
Health
Lite
rac
y
X6.1
Access
X6.
2
Under
s
tand
X6.3 Appraise
X6.
4
Apply
(
Y
1)
Autono
m
y
Y1.
1
Autono
m
y
of obse
r
ved
Y1.2
Co
m
p
etence
to ca
r
e
Y1.3 Relatedness
2.
3.
Ethical Clear
a
nce
Particip
an
t sign
ed
a written
co
nsen
t fo
rm
b
e
fo
re
j
o
i
n
ing th
is stu
d
y
. They were in
fo
rmed
th
at th
is
st
udy
was
vol
unt
a
r
i
l
y
and t
h
ey
can wi
t
h
d
r
a
w
any
t
im
e as
they wish. T
h
e
ethical
clearance was approved by
the ethical commis
i
on, Airl
angga Univ
ersity Su
rab
a
ya, In
don
esia. Fo
rmal p
e
r
m
issio
n
to
con
d
u
c
t th
is stu
d
y
al
so obt
ai
ne
d f
r
om
Di
st
ri
ct
Health Office Surabaya.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
There
are
253 Directly
Obs
e
rve
d
Treatm
e
n
t
(DOT) lung
TB
p
a
tien
t
s jo
in
ed
i
n
t
h
e stud
y th
at
assi
gne
d i
n
fi
v
e
di
st
ri
ct
s al
l
ove
r Su
ra
bay
a
C
i
ty
. As sho
w
n i
n
Ta
bl
e 2,
charact
eri
s
t
i
c
s of t
h
e
m
a
jo
ri
t
y
of
resp
o
nde
ns a
g
ed 2
0
–
30 a
n
d 4
1
–
50 y
ear
s, 6
7
.
2
% fem
a
le, 3
8
,
8
% seni
o
r
hi
g
h
sc
ho
ol
,
42
.7
% i
n
com
e
1 –
2
m
i
ll
i
on,
6
0
.
9
%
h
u
s
b
a
nd/
wi
fe.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Mod
e
l o
f
Empo
wermen
t to Imp
r
o
v
e Au
t
o
nomy
Directly
Ob
served
Trea
t
m
en
t (
DOT)
.... (S
yamila
tu
l K
h
a
r
iroh
)
16
7
Tab
l
e
2
.
C
h
aracteristics o
f
resp
ond
en
ts
Characteristics
of
DOT
Category
Fr
equency
(f
)
Percentage
(%)
Total
∑
(%)
Age
20 -
30 th
31 -
40 th
41 – 50 th
51 – 60 th
˃
60 tahun
58
81
58
46
10
22.
9
32
22.
9
18.
2
4
253
253
253
253
253
100
100
100
100
100
Male/Fe
m
ale
Male
Fe
m
a
le
83
170
32.
8
67.
2
253
253
100
100
E
ducation pr
im
ary
school
Junior
high sch
ool
Senior
high School
Higher
education
76
67
98
12
30
26.
5
38.
8
4.
7
253
253
253
253
100
100
100
100
Inco
m
e
<
1
m
illion
1 – 2
m
illion
˃
2 jt – 3
m
illion
˃
3
m
illion
68
108
69
8
26.
9
42.
7
27.
3
3.
1
253
253
253
253
100
100
100
100
Patient relat
e
d to
DOT
husband/wife
par
e
nts
br
other
/
sister
son/gir
l
154
42
19
38
60.
9
16.
6
7.
5
15
253
253
253
253
100
100
100
100
As s
h
ow
n i
n
Tabl
e
3, t
h
ere
were
si
g
n
i
f
i
c
a
n
t
rel
a
tions
hips bet
w
een cognation and affection,
health
literacy, co
mmit
m
e
n
t
to
th
e au
ton
o
m
y o
f
DOT TB
p
a
tien
t
s (t>1.96).
Tab
e
l.3
Co
effi
cien
t Param
e
te
r Pat
h
in Con
s
t
r
u
c
t Late
nt
Variables bet
w
een Dir
ect a
n
d Indirect Effects
Causality
relationship between di
rect
and indirect exogenous and
endogen
ous var
i
ab
les
Esti
m
a
tion
t
-value
Re
m
a
rk
Per
s
onal factor
(
X
1)
T
o
Cognation fa
ctor
(
X
2)
0.
39
5.
79
significant
Nur
s
ing I
n
ter
v
ention (
X
4)
T
o
Cognation
factor
(
X
2)
0.
62
9.
51
significant
Nur
s
ing I
n
ter
v
ention (
X
4)
T
o
Fam
i
ly suppor
t (
X
3)
0.
49
3.
01
significant
Cognation Factor
(
X
2)
T
o
Co
m
m
itm
ent (
X
5)
0.
41
5.
35
significant
Fam
i
ly
suppor
t (
X
3)
T
o
Co
m
m
it
m
e
nt (
X
5)
0.
38
3.
01
significant
Nu
rsin
g
In
terv
en
tio
n
(X4
)
To
H
ealth
L
iter
a
cy
(
X
6)
0.
92
15.
12
significant
Health L
iter
a
cy
(
X
6)
T
o
Autono
m
y
(Y1)
0.
39
4.
19
significant
Co
m
m
it
m
e
nt (X5)
T
o
Autono
m
y
(
Y
1)
0.
50
3.
28
significant
C
o
n
v
er
ge
nt
va
l
i
d
i
t
y
of t
h
e t
e
st
resul
t
s
wi
t
h
LISR
EL
on t
h
e devel
o
pm
ent
em
powe
r
i
n
g m
odel
s
base
d
o
n
h
ealth
p
r
om
o
t
io
n
and
h
e
alth
literacy c
o
u
l
d
b
e
seen
o
n
m
o
d
e
ls as
Fig
u
re 1. Th
e
v
a
lu
e
o
f
each
lo
ad
ing
f
acto
r
is sh
own in
th
e Figur
e
1.
Fi
gu
re
1.
Pat
h
di
ag
ram
of t
h
e
st
ruct
u
r
al
e
qua
t
i
on m
odel
of e
ach i
n
di
cat
o
r
o
n
l
a
t
e
nt
vari
a
b
l
e
s aft
e
r
el
im
i
n
at
i
ng
in
sign
ifican
t variab
les
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
IJP
H
S V
o
l
.
5, No
. 2,
J
u
ne 2
0
1
6
:
16
4 – 1
6
9
16
8
The fi
nal
m
odel
i
s
recom
m
e
nde
d f
o
r i
m
prove
d em
powe
r
i
ng m
odel
bas
e
d o
n
heal
t
h
p
r
om
ot
i
on a
n
d
h
ealth
literacy
with
ap
pro
ach
n
u
rsing
i
n
terv
en
tio
n to
au
t
o
nomy DOT can
be seen in
t
h
e Fi
g
u
re
2
.
Fig
u
re
2
.
Em
p
o
w
erm
e
n
t
m
o
del b
a
sed
o
n
h
e
alth
pro
m
o
tio
n
an
d h
ealth literacy
The
res
u
l
t
fo
u
n
d
t
h
at
a
u
t
o
no
m
y
of D
O
T
w
oul
d i
m
pro
v
e
by
co
nsi
d
eri
n
g
som
e
ot
her
fa
ct
ors.
T
hos
e
facto
r
s are
p
e
rso
n
al fact
o
r
s,
n
u
rsin
g
i
n
terv
en
tio
n, cog
n
ition
an
d affection,
fam
ily su
p
port and
h
ealth literacy.
As sh
o
w
n i
n
T
a
bl
e 1 an
d 2,
p
e
rso
n
al
fact
o
r
have t
w
o i
n
di
cat
ors,
whi
c
h re
l
a
t
e
d t
o
t
h
e soc
i
al
-cul
t
u
ral
an
d
pri
o
r
expe
ri
ences
. S
o
ci
al
– c
u
l
t
u
ra
l
as desc
ri
be
d
here
was
n
o
rm
, cu
ltural, income an
d
edu
catio
n
.
In
th
is
research,
m
o
st o
f
DOT lo
w in
co
m
e
an
d sen
i
o
r
h
i
g
h
schoo
l.
Pri
o
r exp
e
rien
ces o
f
DOT t
o
caring
for ill fam
i
ly
me
m
b
er
s.Bandu
r
a
in
year
200
9 stated
that
social – c
u
ltural and
pri
o
r expe
rie
n
ce were
factors
that
influence
co
gn
itio
n
an
d affection
p
e
rson
[9
].
Research
o
n
en
h
a
n
ce th
e
m
e
d
i
catio
n
adh
e
ren
ce with
h
ealth
p
r
o
m
o
t
i
on
m
o
d
e
l sh
ow t
h
e in
fl
u
e
n
c
e of
p
e
rson
al fact
o
r
s to
cog
n
ition
an
d affectio
n facto
r
s i
n
treatmen
t
adh
e
ren
c
e [1
0
]
.
Nu
rsi
n
g i
n
t
e
r
v
ent
i
on
wi
t
h
i
n
di
cat
ors
of e
d
u
cat
i
on an
d s
u
p
e
rvi
s
i
o
n i
n
fl
ue
nce en
ha
nce c
o
g
n
i
t
i
on a
n
d
affection wit
h
indicators of
perceive
d be
ne
fits of action a
nd sel
f
efficacy
. Social cognitive
theory propose
d
by Bandura, t
h
at in
orde
r to im
pr
ove
sel
f
efficacy provide c
o
ncrete
exam
ples of s
u
ccess t
h
at ha
s be
e
n
achi
e
ve
d by
DOT i
n
cari
n
g f
o
r TB
pat
i
e
nt
s rec
ove
ry
,
educat
i
o
n
de
l
i
v
ered
o
n
a con
v
e
n
i
e
nt
em
ot
i
onal
a
m
bience and there
f
ore contri
butes to
e
nha
nce self-efficacy [9]. Resear
c
h
conducte
d by Taym
oori on Health
Prom
otion M
o
del to
pre
d
ict the
phase
be
ha
vior of s
p
or
ts
activities am
ong a
dolesce
nts i
n
Ira
n
s
h
ows t
h
at the
i
m
portance
ofe
nha
nce
self-e
ffi
cacy in adolescents to sports
activities regularly [11].
Family
e
m
o
tio
n
a
l
su
ppo
rt can
i
m
p
r
ov
e DOT co
mmit
m
en
t
an
d
th
e in
fluen
ce o
f
au
ton
o
my
to
d
i
rectly
obs
er
ved t
r
eat
m
e
nt
, care o
f
TB
pat
i
e
nt
s and est
a
bl
i
s
h c
o
o
p
e
r
at
i
on
wi
t
h
n
u
r
s
es, TB
pat
i
e
nt
s an
d f
a
m
i
ly
.
Family su
p
p
o
r
t allo
ws
fam
i
l
i
e
s to
fun
c
tion
o
p
tim
all
y
an
d
can
im
p
r
ov
e t
h
e
h
ealth
ad
aptatio
n
in th
e
fa
m
i
l
y
[12].
Results of researc
h
c
o
nducted
b
y
Paz-So
ld
an
AV,
ab
ou
t
th
e
fa
m
i
ly support
declares t
h
at (1)
p
s
ycho
so
cial su
ppo
rt n
e
ed
ed
to
redu
ce th
e
difficu
lty o
f
come to
th
e clin
ic for treatm
e
n
t
, (2) th
e tend
en
cy o
f
fam
i
lies to
g
i
ve atten
tio
n, emp
a
th
y
d
u
ring
t
h
e treatm
e
nt
p
r
o
g
ram
,
(
3
) p
r
ovi
des feel
i
n
g
com
f
ort
a
bl
e
a
n
d
sa
fe
alth
o
ugh
there
was still a stigma an
d
so
cial i
s
o
l
atio
n in
t
h
e
co
mm
u
n
ity [1
3].
Health literacy with indicators of
access to i
n
form
ation and unde
rsta
nd i
n
fl
uences t
h
e autonom
y of
wi
t
h
i
ndi
cat
o
r
s aut
o
nom
ous
di
rect
l
y
obse
r
v
e
d t
r
eat
m
e
nt
, provide ca
re com
p
etent a
nd coope
r
ate with nurses
,
TB p
a
tien
t
s an
d fam
ily. I
m
p
r
ov
em
en
t in
h
ealth
literacy
can in
crease
in
d
i
v
i
d
u
a
l
au
t
o
no
m
y
an
d
d
e
cisio
n
-
mak
i
n
g
cap
acities [14
]
,[1
5
]
.
Health
literacy
m
i
g
h
t
b
e
m
o
re effectiv
e in
clin
ical d
ecision
s wh
ile em
p
o
w
erm
e
n
t
m
i
ght
exe
r
t
a
st
ro
n
g
er
i
n
fl
u
e
nce
o
n
habi
t
u
al
heal
t
h
be
h
a
vi
o
u
rs
[
1
6]
.
Aut
o
n
o
m
y
of
DOT
TB
pat
i
ent
s
i
s
expecte
d
t
o
inc
r
ease the
cure
rate of TB
patients.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Mod
e
l o
f
Empo
wermen
t to Imp
r
o
v
e Au
t
o
nomy
Directly
Ob
served
Trea
t
m
en
t (
DOT)
.... (S
yamila
tu
l K
h
a
r
iroh
)
16
9
4.
CO
NCL
USI
O
N
Thi
s
m
odel
der
i
ved
f
r
om
bl
en
ded
t
h
e
o
ry
He
al
t
h
Pr
om
ot
i
o
n
M
o
del
(
H
PM
)
an
d
Heal
t
h
Li
t
e
racy
(
H
L
)
wi
t
h
ad
di
t
i
on t
o
rei
n
fo
rci
n
g f
act
ors. T
h
e st
r
e
ngt
h of t
h
i
s
m
odel
i
n
fl
uenc
ed by
pers
o
n
al
fact
or
s, co
gnat
i
on an
d
affection
,
fam
i
ly su
pp
ort an
d h
ealth
literacy
to
en
h
a
n
ce t
h
e au
tono
m
y
Di
rectly Ob
serv
ed
Treatm
e
n
t
(DOT)
ande
xpected to increase
the
c
u
re
rate
of TB
patients.
REFERE
NC
ES
[1]
WHO, “Global Tubercu
l
osis Repor
t 2015,” WHO Librar
y
Catalouging in
Publication
Data, Fr
en
ce, 2015.
[2]
Ministr
y
of He
al
th RI,
“
N
ationa
l
Guidelin
es
for C
ontrol of
TB-20
12,” Jak
a
rta, 201
2.
[3]
H. Agus, “
T
he R
o
le of
Drop Out
Cases DOT of S
m
ear Pos
itive
of
Pulm
onar
y
Tub
e
rculosis
in W
o
rking Area
Publi
c
Health
Center of
Sukowono Jember, 2013
.
h
ttp/
/
d
igilib
.unej.ac.id
. accessed 12 Septem
ber 2013
.
[4]
Duns
t C. J
.
& Trivett
e
C. M
., “
E
m
powerm
e
nt, effect
ive helpg
i
vin
g
practi
ces
and f
a
m
i
l
y
cent
e
r car
e”,
Pe
diatr Nurs,
vol/issue: 22(4), pp.
334-7
,
343
, 1996.
[5]
Ministr
y
of Health RI, “National
Guidelin
es
Nursing Services Tub
e
rc
ulosis,” Jak
a
r
t
a, 2014.
[6]
N. J
.
P
e
nd
er,
“
H
eal
th P
r
om
oti
on
in Nursing Practice (5th
.ed)
,
” Bo
ston, MA, Perso
n
, 2006
.
[7]
S
o
rens
en K
.,
et al.
, “
H
ea
lth L
ite
rac
y
and Publ
ic
Health: A s
y
s
t
em
a
tic r
e
view
and integr
ation o
f
definitions an
d
models,”
BMC P
ublic
Health
,
pp
. 1-13, 2012. ht
t
p
://biom
e
dcentr
al.c
om
/1471-245
8/12/80, sitasi
3
April 2014.
[8]
Kusnendi, “Structural equ
a
t
i
on
m
odels Single
and Mu
ltigroup
Sam
p
les with
lisr
e
l,” B
a
ndung, Al
fabet
a
, 2008.
[9]
B. Alber
t
, “Self
Efficacy
-
in
Ch
ange Society
,
” C
a
mbridge Univers
i
ty
Press, N
e
w York, 2009
.
[10]
Lannon S. L., “Using health pr
omotion m
odel
to enhance medi
cation compliance,”
Journal of Neuroscience
Nursing
, vol. 29, pp. 170-178, 19
97.
[11]
Tay
m
oor
i P., “Aplication of
Social Cognitive Model in
Exp
l
aining
Ph
y
s
ical Activity
in
Ir
anian
Female
Adoles
cent
,
”
Health Educ Res,
v
o
l/issue: 2
5
(2), p
p
. 257–267
, 201
0.
[12]
M.
M.
Frie
dma
n
,
et al.
, “Family
nursing textb
ook: Research
,
theor
y
,
and practice,” interpre
ter, Akhir Yani
S.
Hamid, Ed
5, EGC, Jakarta, 201
2.
[13]
Paz-soldan A. V. & Alb
a
n
E. R
.
, “The provision
of and
n
eed for
social support among a
dult and
pediatric patients
with tuber
c
ulo
s
is in lim
a,
Peru: a
q
u
alit
ativ
e stud
y,
”
BMC health se
rv
ic
e
s
re
se
arc
h
, 2
013
.
http//www.biom
edcen
tral.com/1
472-6963/13/29
0.
[14]
S
o
rens
en K
.,
et al.
, “Explor
ing the ethical scope of health
lit
era
c
y
– a
crit
ic
al l
ite
ratur rev
i
ew,
”
Albanian Medica
l
Journal,
vo
l. 2,
pp. 71-83
, 2013
.
[15]
Volandes A. E. & Paasche-Orlo
w M. K., “Healt
h
litera
c
y
,
he
al
th
inequali
t
y
and a
just health ca
re
s
y
stem
,”
Am J
Biotech
, vol.7, p
p
. 5–10
, 2007
.
[16]
Ey
ubog
lu E.
& Schulz P. J., “Do health
literacy and patien
t em
powerment affect self
care beh
a
viours
?
A survei
stud
y
among Tu
rkish patien
ts with di
abetes,”
BM
J Open
, 2016
. ht
tp;//bm
j
open
.
bm
j.com
/
on Jan
20
16.
Evaluation Warning : The document was created with Spire.PDF for Python.