Evaluasi Instrumen Pengetahuan Kader tentang Terapi Pencegahan Tuberkulosis di satu Puskesmas Kelurahan Binong: pendekatan model Rasch

Theresia Theresia, Sarah Lidya Cicilia, Erpina Sherly Tupel, Gladies Marsela Batewa, Michelle Theresa

Abstract


Indonesia's tuberculosis (TB) profile data based on WHO in 2021: estimated number of TB incidents of 969,000 (354 cases per 100,000 population). Implementation of Tuberculosis Prevention Therapy (TPT) initiated in 2016 by Health Ministries. Health cadres have an important role in handling TB cases. Limited study found toward health cadres toward TPT. This study’s objectives were to describe the knowledge level of health cadres regarding TPT’s implementation and to analyze each item using the Rasch model. Methods: This study used quantitative descriptive and was conducted in April 2023. This study’s sample were 74 community health workers at one Community Health Center in Tangerang District, using purposive sampling technique. The instrument adopted from the WHO and Indonesian Ministry of Health. This study used univariate data analysis and Rasc analysis with Winstep. The Rasch model used to analyze validity and reliability of the (items and respondents) and evaluate the level of difficulty of the questions.The results of this study found that cadres' knowledge of the TPT’s implementation was in the high category of 98.6%. Health cadres still have a high rate of incorrect response: regarding TPT’s implementation for children were 63 (85.1%), regarding TB transmission media were 15 (20.3 %), and regarding Rifampicin’s side effect were 10 (13.5%). Rasch model showed: person reliability was 0.00 (very poor), item reliability (item measure) was 0.93 (very good), and there are 2 items which fulfil three criteria (Outfit mean square, outfit Z-standard, and Point measure correlation). This study disclosed that though description of correct response were mostly good result but when Rasch modelling analysis were implemented then the person reliability result was bad. This study has lowest person reliability and person separation which indicate not enough cadres to distinguish between those with higher and lower abilities. This study has adequate sample size to perform the continuum or item difficulty. Consequently, training must be continued regularly regarding TPT’s implementation and generally TB content. Since TPT’s implementation is still new regulation in Indonesia’s TB national program.



Data profil tuberkulosis (TB) Indonesia berdasarkan WHO pada tahun 2021 menyatakan perkiraan jumlah kejadian TB sebanyak 969.000 (354 kasus per 100.000 penduduk). Implementasi Terapi Pencegahan Tuberkulosis (TPT) dimulai pada tahun 2016 oleh Kementerian Kesehatan. Kader kesehatan mempunyai peran penting dalam penanganan kasus TB. Masih terbatasnya penelitian terkait pengetahuan kader kesehatan terhadap TPT . Tujuan penelitian ini untuk mendeskripsikan tingkat pengetahuan kader kesehatan mengenai pelaksanaan TPT dan menganalisis setiap item dengan model Rasch. Penelitian ini deskriptif kuantitatif dan dilakukan pada bulan April 2023. Sampel penelitian ini adalah petugas kesehatan masyarakat pada Puskesmas Binong, Kabupaten Tangerang yang berjumlah 74 orang, dengan menggunakan teknik purposive sampling. Instrumen yang diadopsi dari WHO dan Kementerian Kesehatan RI. Penelitian ini menggunakan analisis data univariat dan analisis Rasc dengan Winstep. Model Rasch digunakan untuk menganalisis validitas dan reliabilitas (item dan responden) serta mengevaluasi tingkat kesulitan soal. Hasil penelitian menunjukkan bahwa pengetahuan kader terhadap pelaksanaan TPT berada pada kategori tinggi sebesar 98,6%. Kader kesehatan masih mempunyai tingkat kesalahan respon yang tinggi: mengenai penerapan TPT pada anak sebanyak 63 (85,1%), mengenai media penularan TB sebanyak 15 (20,3%), dan mengenai efek samping Rifampisin sebanyak 10 (13,5%). Model Rasch menunjukkan: reliabilitas orang sebesar 0,00 (sangat buruk), reliabilitas item (ukuran item) sebesar 0,93 (sangat baik), dan terdapat 2 item yang memenuhi tiga kriteria (Outfit mean square, outfit Z-standard, dan Point measure correlation). Penelitian ini mengungkapkan bahwa meskipun deskripsi respon yang benar sebagian besar memberikan hasil yang baik tetapi ketika analisis pemodelan Rasch diterapkan maka hasil reliabilitas orang tersebut buruk. Penelitian ini memiliki keandalan orang dan pemisahan orang yang paling rendah yang menunjukkan tidak cukup kader untuk membedakan antara mereka yang berkemampuan lebih tinggi dan lebih rendah. Penelitian ini memiliki ukuran sampel yang memadai untuk melakukan kesulitan kontinum atau item. Oleh karena itu, pelatihan harus dilanjutkan secara berkala mengenai penerapan TPT dan konten TB secara umum. Mengingat penerapan TPT masih merupakan peraturan baru dalam program nasional TB di Indonesia.



References


WHO WHO. TB deaths and incidence. Global tuberculosis report [Internet]. 2021 [cited 2023 May 14];13–4. Available from: https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022

World Health Organization. Annual Report of Tuberculosis. Annual Global TB Report of WHO [Internet]. 2022 [cited 2023 May 14];8(1):1–68. Available from: https://www.who.int/publications/i/item/9789240061729

Koesoemadinata RC, McAllister SM, Soetedjo NNM, Ratnaningsih DF, Ruslami R, Kerry S, et al. Latent TB infection and pulmonary TB disease among patients with diabetes mellitus in Bandung, Indonesia. Trans R Soc Trop Med Hyg. 2017;111(2)

Abongo T, Ulo B, Karanja S. Community health volunteers’ contribution to tuberculosis patients notified to National Tuberculosis program through contact investigation in Kenya [Internet]. Vol. 20, BMC Public Health. Springer Science and Business Media LLC; 2020. Available from: http://dx.doi.org/10.1186/s12889-020-09271-7

Kumar A, Rana RK, Sundram S, Sinha SK, Jaiswal R, Kashyap V. Progression from tuberculosis to multi drug resistance-TB in revised national tuberculosis control programme: perspectives from health system care givers [Internet]. Vol. 6, International Journal Of Community Medicine And Public Health. Medip Academy; 2019. p. 2378. Available from: http://dx.doi.org/10.18203/2394-6040.ijcmph20192091

Putri ANE, Novrikasari N, Idris H. Analysis of the Performance of Tuberculosis Program Implementing Officers in the Suspect Network of Tuberculosis At Community Health Center, Palembang City [Internet]. Childhood Stunting, Wasting, and Obesity, as the Critical Global Health Issues: Forging Cross-Sectoral Solutions. Masters Program in Public Health, Universitas Sebelas Maret; 2020. p. 50–66. Available from: http://dx.doi.org/10.26911/the7thicph-fp.04.07

Datiko DG, Yassin MA, Tulloch O, Asnake G, Tesema T, Jamal H, et al. Exploring providers’ perspectives of a community based TB approach in Southern Ethiopia: Implication for community based approaches. BMC Health Serv Res. 2015 Nov 9;15(1).

Dangisso MH, Datiko DG, Lindtjørn B. Accessibility to tuberculosis control services and tuberculosis programme performance in southern ethiopia [Internet]. Vol. 8, Global Health Action. Informa UK Limited; 2015. p. 29443. Available from: http://dx.doi.org/10.3402/gha.v8.29443

Biermann O, Dixit K, Rai B, Caws M, Lönnroth K, Viney K. Building on facilitators and overcoming barriers to implement active tuberculosis case-finding in Nepal, experiences of community health workers and people with tuberculosis [Internet]. Vol. 21, BMC Health Services Research. Springer Science and Business Media LLC; 2021. Available from: http://dx.doi.org/10.1186/s12913-021-06290-x

Nagaraja SB, Satyanarayana S, Shastri S. Active tuberculosis case finding in India: need for introspection [Internet]. Vol. 7, Public Health Action. International Union Against Tuberculosis and Lung Disease; 2017. p. 307. Available from: http://dx.doi.org/10.5588/pha.17.0074

Rosapep LA, Faye S, Johns B, Olusola-Faleye B, Baruwa EM, Sorum MK, et al. Tuberculosis care quality in urban Nigeria: A cross-sectional study of adherence to screening and treatment initiation guidelines in multi-cadre networks of private health service providers [Internet]. Vol. 2, PLOS Global Public Health. Public Library of Science (PLoS); 2022. p. e0000150. Available from: http://dx.doi.org/10.1371/journal.pgph.0000150

Odendaal WA, Lewin S. The provision of TB and HIV/AIDS treatment support by lay health workers in South Africa: A time-and-motion study. Hum Resour Health. 2014 Apr 4;12(1).

Abongo T, Ulo B, Karanja S. Community health volunteers’ contribution to tuberculosis patients notified to National Tuberculosis program through contact investigation in Kenya [Internet]. Vol. 20, BMC Public Health. Research Square Platform LLC; 2020. Available from: http://dx.doi.org/10.21203/rs.2.21153/v3

Porusia M, Abshor DA. A Description of Cadre Motivation of Community TB-HIV Care Aisyiyah in Sukoharjo and Sragen District [Internet]. Proceedings of the 1st International Conference on Social Determinants of Health. SCITEPRESS - Science and Technology Publications; 2019. p. 20–3. Available from: http://dx.doi.org/10.5220/0008370500200023

Karbito K, Susanto H, Adi MS, Sulistiyani S, Handayani OWK, Sofro MAU. Latent tuberculosis infection in family members in household contact with active tuberculosis patients in Semarang City, Central Java, Indonesia [Internet]. Vol. 13, Journal of Public Health in Africa. PAGEPress Publications; 2022. Available from: http://dx.doi.org/10.4081/jphia.2022.2157

Direkrorat Jenderal Pencegahan dan Pengendalian Penyakit Kementerian Kesehatan Republik Indonesia. Waspada TBC Laten, Tidak Bergejala Bisa Muncul Kapanpun [Internet]. Kementerian Kesehatan RI. 2021. p. 57792. Available from: https://www.kemkes.go.id/article/view/19093000001/penyakit-jantung-penyebab-kematian-terbanyak-ke-2-di-indonesia.html%0Ahttps://www.kemkes.go.id/article/view/19031800003/cegah-penyalahgunaan-narkoba-kemenkes-ajak-terapkan-germas.html%0Ahttps://www.depkes.

Kusuma IY, Triwibowo DN, Pratiwi ADE, Pitaloka DAE. Rasch Modelling to Assess Psychometric Validation of the Knowledge about Tuberculosis Questionnaire (KATUB-Q) for the General Population in Indonesia. Int J Environ Res Public Health. 2022;19(24).

Rinayati R, Harsono H, Erawati AD. Knowledge, motivation, attitude, job design and health cadre performance: a cross sectional study [Internet]. Vol. 12, International Journal of Public Health Science. Institute of Advanced Engineering and Science; 2023. p. 385–91. Available from: http://dx.doi.org/10.11591/ijphs.v12i1.21930

Lee EH, Lee YW, Kang HJ. Psychometric properties of the revised Diabetes Knowledge Test using Rasch analysis. Patient Educ Couns. 2022;105(4).

Kaneda T, Takabatake S, Higashi Y, Horishima Y, Somei Y, Nakaoka K, et al. Evaluation of psychometric properties of the activities of daily living scale of motor function used by caregivers using Rasch analysis. J Phys Ther Sci. 2020;32(2).

Sumintono B, Widhiarso W. Aplikasi Pemodelan Rasch Pada Assessment Pendidikan [Applications of Rasch Modeling in Educational Assessments]. Aplikasi Permodelan Rasch Pada Assesment Pendidikan. 2015.

Boone WJ, Yale MS, Staver JR. Rasch analysis in the human sciences. Rasch Analysis in the Human Sciences. 2014.

Bessing B, Honan CA, van der Mei I, Taylor B V., Claflin SB. Development and psychometric properties of the Multiple Sclerosis Knowledge Assessment Scale: Rasch analysis of a novel tool for evaluating MS knowledge. Multiple Sclerosis Journal. 2021;27(5).




DOI: http://dx.doi.org/10.33846/sf.v15i2.4888

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