1.

1 INTRODUCTION

Pulmonary tuberculosis (TB) is a contagious disease that remains a serious health

issue in Indonesia because it has a significant impact on diminishing work
productivity. To optimize the control and treatment of pulmonary tuberculosis, the
Ministry of Health of the Republic of Indonesia developed a national standard that
became a reference for health workers in public health service units (puskesmas)
in Indonesia in carrying out pulmonary TB control and treatment (Kemenkes RI,
2016). In the intense phase of pulmonary tuberculosis treatment, the client
receives medication daily and must be evaluated daily to prevent the development
of drug resistance. If the treatment in this phase is administered correctly,
pulmonary TB clients become non-infectious within two weeks, and the majority
of BTA (Acid-Resistant Bacteria) pulmonary TB customers become BTA
negative within two months, hence preventing client dropout and re-treatment
(Ministry of Health RI, 2015).
Knowledge, motivation, the role of the PMO, access, family support, distance,
patient motivation, and drug adverse effects are some of the factors that impact
dropout (Nuraidah et al., 2016). According to research (Natalya and Anwar,
2013), clients who were not accompanied by a PMO were 26.3% compliant and
21.2% non-compliant (dropped out) during the intense phase. Meanwhile, 82,1%
of clients accompanied by the PMO were compliant, while 3.6% were not. Some
of the causes for noncompliance with treatment during the intense phase are that
the client feels cured or that he is bored and sick when taking medication daily.
According to research (Himawan, Hadisaputro, and Suprihati, 2015), clients
dropped out because they felt well (45.7%), experienced negative effects of drugs
(17.1%), were bored taking prescriptions (11.4%), there was no cost (8.5%), and
other reasons (17.1 percent ). Research (Prawulandari, 2018) on the experience of
Multi-Drug Resistant Tuberculosis (TB-MDR) patients in successful treatment in
the Semarang City region reveals that many patients who disagree face reality,
prolonged anxiety that interferes with interaction with the social environment,
stress, and boredom because they must take medication. Research (Rejeki, Nurses,
and Permatasari, 2012) on the experience of undergoing category 2 TB treatment
in the Pekalongan Regency of Central Java revealed that as many as seven
patients had physical, psychological, financial, and healthcare issues. The yearly
prevalence rate of all pulmonary TB cases is 140 per 100,000 people, with a
proportion of 45% in the South Asian region, 25% in the African region, 17% in
the Western Pacific region, 7% in the Eastern Mediterranean region, 3% in the
European region, and 3% in the American region. Indonesia is second in the
world, after India, for the most pulmonary tuberculosis patients (WHO, 2017).
East Java Province placed second in Indonesia in 2016 after West Java Province
in the number of BTA pulmonary TB patients discovered, with 21,606 new cases,
and the number of BTA pulmonary TB cases that were successfully treated, with
20,128 cases (Ministry of Health, 2017). East Java still ranks second in Indonesia
after West Java Province in terms of the number of BTA pulmonary TB patients
discovered in 2017, with 22,585 new positive cases and 21,311 positive BTA
pulmonary TB cases successfully treated (Ministry of Health RI, 2018). In 2016,
there were 492 cases of tuberculosis in Magetan Regency, 304 of which were
BTA-positive pulmonary tuberculosis. In 2016, 48.41 percent of new BTA-
positive TB cases were identified (Dinkes Magetan, 2017).
Based on the findings of a pilot study done in September 2018 at the Taji Health
Center in the Magetan Regency, there were 22 patients with pulmonary
tuberculosis who underwent intense phase treatment and 12 patients in the
advanced phase. An interview with a nurse in charge of a pulmonary tuberculosis
program at the Taji Health Center in the Magetan Regency revealed that none of
the pulmonary TB clients dropped out. In contrast, clients frequently feel
depressed, bored, resentful, useless, and helpless, and frequently complain about
the changes in their health conditions. As a result, nurses are sometimes overly
insistent when urging clients to limit their trips to the health center. Chrisnawati,
Beda, and Maratning (2017) found that the quality of life of tuberculosis (TB)
patients undergoing treatment are dependent on their physical condition,
emotional distress, individual and family coping, social support obtained from
family and surrounding people, and the environment that supports pulmonary TB
patients in their daily lives. The results of qualitative research (Prawulandari,
2018) indicate that a good method of adaptation in undergoing saturation and
obstacles during a long treatment in MDR-TB patients is based on the process of
self-awareness in the form of motivating change, strong support systems, and
continuous and continuous coaching efforts.
If depression, boredom, emotions of powerlessness, and worthlessness are
permitted in clients with pulmonary tuberculosis, the client risks not adhering to
therapy due to the lengthy duration of treatment. Thus, the customer must undergo
re-treatment. There has been numerous quantitative research on intensive phase
therapy of pulmonary tuberculosis, as well as qualitative studies on the experience
of experiencing category 2 TB treatment and the experience of Multi-Drug
Resistant Tuberculosis (TB-MDR) patients undergoing successful treatment.
However, no in-depth research has been conducted on the experiences of
pulmonary TB patients receiving intensive phase treatment. Therefore, researchers
are interested in delving deeper into pulmonary TB clients undergoing intensive
phase treatment in terms of the adaptation process, support system, obstacles
overcome, and expectations in undergoing intensive phase treatment in the future
so that clients have strength, good motivation, confidence, and confidence in
undergoing TB treatment regularly until they are declared cured to prevent re-
treatment and resistance to OAT. Researchers are interested in utilizing qualitative
methodologies with phenomenological design to examine the processes,
meanings, and comprehension of an individual. In addition, researchers wish to
describe, investigate, and explain the experiences of clients undergoing intense
phase therapy for pulmonary tuberculosis at the Taji Health Center in Magetan
Regency.