Agustine.
Santoso.
Mugianti.
Suprajitno.
Paju.
Hamid.
, & Widyastutik.
Theory of Planned BehaviorAos Method on Knowledge and Preventive Behavior Toward Tuberculosis.
JURNAL INFO KESEHATAN, 23.
, 420-427.
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Jurnal Info Kesehatan Vol.
No.
September 2025, pp.
P-ISSN 0216-504X.
E-ISSN 2620-536X
DOI: 10.
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Iss3.
Journal homepage: https://jurnal.
id/index.
php/infokes RESEARCH Open Access Theory of Planned BehaviorAos Method on Knowledge and Preventive Behavior Toward Tuberculosis Uly Agustine1a*.
Shelfi Dwi Retnani Putri Santoso1b.
Sri Mugianti2c.
Suprajitno2d.
Wanto Paju1e.
Hamid3f.
Otik Widyastutik4g Department of Nursing.
Poltekkes Kemenkes Kupang.
Waikabubak City.
East Nusa Tenggara.
Indonesia Department of Nursing.
Poltekkes Kemenkes Malang.
Malang City.
East Java.
Indonesia Department of Nursing.
University STRADA Indonesia.
Kediri City.
East Java.
Indonesia Doctoral Program in Medical Sciences.
University of Tsukuba.
Tsukuba City.
Japan Email address: agustineuly@gmail.
Email address: shelfi.
putri@gmail.
Email address: sri_mugianti@poltekkes-malang.
Email address: suprajitno_skp@poltekkes-malang.
Email address: pajuwanto@gmail.
Email address: hamid.
ns@gmail.
Email address: s2330453@u.
Received: 8 February 2025 Revised: 24 April 2025 Accepted: 24 April 2025 Abstract Tuberculosis (TB) is an infectious disease that has become a global health concern, with Indonesia being the country with the second-highest number of pulmonary TB cases after India.
The level of knowledge and preventive behavior regarding TB significantly influences both the spread and the success of TB treatment.
This study aims to evaluate the impact of health education based on the Theory of Planned Behavior (TPB) on TB prevention knowledge and behavior among patients.
The study design utilized a quasi-experimental approach with control and intervention groups, where the intervention was administered through face-to-face education and followed by smart chat support sessions for one month.
A total of 50 respondents participated, divided into treatment and control groups.
Data analysis employed the Wilcoxon Signed Ranks Test and Mann-Whitney The study results show that the statistical analysis indicated a significant improvement in knowledge and preventive behavior in the intervention group post-intervention .
=0.
, while the control group showed no significant change.
The finding of this this improvement suggests that TPB-based interventions, which encompass attitudes, subjective norms, and perceived behavioral control, are effective in influencing health behavior changes.
The conclusion is TPBbased health education through face-to-face sessions and smart chat follow-ups can be recommended as an intervention strategy to enhance TB prevention knowledge and behavior among high-risk populations.
Keywords: Behavior.
Education.
Knowledge.
Theory of Planned Behavior.
Tuberculosis.
Corresponding Author:
Uly Agustine Department of Nursing.
Poltekkes Kemenkes Kupang.
Waikabubak City.
East Nusa Tenggara.
Indonesia Email: agustineuly@gmail.
AThe Author.
This article is distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.
0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author.
and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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INTRODUCTION
Tuberculosis (TB) is an infectious disease that poses a significant global health concern.
Indonesia ranks as the country with the second highest incidence of pulmonary TB after India, 02 million cases reported (Santoso, et al.
, 2.
According to the WHO .
Global Tuberculosis Report.
Indonesia has a high TB burden, with a mortality rate of 40 per 100,000 population and 395 new cases per 100,000 population (WHO, 2016.
Loya.
Santoso & Paju.
Santoso & Sasmito, 2.
The island of East Nusa Tenggara contributes to this burden with a recorded 20,599 TB cases and a treatment adherence rate of only 57.
7% (Badan Penelitian dan Pengembangan Kesehatan, 2019.
Santoso et al.
, 2.
In 2018.
West Sumba reported 1,066 cases of smear-positive pulmonary TB (Badan Penelitian dan Pengembangan Kesehatan, 2019.
Santoso et al.
, 2.
A survey conducted among 20 respondents at two public health centers in West Sumba in 2023 revealed that 17 patients with smear-positive pulmonary TB had limited knowledge about the disease, which negatively impacted their preventive behaviors.
Behavior encompasses all human activities, whether observable to others or not (Ramadhayanti et al.
Prevention refers to actions taken to curb disease transmission and protect individuals from infection.
Poor behavioral outcomes among TB patients are often attributed to insufficient knowledge about TB and its transmission (Damanik et al.
, 2.
Factors influencing self-care behavior include knowledge related to preventive screening, educational background, health literacy, and cohabitation with family members (Marhamah, 2.
This study employs the Theory of Planned Behavior (TPB) as its conceptual framework.
The main constructs within TPB have demonstrated a significant association with behavioral intention, allowing for the prediction of intention to engage in preventive actions (Barati et al.
Effective preventive behaviors for pulmonary TB require high levels of patient commitment and a stable intention.
Education aimed at enhancing compliance based on the Theory of Planned Behavior (TPB) is crucial for reinforcing patientsAo intent to maintain To enhance patient adherence, a structured intervention for TB patient compliance is essential for fostering compliant behavior.
According to Shmueli, .
in the Theory of Planned Behavior, behavior is shaped by belief-based approaches that form intentions and drive individuals to engage in specific actions.
Key intention determinants include attitude, subjective norms, and perceived behavioral control.
This concept is supported by a metaanalysis by Fischer & Karl, .
, which identified significant relationships between attitude, subjective norms, and perceived behavioral control with behavioral intention.
Similarly.
Hagger et al.
, .
indicated that the TPB structure effectively fosters compliance intentions.
This study focuses on the application of Health Education based on the Theory of Planned Behavior using a Face-to-Face and Smart Chart Method to enhance knowledge and preventive behaviors in pulmonary TB patients.
This study aims to evaluate the impact of health education based on the Theory of Planned Behavior (TPB) on TB prevention knowledge and behavior among patients.
RESEARCH METHOD
This study design is a quasi-experimental research with a one-group pre- and post-test with control group design, wherein the intervention group received Health Education based on the Theory of Planned Behavior, using Face-to-Face and Smart Chart methods, while the control group received standard treatment procedure explanations from the nurse.
The sample size calculation was performed using the PS-Power Sample Size Calculation software.
Sample selection was conducted through convenience sampling from February to August 2024 across three health centers in West Sumba, which report the highest number of pulmonary TB cases.
A total of 50 patients were included, divided into an intervention group and a control group with 25 patients each.
Inclusion criteria required patients to be over 21 years old, receiving TB Agustine.
Santoso.
Mugianti.
Suprajitno.
Paju.
Hamid.
, & Widyastutik.
Theory of Planned BehaviorAos Method on Knowledge and Preventive Behavior Toward Tuberculosis.
JURNAL INFO
KESEHATAN, 23.
, 420-427.
https://doi.
org/10.
31965/infokes.
Vol23.
Iss3.
| 422
treatment without severe complications, able to comprehend instructions, and possessing adequate hearing.
Exclusion criteria encompassed MDR-TB patients, those with hearing impairments, or patients with comorbidities.
Patients who passed away before the post-test were classified as drop-outs.
The research steps involved initially assigning respondents to either the intervention or control group, followed by a pre-test survey assessing knowledge, attitudes, and practices (KAP) among TB clients.
Each pre-test required 15-20 minutes to complete.
The control group only received standard information about tuberculosis treatment procedures from nurses in the two health centers in West Sumba.
East Nusa Tenggara.
Indonesia.
The intervention group received educational sessions based on the Theory of Planned Behavior via Face-to-Face and Smart Chart methods.
The face-to-face educational activity was conducted once, followed by twice-weekly smart chat messages over a one-month period.
Subsequently, a post-test KAP survey was administered to TB clients after the intervention.
The research instruments utilized were standardized and had been validated for reliability.
Knowledge, attitudes, and practices were assessed using the KAP survey (Zakaria et al.
, 2.
In addition, we noted lower reliability (RaykovAos rho = 0.
For reliability.
CronbachAos alpha .
or IRT and EFA) and RaykovAos rho .
or CFA) were used, with the value Ou 0.
65 (CronbachAos alph.
and Ou 0.
7 (RaykovAos rh.
considered acceptable.
The questionnaire employed to measure knowledge about pulmonary TB prevention consisted of 10 closed-ended questions using the Guttman scale, where correct answers were scored as 1 and incorrect answers as 0.
To measure preventive behaviors for pulmonary TB, a 10-item questionnaire was used with positive statements on a Likert scale, with scores ranging from "always=4," "often=3," "sometimes=2," "seldom=1," to "never=0" (Tuharea et al.
, 2.
Data analysis was performed using t-tests.
Within-group differences were analyzed with Wilcoxon and Mann-Whitney tests and using statistical software.
This study received ethical approval from the Research Ethics Committee of STIKes Bahrul Ulum Jombang, with ethics number 137/EC/KEPK-BU/I/2023, issued on January 27, 2024.
RESULTS AND DISCUSSION
Table 1.
Demographic Characteristic Data of Respondents.
Treatment Group Control Group Total p-value Characteristic Gender Men Female <40 years Age >41 years Table 1 presents a total of 50 respondents with tuberculosis, divided into two groups: 25 respondents in the intervention group and 25 in the control group.
An equivalence test result indicated p > 0.
05, suggesting no significant differences in gender, age, education level, occupation, or duration of TB between the intervention and control groups, indicating homogeneity across these characteristics.
The data also reveals that the majority of respondents were men.
In the intervention group, 16 respondents were men .
%) and 9 were female .
%), while in the control group, 15 were men .
%) and 10 were female .
%).
Most respondents were over 41 years old compared to those under 40.
In the intervention group, 14 respondents were over 41 .
%) and 11 were under 40 .
%).
In the control group, 13 respondents were over 41 .
%) and 12 were under 40 .
%).
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Table 2.
Results of the Mann-Whitney U Test and Wilcoxon Signed Ranks Test for Knowledge and Behavior Scores in the Intervention and Control Groups.
Pre-test Post-test p-value Variable Group Mean SD Mean SD wilcoxon Treatment Knowledge Control Mean Difference Mann-Whitney U Test Treatment Behavior Control Mean Difference Mann-Whitney UTest Table 2 indicates that the results of the Mann-Whitney U Test for the pre-test knowledge scores show a p-value of 0.
283, which means there is no significant difference in knowledge between the intervention and control groups before the intervention was conducted.
In contrast, the results of the Mann-Whitney U Test for the post-test knowledge scores show a p-value of 000, indicating a significant difference in knowledge between the intervention and control groups after the intervention.
The results of the Wilcoxon Signed Ranks Test for the intervention group yield a p-value of 0.
000, indicating a significant difference in knowledge before and after the intervention.
The control group also shows a p-value of 0.
039, indicating a difference in knowledge before and after the intervention.
Table 2 further shows the results of the Mann-Whitney U Test for the pre-test behavior scores, with a p-value of 0.
234, meaning there is no significant difference in behavior between the intervention and control groups before the intervention.
Conversely, the results of the MannWhitney U Test for the post-test behavior scores indicate a p-value of 0.
000, signifying a significant difference in behavior between the intervention and control groups after the The Wilcoxon Signed Ranks Test for the intervention group also shows a p-value 000, indicating a significant difference in behavior before and after the intervention.
Similarly, the control group shows a p-value of 0.
000, indicating a difference in behavior before and after the intervention.
DISCUSSION