Komunikasi kesehatan dalam pengobatan penyakit di kalangan masyarakat miskin

Abstract

World Health Organization (WHO) data shows that the condition of Indonesian public health is still poor. Indonesia sits in the fourth among countries in the world with related TB cases after India, China, and South Africa (WHO 2012). Prevalence of all TB cases are estimated of 680,000 and 450,000 new cases per year. The number of death caused by TB is estimated 65,000 per year (WHO 2012). To overcome this problem, since 1995 Indonesia has implemented Directly Observed Treatment Short course (DOTS) as a method of TB treatment recommended by the WHO and various agencies involved in a movement known as "STOP TB Partnership" (Kemenkes 2011). DOTS method is not only implemented through clinical approach (self medication or in the hospital), but also community-based approaches, especially among the poor with high prevalence of TB. The role of communication intervention becomes very important in TB treatment, so the demands on the development of health communication theory are also higher. Previously, health communication approach emphasized the importance of delivering information to the notion that people's reluctance to seek treatment was caused by lacking of knowledge about TB disease problem is known as transfer information approach or biomedical approach. Later, multi-level approach is needed to cope with the complexity of such vigorous movement of "Stop TB Partnership". This study used the theory of ACMS (McKee 1992), a multitrack model (Tufte and Mefalopulos 2009) to analyze structural and social issues and Health Believe Model (Rosenstock et al. 1988) to explain the behavior of the patient-level health . According to McKee (1999), the ACMS concept consists of three communication interventions namely advocacy, social mobilization, and program communication. Each of intervention works in different level but is related one another. Advocacy and social mobilization interventions are aimed to address the problems and obstacles in the development of social and structural level communication while at the level of individual programs Advocacy is intended to mobilize political commitment while social mobilization is intended to foster Partnerships in order to mobilize resources and services. Furthermore, social barriers can be overcome by executing structural and communication programs aimed at changing behavior. Research was conducted in May to December 2012. The research used qualitative approach with case by case study method of communication programs Communication and Social Mobilization Advocacy (AKMS) TB Control Program in the poor region by Community TB Care 'Aisyiyah KPT West Jakarta in Kelurahan Kalianyar, Tambora, West Jakarta. A total of 18 informants as a source of data, was obtained by the snowball technique. They knew and had experiences the activities of the Community TB Care Program 'Aisyiyah KPT West Jakarta. They represented people from different backgrounds namely diverse communities, community leaders, religious leaders, community volunteers, health workers, Drug Drinking Companion (PMO) and TB patients who were subjected to the Community TB Care 'Aisyiyah. Six of the informants represented patients based on their severity level, marital status, occupation, education level and age. Researcher collected data, especially with in-depth interviews and observations on the informants who were involved in the cases studied. Triangulation was implemented by checking the data that obtained through several sources. The data was analyzed to produce a conclusion, subsequently sought agreement (member check) with the data sources. Member check group discussions were conducted with informants and triangulation methods namely in-depth interviews with a variety of sources and by direct observation. The results showed groups of people (civil society) in charge of the TB control program successfully obtained commitment from decision makers in the city and district levels, therefore the basis of social mobilization could generate participation at the municipal level by donating the treatment of citizens or economically disadvantaged groups. Status of the head of the district government as a cadre of community organization is responsible for the support to strengthen TB control program and utilize network resources to gather a wider, through political influence (the health centers and sub-districts) and private networks that open patient access to medical services and economic assistance. At the community or village level, person in charge of the program was able to support social mobilization by utilizing existing resources in the form of social capital that cooperates and concerns on TB patients through volunteers, community leaders and PMO. Health behavior change at the individual level, especially in poor communities would not be possible without the advocacy, mobilization and communication (ACMS). ACMS successfully drives and empowers communities so that information of TB treatment up to individual level. Mode of communication used was a combination between participatory and dialogic monologues. Mode monologues occur in the training and delivering of information about the disease and treatment to TB patients, volunteers and community leaders as well as the PMO. While dialogic communication forums was formed to solve the problem. Monitoring forums and patient meetings became not only a way of information exchange about treatment of TB, but also problem solving and consulting arena and 'vent' in assisting patients. Patient's visits and mentoring by the PMO are not only aimed to monitor of treatment but as an important part of entertaining and provide encouragement to patients who are anxious and tired of taking medication. Dialogical participatory mode of communication in health communication is required not only a transfer of information from the owner of the program but also as an approach for the exchange of views in order to cure a disease. Credibility of cadres and PMO was not only shaped by knowledge about the disease and treatment of TB acquired through training but also by their sincerity. Their high ability encouraged patient to respond positively despite cadres' and PMOs' scary and violent manner but the patients interpreted them as forms of concern for him and motivated him to undergo treatment. Patients with status as parents with dependent children had more determination to recover, while single status patients stopped taking the drug due to lack of motivation to recover. Interpersonal approach thus thrusted and closeness of the communicator and the communicant are the most influential factors in shaping perception of the threat of disease. While the credibility of the communicator and the family can predispose individuals to make decisions as a behavior change effort to cure the disease. Perceived threat of TB patients view of the Health Belief Model shaped strongly by perception (perceived severity) patients and encouragement from the outside (cues to action) namely credibility of cadres and PMO. Despite the perception of vulnerability, gender, marital status, perceived benefict and perceived barier affect pain perception of the threat, but the pain has meaning severe for patients were the factors most strongly affecting the perception of the threat of TB illness. TB threat perception of pain was patients perceived influence on health behavior change in the treatment of TB.