8/10/2019 DRAFT 2.doc

1/43

Chapter 1

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale

Health is Wealth! This is one state"ent that the people #elie$e

on as the% li$e in the &i'erent &i"ensions o( the )orl&* &oin+ the $er%

#est to s,r$i$e (ro" the &i'erent &ile""as o( li(e in $ario,s aspe-ts!

.or so "an%/ #ein+ health% has not #een so &i0-,lt sin-e the -,res o(

so"e illness are (o,n& in o,r o)n #a-%ar&s s,-h as (r,its/ $e+eta#les/

an& "an% "ore! We/ the people/ ha$e #een -onstantl% &oin+ those

tra&itional steps )hen )e -annot ha$e the opport,nit% to o#tain a

hi+her le$el o( treat"ent!

As &e2ne& #% the Worl& Health Or+ani3ation 4WHO5 on its 1678

Constit,tion* Health is the -on&ition )herein a person li$es a health%

li(est%le in either ph%si-al/ so-ial or in "ental aspe-ts an& )hen a

person &oes not a-9,ire an illness or &isease! Basi-all%/ it is o,r

li(eti"e in$est"ent an& helps ,s -on9,er the )orl& an& li$e the )a%

)e )ant it to #e! Besi&es/ it is o,r -hoi-e to #e-o"e one or not*

&epen&in+ on the sit,ation! The )orl&/ #ein+ "ol&e& )ith &i'erent

-atastrophes an& &isasters/ is #e-o"in+ e$en "ore -o"ple:! At the

sa"e ti"e/ o,r pop,lation starts an& -ontin,es to +ro) e$en #i++er!

.or this ti"e aro,n&/ )e -annot sa% that all o( the people are still

8/10/2019 DRAFT 2.doc

2/43

health%! Besi&es/ there are those -reat,res s,-h as "i-ro#es

-ontin,in+ to +ro) in s)ar"s an& are ,n-ontrolla#le!

Be-a,se o( this/ a &isease or an a#nor"al "e&i-al -on&ition is

&e$elope&! It a'e-ts #oth h,"ans an& ani"als as en&e"i-/ epi&e"i-/

or pan&e"i-! It #e-o"es a -on-ern to e$er% people in the )orl&! B,t

&espite the )a% &iseases o--,r in o,r en$iron"ent/ there are still )a%s

on ho) to treat an& pre$ent the"!

.a-tors that -an a++ra$ate the &isease an& -an "ae a person

"ore s,s-epti#le to it in-l,&e ha$in+ a lo) i"",ne s%ste" as

espe-iall% i"",no-o"pro"ise& in&i$i&,als/ poor n,trition/

o$erpop,lation/ po$ert%/ ,r#ani3ation/ "i+ration/ #elo) a$era+e li$in+/

an& intera-tion )ith other patients -arr%in+ the &isease!

Literall%/ people in &i'erent -o"",nities are threatene& )hen

the% ha$e no)n s,-h &isease e$en i( the% ha$e onl% seen it in

tele$isions/ hear& it on the ra&io or ha$e rea& (ro" #oos! O(ten/ the

h,"anit% o,+ht to #elie$e e$er%thin+ a#o,t it #e-a,se e$er%one

no)s it )ill #e har& to re-o$er i( ,ntreate&!

Ri;en state& in a ne)s arti-le last

8/10/2019 DRAFT 2.doc

3/43

Health O0-e state that a"on+ the 7= #aran+a%s/ Baran+a% Basa has

the hi+hest n,"#er o( TB -ases )ith a total o(

a&"inistration/ as patients -o"plian-e is an i"portant ele"ent

#et)een "e&i-al "eas,res an& treat"ent res,lts! I( the patient is a

non-o"pliant/ he or she )ill a-9,ire "ore -o"pli-ations an& (or )orse/

,n-ontrolle& &eath rate -ontin,es to e:ist!

8/10/2019 DRAFT 2.doc

4/43

On the +oo& si&e/ ho)e$er/ in(or"ation on the s,--ess o( TB

-ontrol in the Philippines has #een re-or&e& )ith si+ni2-ant

i"pro$e"ent )ith the &isease &ete-tion an& treat"ent! A--or&in+ to

The Philippine Star 4

8/10/2019 DRAFT 2.doc

5/43

"atter/ it is s%non%"o,s to the patients a+ree"ent an& a-ti$e

parti-ipation!

Despite the (a-t that the +o$ern"ent* parti-,larl% the

Depart"ent o( Health an& other health a+en-ies/ pro$i&e e$er%thin+

an& all o( the ser$i-es nee&e& in this Dire-tl% O#ser$e& Treat"ent

Short>Co,rse Pro+ra"/ -o"plian-e has still #een an iss,e in P,#li-

Health #e-a,se there are still other people )ho (ail to -o"plete the

"e&i-ation in a +i$en ti"e! In this -ase/ non>-o"plian-e "a% lea& to

other -o"pli-ations!

The resear-hers )ho are (o,rth %ear le$el phar"a-% st,&ents/

ha$e +aine& no)le&+e on p,#li- health/ "i-ro#iolo+% an&

phar"a-e,ti-al -are/ are -apa#le o( -on&,-tin+ the ,n&er+ra&,ate

resear-h entitle& Fno)le&+e an& Patients Co"plian-e on TB>DOTS

Pro+ra" in the Health Center o( Baran+a% Basa/ Lap,>Lap, Cit%/

Ce#,!

The resear-hers p,rposel% -hose the topi- (or resear-h &,e to

the (ollo)in+ reasonsG 2rst/ to e:a"ine the -hallen+es o( Dire-tl%

O#ser$e& Treat"ent Short Co,rse i"ple"entation strate+ies in the

treat"ent o( t,#er-,losis/ )ith the perspe-ti$e to &eter"ine (a-tors

in,en-in+ a+ainst its e'e-ti$e i"ple"entation* se-on&/ to esta#lish

a)areness o( the &isease a"on+ patients )ith t,#er-,losis* thir&/ to

esta#lish an& loo (or the relationship #et)een no)le&+e an&

patients -o"plian-e on TB>DOTS Strate+%* an& lastl%/ to en-o,ra+e

8/10/2019 DRAFT 2.doc

6/43

the people in o,r -o"",nities to -o"pl% )ith an% treat"ent re+i"en

espe-iall% (or the TB &isease!

Theoreti-al Ba-+ro,n&

This resear-h st,&% a#o,t Fno)le&+e an& Patients Co"plian-e

on T,#er-,losis> Dire-tl% O#ser$e& Treat"ent Short>Co,rse 4TB>DOTS5

Pro+ra" in the Health Center o( Baran+a% Basa/ Lap,>Lap, Cit%/

Ce#,/ (o-,ses on t)o i"portant $aria#lesG no)le&+e an& patients

-o"plian-e!

Ro&ri+,e3 4a-t,ali3ation as state&! Health/

,n&er ph%siolo+i-al nee&s is -onsi&ere& to #e a #asi- or (,n&a"ental

nee& (or all o( ,s in or&er to a$oi&/ pre$ent/ an& treat illness that )o,l&

in-rease the ris o( "or#i&it% an& "ortalit% an& in relation )ith the

+oal o( the T,#er-,losis>Dire-tl% O#ser$e& Treat"ent Short>Co,rse #%

the Depart"ent o( Health 4DOH5 )hi-h is to -ontrol an& era&i-ate

t,#er-,losis!

A--or&in+ to a"es an& Ro$ers 4

8/10/2019 DRAFT 2.doc

7/43

ph%si-al/ "ental/ an& so-ial )ell>#ein+! The thir& "o&el or the Wellness

Mo&el sa%s that health is the point at )hi-h an in&i$i&,al has

-oor&inate& his or her #o&%/ "in&/ an& spirit res,ltin+ to a #etter state

o( hi+her (,n-tionin+/ ener+%/ an& -o"(ort! En$iron"ental Mo&el

a0r"s that health% people -an a&,st to ph%si-al an& so-ial

s,rro,n&in+s an& &o not e:perien-e the ,n&,e pain/ &is-o"(ort/ or

&isa#ilit%!

Her+enhann 4-onte"plation or the sear-hin+

o( ones inner tho,+hts/ (eelin+s/ an& e:perien-es! Mostl%/ sensor%

e:perien-e -an onl% re"in& one o( )hat )as alrea&% no)n! There(ore/

(or Plato/ all no)le&+e -o"es (ro" re"inis-en-e/ (or" re"e"#erin+

the e:perien-es the so,l ha& #e(ore enterin+ the #o&%! He also

#elie$e& that that ,lti"ate realit% -onsiste& o( i&eas or (or"!

As -ite& #% Jreen)oo& 4

8/10/2019 DRAFT 2.doc

8/43

A%ers/ et!al 4

8/10/2019 DRAFT 2.doc

9/43

re+,lati$e s%ste"s theor%* a theor% that sees the sin+le person as

so"e#o&% )ho -an tae -are o( iss,es an& re(ers that #eha$io,r lie

-o"plian-e is #ase& an& &epen&s in li+ht o( -o+niti$e $ie)points an&

the -,rrent stat,s o( ho) a -ir-,"stan-e a&$an-es! Ea-h o( these

$ie)s non>-o"plian-e pro#le"s (ro" &i'erent perspe-ti$es an& +i$es

"ore or less attention to illness -o+nition/ ris per-eption/ "oti$ation

to -o"pl%/ sele-tion an& a-9,isition o( -opin+ #eha$iors/ an& appraisal

pro-esses!

Re$ie) o( Relate& Literat,re

In the s-ope o( p,#li- health* &iseases/ espe-iall% those that are

-a,se& #% in(e-tio,s a+ents/ are the ra"pant an& still -ontin,in+

o#sta-les o( the so-iet%s health! A-9,irin+ a &isease "a% ha$e riss

an& #ene2ts to h,"ans in &i'erent aspe-ts! B,t the )or& &isease

itsel( speas har" an& (or )orse* &eath! Sit,ations -all as it -an #e

a--o,nta#le (or t,#er-,losis! Bein+ one o( the "ost &ea&l% &iseases/

the h,"anit%s health is p,t at stae &,e to the threats that it "a%

#rin+ an& "a% +i$e to the people! Be-a,se o( this/ it is $er% i"portant

(or the people to #e oriente& a#o,t the &isease an& its "e&i-ations!

T,#er-,losis* or in other ter"s TB/ is still -onsi&ere& as one o(

the "aor health #,r&ens )hi-h roots to the s,'erin+s o( the people

)orl&)i&e! Ne$ertheless/ this has #een a lon+>ter" "ission an&

a&$o-a-% (or the health pro(essionals* alon+si&e )ith the +o$ern"ent/

8/10/2019 DRAFT 2.doc

10/43

8/10/2019 DRAFT 2.doc

11/43

1= "illion o( )hi-h o--,r ea-h %ear )orl&)i&e! Ro&a 4

&e$elop"ent o( TB -ontrol "eas,res! S-haa( et al!/ 4

8/10/2019 DRAFT 2.doc

12/43

"ostl% ,n&er>reso,r-e& "ore than =K o( TB -ases arise! One thir& o(

the )orl&s pop,lation is in(e-te& )ith Mycobacterium tuberculosis/

an& >1=K o( in(e-te& people are liel% to &e$elop a-ti$e TB!

S"elt3er/ et!al 4TB &r,+s in

16

the re$ersal o( the tren& at 16 &,e to (a-tors lie in-rease&

i""i+ration/ the H,"an i"",no&e2-ien-% $ir,s 4HI?5 epi&e"i-/ the

i""er+en-e o( ",lti&r,+>resistant strains o( TB!

A--or&in+ to the Worl& Health Or+ani3ations 2n&in+s in TB &r,+s Isonia3i&

an& Ri(a"pi-in an& &i0-,lties in the treat"ent perio& +i$es "ore

8/10/2019 DRAFT 2.doc

13/43

-han-es o( spen&in+ "ore "one% (or the "e&i-ations! In-i&en-es o(

"issin+ TB -ases ha$e al)a%s #een another -hallen+e in the TB

-ontrol sin-e appro:i"atel% 8== -ases re"ain ,n&ete-te& an&

,ntreate&! Ea-h %ear/ trans"ission o--,rs to 1= other .ilipinos!

The National T,#er-,losis Pro+ra" 4NTP5/ in -ooperation )ith

so"e staehol&ers/ has esta#lishe& an& s,staine& its tar+ets on

&ete-tin+ -ases earl% an& to s,#se9,entl% treat the" #% "or#i&ities are

a&&resse& to pre$ent trans"ission an& the in-rease o( patients in the

(,t,re! Part o( the National T,#er-,losis pro+ra" is the Dire-tl%

O#ser$e& Treat"ent Short Co,rse 4DOTS5 )hi-h is the "ain

inter$ention (or TB -ontrol! It is a stan&ar&i3e& -o,rse o( -o"#ine&

therap% )ith the ,se o( &r,+s )hi-h -o$ers the "ar+inali3e&

pop,lations an& $,lnera#le people! 4Depart"ent o( Health/

8/10/2019 DRAFT 2.doc

14/43

National T,#er-,losis Pro+ra"/ A33opar&i 4DOTS in$ol$es t)o treat"ent -ate+ories I an& II )hi-h -o$er

intensi$e an& "aintenan-e phase! In Cate+or% I/ patients )ho -o"pl%

(aith(,ll% )ith the )hole re+i"en )ill #e +i$en "e&i-ation (or si:

8/10/2019 DRAFT 2.doc

15/43

8/10/2019 DRAFT 2.doc

16/43

A--or&in+ to one st,&% that ,tili3e& a sel(>a&"inistere&

treat"ent/ @6K o( the patients )ere lost (ro" the st,&% )ith a 8>

"onth anti>t,#er-,lar &r,+ therap% an& 76K )ith a nine> "onth

treat"ent re+i"en! In -ontrar%/ another st,&% states that those

patients that are ,n&er the 8>"onth re+i"en o( DOTS* (e)er than 1=K

o( the patients )ere lost to (,rther treat"ent! 4Tro% et al!/

ter"/ has its o)n ,lti"ate en&/ )hi-h is -o"plian-e! As &e2ne& #% the

Worl& Health Or+ani3ation 4WHO5/ -o"plian-e or a&heren-e is the

&is-ipline in )hi-h a persons #eha$ior to)ar&s seein+ health "atters

-orrespon&s to the pres-ri#ers re-o""en&ations an& s,++estions! In

this "atter/ it is si"ilar to the patients a+ree"ent an& a-ti$e

parti-ipation! 4as -ite& #% Sellers et al!/

8/10/2019 DRAFT 2.doc

17/43

&e$elope& the Dire-tl% O#ser$e& Treat"ent Short Co,rse in )hi-h

"e&i-ations (or TB patients are to #e a&"inistere& )ith the assistan-e

o( a health pro(essional! Sin-e DOT has -ontri#,te& to #etter

-o"plian-e o( patients/ it has #een a&opte& in In&ia an& Hon+>Fon+ in

the earl% 168=s respe-ti$el%!

Le$els o( -o"plian-e in-l,&eG Hi+h Co"plian-e/ a sit,ation )here

a patient (aith(,ll% -o"plies )ith the "e&i-ation re+i"en +i$en #%

,p&ate& re-or&in+ o( treat"ent/ o#e%in+ the assi+ne& s-he&,les in

re+,lar ter"s/ an& #% (oreseein+ the nee& to a"eliorate li(est%le/

health/ an& -han+e #a& ha#its to +oo& ones 4Ste-el 85! Ne:t le$el is

the Mo&erate Co"plian-e* as -ite& #% Ste-el 485/ is pro#a#l% the

sa"e as Hi+h Co"plian-e! B,t )hat "aes it &istin-t is that the person

in$ol$e& has taen (or +rante& the therapies an& "e&i-ation +i$en #%

the health pra-titioners! He or she "a% -o"pl% )ith the "e&i-ations

(or the 2rst (e) &a%s #,t e$ent,all% stops it &,e to the int,ition o(

so"eone that it is not ne-essar% an%"ore/ a person is not intereste& to

tae the "e&i-ation thinin+ that he or she has alrea&% #een treate&!

Lastl%/ Lo) Co"plian-e on-e a+ain e"phasi3e& #% Ste-el 4865* are

those patients that &o not entirel% (ollo) an& a&here the +i$en s,ita#le

"o&es o( treat"ent an& -lini- s-he&,les o( treat"ent/ "iss &oses o(

+i$en "e&i-ations/ &o not ha$e the initiati$e to alter the a-ti$ities that

-an )orsen the illness an&/ &o not ha$e the )illin+ness to a"eliorate

health an& li(est%le!

8/10/2019 DRAFT 2.doc

18/43

S,pportin+ St,&ies

A 9,alitati$e resear-h #% M,nro et al!/ 45

ela#orate& a#o,t the (a-tors a'e-tin+ -o"plian-e o( a patient to a

"e&i-ation )hi-h are &i$i&e& into ei+ht -ate+oriesG Or+ani3ation o(

Treat"ent an& Care (or TB Patients/ Interpretations o( Illness an&

Wellness/ Fno)le&+e/ Attit,&es/ an& Belie(s a#o,t TB Treat"ent/

.inan-ial B,r&en o( TB Treat"ent/ La) an& I""i+ration/ Personal

Chara-teristi-s an& A&heren-e Beha$ior/ The In,en-e o( Si&e E'e-ts

on Treat"ent A&heren-e/ an& .a"il%/ Co"",nit%/ an& Ho,sehol&

In,en-es as res,lts! This sho)s that patients o(ten tae their TB

"e&i-ation ,n&er to,+h -ir-,"stan-es an& e:perien-e si+ni2-ant

&i0-,lties/ "an% o( )hi-h are o,tsi&e o( their &ire-t -ontrol! Tain+ a

len+th% "e&i-ation re+i"en is not -on$enient an& o(tenti"es in$ol$es

&i0-,lt ,&+"ent/ so"eti"es at si+ni2-ant personal an& so-ial -ost to

the patient! A&heren-e is a -o"ple:/ $ital pheno"enon* a #roa& ran+e

o( intera-tin+ (a-tors in,en-e on treat"ent>tain+ a-tion/ an& patient

#eha$ior "a% "o&i(% &,rin+ the treat"ent pro+ra"! More patient>

-entere& inter$entions an& a (ar +reater o#ser$ation to str,-t,ral

#arriers/ are ne-essar% to enhan-e treat"ent a&heren-e an& &e-rease

the )orl&)i&e &isease! A--or&in+ to an arti-le #% Faona et al!/ 4

8/10/2019 DRAFT 2.doc

19/43

8/10/2019 DRAFT 2.doc

20/43

pre$ention nee&s re$isitin+/ as -o"",nit% "e"#ers see"e& to ha$e

ha& no)le&+e that &i& not relate the &isease to the en$iron"ent! The

la- o( no)le&+e in pre-a,tionar% "eas,res in this +ro,p -o,l& #e

e:plaine& thro,+h or st,&% sa"ple itsel(! Altho,+h these a+e +ro,ps

)ere o( patients )ho -o,l& ha$e a-9,ire& the in(or"ation (ro" the

-lini- &,rin+ the ti"e the% )ere +atherin+ the &r,+s an& their (oo&

s,pplies/ )hi-h )ere o(tenti"es pro$i&e& to patients/ pre$ention &i&

not see" to ha$e #een stresse&>o,t #% the health -are pro$i&ers!

Maorit% o( the patients )ent to spe-iali3e& health (a-ilit% on-e the%

)ere si-! 4Faona et al!/ 5/ an& hi+h 4s-ore o( 6>115!

8/10/2019 DRAFT 2.doc

21/43

A--or&in+ to resear-hes 4as -ite& #% Moha"e& et al!/

the &r,+s )as the "aor reason (or the non-o"plian-e 4@8!==5! More

than hal( o( the TB patients ha& ins,0-ient no)le&+e on TB an& its

8/10/2019 DRAFT 2.doc

22/43

treat"ent! Co"plian-e )as (o,n& to #e si+ni2-antl% asso-iate& )ith

no)le&+e 4p=!=DOTS 4as

-ite& #% Bhatt et al!/

8/10/2019 DRAFT 2.doc

23/43

resistan-e to anti>TB &r,+s! People )ho in(e-t )ill ha$e the sa"e &r,+

resistant strain! While &r,+ resistant TB is treata#le/ it re9,ires

e:tensi$e -he"otherap% ,p to t)o %ears/ it is -ostl% an& "ore to:i- to

the patient!

In this ,n&er+ra&,ate resear-h/ it ,tili3es a t%pe a sa"plin+

"etho& -alle& as ,ni$ersal sa"plin+! Uni$ersal sa"plin+/ as -ite& #%

Ri-har& an& Mar+aret 4166=/ 1non-o"plian-e state that the possi#ilit% to i&enti(% an& -o"pare the

pop,la-e o( an esta#lish"ent to t,#er-,losis> in(e-te& patients "a%

o--,r! Be that as it "a%/ this -an #e teste&/ parti-,larl% )ith

non-o"plian-e st,&ies! B,il&ers an& A+,)a 4

8/10/2019 DRAFT 2.doc

24/43

a&opte& the ,ni$ersal sa"plin+ "etho& (or the st,&% nee&s a

pop,lation that )ill liel% ,sti(% their proposition!

Con-ept,al .ra"e)or

INDEPENDENT ?ARIABLE DEPENDENT ?ARIABLEOUTPUT

Fno)le&+e o(Patients a#o,tT,#er-,losis>

Disease/ Ca,se/Clini-al

Mani(estations/Treat"ent/ an&

Deter"ination onthe .a-tors thatA'e-t Patients

Co"plian-e on theTB>DOTS Pro+ra"

in relation toFno)le&+e

PatientsCo"plian-e on the

Me&i-ationRe+i"en on the TB>

DOTS Pro+ra"

A+eJen&er

So-ioe-ono"i- stat,sE&,-ational#a- ro,n&

8/10/2019 DRAFT 2.doc

25/43

INTER?ENINJ ?ARIABLES

The -on-ept,al (ra"e)or o( this resear-h st,&% is -o"pose& o(

the in&epen&ent $aria#le* no)le&+e o( patients a#o,t T,#er-,losis>

&isease/ -a,se/ -lini-al "ani(estations/ treat"ent/ an& DOTS Pro+ra"!

The &epen&ent $aria#le &eter"ine& in this resear-h st,&% is patients

-o"plian-e on the "e&i-ation re+i"en on the TB>DOTS Pro+ra"!

Lastl%/ the possi#le o,tp,t (or the st,&% in-l,&es the &eter"ination on

the (a-tors that a'e-t patients -o"plian-e on the TB>DOTS Pro+ra" in

relation to no)le&+e!

This st,&% &oes not onl% (o-,s on the in&epen&ent an&

&epen&ent $aria#les na"el% no)le&+e an& patients -o"plian-e

respe-ti$el%! There are also other $aria#les that "a% pro$i&e a

relationship )ith #oth the in&epen&ent an& &epen&ent $aria#les )hi-h

are -alle& the inter$enin+ $aria#les! Inter$enin+ $aria#les or the

"o&i2ers ,se& in the st,&% are a+e/ +en&er/ so-ioe-ono"i- stat,s/ an&

e&,-ational #a-+ro,n&!

THE PROBLEM

State"ent o( the Pro#le"

The ,n&er+ra&,ate st,&% +enerall% ai"s to &eter"ine the

relationship #et)een the no)le&+e an& patients -o"plian-e to)ar&s

the TB>DOTS pro+ra" in Basa health -enter/ Lap,>Lap, Cit%/ Ce#,!

Spe-i2-all%/ the resear-hers ai" to &eter"ine the (ollo)in+G

8/10/2019 DRAFT 2.doc

26/43

1! What is the &es-ription o( the respon&ents in ter"s o( theirG

1!a! a+e

1!#! +en&er

1!-! so-io>e-ono"i- stat,s

1!&! e&,-ational #a-+ro,n&

t,#er-,losis

@! What is the respon&ents le$el o( -o"plian-e

7! Is there a si+ni2-ant relationship #et)een no)le&+e o( the

&isease an& patients -o"plian-e

! Is there a si+ni2-ant relationship #et)een no)le&+e o( the

&isease to

respon&ents a+e/ +en&er/ so-ioe-ono"i- stat,s/ an&

e&,-ational

#a-+ro,n&

8! Is there a si+ni2-ant relationship #et)een patients

-o"plian-e to their

a+e/ +en&er/ so-ioe-ono"i- stat,s/ an& e&,-ational

#a-+ro,n&

Si+ni2-an-e o( the St,&%

This resear-h st,&% is -ra(te& to #e #ene2-ial an& o( para"o,nt

i"portan-e to the (ollo)in+G

8/10/2019 DRAFT 2.doc

27/43

Resear-h Respon&ents! The% )ill #e a#le to +ain "ore no)le&+e

a#o,t T,#er-,losis an& the% )ill #e "ore "oti$ate& to -o"pl% )ith the

"e&i-ation re+i"en o'ere& #% the TB>DOTS pro+ra" to "aintain their

+oo& health!

DOTS O0-e o( Cit% Health! The% )ill #e "ore &e&i-ate& to o'er their

ser$i-es to the TB patients ,n&er the TB>DOTS pro+ra" an& the% )ill

#e a#le to share "ore no)le&+e an& -o,l& +,i&e the" in an% )a%!

Health pro(essionals an& pra-titioners! The% )ill #e also a)are o( the

possi#le iss,es that )o,l& o--,r alon+ the -o,rse o( the TB>DOTS

pro+ra" an& the% )o,l& #e also a#le to assist those that are in the

health -enters!

Me&i-al an& Para"e&i-al St,&ents! The% )ill #e a#le to +ain "ore

no)le&+e o( T,#er-,losis an& the TB>DOTS pro+ra" an& the% )ill

#e-o"e a)are o( the sit,ation o( o,r -o,ntr% in ter"s o( p,#li- health!

Phar"a-% St,&ents! .or the% )ill #e a#le to ,se their #a-+ro,n&

no)le&+e o( the sai& &isease an& its "e&i-ations to ser$e those

patients in the near (,t,re an& the% )ill #e inspire& to e:plore on other

spe-ial 2el&s in phar"a-% not ,st in -o"",nit% &r,+stores/ hospitals/

an& "an,(a-t,rin+ 2r"s!

.,t,re resear-hers! The% )ill #e a#le to +et an i&ea on )hat to

resear-h i( their -hosen topi-s )o,l& still #e in line )ith p,#li- health

-o""on &iseases!

8/10/2019 DRAFT 2.doc

28/43

S-ope an& Li"itations o( the St,&%

The s-ope o( this st,&% )ill (o-,s on the (a-tors a'e-tin+

patients -o"plian-e on the TB>DOTS pro+ra" in the health -enter o(

Baran+a% Basa/ Lap,>Lap, Cit%/ Ce#,! The st,&% -o$ers no)le&+e

an& patients -o"plian-e to)ar&s TB>DOTS! All in(or"ation )as taen

(ro" the patient/ patients "e&i-al re-or& in the health -enter/ #oos/

an& (ro" relia#le so,r-es! The st,&% )ill #e -on&,-te& (ro" De-e"#er

Mar-h

8/10/2019 DRAFT 2.doc

29/43

RESEARCH METHODOLOJ

Resear-h Desi+n

This resear-h st,&% )ill ,tili3e the &es-ripti$e -orrelational

resear-h &esi+n a#o,t no)le&+e an& patients -o"plian-e!

Resear-h En$iron"ent

The st,&% )ill #e -on&,-te& at the health -enter o( Br+%! Basa/

Lap,>Lap, Cit%/ Ce#,! It is sit,ate& in Ta"i%a #esi&e olli#ee (ast (oo&

-hain! A &o-tor/ n,rse/ "i&)i(e/ an& #aran+a% health )orers

s,per$ise an& assist the TB patients ,n&er the pro+ra"! Cons,ltations

are &one e$er% &a% (ro" Mon&a%s to .ri&a%s e$er% a(ternoon #e-a,se

TB patients are to #e isolate& (ro" other patients )ho -o"e to the

health -enter! Cons,ltation in the health -enter is &one #% +ettin+ their

$ital si+ns 4te"perat,re/ #loo& press,re an& )ei+ht5 an& re(erre& to

the &o-tor!

Resear-h Respon&ents

The resear-hers )ill ,tili3e all o( the

8/10/2019 DRAFT 2.doc

30/43

these in-l,&esG a&,lts an& -hil&ren/ the patients &ia+nose& )ith

p,l"onar% t,#er-,losis an& sho)in+ positi$e res,lt o( T,#er-le #a-illi

on &ire-t s"ear an& -,lt,re taen (ro" patients "e&i-al re-or&!

P,l"onar% t,#er-,losis patients ,n&er treat"ent )ith ne+ati$e

M%-o#a-teri," t,#er-,losis s"ear are e:-l,&e& (ro" the st,&%!

Resear-h Instr,"ent

The resear-hers "a&e the 9,estionnaires! The ite"s are #ase&

on the in(or"ation +athere& (ro" the re$ie) o( relate& literat,re! There

)ere a#o,t 7 ite"s )hi-h are translate& to ?isa%an &iale-t (or

respon&ents -on$enien-e! It )ill onl% -ons,"e @= "in,tes to (,ll%

ans)er the 9,estionnaire!

The 9,estionnaires ha$e three se+"ents that in-l,&e patients

in(or"ation )hi-h -ontains 9,estions that i&enti(% the &e"o+raphi-

-hara-teristi-s o( the respon&ent! Another 9,estionnaire (or patients

no)le&+e -o"prises o( 1 9,estions )hi-h ,tili3es tr,e or (alse s-ale

(or s-orin+! .or patients -o"plian-e -o"prises pointer Liert s-ale )hi-h &eter"ines the respon&ents

no)le&+e an& -o"plian-e on the TB>DOTS pro+ra"! The s-ales are as

(ollo)sG

JRADE

TITLE DESCRIPTION

1 Stron+l%Disa+ree

The respon&ent is stron+l% not in (a$or o(the state"ent

< Disa+ree The respon&ent is not in (a$or o( thestate"ent #,t )ith a little a+ree"ent

8/10/2019 DRAFT 2.doc

31/43

@ Neither a+reenor &isa+ree

The respon&ent "a% in (a$or nor not in(a$or )ith the state"ent

7 A+ree The respon&ent (a$ors the state"ent #,t)ith little &o,#t

Stron+l% A+ree The respon&ents stron+l% (a$ors the

state"ent

Resear-h Pro-e&,re

Preli"inar% Preparation

A trans"ittal letter )as s,#"itte& to Dr! ennil%n C!

Cor$era/ Dean o( the Colle+e o( Phar"a-% (or the proposal an&

appro$al o( the resear-h st,&%! Therea(ter/ a trans"ittal letter

)as also +i$en to Br+%! Captain Hon! Isa#elito L! Darna%la (or the

per"ission to -on&,-t the st,&% )ithin the $i-init%! A(ter)ar&s/ a

letter o( re9,est )as +i$en to Dr! Ro&ol(o C! Bera"e/ M!P!H / Cit%

Health O0-er o( Lap,>Lap, Cit%/ Ce#,/ (or the per"ission to

-on&,-t the st,&% in a -ertain #aran+a%!

?ali&ation o( Resear-h Instr,"ent

As (or the $ali&it% o( the resear-h instr,"ent that the

resear-hers "a&e / the resear-hers )ill 2rst e$al,ate the -ontent

o( the 9,estionnaire! A(ter the resear-hers ha$e e$al,ate& the

9,estionnaire/ the% )ill -on&,-t a pre>test (or the $ali&it% an&

relia#ilit% o( the 9,estionnaire on the test )ill #e &one #% lettin+ the

8/10/2019 DRAFT 2.doc

32/43

respon&ents ans)er the resear-her>"a&e 9,estionnaire! The

9,estionnaires )ill #e -olle-te& an& -he-e& to "ae s,re that

there are no 9,estions le(t ,nans)ere& to -orre-t +ra""ati-

errors an& to &eter"ine the &e+ree o( ease in rea&in+/

,n&erstan&in+/ ans)erin+/ an& a&"inisterin+ the sets o(

9,estionnaires!

A-t,al Data Jatherin+

The resear-hers )ill i&enti(% patients in the health -enters

TB Re+istr% Re-or& Boo/ )hi-h re-or&s the patients na"e/

re+istration n,"#er/ &ate o( startin+ an& -o"pletion o(

treat"ent/ &e"o+raphi- &etails/ a&&ress an& &ia+nosis! Then/

the resear-hers )ill -oor&inate )ith the #aran+a% health n,rse

Lea T! Pelae3 one "onth prior to &ata +atherin+ to in(or" the

patients ahea& o( ti"e! The resear-hers )ill e:e-,te the a-t,al

&ata +atherin+ on the 1thto 16tho( De-e"#er

8/10/2019 DRAFT 2.doc

33/43

respon&ents )ill #e +i$en @= "in,tes to ans)er ea-h 9,estion!

While the respon&ents ans)er the resear-h instr,"ent/ the

resear-hers )ill sta% )ithin the $i-init% to entertain 9,estions (or

an% -lari2-ations )hile the resear-h "entor an& the "e&i-al sta'

)at-h o$er the"! Soon therea(ter/ all ite"s )ill #e -olle-te& an&

-he-e& to see i( there are n,"#ers le(t ,nans)ere&! The

resear-hers )ill -ollate an& tall% the &ata! Res,lts (ro" the

9,estionnaires )ill #e en-o&e& an& presente& in a ta#,late&

(or"! Lastl%/ the res,lts o( the &ata )ill #e anal%3e& an&

interprete&!

Statisti-al Treat"ent o( Data

Anal%sis o( the -o"plete& 9,estionnaire )ill #e -arrie& o,t

,sin+ per-enta+es an& (re9,en-% &istri#,tion!

Per-enta+e &istri#,tion )ill #e -o"p,te& thro,+h this (or",laG

100% xn

f=

WhereG

( the (re9,en-% o( the respon&ents s-ore

n the total n,"#er o( respon&ents

.or the no)le&+e an& le$el o( -o"plian-e/ the "ean )as ,se&G

n

xx

=

_

8/10/2019 DRAFT 2.doc

34/43

WhereG

_

x the o$erall "ean

the s," o(

: ea-h respon&ents "ean s-ore

n the total n,"#er o( respon&ents

Then the stan&ar& &e$iation )as -o"p,te& #% the (or",laG

WhereGs stan&ar& &e$iation

the s," o(

: ea-h $al,e in the &ata set

_

x "ean o( all $al,es in the &ata set

n the n,"#er o( respon&ents

The relationship #et)een the t)o $aria#les in this st,&%

4no)le&+e an& patients -o"plian-e5 )ill #e &eter"ine& #%

-o"p,tin+ the Pearson -orrelation -oe0-ient!

WhereG: res,lt o( the le$el o( no)le&+e a"on+ t,#er-,losis

patients

8/10/2019 DRAFT 2.doc

35/43

% res,lt o( the le$el o( patients -o"plian-e a"on+

t,#er-,losis

patients

:% s," o( the -ross pro&,-t o( : an& %

: s," o( the ratin+s #elon+in+ to :

% s," o( the ratin+s #elon+in+ to %

:taile& t>test )ill #e &one!

The resear-hers 2rst set the si+ni2-an-e le$el o( =!= (or

the si+ni2-an-e -orrelation o( the t)o $aria#les! Then/ the

&e+ree o( (ree&o" 4&(

8/10/2019 DRAFT 2.doc

36/43

r Pearson -orrelation -oe0-ient

n n,"#er o( respon&ents

n>$al,e/ the p>$al,e )ill #e

&eter"ine&! I( = 0Q / it "eans that there is no si+ni2-ant

-orrelation #et)een no)le&+e an& patients -o"plian-e! On the

other han&/ there is a si+ni2-ant relationship #et)een no)le&+e

an& patients -o"plian-e i( 0Q !

DE.INITION O. TERMS

In or&er to ha$e a (,ll ,n&erstan&in+ o( the ter"s ,se& in the

st,&%/ the (ollo)in+ are operationall% &e2ne&G

DOTS! Dire-tl% O#ser$e& Treat"ent Short Co,rse is the pro+ra"

opene& #% the Depart"ent o( Health )hi-h has +i$en a lot o(

assistan-e to the t,#er-,losis patients!

Fno)le&+e! It is one o( the "eas,res to #e &eter"ine& in the st,&% i(

the respon&ents are no)le&+ea#le o( their &isease 4t,#er-,losis5 or

not! It is the in&epen&ent $aria#le taen into -onsi&eration (or this

resear-h st,&%!

8/10/2019 DRAFT 2.doc

37/43

Patients Co"plian-e! It is the stat,s o( patient i( he or she reli+io,sl%

-o"pl% )ith the +i$en treat"ent re+i"en at a +i$en ti"e! It is the

&epen&ent $aria#le taen into -onsi&eration (or this resear-h st,&%!

T,#er-,losis! It is a -o""on in(e-tio,s &isease )hi-h ser$es as the

+ro,n& (or -on&,-tin+ this resear-h st,&%!

BIBLIOJRAPH

Boo So,r-es

A+,)a/ N! 4Wallston/ Fenneth/ Wei"an/ ohn/ West/ Ro#ert! 4 Relate& Beha$io,rs! Cambride Handboo! of Pyscholoy"

8/10/2019 DRAFT 2.doc

38/43

Health and Medicine 4

8/10/2019 DRAFT 2.doc

39/43

Po""er$ille/ e're% C! 4

8/10/2019 DRAFT 2.doc

40/43

Tro%/ Da$i& B!/ Ha,#er/ Matthe) ! 4iss

871>87!p&(!

Fa#era/ La"#ert 4,se>o(>

a--o,ntin+>ratios>in> &e-ision>"ain+8!ht"l!

8/10/2019 DRAFT 2.doc

41/43

Faona/ .re&eri- AD/ T,#a/ Mar%/ Si3i%a/ Seter/ Siaona/ Le+anii!

4

Moha"e& A!I!/ o,si( M!A!/ Ottoa P!/ Ba%o,"i/ A! 4In(e-t Mi-ro#iol* 1415G 17>16!para! @>7

N&ei/ Leil,ai .re&ri-! 4

8/10/2019 DRAFT 2.doc

42/43

Manyatta" Samburu District! Nairo#iG Fen%a Me&i-al Trainin+

Colle+e!

Ninan/ Bett% S,san 4

httpG&spa-e!s-ti"st!a-!insp,i#itstrea"1ManilaG DOH! iss,e no! 1/ pp!>!

Sa"ar+an&i/ Osa"a A!/ A#,la#an/ Ah"a& A!/ El Dee Basee" S!/

Mir&a&/ L,ain H!/ Wali/ Sira O! 4

&e-linin+>)ho!

Depart"ent o( Health! 4

8/10/2019 DRAFT 2.doc

43/43

TB Control in the Philippines! PhilippinesG DOH! p!1=!

Depart"ent o( Health! 4httpG)))!&oh!+o$!phno&e@8!ht"l!

USAID! 4K

In(or"ation A+en-%! para 7/! Retrie$e& O-to#er 1