FACTORS AFFECTING THE TUBERCULOSIS cadres

MOTIVATION CASE DETECTION OF TUBERCULOSIS

DISEASE IN THE K CITY

Gita Sekar Prihanti,1 Eko Setyo Herwanto,1 Galih Bayu Prakoso,1 Gusti Gandha

Pandya,1 Cha Cha Astrid Ghesa,1 Hiolda Lubvianda Oktavin,1 Yulanda Fitriana1
1
Department of Medical Education, Faculty of Medicine, Muhammadiyah Malang

University, Malang, Indonesia

*Correspondence to: Gita Sekar Prihanti, Department of Medical Education, Faculty of

Medicine, Muhammadiyah Malang University, Malang, Indonesia

(E-mail:prihantigitasekar@gmail.com)

ABSTRACT

Background and purpose: Tuberculosis (TB) is an infectious disease caused by

Mycobacterium tuberculosis (MTB), The high incidence of TB takes the role of a TB

cadres in TB case finding, where the motivation is one of the factors that support the

performance of TB cadres. Knowing factors that affect the motivation of TB cadres case

detection rate of TB in the Region K City.

Methods: This study is observational analytic method with cross sectional study design

in the city of K. Sampling using a total of 59 TB cadres in K. Samples filled in a

questionnaire containing questions about sociodemographic, attitudes, knowledge, and

motivation with a total of 39 questions. Data were analyzed with descriptive statistics

univariate, bivariate test by Mann Whitney and Kruskal Wallis test and continued

multivariate analysis using logistic regression test.

Results: The results of multivariate analysis showed that there were four independent

variables that have a significant influence on the motivation of TB cadres, the old cadres

factor (p = 0.000;OR = 106,643,280.9; -19.8631 95% CI; -17 108), Job (not working) (p

= 0.001 OR = 0.048;95% CI 1.187; 4855), The appropriate incentives (p = 0.006 OR =

11.611;95% CI -4.215; -0.689) and employment (private) (p = 0.014 OR = 106.64, 95%

CI 0545; 4.811).

Conclusion: The results showed the provision of personal protective equipment,

training in improved understanding and performance is needed, also the provision of

incentives budget both money and non-money. Coaching directly from health workers

to the cadres are required to improve the performance of cadres.

Keywords: TB cadres, Tuberculosis, motivation

INTRODUCTION

Based on the 2014, WHO report on the global level is estimated 9.6 million new

TB cases, with 3.2 million cases diiantaranya female patients. With 1.5 million

mortality due to TB in which 480,000 were women.1 56% of tuberculosis cases

occurred in five countries, namely India, Indonesia, China, the Philippines and

Pakistan.2 Meanwhile, based on the data Riskesdas 2018, the number of TB cases in

Indonesia reaches 0.4 percent of the population, which is about less than 1 million he

who where 23,000 of them came from East Java Province.1

Data from January to December 2018, Kediri City Health Department recorded 820

TB case finding. Of 3 clinics in Kediri region which has a population of most, namely

Sukorame Pubilic Health Care (PHC) with evaluation program results of 71.4%,

Campur Rejo achieve 77.4%, and Pesantren 2 achieve 52.3% which of the three
results are not achieve the specified targets.3

The number of TB treatment failures due to the lengthy process of therapy, several

types of drugs, and the side effects of the drug. Many factors affecting TB patients to

adhere the treatment. Self-motivation, awareness about the disease and treatment,

support and counseling services, family support, nutritional support and social support

is an important driver for the success of the treatment.4

The high prevalence of TB reflects the failure of TB treatment is still high is also

still a lack of involvement of cross-program and cross-sector in TB control both

activities and funding, so the achievement of target performance appraisal clinics were

not achieved. Besides the low rate of discovery of new TB cases in the community is

still low, It requires a good role of TB cadres in Kediri, where as motivation is one of

the factors that support the performance TB cadres.1

Motivation affecting the performance of cadres both intrinsic and extrinsic

motivation. Intrinsic motivation (inner) cadres factors include age, education level, the

old cadres, work, attitude, and knowledge. whereas extrinsic motivation

(encouragement that come from outside the individual), which includes the training of

cadres and incentives. 5, 6, 7

METHODS

This research was observational analytic with cross sectional study design. This

research was conducted at the health center Sukorame Kediri. The study was conducted

in the third week of February in 2019.

Number of samples in this study were all cadres TB Kediri amount 63 people. The

independent variables in this study are the factors that influence the motivation of

cadres of TB that is intrinsic and extrinsic factors. Intrinsic factors (inner) coverage,
education level, occupation, old cadres, knowledge and attitudes TB cadres. Esktrinsik

factors (impulse that comes from outside the individual) includes the training of cadres

and cadres incentives for TB. While the dependent variable in this study is motivated

cadres of TB in TB case detection rate in the city of Kediri.

Comparative data analysis unpaired categorical performed 1 time measurements

with Chi Square test if the requirements are met and use of alternative test

Mann-Whitney or Kruskal-Wallis if the requirements are not met. To determine which

factors influence the attitude of the respondents used logistic regression.

RESULTS

In this study, the data obtained is the primary data taken through measurement

questionnaire on TB cadres in the area of Kediri with the number of respondents 59

people, that is by using a total sampling. In this chapter we will expalin the results of

research by starting from the characteristics of the respondents, the results of Chi-square

analysis, and the results of multivariate analysis.

Table 1. Description of the factors that influence the motivation of TB cadres

against TB
Variables Total Percentage (%)
Gender
Man 6 10.2%
Woman 53 89,8%
Total 59 100%
Age
25-40 13 22.0%
41-60 46 78.0%
> 60 0 0%
Total 59 100%
Level of Education
Elementary / Junior 6 10.2%
Senior 39 66.1%
D3 / S1 14 23.7%
Total 59 100%
 Duration of Been a
cadres
<2 years 22 37.3%
2-4 yrs 30 50.8%
>5 th 7 11.9%
Total 59 100%
Job
Unemployment 28 47.5%
PNS 5 8.5%
Private 13 22.0%
Entrepreneurial 13 22.0%
Total 59 100%
Attitude
Well 59 100%
Enough 0 0%
Less 0 0%
Total 59 100%
Training
Ever 59 100%
Never 0 0%
Total 59 100%
Incentive
Corresponding 48 81.4%
It is not in accordance with 11 18.6%
Total 59 100%
Motivation
Less 3 5.1%
Enough 19 32.2%
Well 37 62.7%
Total 59 100%

Based on the above table it is known that out of 59 respondents, respondents who

have less motivation 3 (5.1%), respondents who have enough motivation as much as 19

(32.2%), and respondents who have a good motivation as much as 37 (62.7 %).

Table 2. Bivariate Test

Motivation
Variables Total P
Less Enough Well
25-40 years 1 9 3 13
Percentage 1.6% 15.2% 5% 22.1% 0.004 (Mann-
Age
40-60 years 2 10 34 46 Whitney)
Percentage 3.3% 16.9% 57.6% 77.9%
Corresponding 3 12 33 48
0.044 (Mann-
Incentive Percentage 5% 20.3% 55.9% 81.3%
Whitney)
It is not in 0 7 4 11
 accordance
with
Percentage 0% 11.8% 6.7% 18.4%
Elementary /
0 1 5 6
Junior
0% 1.6% 8.4% 10.1% 0.288
Level of
SLTA 3 17 19 39 (Kruskal-
Education
5% 28.8% 32.2% 66.1% Wallis)
D3 / S1 0 1 13 14
0% 1.6% 22% 23.8%
<2th 1 11 10 22
1.6% 18.6% 16.9% 37.2%
Duration 0.031
2-4 th 2 8 20 30
of Been a (Kruskal-
3.3% 13.5% 33.8% 50.8%
cadres Wallis)
> 5 th 0 0 7 7
0% 0% 11.8 22%
Unemployed 0 6 22 28
0% 10.1% 37.2% 47.4%
PNS 1 1 3 5
0.007
1.6% 1.6% 5% 8.4%
Job (Kruskal-
Private 0 4 9 13
Wallis)
0% 6.7% 15.2% 22%
Entrepreneurial 2 8 3 13
3.3% 13.5% 5% 22%

The data analysis influence of age and incentives to motivate cadres TB case

detection rate of TB suspects in the town of Kediri using Mann Whitney test has a

significance value (p) respectively are 0.004 and 0.044. Effect of education level, the

old cadres, and work on the motivation of cadres TB case detection rate of TB suspects

in the City of Kediri using Kruskal Wallis test has a significance value (p) respectively

are 0.288, 0.031 and 0.004.

Based on the results of the analysis can be concluded that there is a relation

between the factors of age, education level incentives, the old cadres, and work on the

motivation of cadres TB case detection rate of TB suspects.

Table 3. Multivariate Test

Variables Wald Sig. Lower Bound Upper Bound
554
Threshold [Motivation = 1] .000 -22 658 -19 176
453
 635
[Motivation = 2] .000 -19 010 -16 267
367
[Age = 1] 1,814 .178 -2671 .495
[Age = 2] , , , ,
691
[Duration = 1] .000 -19 863 -17 108
944
[Duration = 2] , , -18 290 -18 290
[Duration = 3] , , , ,
Location 10
[Jobs = 1] .001 1,187 4855
426
[Jobs = 2] .095 .758 -1927 2,645
[Work = 3] 6,056 .014 .545 4,811
[Job = 4] , , , ,
[Incentives = 0] 7428 .006 -4215 -.689
[Incentives = 1] , , , ,
In logistic regression was used comparative lack and enough motivation thare are

age, duration been a cadres, employment and incentives, so we get the following

equation:

Y Low = -20.917- (18 485 (Old cadres <2y) + 3,021 (does not work) + 2,678 (private) -

2.452 (incentives are not appropriate))

Y pretty = -17.639- (18 485 (Old cadres <2y) + 3,021 (does not work) + 2,678 (private)

- 2.452 (incentives are not appropriate))

Old cadres has an influence on the motivation of cadres of TB in the Kediri Region.

OR value obtained is 106,643,280.9 means the chances of cadres working <2y to have

less motivation is 106,643,280.9 rather than acting> 5thn. Because OR> 1 can also be

said the possibility of cadres working <2y to have less motivation is 106,643,280.9 x of

work> 5thn.

Unemployment had an influence on the motivation of cadres of TB in the Kediri

Region. OR value obtained was 0,048 means that no work cadres opportunity to have a

good motivation is 0,048 rather than acting. Because OR <1 can also be said the

possibility of cadres that do not work to have a good motivation is 0,048 x of the cadres

of civil servants and entrepreneurial private work.

 Employment (private) have an influence on the motivation of cadres of TB in the

Kediri Region. OR value obtained is 0.0687 means the chances of cadres who work

(private) to have a good motivation was 0.0687 compared to the work (civil servants

and entrepreneurs). Because OR <1 can also be said the possibility of cadres who work

(private) to have a good motivation is 0.0687 x of the cadres who work (civil servants

and entrepreneurs).

Incentive (not appropriate) have an influence on the motivation of cadres of TB in

the Kediri Region. OR value obtained is 11.611547 cadres incentive means

opportunities not appropriate to have less motivation is 11.611547 than appropriate.

Because OR> 1 can also be said that the incentive cadres possibility not appropriate to

have less motivation is 11.611547 x of the appropriate cadres.

Results present findings of the study without opinion of the authors. Findings

should be concise and can be presented using tables, graphs and narratives. Table must

be single space and must be numbered based on its occurrence in the text. The

maximum of four tables and/or graphs are allowed which must contain a short

self-explanatory title. The title of table is placed above the table with left alignment,

single space. The title of graph is placed under the graph with centre alignment, single

space. Only show the horizontal lines within the tables and do not show the vertical

lines. Please refer to the following examples of table and graph formats.

DISCUSSION

In this study showed a significant relation between age and motivation of cadres TB.

According to research conducted by Sumartini found an association between age and the

role of cadres. This is because with age the level of maturity in thinking and behavior also
increase thereby increasing a person's ability to make decisions, control emotions, to

think rationally, to adapt the behavior to the environment and tolerance for the views of

others. Older age, tend to be more earn the trust of society, because it is considered more

experience and more mature, thus facilitating the smooth implementation of the

discovery of suspected cases of tuberculosis.8

Cadres in the older age groups are more active because it gives them a lot of time in

the morning and there is a commitment in their environment.This statement shows that

the age of respondents got older it will be easier to adapt to the surrounding

environment.9,19 Supported by other research, the older cadres will significantly improve

their performance. Some evidence mentions the older cadres more respected in their

communities than their younger counterparts.20 In society there is a culture that

emphasizes the achievement diandingkan age, education or training received. Therefore,

the older cadres is relatively easy to perform household tasks in the community, because

of the respect they receive from the public can act as something that facilitates their

work.10,21

In the study conducted Maryse also showed that states that The age group 30-40

years to be the most appropriate to be cadres in Kenya to get optimal results. The younger

cadres have less than optimal performance .In Bangladesh cadre of older tend to be more

active than the young.11

The education level showed significant results. This is supported by research

conducted by Ratih, which states the level of education affect a person's level of

knowledge, while knowledge can be obtained from the presence of cadres training. So in

this study, the researchers assume that the level of education no significant effect on the

motivation of cadres due to knowledge about TB cadres are good enough and evenly for
each cadre of TB have been trained.12 In contrast to research conducted by Maryse which

states thathigher education level cadres who have a proven ability good recording. Longer

education cadre can lead to better performance.11

Higher educational status is a factor that significantly associated with performance of

cadres. The high level of education will contribute to the health knowledge, one of the

indicators of this research. In addition, the cadre with higher education status will be

easier to understand how to write and send their monthly reports, and work better.14,17

Long duration been a cadre TB affects motivation. This is according to research

conducted by Yanti where the longer become a health worker will be more and more

experience and knowledge so that health workers can be expected to serve the community

with a better and more professional.7 Cadres who have a longer service life will have a

deeper closeness with the community, because it is more widely known and have

interaction in a longer time / frequent in the community than a new working period.16

Many years of experience as a volunteer associated with increased patient satisfaction in

Kenya and the use of appropriate working tools.11

Longer work experience is one of the factors that influence the research undertaken.

If a cadre has long working experience, they have more opportunity to receive effective

training, supervision and incentives of any kind and to establish confidential relationships

with community members.11,22

Jobs have a relationship to the motivation of cadres. This is according to research

conducted by Maryse which states thatcadres who have fewer household tasks and cadres

depending on the job as a volunteer is found to perform better than others.11

Work also affect the interest of cadre. Works most influential interest in becoming

volunteers are housewives (does not work). Mothers have a good attitude toward interest
in becoming a volunteer. In this study, the distribution of the data also show that as many

as 53 respondents were women showed that women who work as a housewife (not

working) have a strong motivation to become a volunteer.12,23

Incentives have a significant relationship to the motivation of cadres. The results are

consistent with research conducted by Kofi, et al which stated that the incentive is one of

the most extrinsic factors increase the motivation to be a cadre. Incentive have been

shown to improve the performance of the work of health workers in Ghana. Wenting et al

also says that one of the motivating factors is an incentive which is very effective

incentive to increase the performance of health workers.11

Economic incentives and control policies may undermine intrinsic motivation but

well-designed incentives can encourage intrinsic motivation.13,14 In the study conducted

Lindquist, et al researcher trying to determine the motivation for someone to choose a job

with low pay and challenging. The results showed that the volunteers chose their jobs

most common for personal pleasure or the respondents considered that this role is the best

job they can do.15

The lack of clarity over who will pay incentives and the amount of work in the

absence of incentives for some people affect motivation and performance. However,

some health care complained about the participation of cadres only in tasks that are given

incentives.16

TB cadre of knowledge can not be analyzed because of all respondents have good

knowledge with 67-100% of the value of a questionnaire. In research Okeyo mentions the

knowledge about the disease, treatment, and good communication is a key element in

ensuring the quality and communication to patients. Public health officials should have a

good knowledge to facilitate the discovery of cases and appropriate case management, the
prevention and control of TB.5 In the study conducted by Eko Wahyudi suggests there is a

relationship between knowledge of health volunteers with the discovery of a suspect case

of pulmonary tuberculosis. The better knowledge of the cadres of the development tasks

in TB case detection, the better the action in finding cases of TB in the community.14

Attitude can not be analyzed dueall respondents have good knowledge with 67-100%

of the value of a questionnaire. Attitude is essentially a psychiatric condition, feelings,

wishes someone so that it affects the behavior and ultimately realized by deeds. In

research Nisa states that there is a significant relationship between the attitude of health

workers to practice of the invention suspect cases of TB. The better attitude about the task

of developing a cadre of volunteers in TB case finding the better the action cadres in

finding cases of TB in the community.17

Training factors can not be analyzed due all respondents never received training. The

training provided will provide increased knowledge and skills in performing their duties

as volunteers. Training is one of the factors that affect work productivity, job training to

complement the performance of the skill and the proper ways to use work equipment, on

the job training is required not only complement but also to provide basic knowledge.

Because of training program cadres can learn to do something with absolutely and

precisely, and can reduce or abandon mistakes that have been done.7,24 According to

Ratih, training of community health worker can provide the opportunity to learn skills,

receive an education and interaction with higher professional staff. Training not only

provides preventive, curative, or other relevant services to the community, but also to

teach and communicate with the local communities.12

The training has a positive impact on the capacity to provide health care and to build

confidence and skills of cadres in communicating with rural communities.18 Useful and
effective training in terms of the knowledge required to work as a volunteer, as well as

ways of approaching the patient's family. the training they receive is also important in

motivating them to volunteer work in the field of health.18,25

CONCLUSION

Factors that influence intrinsic motivation Kader TB in Kediri is,old cadre with (p =

0.000OR = 106,643,280.9 -19.8631 95% CI; -17 108), Andwork (does not work) with

(p = 0.001 OR = 0.04895% CI 1.187; 4855), Extrinsic factors that affect the motivation

of cadres of TB in the town of Kediri is incentives in accordance with (p = 0.006 OR =

11.61195% CI -4.215; -0.689).

Factor education does not significantly affect the motivation of cadres of TB in the

town of Kediri, with p = 0.288.Factors attitudes, knowledge and training can not be

analyzed in this study because all the cadres have the same value.

ACKNOWLEDGMENT

We would like to thank the Department of Health of Kediri City and staff and all

respondents who have participated in this study who have assisted the implementation

of this study.

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