Implementation of a Nola J. Pender-Based Health Promotion E-Module to Improve Knowledge and Treatment Adherence Among Patients with Pulmonary Tuberculosis

Authors

DOI:

https://doi.org/10.58439/hnp.v4i2.663

Keywords:

pulmonary tuberculosis, Health Promotion Model, educational e-module, knowledge, treatment adherence

Abstract

Background: Pulmonary tuberculosis (TB) remains a major public health concern, requiring effective educational strategies to improve patient knowledge and treatment adherence.

Purpose: This study evaluated the effectiveness of a Nola J. Pender’s Health Promotion Model-based educational e-module in improving knowledge and treatment adherence among patients with pulmonary TB.

Methods: A quasi-experimental pretest–posttest control group study was conducted at RSUP Surakarta, Central Java, Indonesia. Fifty participants were included, comprising 26 in the intervention group and 24 in the control group. The intervention group received e-module-based education, while the control group received routine education. Data were analyzed using the Wilcoxon signed-rank and Mann–Whitney U tests.

Results: Knowledge improved significantly in the intervention group (Z = −4.309, p < 0.001), with 24 participants improving. Treatment adherence also improved significantly (Z = −3.651, p < 0.001), with 21 participants improving. Between-group differences were significant for knowledge (U = 172.000, p = 0.006) and treatment adherence (U = 156.000, p = 0.002), with higher mean ranks in the intervention group.

Conclusions: The Health Promotion Model-based e-module may improve knowledge and treatment adherence among patients with pulmonary TB. Further studies with larger samples and longer follow-up are recommended.

References

Al Khalili, S., Al Yaquobi, F., Al Abri, B., Al Thuhli, K., Al Marshoud, S., Al Rawahi, B., & Al-Abri, S. (2022). Assessing Oman's knowledge, attitude and practice regarding tuberculosis: A cross-sectional study that calls for action. International Journal of Infectious Diseases, 124(Suppl. 1), S4–S11. https://doi.org/10.1016/j.ijid.2022.06.002.

Bashorun, A. O., Linda, C., Omoleke, S., Kendall, L., Donkor, S. D., Kinteh, M.-A., Danso, B., Leigh, L., Kandeh, S., D'Alessandro, U., & Adetifa, I. M. O. (2020). Knowledge, attitude and practice towards tuberculosis in Gambia: A nation-wide cross-sectional survey. BMC Public Health, 20, Article 1566. https://doi.org/10.1186/s12889-020-09685-3.

Huda, M. H., Rahman, M. F., Zalaya, Y., Mukminin, M. A., Purnamasari, T., Hendarwan, H., et al. (2024). A meta-analysis of technology-based interventions on treatment adherence and treatment success among TBC patients. PLOS ONE, 19(12), e0312001. https://doi.org/10.1371/journal.pone.0312001

Javadzade, H., Vahedparast, H., Khodaminasab, A., Tahmasebi, R., Reisi, M., & Kiani, J. (2024). The effect of web-based education on self-care behaviors in cardiovascular patients: Application of the Pender’s Health Promotion Model. Archives of Public Health, 82, 64. https://doi.org/10.1186/s13690-024-01299-0

Jerene, D., van Kalmthout, K., Levy, J., Alacapa, J., Deyanova, N., Dube, T., et al. (2025). Effect of digital adherence technologies on treatment outcomes in people with drug-susceptible tuberculosis: Four pragmatic, cluster-randomised trials. The Lancet, 405(10485), 1155–1166. https://doi.org/10.1016/S0140-6736(24)02847-2.

Kaaffah, S., Kusuma, I. Y., Renaldi, F. S., Lestari, Y. E., Pratiwi, A. D. E., & Bahar, M. A. (2023). Knowledge, attitudes, and perceptions of tuberculosis in Indonesia: A multi-center cross-sectional study. Infection and Drug Resistance, 16, 1787–1800. https://doi.org/10.2147/IDR.S404171

Kandasamy, G., Almaghaslah, D., & Almanasef, M. (2024). Knowledge, attitude and practice towards tuberculosis among healthcare and non-healthcare students at a public university in Saudi Arabia. Frontiers in Public Health, 12, Article 1348975. https://doi.org/10.3389/fpubh.2024.1348975

Kementerian Kesehatan Republik Indonesia. (2025, March 25). Aksi nyata percepatan eliminasi tuberkulosis di Indonesia. https://www.kemkes.go.id/id/47510/Pada-2025-target-nasional.

Liu, X., Thompson, J., Dong, H., Sweeney, S., Li, X., Yuan, Y., et al. (2023). Digital adherence technologies to improve tuberculosis treatment outcomes in China: A cluster-randomised superiority trial. The Lancet Global Health, 11(5), e693–e703. https://doi.org/10.1016/S2214-109X(23)00068-2

Manyazewal, T., Woldeamanuel, Y., Holland, D. P., Fekadu, A., Marconi, V. C., et al. (2022). Effectiveness of a digital medication event reminder and monitor device for patients with tuberculosis (SELFTB): A multicenter randomized controlled trial. BMC Medicine, 20, 310. https://doi.org/10.1186/s12916-022-02521-y

Mohamed, M. S., Zary, M., Kafie, C., Chilala, C. I., Bahukudumbi, S., Foster, N., et al. (2025). The impact of digital adherence technologies on treatment outcomes, adherence, and patient-reported outcomes in tuberculosis: A systematic review and meta-analysis. BMC Infectious Diseases, 25, 1314. https://doi.org/10.1186/s12879-025-11503-3

Pi, Y., Tan, J., Yang, P., Pan, J., Yang, X., Xiang, M., & Li, T. (2025). Knowledge, attitude, and practice toward antitubercular agents among pulmonary tuberculosis patients in southwestern China: A cross-sectional study. Patient Preference and Adherence, 19, 1615–1624. https://doi.org/10.2147/PPA.S520100

Ridho, A., Alfian, S. D., van Boven, J. F. M., Levita, J., Yalcin, E. A., Le, L., et al. (2022). Digital health technologies to improve medication adherence and treatment outcomes in patients with tuberculosis: Systematic review of randomized controlled trials. Journal of Medical Internet Research, 24(2), e33062. https://doi.org/10.2196/33062

Santosa, A., Juniarti, N., Pahria, T., et al. (2025). Digital adherence technology to improve medication adherence in tuberculosis patients: A systematic review and meta-analysis randomized control trials. npj Primary Care Respiratory Medicine, 35, 52. https://doi.org/10.1038/s41533-025-00457-3

Syahrul, S., Irwan, A. M., Saleh, A., Syam, Y., Fiqri, A. M., & Jannah, S. N. (2025). Effectiveness of mobile application-based intervention on medication adherence among pulmonary tuberculosis patients: A systematic review. CIN: Computers, Informatics, Nursing, 43(4), e01213. https://doi.org/10.1097/CIN.0000000000001213

Tadesse, A. W., Sahile, M., Foster, N., McQuaid, C. F., Weldemichael, G. T., Abdurhman, T., et al. (2025). Digital adherence technology interventions to reduce poor end-of-treatment outcomes and recurrence among adults with drug-sensitive tuberculosis in Ethiopia: A three-arm, pragmatic, cluster-randomised, controlled trial. The Lancet Digital Health, 7(9), 100895. https://doi.org/10.1016/j.landig.2025.100895

Wei, X., Hicks, J. P., Zhang, Z., Haldane, V., Pasang, P., Li, L., et al. (2024). Effectiveness of a comprehensive package based on electronic medication monitors at improving treatment outcomes among tuberculosis patients in Tibet: A multicentre randomised controlled trial. The Lancet, 403(10430), 913–923. https://doi.org/10.1016/S0140-6736(23)02270-5

World Health Organization. (2024). Global tuberculosis report 2024. World Health Organization. https://www.who.int/publications/i/item/9789240101531

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Published

2026-10-31

How to Cite

Khaireza Rindang Kamudi, & syafriati, ani. (2026). Implementation of a Nola J. Pender-Based Health Promotion E-Module to Improve Knowledge and Treatment Adherence Among Patients with Pulmonary Tuberculosis . Holistic Nursing Plus, 4(2), 144–162. https://doi.org/10.58439/hnp.v4i2.663

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Vol. 4 No. 2 (2026): Holistic Nursing Plus

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Copyright (c) 2026 Khaireza Rindang Kamudi, ani syafriati

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