IMPROVING TUBERCULOSIS PATIENT COMPLIANCE THROUGHFAMILY NURSING INTERVENTIONS USING THE ABC(ANTECEDENTS–BEHAVIOUR–CONSEQUENCES) APPROACH

Abstract

Background: Tuberculosis control depends not only on drug availability but also on patient compliance with treatment to prevent drug resistance. Families play a crucial role in shaping patients' health behaviors. The ABC (Antecedents–Behavior–Consequences) approach is used to evaluate the effectiveness of family nursing interventions in changing patient behavior from non-adherent to compliant with treatment through strengthening knowledge, family support, and regular monitoring of medication consumption. Case Summary: Patient X (45 years) was diagnosed with smear-positive pulmonary tuberculosis two months ago. He frequently missed his medication due to nausea and a perceived improvement. His wife, a DOT, did not understand the importance of monitoring, resulting in the patient experiencing withdrawal symptoms during treatment. Investigation and Diagnosis: The results showed the patient's sputum was positive and the remaining medication was not according to the therapy schedule. The patient admitted to stopping the medication due to nausea and felt he had recovered and therefore did not need to take the medication daily. Suboptimal family functioning was indicated by low health awareness and weak supervision of medication consumption. The family nursing diagnosis: Ineffective Family Health Management related to the family's inability to optimally care for a sick family member. Management: The intervention was conducted using the ABC approach. In the Antecedents phase, families were educated about the dangers of latent TBC if treatment is not completed, including the creation of reminder calendars, mobile phone alarms, and how to reduce nausea by taking medication after meals or before bed. The Behavior phase involved training the wife as a DOT to accompany the patient while taking medication and integrating the medication schedule into the patient's daily routine. The Consequences phase involved positive reinforcement in the form of praise or small rewards if the medication calendar was filled out each week. Patient progress was monitored through changes in physical condition, such as weight gain and reduced coughing, as evidence of the benefits of treatment adherence. Furthermore, families were taught the importance of direct supervision and consistent emotional support to motivate patients to complete therapy and understand the risk of drug resistance if treatment is stopped prematurely. Outcome: The ABC intervention increased patient compliance from a score of 34 to 60, weight gain from 48 kg to 54 kg, and a negative ARR result. Conclusion: The ABC approach effectively improves patient compliance through increased family understanding, monitoring medication use, and ongoing positive reinforcement. Active family involvement as agents of behavior change is a key factor in the success of long-term TB care.