Volume 3, Number 5, March 2022 e-ISSN: 2797-6068 and p-ISSN: 2777-0915
|
KEYWORDS HIV AIDS, Motivation, Parental Compliance. ARTICLE
INFO Accepted: March, 10th 2022 Revised: March, 13th 2022 Approved: March, 14th
2022 |
ABSTRACT HIV attacks the
sufferer's immune system and if coupled with prolonged psychosocial spiritual
stress will accelerate the occurrence of AIDS, and even increase the
mortality rate. AIDS is incurable. Giving ARV is to suppress the amount of
virus (viral load). The purpose of the study was to motivate parents with
parental compliance in giving their children anti-HIV drugs. This research is
a quantitative method with used purposive sampling, cross sectional
technique, 41 respondents were parents or caregivers of children with HIV
patients who were taking ARV treatment. The results showed that the level of
motivation of parents or caregivers in giving ARV drugs was sufficient 60.98%
and Parental Compliance with HIV Drugs was compliant with 73.17%. Based on
the Spearman Rank statistical test, the correlation value (r) is 0.372 and
the p value is 0.017. P value < (0.05. It is hoped that the officers will
improve the provision of health education about treatment and the impact of
stopping treatment for patients with the method of giving leaflets to each
respondent who comes to take medication so that it can be spread evenly. |
INTRODUCTION
World
Health Organization (WHO) data is known that as many as 35 million people in
the world by the end of in 2015 was exposed to Human Immunodeficiency
Virus/Acquired Immuno Deficiency Syndrome (HIV/AIDS), in the same year as many
as 2.1 million people infected and 1.5 million die because of HIV /AIDS (Lee & Tashev, 2015) . Projection
reason Dead world population by 2030, general Dead consequence disease
infectious the more decreased, but Dead because HIV/AIDS continues increase.
AIDS
cases in East Java are about 8935 cases of the total cases in Indonesia. Trend
highest cases of HIV and AIDS from year 2017 to with 2019 still same, that is
part big on the island Java. Data from the Directorate General of P2P (System
Information on HIV/AIDS and STIs (SIHA), Report year 2019.
Factors
risk HIV/AIDS transmission is very much, but the most important is factor
behavior parenteral sex and history disease. Evaluation the known as quality
live and recommended as reflection how sufferer the respond something the
disease or action medical based on the conditions experienced sufferer (Rachmawati, Al Shaal, M�ller, & Keck, 2013).
By
physiology of HIV attack system immunity body the sufferer and if added with
prolonged psychosocial spiritual stress will speed up occurrence of AIDS, even
increase number death. AIDS really is no can healed. Destination main ARV
administration is for push the number of viruses (viral load), so that will
improve immune status HIV patients and reduce Dead consequence infection
opportunistic. And when this combination antiretroviral (ARV) treatment is
treatmenttherapy best for patient infected with HIV. So age hope People living
with HIV/AIDS (PLWHA) can be extended with ARV (antiretroviral) treatment.
Treatment this could increase immunity the body of PLWHA so that quality his
life also increased (Rachmawati, 2013).
Disobedient
against ARV is not only problem medical, but also influenced by social culture
public local. When approach social and approach medical conducted together,
then the emphasis no only on social processes happening something disease and
illness, but also on interventions within structure social and cultural for
prevent or even treat disease the (Aryastami, Handayani, & Yuniar, 2013) .
Giving
ARV therapy is necessary consider various factor from aspect knowledge, ability,
ability treatment period length, resistance medicine, effect side, reach get
medicine, as well right time for start therapy. Someone who has perceived
susceptibility (perceived vulnerability), meaning that perception individual
about possibility caught something disease will influence behavior they
specifically for do prevention or look for treatment. (Fibriana, 2013) .
According
to study Wardani, et al (2017) PLWHA who get antiretroviral therapy and
demonstrated enhancement CD4 value indicates therapy carried out successful.
Obedient PLWHA undergo antiretroviral therapy with good for 13-24 months could
experience enhancement CD4 count. Compliance level antiretroviral therapy is a
the most dominant variable in influence success therapy (Azzahra, 2019).
The
level of adherence of PLWHA in undergoes anti-retro viral therapy by 52.5% - 95
% (Sugiharti, 2014; Yelmi Reni Putri, 2016). Influencing factors level PLWHA
compliance is motivation from family, effect side, access information, aspect
usefulness and knowledge in operate ARV therapy) (Adiningsih et al 2017 ; Githa
Fungie Galistiani, 2013; Saputro, et al 2016; Sugiharti, 2014).
Saputro,
et al (2016) conveys need existence enhancement motivation and improvement
knowledge therapy antiretroviral to PLWHA so that the level of obedience in
undergoes therapy increase. And need existence understanding factor effect side
(Galistiani & Mulyaningsih, 2013) .
Data
obtained from record medical hospital dr. Saiful Anwar Malang that for Patients
suffering from HIV /AIDS in children in 2020 were 89 patients. In studies
preliminaries carried out in the month of December 2020 to February 2021, data
obtained from record medical that there were 46 patients suffering from HIV
/AIDS who were in control to Polyclinic child. From result, observation
preliminaries conducted on ten patients who will conduct treatment obtained
data that 8 patients obey drink ARV drugs, while 2 people did not obey in drink
ARV drugs. Where is a number of late child for control and drink drugs that
does not routine due to working parents or busyness other. By detailed the
patient who do not obey to drink the first ARV drug that is patient no control
for 6 months because her mother give birth to again. Besides, reason covid 19
pandemic so afraid for control to the hospital while second patient that is
patient no control because his father die and stay with her grandmother so that
no someone delivered to the hospital. Because of that, the treatment for second
child must repeat from beginning again.
Children
who suffer from HIV/AIDS are of course very dependent to parents and caregivers.
Parents ' motivation and support or family is needed by children that. Like our
know parents or family from HIV children also have each one is busy work or
busyness House ladder other. Therefore, that parents or family needs knowing
how motivation and support in obedience give drug to HIV children.
Based
on Thing the on so in effort for reduce percentage the amount of loss to
follow-up researchers need do study with title: "Relationship" Among
Parents' motivation with parental obedience�
in give drug anti Virus pediatric HIV patients at the Children's
Polyclinic RSUD dr. Saiful Anwar Malang". Destination from research this
that is Knowing Connection Among parents motivation with parental obedience in
give drug anti-viral HIV for children At the Children's Polyclinic, RSUD dr.
Saiful Anwar Malang.
METHOD RESEARCH����������������������������������
Method
research that has been used in study this that is descriptive analytic with
cross sectional design. The cross sectional research is research that emphasizes
time variable data measurement independent and variable dependent only one time
at one moment or study this conducted without existence treatment to
respondents and research this aim for learn there is whether or not something
connection Among parents motivation with parental obedience give HIV drugs at
the Children's Polyclinic, RSUD Dr. Saiful Anwar. Population in study this is
all parents or companion living patient together with patient child with HIV
disease at the Children's Poly Hospital, dr. Saiful Anwar Malang in the month
July until with August 2021 is 45.
Sample
study this is all parents or companion patient Children's HIV disease at the
Children's Poly Hospital, dr. Saiful Anwar Malang who entered criteria
inclusion and within 1 month that is month January 2022 as many as 45. Sample
in study this determined with use formula Slovin. Taking Sample with Purposive
sampling method. Test used is a statistical test analysis Sparman Row Test
different this is a non - paremetric test used for analyze legal or not
difference the average value of two group mutual samples in pairs.
RESULT AND DISCUSSION
Research result
Research results served Becomes three
part that is description general the place research, general data, and special
data. General data will serve characteristics respondents who include age, type
gender. Special data containing about parents motivation with parental obedience
give HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang. Study this carried out at the Children's Polyclinic RSUD dr.
Saiful Anwar Malang in the month January 2022 with total sample study as many
as 41 people. Data obtained will serve in form table.
Characteristics respondent in study this collected for knowing description the respondent
used as subject research. Characteristics respondent shown in Table 1.
Table 1. Characteristics Respondent
|
Characteristics |
Frequency |
Percentage |
|
Age |
||
|
<30 years old |
6 |
14.63 |
|
31-40 years old |
12 |
29.27 |
|
41-50 years old |
13 |
31.71 |
|
> 50 years |
10 |
24.39 |
|
Type Sex |
||
|
Woman |
24 |
58.54 |
|
Man |
17 |
41.46 |
�������������������������������������������������������������������������������������������������� Source:
Primary data
Characteristics respondent based on age almost
from half respondents (31.71 %) aged 41-50 years. Type gender, it was found
that the data more from half respondents (58.54%) type sex woman 24 people. Criteria the
motivation of parents to give HIV drugs at the Children's Polyclinic, RSUD Dr.
Saiful Anwar Malang g presented in Table 2.
Table 2. Criteria Motivation
Parents Give HIV Drugs at Children's Polyclinic RSUD Dr. Saiful Anwar Malang
|
Parental Motivation
|
Frequency |
Percentage |
|
Enough |
25 |
60.98 |
|
Well |
16 |
39.02 |
|
Total |
41 |
100 |
�������������������������������������������������������������������������� Source:
Primary data
Research
results show more from part big respondent that is as many as 25 respondents
(60.98%) have motivation give adequate HIV drugs in children. �Grouping data criteria parental
compliance in giving HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful
Anwar Malang presented in Table 3.
Table 3. Criteria Parental
Compliance Giving HIV Drugs in Children's Polyclinic RSUD Dr. Saiful Anwar
Malang
|
Parental Compliance
|
Frequency |
Percentage |
||
|
Not Obey |
11 |
26.83 |
||
|
Obey |
30 |
73.17 |
||
|
Total |
41 |
100 |
||
�������������������������������������������������������������������������� Source:
Primary data
Research
results show part big that is 30 respondents (73.17 %) complied in give HIV drugs.
Tabulation
cross
��������� Result data motivation of parents with
parental compliance in giving HIV drugs at the Children's Polyclinic, RSUD Dr.
Saiful Anwar Malang presented in Table 4.
Table
4. Parental Motivation with Parental Compliance Giving HIV Drugs at the
Children's Polyclinic, RSUD Dr. Saiful Anwar Malang
|
Motivation |
Obedience |
Total |
|
|
Not Obey |
Obey |
||
|
Enough |
10 |
15 |
25 |
|
(40%) |
(60%) |
(100%) |
|
|
Well |
1 |
15 |
16 |
|
(6%) |
(94%) |
(100%) |
|
|
Total |
11 |
30 |
41 |
|
(26.83%) |
(73.17%) |
(100%) |
|
�������������������������������������������������������������������������� Source:
Primary data
Research
results show of 25 respondents who are motivated enough, 60% (15 people) of
respondents obey in give medicine and the rest 10 people do not obey in give
medicine. Of the 16 respondents who are motivated ok, as many as 15 people obey
in give drug
DISCUSSION
Motivation is characteristics
psychological man who gives contribution to level commitment someone. This
thing including the factors that cause, channel, and sustain Act in demand man
in direction determination certain (Efendi, 2008). Research results show more
from part big respondent that is as many as 25 respondents (60.98%) have
motivation give adequate HIV drugs in children. Study this in line with
Puspitasari (2016) level motivation respondent in drink ARV drugs. Majority
Mother with HIV has level low motivation and sufficient in drink ARV drugs.
High level of motivation tends little.
Research results this gap with
results research by Amico et al. (2017) in Mississippi, on 150 people living
with HIV. Amico's research results show that information have influence
although no live by significant to obedience drink medication to the patient
with HIV. Amico explains on his research that get enough information about this
ARV therapy no take effect big to height obedience drink medicine for PLWHA,
however effect on skills behave in the PLWHA, which skills? behave by live take
effect to level obedience treatment for PLWHA. Research results Hovarth (2014)
also points out that for make patient obey in drink ARV drugs then PLWHA must
have relevant information, skills� good
behavior and sufficient motivation.
Motivation intrinsic is
motivation that comes from in self someone. Motivation this sometimes appear
without influence whatever from outside. Usually motivated people by intrinsic
more easy pushed for take action. Motivation extrinsic is the opposite
motivation intrinsic, that is motivation that appears because influence
environment outside. Motivation this use trigger for make somebody motivated.
Motivation in self-respondent that alone influenced by various factor that is
education and knowledge, the more tall level education Somebody so will the
more high level _ motivation. As well as knowledge, more tall level knowledge
somebody eat will the more high level motivation somebody in carry out
treatment programs and drink drug so that will the more obey in carry out
treatment. Besides that, research from Adiatma & Aris (2013) also explains
that motivation somebody influenced by internal factors and factors external.
Internal factors are originating factorfrom in self patient that self and
factor external is originating factor _ from outside individual that itself
which includes family, friends, environment and staff health. Whereas according
to Widyaningrum, (2017) internal factors that influence motivation covers
covers desire from in self alone, knowledge individual, level education,
management self and age. Whereas factor external that is factor economy,
religion, factors supporter family and caregivers.
According to opinion researcher,
factor intrinsic and extrinsic greatly affect parents motivation in give drug
anti- HIV patient children at the Children's Clinic RSUD dr. Saiful Anwar
Malang. The factor in question is about existence parents wish condition child
Becomes more good with drink drug by regularly. Besides that, part big
respondent 31-50 years old where are they still have a desire know big, enough
spirit tall for study about illness suffered �child so that�
will increase parental knowledge.
Compliance is the behavioral
action of a person who receives treatment, follows a diet, and carries out a
lifestyle in accordance with the recommendations of health care providers (Avelina, 2021). Another theory states that medication adherence is a behavior in
completing swallowing drugs according to the recommended schedule and dosage of
drugs according to the specified category, complete if treatment is on time, and
incomplete if not on time.
The results of this study
support Fisher's theory, namely the IMB Model of ART Adherence (2017). Where
motivation affects the level of adherence to taking medication in PLWHA either
directly or indirectly. Motivation includes attitudes/beliefs about the impact
of compliance and non-compliance behavior and evaluation of the results of
these behaviors as well as perceptions of support from others to comply with
taking medication and motivation to meet the expectations of others. Motivation
is needed in carrying out ARV therapy adherence, without motivation ARV therapy
cannot be continued. Meanwhile, Puspitasari (2016) states that compliance is
the level of a person in implementing an internal rule and recommended
behavior. Compliance is the level of a person in carrying out the care,
treatment and behavior recommended by nurses, doctors or other health workers.
Compliance (compliance or adherence) describes the extent to which the patient
behaves to carry out the rules in treatment and behavior suggested by health
workers.
According to Lawrence Green's
theory of Preced-Proced behavior in (Wulandari & Laksito, 2015) Based on a person's actions that influence behavior related to
medication adherence, it is influenced by 3 factors, namely: Predisposing
factors, factors that precede a person's behavior that will encourage behavior,
namely knowledge, attitudes, beliefs, beliefs, values and perceptions that
encourage a person or groups to take action, supporting or enabling factors,
factors that motivate individuals or groups to take action in the form of a
physical environment, availability of health facilities and facilities, ease of
reaching health facilities, service time, and ease of transportation,
reinforcing factors (reinforce factors), including attitudes and support from
family, friends, teachers, health care providers, leaders and decision makers.
The highest 3rd compliance score
in the first question is, "my child always takes ARV according to the dose
recommended by the doctor/nurse/volunteer", "my child usually wears a
clock or cellphone that contains an alarm that can be set to sound every time
he takes medicine" and "Because he is used to taking ARVs, my child
has memorized the frequency of taking drugs every day". Amanda (2020),
stated that HIV medicines must be taken for life regularly, continuously, and
on time. Some important tips for taking medicine are taking medicine at the same
time every day, medicine must always be available wherever the patient is
usually located, for example at the office, at home, and other places, taking
medicine wherever he goes (pockets, bags, etc.), using equipment (clock, cell
phone that contains an alarm that can be set to sound every time you take
medicine) to remind you when to take medicine.
According to the researcher's
opinion, parental adherence to drinking is obedient in giving anti-viral drugs
to children with HIV at the Children's Clinic, RSUD dr. Saiful Anwar Malang is
very high, because there is hope about the expectations of parents so that
their children have better conditions. This is also evidenced by the results of
research showing the habits of parents such as the dosage and frequency as well
as the regular hours of taking medication. From the results of this study, it
was found that one of the respondents had good motivation, but the level of
compliance was less than obedient. This is because both of the patient's
parents died of HIV/AIDS, so the patient is being cared for by his elderly
grandmother. The grandmother of the patient hopes that her grandson can be
cured. However, this patient is very difficult to take medicine because he does
not feel sick. So the researchers concluded that the patient should be informed
about the condition of the disease slowly and adjusted to the age and
psychology of the child.
The results showed that from 25
respondents who had sufficient motivation, 60% (15 people) were obedient in
giving drugs and the remaining 10 people were not compliant in giving drugs. Of
the 16 respondents who have good motivation, as many as 15 people are obedient
in giving drugs. Correlation test obtained P value of 0.017 <
(0.05), which means H1 is accepted so that it can be concluded that there is a
relationship between parental motivation and parental adherence to HIV
medication at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang. The
level of closeness of parents' motivation with parental compliance in giving
HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang by 37.2%
is positive with weak strength. The higher the motivation of parents, the
higher the compliance of parents in giving HIV drugs at the Children's
Polyclinic, RSUD Dr. Saiful Anwar Malang.
The results of this study are in
line with Indiyah's research (2018), showing that of the 31 respondents, 18
respondents (58.1%) had strong motivation, all were obedient in taking TB
medicine, 8 respondents (25.8%) had moderate motivation, all were obedient in taking
TB medicine. taking TB medicine and from 5 respondents (16.1%) whose motivation
is weak, 1 respondent (3%) is obedient in taking TB medicine, while 4
respondents (12.9%) are not compliant in taking TB medicine. The results of the
Spearman Rho test showed that the correlation coefficient = 0.632, p = 0.000,
there was a relationship between motivation and medication adherence in TB
patients at Ngujung Health Center, Maospati District, Magetan Regency.
HIV/AIDS causes multiple crises
simultaneously, causing a health crisis, a development crisis. In other words,
HIV/AIDS causes a multidimensional crisis. As a health crisis, AIDS requires a
response from the community and requires treatment and care services for
infected individuals (Munir, Elahi, Ayub, Frezza, &
Rizzi, 2019) . Children are small humans who still need other people in terms of
parents. Parents here have an important role in responsibilities to their
children. Children with HIV must comply with taking ARV drugs. Children's
compliance in consuming can not be separated from the role of parents.
Patient adherence to the
treatment program is strongly influenced by self-motivation and self-awareness
to comply with the treatment rules. Individual motivation to want to maintain
their health is very influential on factors related to the behavior of patients
in controlling their disease (Arunkumar et al., 2019) .
If you take medication
regularly, the virus cannot reproduce itself. Both the "normal" virus
and both are suppressed because the combination of the 3 drugs continuously
reaches a very strong suppression level in the blood. Therefore it is very important
to swallow the medicine regularly and on time to be effective. If we do not
take the medicine on time, the concentration of the drug in our body will
decrease. If the consistency of the drug in our body decreases, the effect of
controlling the virus will be less good. The HIV virus can defend itself
against drugs at low concentrations, but not at concentrations high enough to
inhibit viral replication. Therefore, we must guarantee the level of the drug
by taking the drug properly (Astuti & Amanda, 2020) .
The motivation of parents living
with HIV in their children is influenced by two things, namely from within the
child with HIV himself, with the encouragement, desire to seek treatment or do
something better and support from family, community and health workers in
handling cases of the child's HIV disease through health education, providing
support, encouragement in accordance with the expected goals. Motivation is
said to be good when a person is able to control himself towards good things.
To increase motivation, it is necessary to provide counseling about diseases
and the dangers of these diseases to threats to human life (Sasongko et al., 2017) . In addition, based on the questionnaire, it explains the motivating
factor of parents' motivation is the desire for a better child's condition. The
desire for a better condition for children is the main desire of every parent,
humans work to be able to eat and eat can continue their life.
According to researchers with
strong motivation, a person has positive expectations, high expectations and
high confidence in carrying out activities related to the problems faced, in
this case the problem of HIV disease treatment.
CONCLUSION
Based on discussion and results study connection
Among parents motivation with parental obedience give HIV drugs at the
Children's Polyclinic, RSUD Dr. Saiful Anwar Malang, get concluded that results
of research show more from part big respondent that is as many as 25
respondents (60.98%) have motivation give adequate HIV drugs in children.
Research results show part big that is 30 respondents (73.17 %) complied in
give HIV drugs. Correlation test obtained P value of 0.017< (0.05), which
means H1 is accepted so that could concluded there is connection Among parents
motivation� with parental obedience give
HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang is
significant. Closeness level parent�s motivation with parental obedience give
HIV drugs at the Children's Polyclinic, RSUD Dr. Saiful Anwar Malang by 37.2%
is positive with strength weak. The more tall parents motivation� so the more tall parental obedience� give HIV drugs at the Children's Polyclinic,
RSUD Dr. Saiful Anwar Malang.
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Copyright holders:
��Ary Bi Rahmawati, Feriana Ira Handian, Lilla
Maria (2022)
First publication right:
Devotion - Journal
of Community Service
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