Fear of Infection, Motivation, and Rewards Related to Health Cadres Performance in Tuberculosis Case Detection

Raden Bagus Bambang Hermanto; Marlina Fitriya Lailatul K; Elis Anugrah Wati Sendewana; Dafrosia Darmi Manggasa

doi:10.33860/mnj.v6i2.4214

Authors

Raden Bagus Bambang Hermanto
bambangwasortb@gmail.com
Department of Nursing, Poltekkes Kemenkes Palu, Central Sulawesi, Indonesia
Marlina Fitriya Lailatul K Poltekkes Kemenkes Palu, Central Sulawesi, Indonesia
Elis Anugrah Wati Sendewana Puskesmas Tagolu, Central Sulawesi, Indonesia
Dafrosia Darmi Manggasa Department of Nursing, Poltekkes Kemenkes Palu, Central Sulawesi, Indonesia https://orcid.org/0000-0002-4851-0646

Keywords:

Tuberculosis; Health cadres; Performance; Motivation; Rewards

Abstract

Background: Indonesia remains one of the countries with the highest tuberculosis (TB) burden globally. In Poso District, the 2023 Case Detection Rate (CDR) reached only 65.87%, still below the national target of 75%. Low case detection contributes to delayed diagnosis, persistent community transmission, and failure to reach TB elimination targets. Objective: To analyze factors associated with the performance of health cadres in detecting TB cases in the working area of Tagolu Primary Health Center, Poso District.

Methods: This descriptive cross-sectional study involved all active health cadres (n=52) selected through total sampling. Data were collected using validated structured questionnaires. Variables included fear of infection, stigma, motivation, rewards, and cadre performance. Data were analyzed using descriptive statistics and Chi-square tests with a significance level of α = 0.05.

Results: Three variables were significantly associated with cadre performance: fear of TB transmission (p = 0.024), motivation (p = 0.004), and rewards (p = 0.039). Stigma was not significantly associated (p = 0.579). Most cadres had high fear of infection (63.5%), low motivation (57.7%), and perceived rewards as adequate (69.2%). A total of 61.5% demonstrated good performance in TB case detection.

Conclusion: Fear of infection, motivation, and rewards are significant determinants of cadre performance in TB case detection. Improving protective equipment availability, strengthening training, and implementing sustainable reward mechanisms are essential to enhance early TB detection in the community

References

Buregyeya, E., Kasasa, S., & Mitchell, E. M. H. (2016). Tuberculosis infection control knowledge and attitudes among health workers in Uganda: A cross-sectional study. BMC Infectious Diseases, 16(1), 1–10. https://doi.org/10.1186/s12879-016-1740-7

Chairani, C., Utami, P. R., Indrayati, S., Almurdi, A., & Rahmayana, R. (2023). Perbedaan Hasil Pemeriksaan Mikroskopis BTA Pada Pasien TB Paru Sebelum dan Sesudah Pengobatan Fixed-Dose Combination (FDC) Fase Intensif. JURNAL KESEHATAN PERINTIS (Perintis’s Health Journal), 10(1), 68–73. https://doi.org/10.33653/jkp.v10i1.969

Cilloni, L., Fu, H., Vesga, J. F., Dowdy, D., Pretorius, C., Ahmedov, S., Nair, S. A., Mosneaga, A., Masini, E., Sahu, S., & Arinaminpathy, N. (2020). The potential impact of the COVID-19 pandemic on the tuberculosis epidemic a modelling analysis. EClinicalMedicine, 28(March), 100603. https://doi.org/10.1016/j.eclinm.2020.100603

Dinas Kesehatan Kabupaten Poso. (2023). Sistem Informasi Tuberkulosis Kabupaten Poso.

Khan, M. S., Mehboob, N., Rahman-Shepherd, A., Naureen, F., Rashid, A., Buzdar, N., & Ishaq, M. (2019). What can motivate Lady Health Workers in Pakistan to engage more actively in tuberculosis case-finding? BMC Public Health, 19(1), 1–9. https://doi.org/10.1186/s12889-019-7326-8

Kigozi, G., Heunis, C., & Engelbrecht, M. (2020). Community health worker motivation to perform systematic household contact tuberculosis investigation in a high burden metropolitan district in South Africa. BMC Health Services Research, 20(1), 1–9. https://doi.org/10.1186/s12913-020-05612-9

Komara, G., Handayani Solihin, A., & Suryamah, Y. (2019). Faktor yang berhubungan dengan Pelaksanaan Gerakan Ketuk Pintu di Puskesmas Arcamanik. Jurnal Sehat Masada, 13(2), 29–41.

MacPherson, P., Khundi, M., Nliwasa, M., Choko, A. T., Phiri, V. K., Webb, E. L., Dodd, P. J., Cohen, T., Harris, R., & Corbett, E. L. (2019). Disparities in access to diagnosis and care in Blantyre, Malawi, identified through enhanced tuberculosis surveillance and spatial analysis. BMC Medicine, 17(1), 1–11. https://doi.org/10.1186/s12916-019-1260-6

Mohd Ghazali, S., Cheong, K. C., Md Nadzri, M. N., Mohd Ghazali, N., Cheng, L. M., Ahmad, L. C. R. Q., Kamarudin, M. K., Ahmad, N. A. R., Zulkifli, A. A., Ling, C. Y., Ruslan, Q., Singh, S., Gill, B. S., Razali, A., & Md Iderus, N. H. (2025). Unmasking the Determinants of Loss to Follow-Up in Pulmonary Tuberculosis: A Study in Selangor, Malaysia. Tropical Medicine and Infectious Disease, 10(8), 226. https://doi.org/10.3390/tropicalmed10080226

Muthmainaha, & Indarjo, S. (2022). Perilaku Kader TB dalam Penemuan Suspek TB selama Pandemi Covid-19 di Puskesmas Pejagoan. Indonesian Journal of Public Health and Nutrition, 2(2), 186–193. https://doi.org/10.15294/ ijphn.v2i2.52907

Nuraisya, M., Adi, M. S., & Saraswati, L. D. (2018). Gambaran Faktor Yang Terkait Dengan Penemuan Kasus Tuberkulosis Paru Di Kabupaten Batang Berdasarkan Karakteristik, Kinerja Petugas Dan Fasilitas Laboratorium Puskesmas. Jurnal Kesehatan Masyarakat (e-Journal), 6(2), 34–41.

Prihanti, G. S., Herwanto, E. S., Prakoso, G. B., Pandya, G. G., Ghesa, C. C. A., Oktavin, H. L., & Fitriana, Y. (2020). Factors affecting tuberculosis cadres’ motivation in the detection of tuberculosis cases in Kediri City, Indonesia. Public Health and Preventive Medicine Archive, 8(2), 134–139. https://doi.org/10.15562/phpma.v8i2.308

Probandari, A., Sanjoto, H., Mahanani, M. R., Azizatunnisa, L., & Widayati, S. (2019). Being safe, feeling safe, and stigmatizing attitude among primary health care staff in providing multidrug-resistant tuberculosis care in Bantul District, Yogyakarta Province, Indonesia. Human Resources for Health, 17(1), 1–10. https://doi.org/10.1186/s12960-019-0354-8

Purnaningsih, M. S., Setiawati, E. P., & Mutyara, K. (2022). Effects of Motivation, Knowledge, and Skills of Lung Tuberculosis Officers on Case Detection Rate of Health Centers. Review of Primary Care Practice and Education (Kajian Praktik Dan Pendidikan Layanan Primer), 5(1), 7. https://doi.org/10.22146/rpcpe.53026

Ramos, A. L., & Mestre, A. M. (2022). Necrotizing pneumonia: a hidden complication. International Journal of Infectious Diseases, 118, 254–255. https://doi.org/10.1016/j.ijid.2022.03.018

Rusdiana, R., Faisya, A. F., & Idris, H. (2025). Determinants of Work Motivation Among Doctors At Community Health Centers in Indonesia. Jurnal Administrasi Kesehatan Indonesia, 13(1), 30–43. https://doi.org/10.20473/jaki.v13i1.2025.30-43

Shimels, T., Asrat Kassu, R., Bogale, G., Bekele, M., Getnet, M., Getachew, A., Shewamene, Z., & Abraha, M. (2021). Magnitude and associated factors of poor medication adherence among diabetic and hypertensive patients visiting public health facilities in Ethiopia during the COVID-19 pandemic. PLOS ONE, 16(4), e0249222. https://doi.org/10.1371/journal.pone.0249222

Sitorus, N., Septyaningrum, D. F., & Yogisutanti, G. (2022). Faktor-Faktor Yang Berhubungan Dengan Pengobatan TB Paru Di Rumah Sakit Paru di Bandung. Jurnal Ilmu Kesehatan Immanuel, 16(2), 93–106. https://doi.org/10.36051/jiki.v16i2.200

World Health Organization. (2022). Global Tuberculosis Report 2022. World Health Organization.

Xu, L., Zhao, W., Li, L., & Du, X. (2022). Use of transcutaneous electrical acupoint stimulation in pulmonary surgery for patients with tuberculosis. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 27, 100298. https://doi.org/10.1016/j.jctube.2022.100298