Perceived Stigma Outranks Social Support and Self-Esteem in Tuberculosis Quality of Life: A Nurse-Led Community Empowerment Diagnosis, Banjarmasin

Dea Ayu Pengukir; Yati Afiyanti; Hiryadi; Solikin

doi:10.37275/icejournal.v6i1.63

Authors

Dea Ayu Pengukir Program Pasca Sarjana, Magister Ilmu Keperawatan, Universitas Muhammadiyah Banjarmasin, Banjarmasin, Indonesia
Yati Afiyanti Program Pasca Sarjana, Magister Ilmu Keperawatan, Universitas Muhammadiyah Banjarmasin, Banjarmasin, Indonesia
Hiryadi Program Pasca Sarjana, Magister Ilmu Keperawatan, Universitas Muhammadiyah Banjarmasin, Banjarmasin, Indonesia
Solikin Program Pasca Sarjana, Magister Ilmu Keperawatan, Universitas Muhammadiyah Banjarmasin, Indonesia

DOI:

https://doi.org/10.37275/icejournal.v6i1.63

Keywords:

Community empowerment, Community health nursing, Quality of life, Social stigma, Tuberculosis

Abstract

Background: Tuberculosis in Indonesia is a social as much as a biological problem, but empowerment programmes target adherence rather than stigma, and no South Kalimantan study has ranked the psychosocial determinants a nurse-led programme could act on.

Objective: To rank perceived tuberculosis stigma, perceived social support and self-esteem by their association with quality of life among adults receiving treatment for pulmonary tuberculosis, so that a nurse-led community empowerment programme can act on the determinant that carries the greatest weight.

Methods: Cross-sectional community diagnosis of 102 adults with pulmonary tuberculosis at the Lung Center ward and DOTS polyclinic, Ulin Regional General Hospital, Banjarmasin. Perceived and internalised tuberculosis stigma (28-item Indonesian scale), quality of life (WHOQOL-BREF-derived), perceived social support (MSPSS) and self-esteem (Rosenberg scale) were measured. Multiple linear regression was used, and the standardised coefficients were contrasted using the covariance matrix recovered from the collinearity diagnostics and selected by the identity R² = β′Rβ.

Results: Severe stigma affected 94.1%; the three stimuli explained 80.6% of the variance in quality of life (R² = 0.806): stigma β = −0.766 (95% CI −0.862 to −0.670; partial r = −0.848), self-esteem β = 0.229 (partial r = 0.423) and social support β = 0.201 (partial r = 0.401), all p < 0.001. Stigma outranked self-esteem by 0.537 and social support by 0.565 standardised units (both p < 0.001, in all 16 admissible reconstructions), while the two contextual stimuli did not differ (p = 0.716).

Conclusion: Perceived stigma is the dominant modifiable correlate of quality of life in this catchment, and the ranking is tested rather than asserted. Nurse-led empowerment should place stigma reduction through kader, family psychoeducation and survivor peer educators ahead of individual counselling, monitoring the continuous score.