FAMILY-BASED INTERVENTIONS IN IMPROVING SELF-EFFICACY AND PREVENTING RELAPSE IN TUBERCULOSIS PATIENTS: A SYSTEMATIC LITERATURE REVIEW

Abstract

Tuberculosis (TB) remains a major global health problem, with poor treatment adherence increasing the risks of treatment failure, relapse, and drug resistance. Family-based interventions may strengthen self-efficacy and improve treatment adherence, although evidence remains fragmented. This review aimed to synthesize evidence on family-based interventions and family involvement in relation to treatment adherence, self-efficacy, treatment success, and relapse among pulmonary TB patients. A mixed-methods systematic review was conducted following PRISMA 2020 guidelines. Scopus, PubMed, SAGE, and Web of Science were searched for English-language primary studies published between 2015 and 2026. Methodological quality was assessed using the Joanna Briggs Institute (JBI) Critical Appraisal Tools, and findings were synthesized narratively. Nine studies from Indonesia, China, Iran, India, Uganda, and Thailand were included: two randomized controlled trials, five cross-sectional studies, one quasi-experimental study, and one qualitative study. Family supervision, medication reminders, emotional support, and structured family empowerment or participatory education were associated with better treatment adherence, treatment success, and health-related quality of life. Qualitative findings suggested that intensive family caregiving strengthened patients’ self-efficacy; however, no quantitative study assessed self-efficacy as an intervention outcome. No study directly measured relapse. One quasi-experimental study reported an increase in cure rates from 73% to 90% following a collaborative family-based intervention. Family involvement, particularly structured empowerment and participatory education, may improve treatment adherence and success among pulmonary TB patients. Evidence regarding self-efficacy and relapse prevention remains limited. Further trials using validated self-efficacy measures and post-treatment follow-up are needed. Structured family-based approaches may be integrated into TB care programs in Indonesia.