Hrev_master Healthcare in Low-resource Settings 2023; volume 11(s1):11194 A systematic review on telenursing as a solution in improving the treatment compliance of tuberculosis patients in the COVID-19 pandemic Ni Nyoman Elfiyunai,1 Nursalam,2 Tintin Sukartini,2 Ferry Efendi2 1Doctoral Program of Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya Indonesia; 2Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia Abstract Introduction: The COVID-19 pandemic had made patients scared of coming to clinics or hospitals, and this could affect the treatment of TB. Therefore, one type of service that can be used by nurses to improve compliance to TB treatment is Telenursing. This article aims to ascertain whether telenursing could be a solution in improving the compliance of TB patients to treatments in the COVID-19 pandemic. Design and Method: This research was conducted using the Randomised Controlled Trial design as well as PRISMA. Furthermore, useful research articles were sourced from the database using the keywords, “Message Reminder and Tuberculosis OR Medication Adherence”. The databases used are Scopus, Science Direct, PubMed, and SAGE, all in English text and from 2015 to 2021, with inclusion criteria. 277 articles were obtained, and then filtered to select 3 articles by reading the main focus of the write-up, with regard to the topic of study. Result: Telenursing can be a solution to reduce the spread of COVID-19, and a substitute for remotely motivating individuals, as social support. Furthermore, it could be used as a reminder to patients to be obedient in carrying out treatments, and as a means of educating and improving good relationships with providers. Conclusions: Telenursing is a fairly effective solution in help- ing TB patients improve treatment compliance, reduce drug dropout rates and missed doses, as well as, raise awareness about the importance of health in the COVID-19 pandemic. Introduction Tuberculosis (TB) is one of the top 10 causes of death in the world.1 Globally, about 10 million people were affected by the dis- ease, with 1.4 million death in 2019.2 TB control efforts with Direct Observed Treatment (DOT) Strategies have been imple- mented in many countries.3,4 However, patients are still unable to complete treatment thoroughly or be declared cured of the disease.5 Many patients do not comply to the treatment because they feel bored, they miss taking their medication, and do not rou- tinely seek treatment due to the length of time the process takes.6 usually about 6 to 8 months.7 Prolonged transmission of the disease, failure of treatment, and risk of resistant variants are serious problems.3,8,9 Furthermore, Multidrug-resistance (MDR) can worsen the outcome of treat- ment, and lead to high morbidity and mortality.10,11 Social support is needed.12 from friends, family, and health workers to improve patients’ trust and compliance in treatment.13 To support compliance, nurses play a role in providing education, communication, observation, and follow-up of patient treatment.14 During the COVID-19 pandemic, many health programs and disease control to the public were discontinued.15 and this also impacted the treatment of cancer patients.16 The secondary effects of the pandemic include damage to the economy, the spread of dis- eases, the reduction of health workers, as well as patients being afraid to come to health care centers.17 The pandemic may also have increased the death of TB patients.18 Mobile technology has been useful for all countries in over- coming obstacles in the provision of health services.19 Strategies to end the epidemic of global TB disease by 2035 require electronic health plans.20 Therefore, a global digital health task force team was set up by the World Health Organization (WHO) in 2015 to help prevent and improve TB treatment.21 Support digital medicine can monitor and ensure the treatment of TB patients.22 Furthermore, mobile-health networks (mHealth) can help TB pro- grams and improve treatment and control compliance to health care centers.23 The use of cell phones is an alternative approach in providing support and reminding patients of their treatments.24 It could also be used in providing support and information to improve patient compliance in treatment.7,9,25 In the form of digital health, technology can help health workers monitor and support TB patients in terms of treatment adherence.26 Previous research has cast doubt on the effectiveness of texting reminders in improv- ing the treatment of tuberculosis patients.4,7 Telenursing is very important to be used by health workers in pandemic times, to pre- vent the transmission of COVID-19. It could also be used to help remind patients to take medication and conduct periodic checks in health care centers. Therefore, the goal of this study was to ascer- tain whether telenursing is a solution in improving the treatment compliance of TB patients. Review Significance for public health Telenursing is very helpful for improving the compliance of patients to Tuberculosis treatment during the COVID-19 pandemic. Telenursing can be one of the options for the public to obtain information, as well as a form of support for patients in carrying out TB treatment and a reminder message to patients to take medication and visit health care facilities at times specified in the patient's mobile service. Telenursing can alleviate the burden on family members' minds when reminding patients to take their TB medication. Telenursing can reduce or eliminate the spread of tuberculosis (TB) to families, groups, or communities and prevent multi-drug resistance in patients and reduce TB mortality. Therefore, this form of nursing is the topic of study in this article. It could be an alter- native in overcoming obstacles in the delivery of health services. [Healthcare in Low-resource Settings 2023; 11(s1):11194] [page 93] No n- co mm er cia l u se on ly Review [page 94] [Healthcare in Low-resource Settings 2023; 11(s1):11194] Table 1. Summary of data description from the included studies. No n- co mm er cia l u se on ly Review [Healthcare in Low-resource Settings 2023; 11(s1):11194] [page 95] Table 1. Summary of data description from the included studies. No n- co mm er cia l u se on ly Design and Methods This study used the Systematic Review approach and was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) method. The authors developed the research problem using PICO with the criteria of a TB patient popu- lation, interventions with short message service reminder messages, or cell phone calls for TB treatment. Furthermore, the authors studied patients who only received standard DOTS services, compliance, or improved treatment of TB patients, using a randomized, blinded, and controlled trial design. Keywords that were used: “tuberculosis”, “reminder messages” AND “tuberculosis” OR “drug compliance”, DOTS treatment, compliance, TB intervention, adherence. Additionally, articles in English published between 2015 and 2021 were obtained from Scopus, SAGE, Science Direct, and PubMed. Two hundred seventy-seven articles were found in the database, including 19 Scopus articles, 24 PubMed articles, 141 ScienceDirect articles, and 93 SAGE articles. The number of articles was reduced to 277 after identifying the articles thoroughly. Furthermore, 116 arti- cles were re-selected based on this inclusion criteria: lack of focus on TB treatment, patient messaging services were not adequately dis- cussed, received only regular treatment from the Directly Observed Treatment Shortcourse (DOTS), and no evidence about TB treatment adherence. Abstracts were also identified and filtered, reducing the number of articles to 161 and bringing the excluded articles to 70. Following the screening process, ten complete articles were selected and used. Data extraction from the selected articles was carried out with the distribution of extraction forms containing metadata such as the author’s name, year, title, research design, subject criteria, research location, intervention, length of follow-up, and results, as shown in Table 1. Results and Discussions The results of the article selection are shown in Figure 1 of the flowchart. The review’s findings yielded ten articles in the follow- ing categories: the respondents ranged from 15 to 80 years old, and the studies were conducted in Northwest Ethiopia,19 Cameroon,4 China’s Anchui Province,27 Pakistani Karachi,7 Malang, Indonesia,9 Heilongjiang, Jiangsu, Hunan, and Chongqin Provinces, China,28 British Columbia Kanda,29 District of Sleman, Indonesia,30 State of Khartoun Sudan,31 TB clinic Khyber Peshawar and Teaching Hospital Nahaqi Emergency Satellite Hospital, Pakistan.32 A total of 8179 TB patients were studied in the overall study. The intervention group received mobile phone reminders and routine DOT care, whereas the control group only received conventional therapy. Previous study explained that through reminder messages sent every day from mobile phones about TB treatment in the form of text messages, there was an increase in treatment compliance, centered on good relationships between providers.19 Text messaging effectively strengthens the level of complete treatment compliance in TB patients, as well as, reduces the possibility of missing medication schedules, and sev- ered treatment. It also increases the awareness of patients to per- form periodic checkups.27 Medication monitors have also been shown to improve TB patient compliance, whereas receiving a reminder via text message does not affect medication adherence,28 even though text messages are sent in both directions every week.29 Because resources are limited, SMS reminders from mobile phones can help improve TB patient compliance.30 When com- pared to patients who do not receive short messages, health ser- vices with reminder messages can have a high cure rate.31 Meanwhile, another study stated that there was no increase in treat- Review Figure 1. Literature search flow diagram. [page 96] [Healthcare in Low-resource Settings 2023; 11(s1):11194] No n- co mm er cia l u se on ly ment success from reminders given via SMS. The low recovery of patients in the 6th month of treatment was estimated to be due to the condition of many school children dropping out of school between the 5th and 6th months of treatment.4 The discussion of the use of Telenursing has been the focus in different research and applied in various disease conditions, as described in the 10 articles above. Eight of the articles explained that there was an increase in treatment adherence and awareness of TB patients to conduct periodic examinations. Meanwhile, between two article showed that texting reminders do not improve the success of TB treatment and the proportion of cures due to high dropout rates between the fifth and sixth months of TB treatment. To reduce the transmission of COVID-19, many measures used by the government, ranges from the wearing of masks, restrictions on crowded places, the closure of public spaces and limiting the number of visits to political gathering every day.33 Meanwhile, as stated by the WHO, this virus was first reported as a pandemic in Wuhan China on December 8, 2019.34 Since then, remote consultation by phone, such as Telenursing, was introduced as it could be beneficial to patients during the pandemic.35,36 Telenursing can provide social support especially when patients do not have someone to remind them about their treat- ment, or are far away from their social support. The patient feels the messages from sms can motivate them to comply to the treat- ment schedule regularly.24 Telenursing via sms message can be a substitute in providing motivation to patients to take TB drugs.9 From research in India and South Africa, patients undergoing TB- HIV treatment expressed discomfort using cell phone via sms.23 The use of telenursing for diabetic patients can help improve their compliance to take medication. It could also serve as a reminder to exercise control when eating, and assist in the provi- sion of health education in urban India.37 Studies conducted in Lesotho and Mozambique on TB/HIV patients via telenursing reported a good relationship between patients and health care providers in the intervention group.38,39 Indian research into TB control can effectively use telenursing as a major source of infor- mation.40 In North West Ethiopia most participants were willing to use telenursing as a means of reminder to take their medication.41 Similarly, in disasters, the use of this form of nursing is essential in helping to provide care.42 However, when the communication is made over the phone and the caller is unclear, there is the risk of the information received being wrong.43 With regards to postnatal situations, consultation via video is fun, but in such conditions, the communication is usually dominated by nurses with a focus on the weight of premature babies.44 Telenursing is also beneficial in interpersonal skills and helps evaluate the competence of doctors in learning activities.45 In post-cataract surgery, telenursing can improve treatment adherence and can provide daily postoperative recovery information.46 It could also be used in the case of burn patients to help in providing education and improving quality of life during the rehabilitation phase.47 Remote care using telenurs- ing in the implementation of regulation and education is very effective, safe, and virtually relevant.48 It is also very beneficial in providing primary care, and could be developed and included in the law on the use of digital technology for nurses.49 Finally, this form of nursing could be used in providing support on the provi- sion of DOT to improve TB patient compliance.50 It could also help improve adherence to treatment and healthy living in patients with a variety of chronic diseases.51,52 Studies on the use of telenursing with SMS may also assist patients in compliance with the release or replacement of endo- scopic retrograde cholangiopancreatography (ERCP).53 Finally, in diabetic patients, this form of nursing could improve patient com- pliance.54 Conclusions Telenursing can be used during the COVID-19 pandemic to reduce health workers’ contact with patients to limit the risk of transmission of the disease from officer to patient and vice versa. It is also a solution for assisting TB patients in improving their compliance to treatment, reducing drug dropout rates and missed doses, as well as raising awareness about the importance of health. Finally, based on this study, the application of telenursing is enough to help improve the compliance to TB treatment in the COVID-19 pandemic. References 1. World Health Organization. Tuberculosis Global Report [Internet]. World Health Organization. 2019; Available from: Review Correspondence: Ni Nyoman Elfiyunai, Doctoral Program of Nursing, Faculty of Nursing, Universitas Indonesia, Jl. Dr. Ir. H. Soekarno, Mulyorejo, Surabaya, Jawa Timur 60115, Indonesia, Tel.:+62-31-5914042, Fax:+62-031-5981841. E-mail: ni.nyoman.elfiyunai-2020@fkp.unair.ac.id. Key words: Telenursing; tuberculosis; medication; adherence; COVID-19. Acknowledgment: The author is grateful to the Doctoral Program of Nursing, Faculty of Nursing, Airlangga University, Surabaya Indonesia, for providing support and encouragement. Contributions: All authors played a role in this article as NNE searched for articles from the database and compiled them, while N and TS served as lecturers and reviewed the final articles. Finally, the author is grateful to the FE lecturer for helping in improving the writing and authoring of this article. Conflict of interests: The author declare no conflict of interest. Funding: None. Clinical trials: This systematic review study was conducted in accor- dance with the accepted practices. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Ethics approval and informed consent: Not applicable. Conference presentation: Part of this paper was presented at the 2nd International Nursing and Health Sciences Symposium that took place at the Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia. Received for publication: 3 December 2021. Accepted for publication: 6 May 2022. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2023 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2023; 11(s1):11194 doi:10.4081/hls.2023.11194 Publisher's note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any prod- uct that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2023; 11(s1):11194] [page 97] No n- co mm er cia l u se on ly