The aim of this project was to (1) examine the effectiveness of MNC-TB prototype using telehealth and telenursing approach to reduce stigma of TB and Covid19, as well as to improve the health outcomes of people with TB in rural area of Sumedang District, West Java Indonesia; (2) explore determinants that are contributing to the successful of telehealth and telenursing for TB patients during Covid19 pandemic to examines the effectiveness of The Mobile Nursing Centre for TB care and prevention.

In this proposed research, mixed methods study was used. During the first stage the team conducted in-depth interviews with people with TB and significant community leaders about stigma of TB during Covid19 pandemic,  their needs to address the problems of TB care and community support, and determinants of successful telehealth and telenursing for people in the community. Based on the results, the second stage the team developed standardized telehealth and telenursing methods for TB care and stigma reduction in the community.   During the third stage the team tested and compared the outcomes of two groups of TB patients and their community who were using the MNC-TB vs those who were not using MNC-TB. This research aided better understanding on the impact of remote collaboration between education, health service representatives, and the community.

In terms of development impact, the PI notes that this study developed a public stigma scale of Tuberculosis during the COVID-19 pandemic taking into account the Indonesian culture, which has not been done before. This public stigma scale helps identify the level of tuberculosis stigma in the society. Nurses and health professionals need to assess the level of social stigma to intervene to reduce it.  Using the validated scale, this study also found that the social stigma of COVID-19 and Tuberculosis are still high in Indonesia. Social and cultural conditions have an impact on TB patients during Covid19 pandemic. In rural areas, most people still have collective cultural activities in local communities. Thus, they prefer direct communication as opposed to engagement online or via apps. Therefore, according to the PI, nurses need to use both direct communication and technology to reduce stigma in the community.  Stigma reduction can help Indonesia increase active case detection rate, which can help find TB patients at an early stage so that the spread of TB can be prevented as early as possible. This can help communities prevent and manage TB without fear or prejudice toward the disease. However, further research is needed to improve the intervention using videos and posters to reduce the stigma of TB in broader society