SOCIALIZATION AND TRAINING OF BASIC RADIOGRAPHY TECHNIQUES FOR EARLY DETECTION OF LUNG DISEASE IN COMMUNITIES IN TUBERCULOSIS-PRONE AREAS OF NORTH SUMATRA

Abstract

Tuberculosis (TB) remains a persistent global public health menace, with Indonesia consistently ranking second worldwide in the burden of TB cases. The province of North Sumatra, in particular, faces a high prevalence of TB, rendering it a priority region for prevention and early detection interventions. Delayed diagnosis and treatment of TB not only exacerbate patient prognosis but also significantly contribute to disease transmission within communities. While chest radiography is a key diagnostic tool for detecting pulmonary diseases, including TB, access to understanding and implementing this technique remains limited in many communities, especially in remote and vulnerable areas. A critical gap in knowledge and skills regarding the basic interpretation of chest radiographs for identifying suspicious pulmonary lesions represents a crucial barrier to effective early screening efforts. This research endeavors to address this critical gap by providing comprehensive socialization and training on basic radiography techniques, designed to empower communities and primary healthcare workers in TB-prone regions of North Sumatra, thereby enhancing early pulmonary disease detection capacities. The primary objective of this study is to evaluate the effectiveness of a basic radiography technique socialization and training program in improving participants' knowledge and skills in the early identification of pulmonary abnormalities within TB-prone communities in North Sumatra. Specifically, the study aims to quantify improvements in participants' knowledge scores before and after the intervention, and to observe changes in their perception and confidence in recognizing potential signs of pulmonary disease through chest radiography. A core hypothesis posits that a structured socialization and training intervention will significantly enhance participants' knowledge and skill levels in basic chest radiograph interpretation for early pulmonary disease detection. This study employed a quantitative pre-experimental design using a one-group pretest-posttest approach, chosen to systematically measure changes in participants' knowledge and skills before and after the training intervention, allowing for a direct evaluation of the program's impact. The research sample comprised 150 individuals, including 100 community representatives and 50 primary healthcare workers from three districts in North Sumatra identified as having the highest TB case rates. Purposive sampling was utilized to ensure adequate representation from communities most in need. The primary research instrument was a structured questionnaire comprising two sections: (1) questions on basic pulmonary anatomy and general chest radiograph interpretation, and (2) case scenarios with corresponding chest radiographs to assess identification abilities. This questionnaire underwent content validation by radiology and psychometric experts and a reliability test using Cronbach's alpha (α=0.85). The research procedure involved interactive socialization sessions explaining the importance of early pulmonary disease detection and introducing basic radiography, followed by intensive practical training sessions covering demonstrations of normal and pathological radiograph interpretation, and case studies. Data analysis was conducted using paired t-tests to compare knowledge scores obtained before and after the intervention. The findings revealed a highly significant impact of the basic radiography technique socialization and training program on participants' knowledge and skills. The average knowledge score increased dramatically from 45.2 ± 8.9 points pre-intervention to 78.5 ± 6.5 points post-intervention (p < 0.001). This substantial increase indicates the effectiveness of the delivered material and training methods in transferring information and fostering a deeper understanding of chest radiograph interpretation. The effect size calculation (Cohen's d) yielded a value of 3.5, signifying a very large effect size and reinforcing the intervention's impact. Secondary analyses identified that primary healthcare workers exhibited a slightly higher increase in scores compared to community representatives, although this difference was not statistically significant (p = 0.08). A noteworthy unexpected finding was the reported increase in confidence among the majority of participants (85%) in identifying potential pulmonary abnormalities from radiographic images, suggesting the training not only enhanced knowledge but also empowered individuals to act. The main pattern observed was an improved ability to identify lesions such as infiltrates, cavities, and pleural effusions on chest radiographs post-training. In conclusion, this study demonstrates that basic radiography technique socialization and training is an effective and efficient intervention for enhancing the knowledge and skills of both communities and primary healthcare workers in early pulmonary disease detection in TB-prone regions. The theoretical contribution of this research lies in its addition of empirical evidence regarding the efficacy of community-based educational approaches in bolstering health screening capacities in resource-limited areas. Practically, these findings underscore the significant potential for such programs to be integrated into existing public health initiatives to strengthen referral systems and expedite diagnosis, ultimately contributing to TB control. Key recommendations include expanding similar programs to other vulnerable regions and exploring the development of training modules that are more adaptive to local contexts and varying literacy levels.