Vicarious Experience and Verbal Persuasion as Key Determinants of Self-Efficacy Among Patients Receiving Pulmonary Tuberculosis Treatment in a Primary Health Center Setting

Background: Pulmonary tuberculosis (TB) remains a major cause of infectious disease mortality worldwide. Beyond the Directly Observed Treatment, Short-course (DOTS) strategy, self-efficacy plays a crucial role in treatment adherence and is influenced by four sources: performance accomplishment, vicarious experience, verbal persuasion, and physiological information. However, evidence on the relative contributions of these sources among Indonesian TB patients remains limited. This study aimed to identify factors associated with self-efficacy among pulmonary TB patients receiving treatment. Methods: A quantitative, cross-sectional design following the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guideline was employed. The population comprised 95 pulmonary tuberculosis patients undergoing treatment during May–June 2025 at Babelan I Primary Health Center, Bekasi Regency, West Java, Indonesia. Purposive sampling yielded 76 participants. Inclusion criteria required patients to be ≥18 years old, in active treatment for at least two months, and able to read and write. Exclusion criteria included severe co-infections (TB-HIV advanced stage, uncontrolled TB-diabetes), cognitive or psychiatric impairment, terminal complications, or transfer to another facility. Data were collected via interviewer-administered Likert-scale questionnaires measuring performance accomplishment (10 items), vicarious experience (10 items), verbal persuasion (10 items), physiological information (10 items), and self-efficacy (15 items). The instruments were validated (r > 0.361) and showed excellent reliability (Cronbach's α: 0.843–0.967). Results: Most participants were aged 31–45 years and predominantly male. Of the 76 participants, most had high self-efficacy (72.4%). Bivariate analysis revealed significant associations between performance accomplishment and self-efficacy (p = 0.003; PR = 1.5, 95% confidence interval [CI]: 1.17–2.1), vicarious experience and self-efficacy (p = 0.0001; PR = 2.0, 95% CI: 1.4–3.0), verbal persuasion and self-efficacy (p = 0.0001; PR = 3.9, 95% CI: 1.4–10.7), and physiological information and self-efficacy (p = 0.002; PR = 1.5, 95% CI: 1.2–1.9). Multivariate analysis identified vicarious experience (OR = 14.2, 95% CI: 2.63–76.92) and verbal persuasion (OR = 7.7, 95% CI: 1.47–40.34) as the dominant independent predictors of self-efficacy; performance accomplishment was excluded from the final model, with physiological information acting as a confounding variable reflecting near-complete separation in the logistic regression model. Conclusion: High vicarious experience and strong verbal persuasion are the factors most strongly associated with self-efficacy in pulmonary tuberculosis patients. Healthcare providers should integrate peer-support programs and systematic motivational counseling into TB management to enhance patient self-efficacy and improve treatment outcomes. Future longitudinal and multi-site studies are recommended.