Community Nurses' Empowerment In Addressing Stagnation of Tuberculosis (TB) Elimination Programs In Indonesia: A Systematic Review

Abstract

Community nurses play a pivotal role in TB care, but their empowerment’s impact on overcoming these barriers remains understudied. This systematic review
examines the influence of community nurses’ empowerment on addressing stagnation in Indonesia’s TB eradication programs, aiming to identify gaps and
opportunities for intervention. A systematic review was used with PRISMA guidelines to analyze studies (2019-2024) on community nurses' empowerment and TB
program stagnation in Indonesia, using PICOT framework (Population: Indonesian community nurses/TB programs; Intervention: empowerment strategies;
Outcome: program stagnation metrics). Searches across Scopus, Google Scholar, ResearchGate, and PubMed utilized keywords: "community nurse empowerment,"
"tuberculosis program stagnation," and "Indonesia." Included studies were peer-reviewed empirical works in English/Indonesian, assessed for bias using Cochrane
and Newcastle-Ottawa tools. Data synthesis combined quantitative analysis with GRADE-CERQual and NVivo-assisted thematic coding of qualitative findings. The
PRISMA analysis of 15 studies demonstrated that empowered community nurses improve TB detection by 27-40% and treatment success by 1.8x in LMICs (PICOT),
with moderate-to-high confidence evidence (CERQual) despite some performance bias (ROB). Thematic analysis (NVivo) identified three effective empowerment
mechanisms: structural support, psychological ownership, and community engagement, though implementation barriers persist in high-burden settings. The structured
empowerment of community nurses significantly enhances TB program outcomes in high-burden settings, and the integrating nurse-focused training, resource
allocation, and policy reforms into national TB elimination strategies are recommended to address implementation gaps.