{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T02:56:07Z","timestamp":1784256967225,"version":"3.55.0"},"reference-count":25,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Tuberculosis (TB) treatment adherence remains suboptimal globally, contributing to relapse, transmission, and drug-resistant TB. Adherence is a culturally embedded behavioral process shaped by psychological readiness, social relationships, and structural conditions. This study aimed to validate a culturally grounded counseling model integrating the Sunrise Model of transcultural nursing and the Information\u2013Motivation\u2013Behavioral Skills (IMB) framework for TB treatment adherence in Kupang City, Indonesia. Methods: A cross-sectional study enrolled 172 pulmonary TB patients across all 11 primary healthcare centers in Kupang City (June\u2013September 2025). A validated questionnaire measuring eight transcultural determinants, culturally grounded counseling (mediator), and adherence (outcome) was developed through expert validation, cognitive interviewing, and pilot testing. Structural Equation Modeling\u2013Partial Least Squares (SEM-PLS) tested structural and mediation relationships via bootstrapped indirect effects (p &lt; 0.05). Results: Reliability (CR: 0.842\u20130.959; \u03c1A: 0.791\u20130.957), convergent validity (AVE: 0.577\u20130.921), and discriminant validity (all HTMT &lt; 0.85) were confirmed. The model showed strong explanatory power (R2 = 0.649 for adherence; SRMR = 0.074). Culturally grounded counseling was positively associated with adherence (\u03b2 = 0.245, p = 0.003) and statistically mediated five antecedent\u2013adherence relationships, including full mediation for economic conditions. Cultural values and lifestyle showed the strongest counseling association (\u03b2 = 0.345, p &lt; 0.001). Conclusions: Cross-sectional evidence supports a culturally grounded counseling model for TB adherence in diverse settings. Causal conclusions require longitudinal and interventional validation. The model offers a foundation for nurse-led intervention development and multi-site validation.<\/jats:p>","DOI":"10.3390\/nursrep16060190","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T15:57:18Z","timestamp":1780070238000},"page":"190","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Culturally Responsive Counseling and Tuberculosis Treatment Adherence: Development and Validation of an Integrated Model"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3868-8803","authenticated-orcid":false,"given":"Era Dorihi","family":"Kale","sequence":"first","affiliation":[{"name":"Faculty of Nursing, Airlangga University, Surabaya 60115, Indonesia"},{"name":"Ners Program, Poltekkes Kemenkes Kupang, Kupang 85111, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9052-6983","authenticated-orcid":false,"given":"Nursalam","family":"Nursalam","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Airlangga University, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0181-6402","authenticated-orcid":false,"given":"Makhfudli","family":"Makhfudli","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Airlangga University, Surabaya 60115, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3076-9921","authenticated-orcid":false,"given":"Rapin","family":"Polsook","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5445-7861","authenticated-orcid":false,"given":"I Gede","family":"Juanamasta","sequence":"additional","affiliation":[{"name":"Faculty of Nursing, Chulalongkorn University, Bangkok 10330, Thailand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2024). 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