Health Promotiondr. Harun Al Rasyid, MPH

Introduction

Influences on health Lifestyle and behaviour

› Knowledge› Beliefs› Culture› Social influences

Environment › Housing/building› Water/sanitation› Hazardous waste › Pollution › Climate

Influences on health

• Health Care• Preventative services• Treatment services• Traditional medicine• Health policy• Primary health care

• Heredity• Genetic attributes

So what is health promotion?What does it aim to do?

How does it do it? Who does it?

What is health promotion?• Lalonde, 1974

Suatu strategi yang ditujukan untuk memberikan informasi, mempengaruhi, dan membantu individu-individu atau kelompok agar mereka bisa memenrima tanggung jawab dan lebih aktif pada hal-hal yang mempengarhui kesehatan fisik dan mental

• A strategy “aimed at informing, influencing and assisting both individuals and organizations so that they will accept more responsibility and be more active in matters affecting mental and physical health”

What is health promotion?• Green, 1980

Kombinasi antara pendidikan kesehatan (penyuluhan) dan intervensi-intervensi yang bersifat organisasi, politik dan ekonomi yang didesain untuk memfasilitasi perubahan perilaku dan lingkungan untuk meningkatkan (status) kesehatan

• Any combination of health education and related organizational, political and economic interventions designed to facilitate behavioral and environmental changes that will improve health

What is health promotion?• Ottawa Charter for Health Promotion, 1986

The process of enabling people to increase control over, and to improve, their health

What is health promotion?• Howatt et al., 2003

Combination of educational, organisational, economic, social and political actions designed with meaningful participation, to enable individuals, groups and whole communities to increase control over, and to improve their health through attitudinal, behavioural, social and environmental changes

Combination of actions

Educational Organizational Economic Social Political

With

Meaningful participation (what is this?)

To

Enable Individuals Groups Whole communities

Toto increase control over, and to improve their health

Through

attitudinal, behavioural, social and environmental changes.

Ottawa Charter for Health Promotion

• Building healthy public policy• Kesehatan belum tentu menjadi agenda para

pengambil kebijakan • Banyak permasalahan kesehatan yang bisa diatasi

melalui intervensi kebijakan

Key:Legislative ActionOrganizational change

Ottawa Charter for Health Promotion

• Creating supportive environments• Menciptakan kondisi tempat tinggal dan tempat kerja

yang aman dan kondusif untuk perilaku sehat

Key:Facilitate healthy behavioursReduce barriers

Ottawa Charter for Health Promotion

• Strengthening community action• Pemberdayaan masyarakat (community empowerment)• Memiliki kemampuan untuk menjaga dan meningkatkan status

kesehatan

Key:empowerment, ownership, control

Ottawa Charter for Health Promotion

• Developing personal skill• Biasanya aktivitas promosi kesehatan lebih banyak fokus kepada

aktivitas penyuluhan kesehatan (KIE) peningkatan pengetahuan• Selain pengetahuan juga diperlukan sikap yang positif dan latihan

keterampilan

Key:educate for healthenhance life skills

Ottawa Charter for Health Promotion

• Re-orienting health services• Lebih menekankan pada aktivitas pencegahan • Lebih memperhatikan (sensitif) pada budaya lokal setiap

daerah memiliki keunikan tersendiri sehingga bisa membutuhkan pendekatan yang berbeda

Key:increase emphasis in preventionsensitive to cultural needs

Health Promotion

health education - behavioural

- structural-------------------------

organisationalactions

-------------------------economic actions

-------------------------political actions

Including advocacy

attitudinalbehavioural

environmentaland

socialchanges

conducive to health

ImprovedHealth status

Settings of Health Promotion

• Health promotion intervention can be applied at:• Family level• School • Workplace• Public places

Theories used in Health Promotion

• Maslow• Health Believe Model• Social Cognitive Theory• Diffusion of Innovation Theory

Abraham Maslow (humanistic theory)

• Basis:We attend to fundamental human needs first self

Actualizationneeds

self esteem needs

lovely belonging needs

safety needs

physiological needs

Health Belief Model

Perceived susceptibilityto problem

Perceived seriousnessof consequences of problem

Perceived benefitsof specified action

Perceived barriersto taking actions

Perceived threat

Perceived expectations

Self-efficacy(perceived

ability to carry out

recommended action)

Cues to action

Social Cognitive Theory(Albert Bandura 1977)

• Individual, environment and behaviour continuously interact and influence each other (reciprocal determinism) • Key components: self- efficacy, learning though observation,

reinforcement, reciprocal determinism, expectations, behavioural capability• This theory is useful for individual, group, and population

program development

Reciprocal determinism

Environmental factors (e.g. Social

norms, access to

community)

Cognitive factors (e.g. Expectations,

attitudes)

Behavioural factors,

skills, practice

Diffusion of Innovation Theory(Everett Rogers)

• Some individuals and groups in society tend to be quicker to pick up new ideas than others. • Others in the community tend to be more suspicious of

change and slow to respond to ‘new-fangled’ idea (new idea but seems complicated/unnecessary)

Classification of adopters:

› Innovators (2-3%)quickest adopt new ideas, less-likely to be trusted by the majority of the community

› Early adopters (10-15%)More mainstream within community, amenable to change, have personal, social and financial resources to adopt the innovation

› Early majority (30-35%)amenable to change, have become persuaded of the benefits of adopting the innovation

› Late majority (30-35%)sceptics, reluctant to adopt ideas until the benefits have been clearly established

› Laggards (10-20%)the most conservative, actively resistant to new ideas

Thank You!