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PERAN & PERILAKU MANUSIADALAM KONTEKS SEHAT DAN
SAKIT
Itsna Luthfi K., S.Kep., Ns.
Tujuan Pembelajaran
Setelah mengikuti kuliah ini, mahasiswa akan: Memahami istilah-istilah kunci Mengeksplorasi mengenai peran dan perilaku
kesehatan Mendapatkan overview mengenai model peran
dan perilaku kesehatan Mengidentifikasi implikasi konsep sehat dan sakit
dalam merumuskan rencana asuhan keperawatan
Istilah-istilah Kunci
Sehat, Sakit (illness & disease) Perilaku Kesehatan & Peran Sakit Pengetahuan dan Perilaku Sikap, Nilai dan Perilaku Model Perubahan Perilaku
SEHAT & SAKIT
WHO Definition of Health
“Health is a state of complete physical, mental, and social well being, and not
merely the absence of disease or infirmity”
Definitions of Illness and Disease
Illness is a reaction to a change in one’s physical state. It is very individual and has social and physical connotations and is influenced by one’s age, gender, education, experience, culture, mental state, and resources
Disease is defined professionally, usually by a physician. It is the basis for medical practice and therapy. It is also the framework for the organization of the health care system and it’s resources.
Confusions on disease and illness
One can have a disease and not be ill One may be ill and not have a disease One may have both disease and illness
Medical Model of Disease
Deviation from normal specific and universal caused by unique biological forces like the breakdown of a machine defined and treated through a neutral
scientific process
Health is determined by interaction of interrelated variables
genetics or biological determinants behavior (diet and lifestyle habits) pre-and postnatal environments
(physical, biologic, economic, and social)
the health care system
PERILAKU KESEHATAN &
PERAN SAKIT
Perilaku Kesehatan
Aktivitas yang bertujuan untuk pencegahan penyakit dan deteksi penyakit pada stadium
asimptomatik
Human behavior, especially health behavior, is complex and not always readily understandable
Health behavior, like other behavior, is motivated by stimuli in an individual’s environment
The response to such stimuli may or may not be directly related to health
Motivation which leads to health influencing behavior may also not be related to health
Motivation for health behavior is dynamic and not static
Perilaku Kesehatan
Tipe Perilaku Kesehatan Health-directed behavior
Observable acts that are undertaken with a specific health outcome in mind
Health-related behaviorThose actions that a person does that may
have health implications, but are not undertaken with a specific health objective in mind
Types Of Health-related Behavior Preventive Health Behavior
action taken when a person wants to avoid being ill or having a problem e.g. a mother takes her child for immunization
Illness Behavioraction taken when a person recognizes signs or
symptoms that suggest a pending illness e.g. a mother gives her child cough medicine after hearing her wheeze
Types Of Health-related Behavior Sick-role Behavior
action taken once an individual has been diagnosed (either self or medical diagnosis) e.g. a mother decides that her child has malaria and takes him to the clinic for treatment
Illness Behavior (Mechanic, 1962)
The ways in which given symptoms may be:Differentially perceivedEvaluatedActed upon (or not acted upon) by different
kinds of person
Illness Behavior (Harding &Taylor, 2002)
An active rather than passive process that involves interpreting symptoms, evaluating possible responses and, finally, deciding on whether to try to alleviate those symptoms or simply to ignore them.
Influenced by the individual’s interpretations of an appropriate response to symptoms pre-existing belief systems determined culturally & experientially influenced by dialogue with others & societal norms & values may be initiated by one person on behalf of another – the “lay
referral system”
Sick Role Behavior (Parson, 1951)Right and Responsibility of Sick Person
Freedom from blame for illness
Exemption from normal roles and tasks
To do everything possible to recover
To seek competent care
Determinan Perilaku Kesehatan
Psychological Socio-Cultural
Cultural differences in pain perception &
responses to pain (Zborowski,1952)
Pathways into & accessibility of child &
adolescent mental health services are highly
ethnically, culturally & socially determined
(Daryanani et al, 2001) Economy Environmental
Abnormal Illness Behavior
The persistence of a maladaptive mode of perceiving, evaluating, and acting in relation to one’s own state of health, despite that a doctor (or other appropriate social agent) has offered a reasonably lucid and accurate explanation of the
nature of the illness and the appropriate course of management to be followed with opportunities for discussion, negotiation and clarification, based on a thorough examination and assessment of all parameters of functioning (including the use of special investigations where necessary), and taking into
account the patient’s age, educational and sociocultural background.
Pilowsky 1978.
PENGETAHUAN & PERILAKU
PHASES BETWEEN KNOWLEDGE & BEHAVIOUR
(Fishbein & Ajzen 1975)
Knowledgeof correcthealth action
Perception Interpretation SaliencePutting theknowledgeinto action
Pengetahuan & Perilaku Tidak seharusnya diasumsikan bahwa
seseorang selalu berpengetahuan mengenai perilaku kesehatan yang sesuai, tetapi harus diasumsikan bahwa pengetahuan akan menjamin perubahan pada perilaku
Ketika pengetahuan dirasa penting maka hal ini harus ditonjolkan kepada klien
Pengetahuan & Perilaku
Transfer pengetahuan ke dalam tindakan tergantung [pada faktor internal dan eksternal yang luas, meliputi nilai-nilai, sikap dan keyakinan
Untuk sebagian orang, proses transfer pengetahuan ini memerlukan keahlian khusus (enabling factors) yang dapat berupa keterampilan interpersonal
SIKAP, NILAI-NILAI DAN PERILAKU
Sikap, Nilai-nilai dan Perilaku Attitudes are value-ladened social judgements
which possess a strong evaluative component
Attitudes have different components - cognitive (belief), emotional (feeling) and behavioural (predispositions to act)
There is no clear or linear progression from attitudes to behavior, but equally, behavior change may precede and influence attitudes
Sikap, Nilai-nilai dan Perilaku An individual’s attitude to a specific action and
their intention to adopt it is influenced by:beliefs, motivation which comes from the person’s
values, attitudes and drives (instincts), andthe influence from social norms
A belief represents the information a person has about an object or action. It links the object to some attribute.
Values are acquired through socialization and are those emotionally charged beliefs which make up what a person thinks is important.
MODEL PERUBAHAN PERILAKU
Model Perubahan Perilaku
The model identifies a number of stages which a person can go through during the process of behavior change
It takes a holistic approach, integrating a range of factors such as the role of personal responsibility and choices, and the impact of social and environmental forces that set very real limits on the individual potential for behaviour change
It provides a framework for a wide range of potential interventions by health promoters
1. THE COGNITIVE DISSONANCE MODEL(Festinger-1957)
The model holds that inconsistency is a painful or uncomfortable state
Since dissonance is psychologically uncomfortable, it will motivate an individual to reduce dissonance to achieve consonance
In addition, the individual will actively avoid situations and information that are likely to increase the dissonance
COGNITIVE DISSONANCE MODEL The consequences of this are vital for anyone
involved in the process of influence For example, if a respected role model with
whom an individual identifies makes a statement or declaration with which the individual disagrees, consonance is achieved by either:(a) changing the belief, or
(b) changing attitudes to the respected person
2. MASLOW’S HIERARCHY OF NEEDS (Maslow - 1968)
Basic physiological needs - hunger, thirst and related needs
Safety needs - to feel secure and safe, out of danger
Belongingness and love needs to affiliate with others, be accepted and being
Esteem needs - to achieve, be competent, and gain approval and recognition
Self-actualization needs - to find self-fulfilment and realise one’s own potential
MASLOW’S HIERARCHY OF NEEDS
MASLOW’S HIERARCHY OF NEEDS
Behavior is motivated by a hierarchy of human needs
Explains why not everybody responds to the obviously beneficial and well-meaning interventions
Health needs may be compromised for the sake of satisfaction of low-order needs
3. THE HEALTH BELIEF MODEL (Rosenstock and Becker - 1974)
“Two major factors influence the likelihood that a person will adopt a recommended preventive health action
First they must feel personally threatened by disease i.e. they must feel personally susceptible to a disease with serious or severe consequences
Second they must believe that the benefits of taking the preventive action outweigh the perceived barriers to (and/or cost of) preventive action”
HEALTH BELIEF MODEL (Visual)
Demographic variable[age, sex, raceethnicity, etc.]
Socio-psychologicalvariables
Perceived Threat ofDisease “X”
PerceivedSusceptibility to
Disease “X”
Perceived Severityof Disease “X”
Perceived benefitsof preventive
action
minus
Perceived barriersto preventive
action
Likelihood of TakingRecommended
Preventive HealthActionCues To Action
Mass Media CampaignsAdvice from others
Reminder postcard from physicilan or dentistIllness of familiy member or friend
Newspaper or magazine article
INDIVIDUALPERCEPTIONS
MODIFYINGFACTORS
LIKELIHOODOF ACTION
HEALTH BELIEF MODEL (Detailed)Concept Definition Application
PerceivedSusceptibility
One’s opinion of chances ofgetting a condition
Define population(s) at risk basedon a person’s features or behaviour.Heighten perceived susceptibilityif too low
PerceivedSeverity
One’s opinion of how serious acondition and its sequelae are
Specify consequences of risk andcondition
PerceivedBenefits
One’s opinion of the efficacy ofthe advised action to reduce risk orseriousness of impact
Define action to talk: how, where,when; clarity the positive effects tobe expected
PerceivedBarriers
One’s opinion of the tangible andpsychological costs of the advisedaction
Identify and reduce barriersthrough reassurance, incentives,assistance
Cues to Action Strategies to activate “readiness” Provide how-to information,promote awareness, reminders
Self-Efficacy Confidence on one’s ability to takeaction
Provide training, guidance inperforming action
MODIFIED HEALTH BELIEF MODEL AS APPLIED TO HIV/AIDS PROGRAMME
PerceivedsusceptibilityYoung man hasbeen engaging insex with multiplepartners.
PerceivedSeverityYoung manbelieves thatAIDS is a deathsentence sincethere is no cure.
PerceivedThreatYoung manbelieves that heis at risk becausefriend is ill.
Cues to ActionRadio messagesexplaining theneed for safe sex.Peer education onsafe sex and HIV.
Benefits/ barriers Condoms are
easy to use, onecan feel safe
Condoms notreadily available,costly
DesiredBehaviourYoung man buysand uses condomsregularly.
Self-efficacyYoung man hashad practice usingcondoms and feelsconfident to usethem.
4. THEORY OF REASONED ACTION (Fishbein and Atzen - 1975) Proposes that voluntary behavior is predicted by
one’s intention to perform the behavior (e.g. how likely is it that you will take up a quit smoking program?)
Intention, in turn, is a function of :attitude towards the impending behavior (do you
feel good or bad about quitting?), and subjective norms (do most people who are
important to you think you should quit?)
THEORY OF REASONED ACTION Attitude is a function of beliefs about the
consequences of the behaviour (how important do you think it is to quit?) weighted by an evaluation of the importance of that outcome (how important is it to you to quit?)
Subjective norms are a function of expectations of significant others (does your spouse think you should quit?) weighted by the motivation to conform (how important is it to do what your spouse wants?)
THEORY OF REASONED ACTION
External variables
DemographicvariablesAge, sex, occupationsocio-economicstatus, religion,education.
Attitudes towardstargetsAttitude towardspeopleAttitudes towardsinstitutions
Personality traitsIntroversion-extraversionNeuroticismAuthoritarianismDominance
Beliefs that thebehaviour leads tocertain outcomes
Evaluation of theoutcomes
Beliefs that specificreferents think Ishould not performthe behaviour
Motivation tocomply with thespecific referents.
Attitudes towardsthe behaviour
Relativeimportance ofattitudinal andnormativecomponents
Subjective norm
Intention Behaviour
Possible explanations for observed relations between external variables and behaviour.
Stable theoretical relations linking beliefs to behaviour.
5. STAGES OF CHANGE MODEL(Prochaska and DiClemente -1984)
Pre-contemplationNot interested in changing ‘risky’ lifestyle
Exit:Maintaining ‘safer’ lifestyle
Action:Making changes
Maintenance:Maintainingchange
Relapse:Relapsingback
Contemplating:Thinking about change
Commitment:Ready to change
Stages Of Change Model As Applied To Hiv/Aids Programme
PrecontemplationYoung man has heard
about AIDS but doesn’t think it is
relevant to his life.
ContemplationYoung man
believes that he and his friends are at risk and
thinks that he should do something.
Decision/DeterminationYoung man is
ready & plans to use condoms
so goes to a shop to buy them.
MaintenanceWearing condoms
has become a habit and young man
regularly buys them.
ActionYoung man buys
and uses condoms.
6. THE DIFFUSION OF INNOVATION THEORY (Rogers - 1962)
The adoption of ideas in a community diffuses among individuals in that community at varying rates
Early in the introduction of a new idea, it is picked up by ‘innovators’. They want to be the first to do things and they may not be respected by others in the social system.
THE DIFFUSION OF INNOVATION THEORY (Rogers - 1962)
The second group of people, the ‘early adopters’ who are very interested in the innovation but they are not the first to sign up. They wait until the innovators are already involved to make sure the innovation is useful. They are respected by others in the social system and looked at as opinion leaders.
The next group ‘early majority’ (about 34% of the target population) may be interested in the innovation but will need external motivation to become involved, They will deliberate for some time before making a decision.
THE DIFFUSION OF INNOVATION THEORY
(Rogers - 1962) The ‘late majority’ are next and it will take more
time to get them involved for they are skeptical and will not adopt an innovation until most people in the social system have done so.
The last group the‘laggards’ (about 16% of the target population are not very interested in innovation and would be the last to become involved. They are very traditional and are suspicious of innovations. Laggards tend to have limited communication networks, so they really do not know much about new things.
DIFFUSION OF INNOVATION PROCESS
Time
Innovators
Early adopters
Early majority
Late majority
Late adopters
Source: Green & MCAlister 1984.
DIFFUSION MODEL
KNOWLEDGE PERSUASION DECISION IMPLEMENTATION CONFIRMATION
PRIOR CONDITIONS1. Previous practice2. Felt needs/problems3. Innovativeness4. Norms of social systems
COMMUNICATION CHANNELS
Characteristics ofthe DecisionMaking Unit:1. Socio-
economiccharacteristics
2. Personalityvariables
3. Communicationbehaviour
Perceived Characteristicsof the Innovation1. Relative Advantage2. Compatibility3. Complexity4. Trialability5. Observability
1. Adoption Continued AdoptionLater Adoption
2. Rejection DiscontinuanceContinued Rejection
Referensi
1. Harris, Newman L. 2004. Origin, Recognize & Management of Abnormal Illness Behavior. Sydney: Annual Scientific Meeting Presentation.
2. Potter & Perry. 2005. Fundamentals of Nursing: Concepts, Issues and Opportunities. 4th ed. Philadelphia: Lippincott-Raven Publisher
3. Taylor C, LilisC, Le Mone, P. 1997. Fundamentals of Nursing: The Art and Science of Nursing Care. Philadelphia: Lippincott-Raven Publishers.
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