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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