PLAL1P 8CMC1lCn MCuLLS

uLS? lnu8A ?Anl

CCMMunl1? PLAL1P nu8SlnC uLA81MLn1
lACuL1? Cl nu8SlnC
unlvL8Sl1AS Au!Au!A8An
PealLh romouon
! P ls Lhe sclence and arL of helplng people change Lhelr llfesLyle Lo move
Loward a sLaLe of opumal healLh
! Cpumal healLh ls dened as a balance of physlcal, emouonal, soclal,
splrlLual, and lnLellecLual healLh
! LlfesLyle change can be faclllLaLed Lhrough a comblnauon of eorLs Lo
!"#$"%! $'$(!"!))* %#$"+! ,!#$-./( $"0 %(!$1! !"-.(/"2!"1) LhaL
supporL good healLh pracuces.
! Cf Lhe Lhree, supporuve envlronmenLs wlll probably have Lhe greaLesL
lmpacL ln produclng lasung changlng
lour aradlgms of PealLh romouon
(Caplan and Polland, 1990)
Mode of PealLh romouon lnLervenuon
Models of PealLh: 1he rogresslon
! 8lomedlcal model
! locused on Lhe physlologlcal deLermlnanLs of healLh and dlsease
! 1he body slmllar Lo a machlne ln need of repalr
! locus on dlagnosuc and Lherapeuuc LreaLmenLs
Models of PealLh: 1he rogresslon
! 8ehavloral model
! 4 facLors ldenued as aecung healLh - human blology, envlronmenL, llfesLyles,
healLh care organlzauon
! LlfesLyle became Lhe lnlual focus as lL llnked healLh sLaLus and personal rlsk
behavlors
Models of PealLh: 1he rogresslon
! locus was on reduclng healLh lnequlues cased by socloeconomlc and
envlronmenLal facLors
! A new concepLuallzauon of healLh emerged whlch accounLed for Lhe
sLrucLural lnuences on healLh behavlors: lnuences such as poverLy and
approprlaLe houslng for lnsLance (Laverack, 2004)
! lL was Lhen LhaL we began Lo undersLand and aruculaLe Lhe broad Lhe
deLermlnanLs of healLh and Lhe lnLerrelauonshlps among Lhem
! More recenLly, nurses have begun bulld on Lhls approach by uslng a soclo-
ecologlcal model Lo gulde Lhelr work
PealLh romouon Models
! CommunlLy ecologlcal model
! Soclal ecologlcal model
! CommunlLy plannlng model
! 1he 8LCLuL 8CCLLLu model
! CommunlLy dluslon model
! uluslon of lnnovauon model
! Soclal markeung model
Lcologlcal Model
! uenluon
Lcologlcal models are comprehenslve healLh promouon
models LhaL are mulufaceLed concerned wlLh envlronmenLal
change, behavlor, and pollcy LhaL help lndlvldual make
healLhy cholces ln Lhelr dally llves
Lcologlcal Model
! uenlng leaLures
! 1he denlng feaLure of an ecologlcal model ls LhaL lL Lakes lnLo accounL Lhe
physlcal envlronmenL and lLs relauonshlp Lo people aL lndlvldual, lnLerpersonal,
organlzauon and communlLy levels
! 1he phllosophlcal underplnnlng ls Lhe concepL LhaL behavlor does noL occur wlLhln
a vacuum
Lcologlcal Model
! underlylng Assumpuons
! 8ehavlors are lnuenced by lnLrapersonal, soclal, culLural, and physlcal
envlronmenLal varlables
! varlables are llkely Lo lnLeracL
! need Lo address varlables aL muluple levels Lo undersLand and change healLh
behavlors
! 1here are muluple levels of lnuence ranglng from lndlvldual Lo publlc pollcy
Lcologlcal Model
! CharacLerlsucs
! lnuenclng behavlors happens on muluple levels. lnLerpersonal facLors, soclal and
culLural envlronmenLs and physlcal envlronmenLs can lnuence healLh behavlors
! lnuences rarely aecLs slngle levels. 1o be useful ln deslgnlng sLudles and
lnLervenuons, Lhe model should predlcL how Lhe caLegorles of behavlor
deLermlnanLs lnLeracL
! LnvlronmenLs dlrecLly lnuence behavlors. LnvlronmenL: space ouLslde Lhe
lndlvldual. Lcology: lnLerrelauons beLween organlsms and Lhelr envlronmenLs
Soclal Lcologlcal Model
! An ecologlcal model wlLh a focus on soclal facLors
! ln Lradluonal ecologlcal envlronmenLs Lradluonally have referred Lo one's
physlcal envlronmenL
Soclal Lcologlcal Model
! Common deplcuons
! llve levels
! lndlvldual
!"#$%&'$()"%* ,%-#)$(
! 8elauonshlp
!"#'$&'$()"%* ,%-#)$(
! lnsuLuuonal
.$/%"!0%1)"%* ,%-#)$(
! CommunlLy facLors
! SocleLal/ publlc pollcy

! lour levels
! lndlvldual
!"#$%&'$()"%* ,%-#)$(
! 8elauonshlp
!"#'$&'$()"%* ,%-#)$(
! CommunlLy facLors
! SocleLal/ publlc pollcy
Soclal Lcologlcal Model: lndlvldual Level
lnLrapersonal
! Lncompasses Lhe knowledge, amLudes and skllls of Lhe lndlvldual
! sychologlcal Lheorles foundauonal lmplemenLauon

Soclal Lcologlcal Model: 8elauonshlp level

lnLerpersonal
! Plgh level of lmporLance ln healLh relaLed behavlor
! lncludes famlly, frlends, lnumaLe parLners
! Many behavlors are profoundly shaped by famllles parucularly Lhose hablLs learned
early ln llfe
! Soclal neLworks key
Soclal Lcologlcal Model: lnsuLuuonal
Crganlzauons
! SLraLegles wlll slmllar Lo Lhose lnsuLuLed aL communlLy and socleLal spheres
(4 sLep model does noL lnclude Lhls level)
! Slgnlcance ln 3 sLeps models aurlbuLed Lo Lhe facL LhaL people spend one-
Lhlrd Lo one-half ln lnsuLuuonal semngs, parucularly schools and workplaces
Soclal Lcologlcal Model: CommunlLy
Larger communlLy
! Cf parucular slgnlcance ln LhaL organlzauons and lndlvlduals wlLhln a
communlLy can work LogeLher Lo promoLe healLhy goals
! CommunlLy norms lnuenual aL Lhls level
Soclal Lcologlcal Model: SocleLal
! Soclal norms
! ubllc pollcy
! 8egulauons and llmlLauons on behavlors
! usually Lhe mosL expllclL and conLroverslal measure LhaL, local, sLaLe and nauonal
governmenLs healLhy behavlors
! Laws, regulauons, resLrlcuons
locus of Lhe lnLervenuon: lndlvldual
! lndlvldual level lnuences are blologlcal and lnclude personal hlsLory facLors
LhaL lncrease Lhe llkellhood LhaL an lndlvldual wlll become a vlcum or
perpeLraLor of vlolence
! lnLervenuons for lndlvldual-level lnuences are oen deslgned Lo LargeL
soclal and cognluve skllls and behavlor and lnclude approaches such as
counsellng, Lherapy, educauonal Lralnlng sesslons (owell eL al, 1999)
locus of Lhe lnLervenuon: 8elauonshlp
! lnLerpersonal relauonshlp-level lnuences are facLors LhaL lncrease rlsk as a
resulL of relauonshlps wlLh peers, lnumaLe parLners and famlly members
! A person's closesL soclal clrcle - peers, parLners and famlly members - can
shape Lhe lndlvldual's behavlors and range of experlence (uahlberg and
krug, 2002)
! lnLervenuons for lnLerpersonal relauonshlp-level lnuences could lnclude
famlly Lherapy, bysLander lnLervenuon sklll developmenL, and parenung
Lralnlng (owell eL al., 1999)
locus of Lhe lnLervenuon: CommunlLy
! CommunlLy level lnuences are facLors LhaL lncreased rlsk based on
communlLy and soclal envlronmenLs and lnclude an lndlvldual's experlences
and relauonshlps wlLh schools, workplaces and nelghborhoods
! lnLervenuons for communlLy-level lnuences are Lyplcally deslgned Lo
lmpacL Lhe cllmaLe, sysLems, and pollcles ln a glve semng
locus of Lhe lnLervenuon: SocleLal
! SocleLal-level lnuences are larger, macro level, facLors LhaL lnuence sexual
vlolence such as gender, lnequallLy, rellglous or culLuLal bellef sysLems,
socleLal norms, and economlc or soclal pollcles LhaL creaLe or susLaln gaps
and Lenslons beLween groups of people
! lnLervenuons:
! ollcy focused on lnLervenuons Lyplcally lnvolve collaborauons by muluple
parLners Lo change laws and pollcles relaLed Lo sexual vlolence or gender
lnequallLy
! Soclal norm focused lnLervenuon would be Lo deLermlne socleLal norms LhaL
accepL vlolence and Lo ldenufy sLraLegles for changlng Lhose norms
lmpllcauons for appllcauon
! ln applylng Lhe soclo-ecologlcal model, we should clear abouL
! Who
! WhaL
! when
! AlLhough Lhere ls a speclc sLraLegy and focus lnLervenuons wlll have
broader lmpllcauons
Soclal Lcologlcal Model
! 1he soclal ecologlcal model supporLs a comprehenslve publlc healLh
approach LhaL noL only addresses an lndlvldual's rlsk facLors buL also Lhe
norms, bellefs, and soclal and economlc sysLems LhaL creaLe Lhe condluons
for Lhe occurance of communlLy healLh lssues
Soclal Lcologlcal Model
! 1he lmpacL of communlLy on healLh ls noL unldlrecuonal (l.e. my communlLy
aecLs my healLh)
! 1he relauonshlp ls bl-dlrecuonal )l.e. lndlvlduals sLrengLhen or weaken a
communlLy and lnuence Lhe well belng of oLhers) and lnLerconnecLed (Lhe
communlLy and lLs members are lnseparable)
Soclal Lcologlcal Model
! Soclo-ecologlcal model approaches vlew healLh as a producL of Lhe
relauonshlp beLween Lhe lndlvldual and Lhe envlronmenL
! locus on enhanclng people's capaclLy Lo engage ln and creaLe Lhelr soclal
envlronmenL
! 1hey are muludlsclpllnary wlLh a sLrong cluzen paruclpauon componenL
CCMMunl1? LAnnlnC MCuLL
! lannlng model exlsL aL macroscoplc level
! 1he 8LCLuL-8CCLLu Model
redlsposlng
8elnforclng
Lnabllng
ConsLrucLs
Lducauonal/ LnvlronmenLal
ulagnosls
Lvaluauon


ollcy
8egulaLory
Crganlzauonal
ConsLrucLs
Lducauonal
LnvlronmenLal
uevelopmenL

8LCLuL-8CCLLu MCuLL
! Planning model dirancang oleh Lawrence Green & Marshall
Kreuter "health education & health promotion programs
! Its overriding principle is that most enduring health behavior
change is voluntary in nature
! Draws on fields of epidemiology, social & behavioral science
8LCLuL-8CCLLu MCuLL
! Looks at desired outcomes first-asks the why before the how
! This principle is reflected in a systematic planning process which
seeks to empower individuals with understanding, motivation
and skills and active engagement in community affairs to
improve their quality of life
8LCLuL-8CCLLu MCuLL
LlemenLs of 8LCLuL-8CCLLu
! hase 1 - soclal dlagnosls
! hase 2 - epldemlologlcal dlagnosls
! hase 3 - behavloral envlronmenLal dlagnosls
! hase 4 - educauonal/ organlzauonal dlagnosls
! hase 3 - admlnlsLrauve and pollcy dlagnosls
! hase 6 - ready for program lmplemenLauon
! hase 7-9 - daLa collecuon and evaluauon
hase 1 Soclal ulagnosls
! Before PRECEDE-PROCEED
! Telah memiliki Shared vision
! Masalah kesehatan tertentu telah diidentifikasi dan beberapa
tujuan kesehatan awal yang terukur telah ditetapkan
! Aktivitas untuk memulai pengkajian kebutuhan dan mempelajari
masalah
! Untuk membantu mengklarifikasi fase pertama sebelum pindah
ke fase kedua.
hase 2 Lpldemlologlcal ulagnosls
! Data
! Collection
! Sources
! comparisons
hase 3 8ehavloral & LnvlronmenLal
lacLors
! Step 1
possible risk factors associated with the problem are listed #
literature review
! Step 2
break into behavioral and environmental
! Step 3
make the criteria " ask experts and community personnels
hase 3 8ehavloral & LnvlronmenLal
lacLors
! SLep 4
1enLukan prevalensl perllaku dan frekuesnl fakLor llngkungan LerllbaL
1enLukan fakLa LerkalL fakLor2 yang berkonLrlbusl Lerhadap masalah
klaslkaslkan men[adl fakLor penung & udak penung
! SLep 3
1enLukan changeablllLy
Croup process " low or hlgh llkellhood of change
hase 3 8ehavloral & LnvlronmenLal
lacLors
! SLep 6
CreaLe an lmporLance and changeablllLy maLrlx
! SLep 7
8uaL Lu[uan pada fakLor penung dan yang dapaL dlubah
Slapa yang dlekspekLasl unLuk berubah?
Apa yang dlekspekLasl unLuk berubah?
8erapa banyak yang berubah?
kapan akan berubah?
hase 4 Lducauonal & Crganlzauonal
ulagnosls
! redlsposlng facLors
Cognluve & aecuve aurlbuLes
knowledge, self-emcacy, locus of conLrol, amLudes, bellefs, percepuons
rovlde a rauonale or mouvauon Lo perform a glven behavlor

hase 4 Lducauonal & Crganlzauonal
ulagnosls
! 8elnforclng facLors
Soclal supporL
arenLs, famlly members, co-workers, peers, frlends, healLh care provlders,
supervlsors " lnuenual medla
! Lnabllng facLors
AsslsL ln promoung Lhe chosen acuon
Lducauonal resources, supporuve pollcles, changes, sklll developmenL
envlronmenLal
3$4! )5!%.6% /,7!%8-!) 9/( !$%# 9$%1/(
hase 3 AdmlnlsLrauve & ollcy
ulagnosls
! SLep 1
lan for ume uullzauon & personnel needs
Canu charLs
! SLep 2
AssessmenL of avallable resources
MaLerlal needs (educauonal, compuLer), bulldlng needs, Lralnlng or re-
Lralnlng of personnel
! SLep 3
ldenukasl hambaLan " nanclal, goal conlcL, change, commlLmenL
ollcy dlagnosls
! Step 1:
! assess policies, regulations, organization
! Determine loyalty of personnel,
! Are your goals consistent within the organization?
! Do you have the flexibility to do new things?
! Is there a flexibility for the administrators to determine policy
implementation?
ollcy dlagnosls
! Step 2: assessment the politics
! Who wlLhln Lhe organlzauon and ouLslde of Lhe organlzauon wanL Lhls Lo
succeed?
! A plan for maxlmlzlng lnvolvemenL of Lhose who can help
hase 6 lmplemenLauon
! Programs are like a child, it needs room to breathe,
experiment, adapt to new circumstances & people
! Checklist " process evaluation begins
hase 7 rocess Lvaluauon
! Do what you said that you would do
! Following the Gantt charts
! Changes, have been documented?
! Methods " interview, focus group, paper trail
! Discussions center on predisposing, reinforcing, & enabling
factors
hase 8 lmpacL Lvaluauon
! Dapat diukur " changes as set out by the objectives (phase 3)
! Planning " how changes would be measured
! Umumnya, ukuran pensil dan kertas, ukuran observasi dan
catatan.
hase 9 CuLcome Lvaluauon
! Are you achieving the program goals?
! Usually done by examining the bottom line after a few years of
programming
SLrengLhs vs. LlmlLauons
:1(!"+1#) ;.2.1$8/")
8anyak dlgunakan 1erganLung pada lnpuL &
experL analysls
lase 1 dapaL dllakukan secara
kolekuf
1ldak menekankan pada
kondlsl soslo-envlronmenLal
romosl paruslpasl komunlLas
se[ak proses awal
Cenderung berorlenLasl pada
masalah darl pada hasll yang
posluf
1ersedla formaL unLuk
ldenukasl fakLor LerkalL,
perllaku, dan program
Menekankan pada program
pelayanan dl LempaL prakLek
SLrengLhs vs. LlmlLauons
:1(!"+1#) ;.2.1$8/")
1erlnLegrasl dengan
banyak Leorl promosl
kesehaLan
MembuLuhkan banyak
daLa, survey, dan caLaLan
Selmbang anLara kapaslLas
unLuk melaksanakan &
kebuLuhan
8ahaya/ yang udak
dllnglnkan unLuk slLausl
LerLenLu
8LCLuL-8CCLLu MCuLL
8ogers' (1993) uluslon of lnnovauon
! Pow new ldeas, producLs, and behavlors become norms
! All levels: lndlvldual, lnLerpersonal, communlLy, and organlzauonal
! Success deLermlned by: naLure of lnnovauon, communlcauon channels,
adopuon ume, soclal sysLem
8ogers' (1993) uluslon of lnnovauon
! naLure of lnnovauon
! 8elauve advanLage over whaL ls belng replaced
! Compauble wlLh values of lnLended users
! Lasy Lo use
! CpporLunlLy Lo Lry lnnovauon
! 1anglble beneLs
8ogers' (1993) uluslon of lnnovauon
! Communlcauon channels
! Mass medla (enhanced by llsLenlng groups, call-ln opporLunlues, and face-Lo-face
approaches
! eers
! 8especLed leaders
8ogers' (1993) uluslon of lnnovauon
! Adopuon ume
! Awareness " lnLenuon " adopuon " change
! Cradual
! MovemenL Lhrough groups
! loneers
! Larly adopLers
! masses
8ogers' (1993) uluslon of lnnovauon
! Soclal sysLem
! ldenufy lnuenual neLworks Lo dluse lnnovauon: healLh sysLems, schools,
rellglous and pollucal groups, soclal clubs, unlons, and lnformal assoclauons
! ldenufy oplnlon leaders, peers, and LargeLed medla channels Lo dluse
lnnovauons

8ogers' (1993) uluslon of lnnovauon
! SLage of adopuon
! Awareness - Lhe lndlvldual ls exposed Lo Lhe lnnovauon buL lacks compleLe
lnformauon abouL lL
! lnLeresL - Lhe lndlvldual becomes lnLeresLed ln Lhe new ldeas and seeks addluonal
lnformauon abouL lL
! Lvaluauon - lndlvldual menLally applles Lhe lnnovauon Lo hls presenL and
anuclpaLe fuLure slLuauon, and Lhen decldes wheLher or noL Lo Lry lL
! 1rlal - Lhe lndlvldual makes full use of Lhe lnnovauon
! Adopuon - Lhe lndlvldual decldes Lo conunue Lhe full use of Lhe lnnovauon
Soclal Markeung
! 8rlngs abouL behavlor change
! More cosL eecuve by reachlng larger numbers
Soclal Markeung
! 1he four 's of Soclal markeung
! roducL
! rlce
! lace
! romouon
Soclal Markeung
! roducL
! WhaL we are oerlng people:
! Servlce
! 8ehavlor
! CommodlLy (Langlble beneLs)
Soclal Markeung
! roducL musL be:
! Soluuon Lo a problem
! 8eneLs
! unlque
! Compeuuve
! 8eal
! uened ln Lerms of Lhe user's bellefs, pracuces and values
Soclal Markeung
! rlce
! 1he cosL of adopung Lhe producL
! Money
! 1lme
! leasure
! Loss of self-esLeem
! LmbrrassmenL
Soclal Markeung
! lace
! Channels for lnformauon
! Where servlce ls provlded
! Where lnformauon ls recelved
! Where Langlble producL ls purchased
! Avallable
! Lasy Lo nd and use
! ApproprlaLe
! 1lmely
Soclal Markeung
! romouon
! Message deslgn elemenLs
! 1ype of appeal
! 1one
! Spokesperson
PealLh romouon SLraLegles: Cuawa
CharLer 3 SLraLegles
! Cuawa CharLer (1986) dened Lhe prerequlslLes for healLh
! eace'shelLer
! Lducauon
! lood
! lncome
! A sLable ecosysLem
! SusLalnable resources
! Soclal [usuce
! LqulLy
(led Lo Lhe developmenL of Lhe deLermlnanLs of healLh)
Cuawa CharLer for healLh romouon
(1986)
! 8ulldlng healLhy publlc pollcy
! Collaborauve eorL Lo deLermlne Lhe lmporLanL areas where pollcles can make a
dlerence
! lL shapes how money, power, and maLerlal resources are spread ouL ln socleLy
Cuawa CharLer for healLh romouon
(1986)
! Creaung supporuve envlronmenLs
! Pelp Lo ensure LhaL physlcal envlronmenLs are healLhy and safe
! SLrengLhenlng communlLy acuon
! 8efers Lo communlLy developmenL approach
! PealLh professlonals help communlLy members ldenufy lmporLanL lssues
Cuawa CharLer for healLh romouon
(1986)
! ueveloplng personal skllls
! Pelps cllenLs develop personal skllls, coplng and galnlng conLrol over Lhelr healLh
and envlronmenL
! 8eorlenLauon healLh servlces
! lmprove access Lo prlmary healLh care, lmprovemenL ln communlLy based
servlces, lncreased famlly care and publlc paruclpauon
PealLh romouon Across Semngs
! lamlly
! School
! Workplace: facLory, healLh cenLer, hosplLal
! MarkeL place
! CommunlLy: vlllage, Lown, clLy
PealLh romouon for vulnerable Croups
! vulnerable groups have greaLesL rlsk of poor physlologlcal, psychologlcal,
soclal and splrlLual healLh ouLcomes
! LllmlnaLe healLh dlsparlues
! rovlde culLural compeLenL healLh promouon program