THEORIES AND MODELS OF HEALTH BEHAVIOUR

THEORIES AND MODELS OF HEALTH BEHAVIOURdr. Roro Rukmi Windi Perdani, M.KesBag IKKOM/IKM Fakultas Kedokteran Unila

THEORIES AND MODELS OF HEALTH BEHAVIOURPrecede-Procede model/ Theory of L.GreenTheory of L.BlumTheory of Reasoned actionTheory of Planned BehaviourSocial Learning theoryTheory of Behaviour Application analysisTheory diffusion innovationTranstheoritical modelThe Stages of substances use theoryCommunication/persuasion theoryTheory A-B-CHealth Belief ModelBasics of protection motivation theorySocial cognitive theoryCognitive consistency theory

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PRECEDE-PROCEDE Model/ Theory of L.Green

HEALTH PROMOTION

PredisposingFactor

ReinforcingFactor

Enabling Factor

BehaviourAndLifestyleEnvironment

Health

QualityOf life

The Precede-Proceed model for health promotion planning and evaluation Phase 1 Social diagnosis

Phase 2EpidemiologicaldiagnosisPhase 3Behavioral andEnvironmentaldiagnosisPhase 4Educational andOrganizationaldiagnosisPhase 5Administrative andPolicy diagnosisPhase 6 Implementation

Phase 7 Process Phase 8 Impact Phase 9 OutcomeHealth EducationPolicyRegulationorganization

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Behaviour

Environment

Health Quality oflife

Social indicators -Absenteeism-Achievement-Aesthetics-Alienation-Comfort-Crime-Crowding-Discrimination-Happiness-Hostility-Illigitimacy-Performance RiotsSelf-esteemUnemploymentWelfareVital Indicators :-Disability-Discomfort-Fertility-Fitness-Morbidity-Mortality-Physiological risk factorsDimensions :-Distribution-Duration-Functional level-Incidence -Intensity-Longevity-PrevalenceEnvironmentalIndicators :EconomicPhysicalServicesSocial

Dimensions :AccessAffordabilityEquityBehavioralIndicators :-Compliance-Consumption pattern-Coping-Preventive action-Self-care -Utilization

Dimensions:-Frequency-Persistence -Promptness-Quality-Range

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Behavior(Actions)of individuals,groups, orcommunitiesEnvironmentalfactorsPredisposingFactors:-Knowledge-Attitudes-Beliefs-Values-PerceptionReinforcing Factors:-Attitudes and behavior of health personnel and other, peers, parents,employers, etcEnabling factors:-Availability of resources-Accessibility-Referrals-rules and laws-SkillsHealth educationComponentof healthPromotionprogramPolicyRegulationorganization

Direct CommunicationTo public,Patients, Employees, etc

IndirectCommunicat.Through staffTraining,Supervision,ConsultationfeedbackTrainingCommunityorganization

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Precede = Pendahulu

P = PredisposingR = ReinforcingE = EnablingC = Constructs inE = Educational EnvironmentalD = DiagnosisE = EvaluationProceed = Proses yang berlangsung dan hasilnyaP = PolicyR = RegulatoryO = OrganizationalC = Constructs inE = Educational and E = EnvironmentalD = DevelopmentPrecede :Menjamin sebuah program yang akan dilaksanakan sesuai dengan kebutuhan dan Keinginan individu/masyarakat

Proceed :Menjamin program yang akan dijalankan akan :tersedia sumber dayanyaMudah diakses/dicapaiDapat diterima secara politik dan peraturan yang adaDapat dievaluasi oleh policy makers, consumers, dan administrators

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Theory of Reasoned actionTheory of Planned Behaviour

THE THEORY OF REASONED ACTION

Behaviour

BehaviourIntention

Important normsAttitudes towardsThe behaviour

SubjectiveNorms

Believe about outcomesEvaluation of these outcomesBelieve about important othersAttitudes to theBehaviour

Motivation to comply with important others

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THE THEORY OF PLANNED BEHAVIOUR

Behaviour

BehaviourIntention

Attitudes towardsThe behaviour

SubjectiveNorms

Believe about outcomesEvaluation of these outcomesBelieve about important othersAttitudes to theBehaviour

Motivation to comply with important others

Internal control factors

External control factors

Behaviouralcontrol

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Social Learning Theory

Social learning theoryPERSON/INDIVIDUPERILAKU

LINGKUNGAN

Reinforcement

Outcome expectationSelf-efficacy

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1941, Neil Miller & John DollardKita belajar (learn) meniru perilaku orang lain, bukan semata karena instink social learning (pembelajaran sosial)Perilaku peniruan (imitative behavior) terjadi karena kita merasa mendapat imbalan bila meniru perilaku orang lain dan mendapat hukuman ketika kita tidak menirunya1959, 1963, Albert Bandura & Richart WaltersKita belajar dengan observational learning, pembelajaran melalui pengamatan. Misal : perilaku agresif anak setelah mengamati perilaku agresif dalam film kartun1971, BanduraTeori pembelajaran sosial tidak hanya menggunakan pendekatan perilaku, namun perlu pertimbangan proses mental

Menurut BanduraSocial Learning Theory Bagaimana kita dipengaruhi oleh lingkungan melalui penguatan (reinforcement) dan observational learningCara pandang & cara pikir yang kita miliki terhadap informasiSebaliknya, perilaku kita mempengaruhi lingkungan kita dan menciptakan penguatan (reinforcement) dan observational opportunity, peluang bisa diamati oleh orang lain

Teori Bandura memfokuskan pada hubungan segitiga antara orang (menyangkut proses kognitif), perilaku dan lingkungan yang saling mempengaruhiLearning didapat melalui 3 proses :Direct experience (pengalaman langsung)Indirect or vicarious experience from observing other (modelling)The storing and processing of complex information in cognitive operation that enable one of complex information the concequences of actions, represent goals in thought and weight evidence from various sources to asses oness own capabilities (penyimpanan & pemrosesan informasi yang kompleks dalam kognitif yang memungkinkan seseorang untuk mengantisipasi konsekuensi tindakan, merepresentasikan tujuan pemikiran & pembuktian bermacam-macam sumber untuk menaksir kemampuannya sendiri)

Perilaku sebagai akibat adanya self efficacy (kemampuan diri) dan harapan terhadap hasil dari perilaku tersebut.Pengalaman dan suatu perilaku yang mendukung kognitif seseorangPemahaman terhadap pengalaman orang lain.Proses pemahaman terhadap orang lain (vicarious learning)Memperhatikan modelMengingat apa-apa yang telah diobservasiMeniru perilakuMemperkuat perilaku

Modeling : penambahan dan atau pengurangan tingkah laku yang teramati, menggeneralisir berbagai pengamatan sekaligus melibatkan proses kognitifProses modelling :Perhatian : dipengaruhi oleh asosiasi pengamat terhadap model, sifat model & arti penting tingkah laku yang diamatiRepresentasi : tingkah laku yang akan ditiru harus disimbolisasikan dalam ingatanPeniruan tingkah laku : pengamat harus punya kemampuan menirukan perilaku modelMotivasiPenguatanResiprocal determinism : seseorang akan bertingkah laku dalam situasi yang dia pilih secara aktif

Social Learning TheoryPerson / Individu

Perilaku Lingkungan Self EfficacyReinforcementOutcome expectation

Person / IndividuPengetahuanSikapPersepsiNiatPerilaku / action / tindakanLingkunganTemanKeluargaTetangga(lebih pada norma group)Dampak yang diharapkanKemampuan diriTinggiRendah PenguatanPositifNegatif

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TRANS THEORETICAL MODEL OF BEHAVIOUR CHANGE

TRANS THEORETICAL MODEL OF BEHAVIOUR CHANGEPrecontemplationNot intending to make any changes

ContemplationConsidering a change

Preparation Make small changes

ActionActively engaging in a new behaviour

MaintenanceSustaining the change overtime

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Health Believe Model

Basics of Health Belief ModelCues to actionSusceptibilitySeverityBenefitsCostsLikelihood ofBehaviourDemographicVariable

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Susceptibility to illness ( My chances of getting lung cancer are high)

The severity of the illness ( Lung cancer is a serious illness)

The cost involved in carrying out the behaviour ( Stopping smoking will make me irritable)

The benefits involved (Stopping smoking will save me money)

Cues to action Internal ( The symptom of breathlessness) External ( Information from leaflet)

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End of the slide