Introduction

Health Promotion
dr. Harun Al Rasyid, MPH
 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
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
 Educational
 Organizational
 Economic
 Social
 Political
 Meaningful participation (what is this?)

To
 Enable
 Individuals
 Groups
 Whole communities
 to 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 Action
Organizational 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 behaviours
Reduce 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 health
enhance 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 prevention
sensitive to cultural needs
 Health Promotion
health education
- behavioural
- structural
attitudinal
-------------------------
behavioural
organisational
environmental
actions Improved
and
------------------------- Health
social
economic status
changes
actions
conducive
-------------------------
to health
political actions
Including advocacy
 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
Actualization
needs

self esteem needs

lovely belonging needs

safety needs

physiological needs
 Health Belief Model
Perceived susceptibility
to problem

Perceived threat
Perceived seriousness
of consequences of problem Self-efficacy
(perceived
ability to carry
Perceived benefits out
of specified action recommended
action)
Perceived expectations

Perceived barriers
to taking actions

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
Cognitive
factors (e.g.
factors (e.g.
Social norms,
Expectations,
access to
attitudes)
community)

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!