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Desain promosi kesehatan pada level individu, keluarga, kelompok, dan komunitas DESY INDRA YANI COMMUNITY HEALTH NURSING
Desain promosi kesehatan pada level individu,
keluarga, kelompok, dan komunitas
DESY INDRA YANI
COMMUNITY HEALTH NURSING DEPARTMENT
FACULTY OF NURSING
UNIVERSITAS PADJADJARAN
S
Continuum of Health Promotion Practice S  Se#ngs and Suppor.ve Environments S  Community Ac.on S  Health Informa.on
Continuum of Health Promotion
Practice
S  Se#ngs and Suppor.ve Environments
S  Community Ac.on
S  Health Informa.on and Social Marke.ng
S  Health Educa.on and Skills Development
S  Screening, Individual Risk Assessment and Immunisa.on
Primary prevention S  Primary preven.on focuses on changing behaviors to prevent illness from occurring. S  For
Primary prevention
S  Primary preven.on focuses on changing behaviors to prevent
illness from occurring.
S  For example, a primary preven.on program for HIV-nega.ve
individuals would aim to prevent infec.on by promo.ng the
use of condoms and other safe-sex strategies.
Secondary prevention S  Secondary preven.on interven.ons are those that occur aIer the individual has been diag-
Secondary prevention
S  Secondary preven.on interven.ons are those that occur aIer the
individual has been diag- nosed with a condi.on, disease, or illness
and seek to stop or reverse its progression.
S  In the case of HIV, a secondary preven.on interven.on would focus
on behavior change to prevent other strains of the virus from
infec.ng those already infected.
S  Current health policy emphasizes secondary preven.on, although it
has been argued that devo.ng more resources to primary
interven.on might benefit popula.on health more substan.ally
(Kaplan, 2000).
Tertiary prevention S  Ter/ary preven.on interven.ons seek to control the devasta.ng complica.ons of an illness or
Tertiary prevention
S  Ter/ary preven.on interven.ons seek to control the
devasta.ng complica.ons of an illness or nega.ve health
condi.on.
S  An interven.on to get hospitalized cancer pa.ents to give up
smoking to promote recovery from their surgery is an example
of a ter.ary preven.on interven.on.
Individual-level interventions S  Individual-level interven.ons are characterized by higher levels of personal interac.on between the targets
Individual-level interventions
S  Individual-level interven.ons are characterized by higher
levels of personal interac.on between the targets of the
interven.ons and their providers and are more likely to be
based on psychosocial or bio- medical explana.ons for
behavior.
S  An example is a program to reduce smoking prevalence by
having physicians provide advice and support for smoking
cessa.on (Goldstein et al., 1997).
Individual-level interventions S  Evalua.ons of such interven.ons led to the recommenda.on in 1996 by the United
Individual-level interventions
S  Evalua.ons of such interven.ons led to the recommenda.on
in 1996 by the United States Agency for Health Care Policy and
Research (AHCPR) that physicians prac.ce the “Four Rs”
during their pa.ents’ checkups:
S  emphasize the risks of smoking, the rewards of qui#ng,
S  the relevance of the risks of smoking to the smoker
S  (and the rewards of qui#ng), and
S  repe
..
on
of these messages (Fiore, Jorenby, & Baker, 1997).
Individual-level interventions S  Family members or friends can also become involved in S  individual-level approaches. S 
Individual-level interventions
S  Family members or friends can also become involved in
S  individual-level approaches.
S  For example, social pressure by a spouse or family members to
change an individual’s behavior (i.e., social control) has been
associated with the degree to which spouses reduce their
levels of smoking (Westmaas, Wild, & Ferrence, 2002).
Design HP Level of preven.on •  Primary preven.on •  Secondary preven.on •  Ter.ary preven.on Approach • 
Design HP
Level of
preven.on
•  Primary preven.on
•  Secondary preven.on
•  Ter.ary preven.on
Approach
•  The amount of financial resources available
•  Poli.cal considera.ons
•  Findings from prior preven.on/interven.on research
•  The likelihood of community coopera.on
•  The believed causes of the behavior or illness in ques.on.
Steps in designing prevention interventions S  deciding who should be the target of the interven.on. S 
Steps in designing prevention
interventions
S  deciding who should be the target of the interven.on.
S  This decision should be partly related to whether the focus of the
interven.on is primary, secondary, or ter.ary preven.on.
S  Many illness-promo.ng behaviors begin during youth or
adolescence, and so primary interven.ons will oIen need to
target individuals in these age groups.
Steps in designing prevention interventions S  Iden.fy health issue(s) S  What: Health issues amenable to health
Steps in designing prevention
interventions
S  Iden.fy health issue(s)
S  What: Health issues amenable to health promo.on programmes
S  With: Community, public health providers,etc
S  Based on:
S  Health needs analysis
S  Other local, regional, na.onal strategic priori.es
Steps in designing prevention interventions S  Priori.se health issues S  What: Health issues amenable to health
Steps in designing prevention
interventions
S  Priori.se health issues
S  What: Health issues amenable to health promo.on programmes
S  With: Community, public health providers,etc
S  Based on:
S  Local informa.on from above
S  Other local, regional and na.onal programmes
Steps in designing prevention interventions S  Develop health promo.on programmes S  What: Health issues amenable to
Steps in designing prevention
interventions
S  Develop health promo.on programmes
S  What: Health issues amenable to health promo.on programmes
S  With: Community, public health providers,etc
S  Based on:
S  A Guide to Developing Health Promo.on Programmes in Primary
Health Care Se#ngs
S  Evidence-based prac.ce
S  Workforce capability and capacity
Steps in designing prevention interventions S  Funding for Implementa.on of Health Promo.on Programmes S  What: Health
Steps in designing prevention
interventions
S  Funding for Implementa.on of Health Promo.on Programmes
S  What: Health issues amenable to health promo.on programmes
S  With: Community, public health providers,etc
S  Based on:
PLANNING HP PROGRAM S
PLANNING HP
PROGRAM
S
PLANNING Planning is a series of decisions, from general strategic decisions (e.g., iden.fying priori.es), to specific
PLANNING
Planning is a series of decisions, from general strategic decisions
(e.g., iden.fying priori.es),
to specific opera.onal details (e.g., program implementa.on) ,
based on the collec.on and analysis of a wide range of
informa.on.
WHY PLAN? S  To get from your star.ng point to your desired end point. S  To
WHY PLAN?
S  To get from your star.ng point to your desired end point.
S  To direct resources to where they will have the greatest
impact.
S  To ensure the development and implementa.on of effec.ve
and appropriate health promo.on programming.
Relationship between planning types: purpose
Relationship between planning
types: purpose
Relationship between planning types: scope
Relationship between planning
types: scope
Relationship between planning types: time required for completion
Relationship between planning
types: time required for completion
Relationship between planning types: stakeholders
Relationship between planning
types: stakeholders
The 6 steps to planning a health promotion program
The 6 steps to planning a health
promotion program
Step 1: manage the planning process S  Factors to consider: S  On sider up front but
Step 1: manage the planning
process
S  Factors to consider:
S  On sider up front but re-visit
regularly
S  Par.cipa.on
S  Time
S  Money/resources
S  Data-gathering
S  Decision-making
S  Document—these could become
terms of reference or a project
charter
S  Resul.ng document usually goes
forward for stakeholder approval
Participation S  Par.cipa.on of clients, staff and stakeholders is cri.cal S  Plan with people, not for
Participation
S  Par.cipa.on of clients, staff and stakeholders is cri.cal
S  Plan with people, not for them
S  Involve stakeholders in every step of the process
Time S  Par.cipatory planning takes longer S  The par.cipatory ideals of health promo.on planning can, and
Time
S  Par.cipatory planning takes longer
S  The par.cipatory ideals of health promo.on planning can, and
oIen do, conflict with poli.cal and cost issues
Money/ Resources S  Includes allocated funds, staff, volunteers, .me of year, equipment, space, etc. S  Includes
Money/ Resources
S  Includes allocated funds, staff, volunteers, .me of year,
equipment, space, etc.
S  Includes in-kind contribu.ons from partners
S  Consider short-term expense versus long-term pay-off
Data Gathering S  What informa.on do you need to make programming decisions? • Step 2: situa.onal
Data Gathering
S  What informa.on do you need to make programming decisions?
• Step 2: situa.onal assessment will
S  focus on this in more detail
S  In making the case for your plan, what will decision-makers need to
know?
S  Look for data on underlying determinants of health issues (income,
educa.on, social support, employment and working condi.ons, etc.)
Data Gathering (2) S  Look for best prac.ces on your issue S  Use literature syntheses/reviews S 
Data Gathering (2)
S  Look for best prac.ces on your issue
S  Use literature syntheses/reviews
S  Examine theories underlying priority health issues
Decision Making S  Decisions about .me lines and alloca.on of resources are required throughout the planning
Decision Making
S  Decisions about .me lines and alloca.on of resources are
required throughout the planning process
S  It can be a challenge to make .mely decisions throughout the
planning process
S  Consider the poli.cal context in which you are planning
S  Ul.mately you will need to decide whether the condi.ons are
right to proceed with planning
Step 2: conduct a situational assessment S  Situa.onal assessment is similar to a need as assessment
Step 2: conduct a situational
assessment
S  Situa.onal assessment is similar to a need as assessment except:
S  It looks beyond the individual to the surrounding environment (social
determinants of health)
S  Takes into account mul.ple sources of informa.on
S  Emphasizes strengths—what is working well?—rather than deficits—
S  what is not working?
S  Situa.onal assessments apply to popula.ons, rather than individuals
S  A snapshot of the present used to plan for the future
Why conduct a situational assessment? S  To learn more about popula.on of interest(i.e., who's affected by
Why conduct a situational
assessment?
S  To learn more about popula.on of interest(i.e., who's affected
by your health issue)
S  To an.cipate trends and issues that may affect the
implementa.on of your program
S  To iden.fy community wants, needs, assets
S  To set priori.es
S  To inform pending decisions regarding your program
6 steps to conducting a situational assessment S  Iden.fy key ques.ons to be answered through the
6 steps to conducting a
situational assessment
S  Iden.fy key ques.ons to be answered through the situa.onal
assessment
S  Develop a data-gathering plan
S  Gather the data
S  Organize, synthesize and summarize the data
S  Communicate the informa.on
S  Consider how to proceed with planning
Identify key questions to be answered through the situational assessment S  A situa.onal assessment should answer
Identify key questions to be
answered through the
situational assessment
S  A situa.onal assessment should answer three ques.ons:
S  What is the situa.on?
S  What is making the situa.on beler and what is making it worse?
S  What possible solu.ons, interven.ons and ac.ons can you take
to deal with the situa.on?
Develop a data-gathering plan S  Use diverse types of data S  e.g., survey data, evalua.on findings,
Develop a data-gathering plan
S  Use diverse types of data
S  e.g., survey data, evalua.on findings, best prac.ce syntheses/
guidelines, community stories, stakeholder mandates, etc.
S  Use diverse data-collec.on methods
S  e.g., stakeholder consulta.ons, surveys, literature reviews, etc.
S  Use diverse sources of data
S  e.g., community spokespersons, journals, consultants,
professional associa.ons, resource centres, etc.
Gather the data S  Make sure the people collec.ng data have the right skills to do
Gather the data
S  Make sure the people collec.ng data have the right skills to do it
properly
S  Keep good records about where the data came from so that you can
weight it accordingly and reference it as you move into decision-
making
S  For example consider:
S  Was the study published in a peer-reviewed journal or an unpublished
report?
S  Who analyzed the informa.on – researchers or community members?
Organize, synthesize and summarize the data S  Organize the findings by the original three key ques.ons:
Organize, synthesize and
summarize the data
S  Organize the findings by the original three key ques.ons:
S  What is the situa.on?
S  What is making the situa.on beler and what is making it
worse?
S  What possible solu.ons, interven.ons and ac.ons can you
take to deal with the situa.on?
What is the situation? S  Summarize the trends, public percep.ons ,and stakeholder concerns. S  Examples of
What is the situation?
S  Summarize the trends, public percep.ons ,and stakeholder
concerns.
S  Examples of ques6ons you can ask:
S  What impact is the current situa.on having on health, quality of
life and other societal costs?
S  What groups of people are at highest risk of health and quality of
life problems?
S  What se#ngs or situa.ons are high risk ,or pose a unique
opportunity for interven.on?
What is making the situation better or worse? (analyze inYluences) S  Risky or nega.ve behaviours? S 
What is making the situation better
or worse? (analyze inYluences)
S  Risky or nega.ve behaviours?
S  What makes people behave in these ways?
S  Poli.cal , economic, environmental, social and technological trends?
(PEEST)
S  Condi.ons in the social and organiza.onal environment and society?
S  Internal strengths and weaknesses? Opportuni.es and threats in
your environment? (SWOT)
What is making the situation better or worse? (analyze inYluences)
What is making the situation better or
worse? (analyze inYluences)
Analyze inYluences on the situation S  At what level of the environment does this factor influence
Analyze inYluences on the
situation
S  At what level of the environment
does this factor influence the
situa.on – individual, network,
organiza.onal, or societal?
What possible solutions, interventions and actions can you take to deal with the situation? S  List
What possible solutions, interventions and
actions can you take to deal with the
situation?
S  List all of the possible ac.ons that may be taken to address
your issue
S  Keep track of the source of the informa.on
S  Note informa.on available about effec.veness and feasibility
to help with later priori.za.on efforts
Communicate the information S  Summarize results in a variety of ways for different learning styles. S 
Communicate the information
S  Summarize results in a variety of ways for different learning styles.
S  For example, supplement words with visuals (diagrams, tables,
graphs, etc.)
S  Use different communica.on approaches for different audiences.
S  For example, provide reports of different lengths for different
audiences
(e.g., one-page lis.ng of key findings, execu.ve summary, full
report).
Consider how to proceed with planning S  Is your data complete? S  Do you have sufficient
Consider how to proceed with
planning
S  Is your data complete?
S  Do you have sufficient resources to make an impact on the
situa.on?
S  What are your next steps?
Step 3: set goals, population(s) of interest and objectives S  Goals usually: S  Are encompassing or
Step 3: set goals, population(s)
of interest and objectives
S  Goals usually:
S  Are encompassing or global
S  Include all aspects of a program
S  Provide overall direc.on
S  Are general in nature
S  Take a long .me to complete
S  Do not have a deadline
S  Are not observed, but inferred because they include words like
evaluate, know, improve, and understand
S  Are not measurable
Program goal example – NutriSTEP® program (nutrition screening tool for every preschooler) S  The goal of
Program goal example – NutriSTEP® program
(nutrition screening tool for every preschooler)
S  The goal of the NutriSTEP® program is to improve the
nutri.onal health of young Ontario preschool children.
Terminology varies Terms Alterna6ves Ac6vi6es Goal Indicators Objec6ves Outcome evalua6on Popula6on of interest Resources Strategies Process
Terminology varies
Terms
Alterna6ves
Ac6vi6es
Goal
Indicators
Objec6ves
Outcome evalua6on
Popula6on of interest
Resources
Strategies
Process objec6ves, implementa6on objec6ves
Purpose, mission
Benchmarks, criteria for success, outputs
Outcomes, impacts, effects
Summa6ve evalua6on
Target group, audience, community
Budget, assets, inputs
Components, ini6a6ve, interven6on
Objectives
Objectives
Process versus outcome objective S  Process objec6ves • Describeprogramac6vityandimplementa6on • Some.mesknownasprogramtrackingormonitoring S  Outcome objec6ves • Describewhatsuccesswouldbefortheprogram
Process versus outcome
objective
S  Process objec6ves
• Describeprogramac6vityandimplementa6on
• Some.mesknownasprogramtrackingormonitoring
S  Outcome objec6ves
• Describewhatsuccesswouldbefortheprogram
• DescribeeffectsoIheprogramac.vi.esatproducingchange
Elements of a well-written process objective
Elements of a well-written
process objective
Examples of process objectives in four elements
Examples of process objectives
in four elements
Elements of a well-written outcome objective
Elements of a well-written
outcome objective
Set outcome objectives for four levels
Set outcome objectives for four
levels
Set outcome objectives for four levels
Set outcome objectives for four
levels
Set outcome objectives for four levels
Set outcome objectives for four
levels
Set outcome objectives for four levels: individual
Set outcome objectives for four
levels: individual
Set outcome objectives for four levels: social/network
Set outcome objectives for four
levels: social/network
Set outcome objectives for four levels: organization
Set outcome objectives for four
levels: organization
Set outcome objectives for four levels: society
Set outcome objectives for four
levels: society
Examples of outcome objectives in four elements
Examples of outcome objectives
in four elements
Step 4: choose strategies and activities and assign resources
Step 4: choose strategies and
activities and assign resources
Step 4: choose strategies and activities and assign resources
Step 4: choose strategies and
activities and assign resources
Step 5: develop indicators
Step 5: develop indicators
Examples of indicators S  Objec6ve S  By the end of the year, all Toronto hospitals have
Examples of indicators
S  Objec6ve
S  By the end of the year, all Toronto hospitals have policies,
procedures and prac.ces which promote and support breast-
feeding
S  Indicator
S  % of hospitals with baby-friendly designa.on
Step 6: review the plan
Step 6: review the plan