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Dasar Kesehatan Masyarakat

Fa k u l t a s Ke s e h a t a n M a s y a r a k a t
Universitas Indonesia

ILMU SOSIAL-PERILAKU
DAN
K E S E H ATA N M A S YA R A K AT

Public Health 101, Richard


Riegelman, 2010
Program Sarjana Kesehatan Masyarakat, FKM UI, 2

LEARNING OBJECTIVES

1. Menjelaskan hubungan antara ilmu sosial, ilmu perilaku,


dan kesehatan masyarakat
2. Mengilustrasikan bagaimana status sosial ekonomi dapat
mempengaruhi kesehatan
3. Mengilustrasikan bagaimana budaya dan agama dapat
mempengaruhi kesehatan
4. Mengidentifikasi dan mengilustrasikan tahapan dalam
perubahan perilaku yang membentuk tahapan model
perubahan
5. Mengidentifikasi cara intervensi di tingkat individu
ataupun sosial dapat memperkuat satu sama lain dalam
mempengaruhi perubahan perilaku
6. Menjelaskan prinsip pemasaran sosial

D a s a r Ke s e h a t a n M a s y a r a k a t
P r o g r a m S 1 Ke s e h a t a n M a s y a r a k a t

P E N G A N TA R
S a a t k i t a p erg i ke su a tu n e g a r a d i A s i a , k i t a a ka n
menemukan bahwa budaya disana hampir
m e m p e n g a r u h i se t i a p a s p ek ke h i d u p a n m ereka .
Mulai dari apa yang mereka makan, cara
m e m a s a k n y a , p er i l a ku ke p u s a t p e l a y a n a n
m a s y a r a ka t , ke p erc a y a a n m e reka a ka n p e n y eb a b
penyakit serta kemampuan mereka dal am
m e n g u b a h n y a m el a l u i u p a y a ke se h a t a n m a s y a r a ka t .

Bagaimana kebudayaan berpengaruh pada aspek kesehatan

Bagaimana sosial ekonomi berpengaruh pada aspek kesehatan

Bagaimana agama berpengaruh pada aspek kesehatan

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#3
yaraka

K E S E H ATA N M A S YA R A K AT D A N I L M U S O S I A L - P E R I L A K U
Social
Science
Discipline

Examples of Disciplinary Contributions to Public


Health

Psychology

Theories of the origins of behavior and risk taking tendencies and


methods for altering individual and social behaviors

Sociology

Theories of social development, organizational behavior, and


systems thinking. Social impacts on individual and group behaviors

Anthropolog
y

Social and cultural influences on individual and population decision


making for health with a global perspective

Political
science/Publ
ic policy

Approaches to government and policy making related to public


health. Structures for policy analysis and the impact on
government on public health decision making

Economics

Understanding the micro- and macroeconomic impact on public


health and health care systems

Communicat Theory and practice of mass personalized communication and the


ion
role of media in communicating health information and health risks
Demograph
y

Understanding demographic changes in populations globally due to


aging, migration, and differences in birth rates, plus their impact
on health and society

Understanding the impacts of geography on disease and


I
l
m
u
S o s i a l -ofP disease,
e r i l a kasuwell
d aasn methods
K e s e for
h adisplaying
t a n M aand
s#4
yaraka
Geography
determinants

E N G A R U H S TAT U S S O S I A L- E KO N O M I PA DA K E S E H ATA N M A S YA RA KAT

Pe n d a p a t a n E ko n o m i

A k s e s ke Pe l a y a n a n Ke s e h a t a n

S t a t u s Pe n d i d i ka n

Angka Harapan Hidup

Status
Kesehat
an

Status Sosial
Ekonomi

Ke t e r p a p a r a n a k a n
R i s i ko Pe n y a k i t

S t a t u s S o s i a l E ko n o m i

Ko n t r o l d a n p a r t i s i p a s i s o s i a l d i b u t u h k a n u n t u k
menjelaskan perbedaan-perbedaan substansial dalam
ke s eh a t a n
Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#5
yaraka

E N G A R U H S TAT U S S O S I A L- E KO N O M I PA DA K E S E H ATA N M A S YA RA KAT


Type

Examples

Living
conditions

Increases in sanitation, reductions in crowding, methods of


heating and cooking

Overall
educational
opportunities

Education is the strongest association with health behaviors and


health outcomes
May be due to better appreciation of factors associated with
disease and greater and ability to control these factors

Educational
opportunities
for women

Education for women has an impact on the health of children


and families

Occupational
exposures

Lower socioeconomic jobs are traditionally associated with


increased exposures to health risks

Access to
goods and
services

Ability to access goods, such as protective devices and high


quality foods and services, including medical and social services
to protect and promote health

Family size

Large family size affect health and its traditionally associated


with lower socioeconomic status and with lower health status

Exposures to
high risk
behaviors

Social alienation related to poverty may be associated with


violence, drugs, other high risk behaviors

I l m u Lower
S o s isocioeconomic
a l - P e r i l a status
k u dassociated
a n K e s with
e h agreater
t a n exposure
M a s#6
y ator a k a

P E N G A R U H B U D AYA PA D A K E S E H ATA N M A S YA R A K AT

Ke b u d a y a a n b e r h u b u n g a n d e n g a n p e r i l a ku s e s e o r a n g .
Budaya dapat menentukan yang baik dan buruk
ataupun yang sehat dan tidak sehat. Hal ini
berhubungan dengan

g ay a h i d u p ,

ke p e r c ay a a n a k a n s u a t u r i s i ko , d a n
ke p e r c ay a a n a k a n t i p e t u b u h

contohnya

beber apa kebudayaan yang menganggap ber tubuh


besar merupakan simbol sehat

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#7
yaraka

P E N G A R U H B U D AYA PA D A K E S E H ATA N M A S YA R A K AT

Ways That Culture


May Affect Health

Examples

Culture is related to
behavior social practices
may put individuals and
groups at increased or
reduced risk

Food preferences vegetarian, Mediterranean


diet
Cooking methods
History of binding of feet in China
Female genital mutilation
Role of exercise

Culture is related to
response to symptoms, such
as level of urgency to
recognize symptoms, seek
care, and communicate
symptoms

Cultural differences in seeking care and selfmedication


Social, family, and work structures provide
varying degree of social support low degree of
social support may be associated with reduced
health-related quality of life

Culture is related to the


types of interventions that
are acceptable

Variation of degree of acceptance of traditional


Western medicine including reliance of self-help
and traditional healers

Culture is relates to the


Cultural differences in follow-up, adherence to
response to disease and for
treatment, and acceptance of adverse outcome
interventions
I l m u S o s i a l - P e r i l a k u d a n K e s e h a t a n M a s#8
yaraka

P E N G A R U H A G A M A PA D A K E S E H ATA N M A S YA R A K AT

Agama dapat memberikan pengaruh


p e n t i n g p a d a ke s e h a t a n .

Contoh: Khitanan

p a d a ka u m l a k i - l a k i d a p a t m en u r u n ka n r i s i ko a ka n
H I V / A I D S . Pe r i l a ku d a l a m a g a m a d a p a t m e m b e r i ka n
dampak secara langsung maupun tidak langsung akan
st a t u s ke se h a t a n s es eo r a n g

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#9
yaraka

P E N G A R U H A G A M A PA D A K E S E H ATA N M A S YA R A K AT

Ways That Religion


May Affect Health
Religion may affect social
practices that put
individuals at increased or
reduced risk

Examples

Sexual: circumcision, use of contraceptive


Food: avoidance of seafood, pork, beef
Alcohol use: part of religion versus
prohibited
Tobacco use: actively discouraged by
Mormons and Seventh-Day Adventists as
part of their religion

Religion may affect


response to symptoms

Christian Scientist reject medical care as a


response to symptoms

Religion may affect the


types of interventions that
are acceptable

Religion may affect the


response to disease and to
interventions

Role of prayer as an intervention to alter


outcome

Ilmu

Prohibition against blood transfusions


Attitudes toward stem cell research
Attitude toward abortion
End-of-life treatments

Sosial-Perilaku

dan

Kesehatan

M a s#10
yaraka

P E R U B A H A N P E R I L A K U K E S E H ATA N

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#11
yaraka

P E R U B A H A N P E R I L A K U K E S E H ATA N

Perubahan
Perilaku

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#12
yaraka

P E R U B A H A N P E R I L A K U K E S E H ATA N

U p ay a
Perubaha
n Perilaku

Ilmu

A s p e k fi s i k , s o s i a l , e k o n o m i s e r i n g
menjadi pengahalang dalam upaya
p e r u b a h an p er ila ku m es k ip u n
individu tersebut sudah
t e r m o t i fi k a s i

Sosial-Perilaku

dan

Kesehatan

M a s#13
yaraka

U PAYA P E R U B A H A N P E R I L A K U K E S E H ATA N

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#14
yaraka

S TA G E S O F C H A N G E M O D E L

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#15
yaraka

S TA G E S O F C H A N G E M O D E L
Stage of Change
1.
Precontemplatio
n

Actions

Example-Cigarette Smoking

Prognosticate

Individual not
considering change

Assessing readiness for


change-timing is key

2. Contemplation

Motivate change

Individual thinks
actively about the
health risk and
action requires to
reduce the risk
Issue of change is
on the individuals
agenda but no
action

Ilmu

Provide information
focused on short and
intermediate gains from
behavioral change, as
well as long-term
benefits
Doubtful, dire and
distant impacts are less
effective

Establish baseline to assess


S
o s i aofl the
- P problem,
erilaku
severity

Determine individuals readiness to


quit. If not ready, indicate
receptivity to help in the future
Look for receptive timing such as
during acute respiratory symptoms
Social factors, such as workplace
and indoor restriction on smoking
and taxation, increase likelihood of
entering pre contemplation phase

Reinforce increase in exercise level,


reduction in cough, financial
savings, serving as example to
children, protection of fetus, etc.
Also continue to inform of longer
term effects on health

d
a n Klog
e of
s etiming,
h a t frequency,
a n M a and
s#16
yaraka
Develop

S TA G E S O F C H A N G E M O D E L
Stage of
Change
3. Preparation

Prepare for
action including
developing a
plan and setting
a timetable

Actions

Example-Cigarette Smoking

Plan change
Set specific measurable
and obtainable goals
with deadlines

Quit date or possible tapering if


heavy smoker

Two or more well


chosen simultaneous
interventions may
maximize effectiveness

Family support, peer support,


individual planning, medication,
etc. may reinforce and multiply
impacts

Recognize habitual
nature of existing
behavior and remove
associated activities

Ilmu

Sosial-Perilaku

Remove cigarettes, ashtrays,


and other associated smoking
equipment
Remove personal and
environmental impacts of past
smoking, such as teeth
cleaning and cleaning drapery
Anticipate temptations, such
as associations with food,
drink, and social occasions

dan

Kesehatan

M a s#17
yaraka

S TA G E S O F C H A N G E M O D E L
Stage of Change
4. Action

Actions

Example-Cigarette Smoking

Reinforce change
Provide/suggest tangible
rewards

Provide rewards, such as alternative


use of money focus on personal
hygiene or personal environment

Observable
changes in
behavior with
potential for
relapse

Positive feedback
encouragement of new
behavior
Anticipate adverse effects
and frustrations

Utilize group/peer support

Ilmu

Sosial-Perilaku

Focus on measurable progress


toward new behavior
Provide receptive environment,
but avoid focus on excuses
Take short term one-day-at-a-time
approach
Recognize cravings and have plan
including use of medications
Recognize potential for symptoms
to worsen at first before
improvement occurs
Anticipate potential for weight
gain and encourage exercise and
other behaviors to reduce
potential for weight gain

Family and peer reinforcement critical


during action phase

dan

Kesehatan

M a s#18
yaraka

S TA G E S O F C H A N G E M O D E L
Stage of
Change
5.
Maintenance

New behavior
needs to be
consolidated as
past of
permanent
lifestyle change

Ilmu

Actions

Example-Cigarette Smoking

Maintain change
Practice/reinforce
methods for
maintaining new
behavior

Avoid old associations and


prepare/practice response when
encountering old circumstances

Recognize long term


nature of behavioral
change and need for
supportive peers and
social reinforcement

Negative social attitudes toward


smoking among peers and
society along with social
restrictions, such as limiting
public indoor smoking and social
actions, such as taxation, help
prevent smoking and reinforce
maintenance of cessation

Sosial-Perilaku

dan

Kesehatan

M a s#19
yaraka

SOCIAL MARKETING

S e b u a h u p ay a p e n e r ap an p e n d e kata n m a r ke tin g
u n tu k m e r u b a h p e ri laku s e kel om p ok or an g
S o c ia l m ar keti n g m e r u p a kan b e n tu k p en g g u n aan
d a n p e r lu asa n p ro d u k m ar ke tin g tr a d is ion al.
B eb er a p a u p a y a so sia l m a r ke tin g :

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#20
yaraka

4Ps SOCIAL MARKETING

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#21
yaraka

TIPE ADOPTER

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#22
yaraka

I M P L E M E N TA S I P E R U B A H A N P E R I L A K U

Perubahan perilaku akan lebih sukses


a p a b i l a t e r d a p a t u p ay a
m e n g ko m b i n a s i k a n a n t a r a i n d i v i d u ,
ke l o m p o k b e r i s i ko , d a n p o p u l a s i , a t a u
m a s y a r a k a t s e c a r a ke s e l u r u h a n .

Ilmu

Sosial-Perilaku

dan

Kesehatan

M a s#23
yaraka

Change is a non-linear
process that sometimes
re quire s yo u t o t a ke a
step back before you
move forward

D a s a r Ke s e h a t a n M a s y a r a k a t
P r o g r a m S 1 Ke s e h a t a n M a s y a r a k a t

Dasar Kesehatan Masyarakat


Fa k u l t a s Ke s e h a t a n M a s y a r a k a t
Universitas Indonesia

ILMU SOSIAL-PERILAKU
DAN
K E S E H ATA N M A S YA R A K AT
Daftar Pustaka: Public Health 101, Richard
Riegelman, 2010
S e k i a n d a n Te r i m a k a s i