PERAN & PERILAKU MANUSIA

DALAM KONTEKS SEHAT DAN

SAKIT
Itsna Luthfi K., S.Kep., Ns.
Tujuan Pembelajaran
Setelah mengikuti kuliah ini, mahasiswa akan:
 Memahami istilah-istilah kunci
 Mengeksplorasi mengenai peran dan perilaku
kesehatan
 Mendapatkan overview mengenai model peran
dan perilaku kesehatan
 Mengidentifikasi implikasi konsep sehat dan sakit
dalam merumuskan rencana asuhan keperawatan
Istilah-istilah Kunci
 Sehat, Sakit (illness & disease)
 Perilaku Kesehatan & Peran Sakit
 Pengetahuan dan Perilaku
 Sikap, Nilai dan Perilaku
 Model Perubahan Perilaku
SEHAT & SAKIT
WHO Definition of Health

“Health is a state of complete physical,

mental, and social well being, and not
merely the absence of disease or
infirmity”
Definitions of Illness and Disease
 Illness is a reaction to a  Disease is defined
change in one’s
physical state. It is very
individual and has
social and physical
connotations and is
influenced by one’s age,
gender, education,
experience, culture,
mental state, and
resources
professionally,
usually by a
physician. It is the
basis for medical
practice and therapy.
It is also the
framework for the
organization of the
health care system
and it’s resources.
Confusions on disease and illness

 One can have a disease and not be ill

 One may be ill and not have a disease
 One may have both disease and illness
Medical Model of Disease
 Deviation from normal
 specific and universal
 caused by unique biological forces
 like the breakdown of a machine
 defined and treated through a neutral
scientific process
Health is determined by interaction of
interrelated variables

 genetics or biological determinants

 behavior (diet and lifestyle habits)
 pre-and postnatal environments
(physical, biologic, economic, and
social)
 the health care system
PERILAKU KESEHATAN
&
PERAN SAKIT
 Perilaku Kesehatan

Aktivitas yang bertujuan untuk pencegahan

penyakit dan deteksi penyakit pada stadium
asimptomatik
 Perilaku Kesehatan

 Human behavior, especially health behavior, is complex

and not always readily understandable
 Health behavior, like other behavior, is motivated by
stimuli in an individual’s environment
 The response to such stimuli may or may not be directly
related to health
 Motivation which leads to health influencing behavior
may also not be related to health
 Motivation for health behavior is dynamic and not static
Tipe Perilaku Kesehatan
 Health-directed behavior
Observable acts that are undertaken with a
specific health outcome in mind

 Health-related behavior
Those actions that a person does that may
have health implications, but are not
undertaken with a specific health objective in
mind
Types Of Health-related Behavior
 Preventive Health Behavior
action taken when a person wants to avoid
being ill or having a problem e.g. a mother takes
her child for immunization

 Illness Behavior
action taken when a person recognizes signs or
symptoms that suggest a pending illness e.g. a
mother gives her child cough medicine after
hearing her wheeze
Types Of Health-related Behavior
 Sick-role Behavior
action taken once an individual has been
diagnosed (either self or medical diagnosis)
e.g. a mother decides that her child has
malaria and takes him to the clinic for
treatment
Illness Behavior (Mechanic, 1962)
 The ways in which given symptoms may be:
Differentially perceived
Evaluated
Acted upon (or not acted upon) by different
kinds of person
Illness Behavior (Harding &Taylor, 2002)
 An active rather than passive process that involves
interpreting symptoms, evaluating possible
responses and, finally, deciding on whether to try to
alleviate those symptoms or simply to ignore them.

 Influenced by the individual’s interpretations of an

appropriate response to symptoms
 pre-existing belief systems determined culturally & experientially
 influenced by dialogue with others & societal norms & values
 may be initiated by one person on behalf of another – the “lay
referral system”
 Sick Role Behavior (Parson, 1951)
Right and Responsibility of Sick Person

 Freedom from blame  To do everything

for illness possible to recover
 Exemption from  To seek competent
normal roles and care
tasks
Determinan Perilaku Kesehatan
 Psychological
 Socio-Cultural
Cultural differences in pain perception & responses
to pain (Zborowski,1952)
Pathways into & accessibility of child & adolescent
mental health services are highly ethnically,
culturally & socially determined (Daryanani et al,
2001)
 Economy
 Environmental
 Abnormal Illness Behavior
The persistence of a maladaptive mode of perceiving,
evaluating, and acting in relation to one’s own state of health,
despite that a doctor (or other appropriate social agent) has
offered a reasonably lucid and accurate explanation of the
nature of the illness and the appropriate course of management
to be followed with opportunities for discussion, negotiation and
clarification, based on a thorough examination and assessment
of all parameters of functioning (including the use of special
investigations where necessary), and taking into account the
patient’s age, educational and sociocultural background.

Pilowsky 1978.
PENGETAHUAN & PERILAKU
 PHASES BETWEEN
KNOWLEDGE & BEHAVIOUR
(Fishbein & Ajzen 1975)

Knowledge Putting the

of correct Perception Interpretation Salience knowledge
health action into action
Pengetahuan & Perilaku
 Tidak seharusnya diasumsikan bahwa
seseorang selalu berpengetahuan mengenai
perilaku kesehatan yang sesuai, tetapi harus
diasumsikan bahwa pengetahuan akan
menjamin perubahan pada perilaku

 Ketika pengetahuan dirasa penting maka hal ini

harus ditonjolkan kepada klien
Pengetahuan & Perilaku
 Transfer pengetahuan ke dalam tindakan
tergantung [pada faktor internal dan eksternal
yang luas, meliputi nilai-nilai, sikap dan
keyakinan

 Untuk sebagian orang, proses transfer

pengetahuan ini memerlukan keahlian
khusus (enabling factors) yang dapat berupa
keterampilan interpersonal
SIKAP, NILAI-NILAI DAN
PERILAKU
Sikap, Nilai-nilai dan Perilaku
 Attitudes are value-ladened social judgements
which possess a strong evaluative component

 Attitudes have different components - cognitive

(belief), emotional (feeling) and behavioural
(predispositions to act)

 There is no clear or linear progression from

attitudes to behavior, but equally, behavior change
may precede and influence attitudes
Sikap, Nilai-nilai dan Perilaku
 An individual’s attitude to a specific action and
their intention to adopt it is influenced by:
beliefs, motivation which comes from the person’s
values, attitudes and drives (instincts), and
the influence from social norms
 A belief represents the information a person
has about an object or action. It links the object
to some attribute.
 Values are acquired through socialization and
are those emotionally charged beliefs which
make up what a person thinks is important.
MODEL PERUBAHAN
PERILAKU
Model Perubahan Perilaku
 The model identifies a number of stages which a
person can go through during the process of
behavior change
 It takes a holistic approach, integrating a range of
factors such as the role of personal responsibility
and choices, and the impact of social and
environmental forces that set very real limits on
the individual potential for behaviour change
 It provides a framework for a wide range of
potential interventions by health promoters
1. THE COGNITIVE DISSONANCE MODEL
(Festinger-1957)

 The model holds that inconsistency is a

painful or uncomfortable state
 Since dissonance is psychologically
uncomfortable, it will motivate an individual
to reduce dissonance to achieve
consonance
 In addition, the individual will actively avoid
situations and information that are likely to
increase the dissonance
COGNITIVE DISSONANCE MODEL

 The consequences of this are vital for anyone

involved in the process of influence
 For example, if a respected role model with
whom an individual identifies makes a
statement or declaration with which the
individual disagrees, consonance is achieved
by either:
(a) changing the belief, or
(b) changing attitudes to the respected person
2. MASLOW’S HIERARCHY OF NEEDS
(Maslow - 1968)
MASLOW’S HIERARCHY OF NEEDS

Self-actualization needs - to
find self-fulfilment and
realise one’s own potential
Esteem needs - to
achieve, be competent, Belongingness
and gain approval and and love needs
recognition to affiliate with
others, be
accepted and
being
Safety needs - to feel secure and safe, out
of danger

Basic physiological needs - hunger, thirst and related

needs
MASLOW’S HIERARCHY OF NEEDS

 Behavior is motivated by a hierarchy of

human needs
 Explains why not everybody responds to
the obviously beneficial and well-
meaning interventions
 Health needs may be compromised for
the sake of satisfaction of low-order
needs
3. THE HEALTH BELIEF MODEL
(Rosenstock and Becker - 1974)

“Two major factors influence the likelihood that a

person will adopt a recommended preventive
health action

First they must feel personally threatened by

disease i.e. they must feel personally susceptible to
a disease with serious or severe consequences

Second they must believe that the benefits of

taking the preventive action outweigh the perceived
barriers to (and/or cost of) preventive action”
 HEALTH BELIEF MODEL (Visual)
IN D IV ID U A L M O D IF Y IN G L IK E L IH O O D
P E R C E P T IO N S FACTORS O F A C T IO N

D e m o g ra p h ic v a ria b le P erc eiv ed b e n efits

[a g e , se x , ra ce o f p re v en tiv e
e th n ic ity, etc .] a ctio n
S o c io -p syc h o lo g ic a l
v a ria b les m in u s

P erc eiv e d b a rriers

P e rc e iv e d to p re v e n tiv e
S u sc ep tib ility to P erc eiv ed T h rea t o f a ctio n
D ise a se “X ” D isea se “X ”
P erc eiv e d S e v e rity
o f D ise a se “X ” L ik e lih o o d o f T a k in g
R eco m m ended
P rev en tiv e H ea lth
C u e s T o A c tio n A ctio n
M a ss M e d ia C a m p a ig n s
A d v ic e fro m o th e rs
R e m in d e r p o stc a rd fro m p h y sicila n o r d en tist
Illn e s s o f fa m iliy m e m b er o r frie n d
N e w sp a p e r o r m ag az in e article
 HEALTH BELIEF MODEL (Detailed)
C oncept D e f in itio n A p p lic a tio n
P e r c e iv e d O n e ’s o p in io n o f c h a n c e s o f D e fin e p o p u la tio n (s) a t risk b a se d
S u sc e p tib ility g e ttin g a c o n d itio n o n a p e rso n ’s fe a tu re s o r b e h a v io u r.
H e ig h te n p e rc e iv e d su sc e p tib ility
if to o lo w

P e r c e iv e d O n e ’s o p in io n o f h o w se rio u s a S p e c ify c o n se q u e n c e s o f risk a n d

S e v e r ity c o n d itio n a n d its se q u e la e a re c o n d itio n

P e r c e iv e d O n e ’s o p in io n o f th e e ffic a c y o f D e fin e a c tio n to ta lk : h o w , w h e re ,

B e n e fits th e a d v ise d a c tio n to re d u c e risk o r w h e n ; c la rity th e p o sitiv e e ffe c ts to
se rio u sn e ss o f im p a c t b e e x p e c te d

P e r c e iv e d O n e ’s o p in io n o f th e ta n g ib le an d Id e n tify a n d re d u c e b a rrie rs
B a r r ie r s p syc h o lo g ic a l c o sts o f th e a d v ise d th ro u g h re a ssu ra n c e , in c e n tiv e s,
a c tio n a ssista n c e

C u e s to A c tio n S tra te g ie s to a c tiv a te “ re a d in e ss” P ro v id e h o w -to in fo rm a tio n ,

p ro m o te a w a r e n e ss, re m in d e rs

S e lf-E ffic a c y C o n fid e n c e o n o n e ’s a b ility to ta k e P ro v id e tra in in g , g u id a n c e in

a c tio n p e rfo rm in g a c tio n
 MODIFIED HEALTH BELIEF MODEL AS APPLIED TO
HIV/AIDS PROGRAMME
B e n e f it s / b a r r ie r s
P e r c e iv e d  C o n d o m s are
s u s c e p t ib ility e a s y to u s e , o n e
Y oung m an has c a n fe e l sa fe
P e r c e iv e d  C ondom s not
b e e n e n g a g in g in
T hreat r e a d ily a v a ila b le ,
s e x w ith m u ltip le
Y oung m an c o s tly
p a rtn e rs.
b e lie v e s th a t h e
is a t ris k b e c a u s e
fr ie n d is ill. D e s ir e d
B e h a v io u r
Y oung m an buys
P e r c e iv e d an d u ses co n d o m s
S e v e r ity C u e s t o A c t io n re g u la rly .
Y oung m an R a d io m e s s a g e s
b e lie v e s th a t e x p la in in g th e
A ID S is a d e a th n e e d fo r sa fe se x . S e lf- e ff ic a c y
s e n te n c e s in c e P e e r e d u c a tio n o n Y oung m an has
th e r e is n o c u re . s a fe s e x a n d H IV . h a d p ra c tic e u sin g
c o n d o m s a n d fe e ls
c o n fid e n t to u se
th e m .
4. THEORY OF REASONED ACTION
(Fishbein and Atzen - 1975)
 Proposes that voluntary behavior is predicted by
one’s intention to perform the behavior (e.g. how
likely is it that you will take up a quit smoking
program?)

 Intention, in turn, is a function of :

attitude towards the impending behavior (do you
feel good or bad about quitting?), and
 subjective norms (do most people who are
important to you think you should quit?)
THEORY OF REASONED ACTION
 Attitude is a function of beliefs about the
consequences of the behaviour (how
important do you think it is to quit?) weighted
by an evaluation of the importance of that
outcome (how important is it to you to quit?)
 Subjective norms are a function of
expectations of significant others (does your
spouse think you should quit?) weighted by
the motivation to conform (how important is
it to do what your spouse wants?)
 THEORY OF REASONED ACTION
External variables Beliefs that the
behaviour leads to
D em ographic certain outcomes
A ttitudes towards
variables the behaviour
A ge, sex, occupation
socio-economic Evaluation of the
status, religion, outcomes
education.
Relative
A ttitudes towards importance of
targets attitudinal and
A ttitude towards normative
people components
A ttitudes towards Beliefs that specific
institutions referents think I
should not perform Intention Behaviour
the behaviour
Personality traits
Introversion- Subjective norm
extraversion M otivation to
N euroticism comply with the
A uthoritarianism specific referents.
D ominance

Possible explanations for observed relations between external variables and behaviour.
Stable theoretical relations linking beliefs to behaviour.
5. STAGES OF CHANGE MODEL
(Prochaska and DiClemente -1984)
Exit:
Maintaining
‘safer’ lifestyle
Action: Maintenance:
Making Maintaining
changes change

Commitment: Relapse:
Ready to Relapsing
change back

Contemplating:
Thinking
Pre-contemplation about change
Not interested in
changing ‘risky’
lifestyle
Stages Of Change Model As Applied To Hiv/Aids Programme

Contemplation Decision/
Precontemplation Young man Determination
Young man has heard believes that he Young man is
about AIDS but and his friends ready & plans to
doesn’t think it is are at risk and use condoms
relevant to his life. thinks that he should so goes to a shop
do something. to buy them.

Maintenance Action
Wearing condoms Young man buys
has become a habit and uses condoms.
and young man
regularly buys them.
6. THE DIFFUSION OF INNOVATION
THEORY
(Rogers - 1962)
 The adoption of ideas in a community
diffuses among individuals in that
community at varying rates
 Early in the introduction of a new idea, it is
picked up by ‘innovators’. They want to
be the first to do things and they may not
be respected by others in the social
system.
THE DIFFUSION OF INNOVATION THEORY
(Rogers - 1962)

 The second group of people, the ‘early adopters’ who

are very interested in the innovation but they are not
the first to sign up. They wait until the innovators are
already involved to make sure the innovation is useful.
They are respected by others in the social system and
looked at as opinion leaders.

 The next group ‘early majority’ (about 34% of the

target population) may be interested in the
innovation but will need external motivation to
become involved, They will deliberate for some
time before making a decision.
 THE DIFFUSION OF INNOVATION
THEORY
(Rogers - 1962)
 The ‘late majority’ are next and it will take more
time to get them involved for they are skeptical and
will not adopt an innovation until most people in the
social system have done so.

 The last group the‘laggards’ (about 16% of the

target population are not very interested in
innovation and would be the last to become involved.
They are very traditional and are suspicious of
innovations. Laggards tend to have limited
communication networks, so they really do not know
much about new things.
 DIFFUSION OF INNOVATION PROCESS

Late adopters

Late majority

Early majority

Early adopters

Innovators

Time

Source: Green & MCAlister 1984.

 DIFFUSION MODEL

PRIOR CONDITIONS
1. Previous practice
2. Felt needs/problems
3. Innovativeness
4. Norms of social systems
COMMUNICATION CHANNELS

PERSUASION DECISION IMPLEMENTATION CONFIRMATION

KNOWLEDGE

Characteristics of Perceived Characteristics

the Decision of the Innovation
Making Unit: 1. Relative Advantage
1. Socio- 2. Compatibility 1. Adoption Continued Adoption
economic 3. Complexity Later Adoption
characteristics 4. Trialability
2. Personality 5. Observability
variables 2. Rejection Discontinuance
3. Communication Continued Rejection
behaviour
Referensi
1. Harris, Newman L. 2004. Origin, Recognize &
Management of Abnormal Illness Behavior.
Sydney: Annual Scientific Meeting Presentation.
2. Potter & Perry. 2005. Fundamentals of
Nursing: Concepts, Issues and Opportunities.
4th ed. Philadelphia: Lippincott-Raven Publisher
3. Taylor C, LilisC, Le Mone, P. 1997.
Fundamentals of Nursing: The Art and Science
of Nursing Care. Philadelphia: Lippincott-Raven
Publishers.
Terima Kasih