SOCIAL & BEHAVIORAL

THEORIES & FRAMEWORK

of Public Health
RST-21-FKM-S1

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 BERBAGAI FAKTOR SOSIAL &
PERILAKU dalam KESEHATAN
MASYARAKAT
• The Social Ecological Model of PH:
• Merupakan Kaitan Biologi, Perilaku & Budaya.
• Hampir semua kondisi Kesehatan/ penyakit mempunyai penyebab
multifaktor yg meliputi proses interaksi yg kompleks didalam &
diluar DIRI seseorang
• Misal STRESS dapat merupakan komponen dasar/ melatar
belakangi semua penyakit. Stres fisik dan psikologis dapat
mempunyai efek kemampuan seseorang utk melawan penyakit
dan restore Kesehatan/ mencapai kesembuhan.
- Infeksi akut & khronis

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 BERBAGAI FAKTOR SOSIAL &
PERILAKU dalam KESEHATAN
MASYARAKAT
• PENYAKIT: akibat menurunnya SISTIM PERTAHANAN TUBUH yang ALAMI –
internal : sangat sensitif terhadap emosi
- eksternal : stressor lingkungan hidup.
• STRESSOR : - POSITIF
- NEGATIF
• STRESSOR: - FISIK
- PSIKHIS
.* Kaplan,1991: Psychosocially mediated immunity is primary factor in
most people’s susceptibility to infection.
• Today, the role of stress in health is documented, research –a dynamic
field of study called PSYCHONEUROIMMUNILOGY

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 BERBAGAI FAKTOR SOSIAL & PERILAKU dalam KESEHATAN
MASYARAKAT

•SOCIAL SUPPORT  have PROTECTIVE EFFECT on wellbeing

interact with large network of friends & family members

. MANUSIA ….> MAHKLUK SOSIAL---> dukungan sosial antar sesama.
.
Link & Phelan, 1995:
Social environment can affect heath status, may through
social structural arrangement:
- education - income
- medical services - social status
- prestige

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 REFERENCES
• Corell, Jeannine, Carol A.Bryant & J.Nell Henderson, with
contributions from Melinda S. Fortholer and Gwendolyn P.Quinn.
2001. Social and Behavioral Foundations of Public Health. California
91320, Sage Publications.Inc.

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 Theories of human health behavior
1. WHO Experts Theory of Health Behavior
B = f (TF,RF,R,C)
B = Behavior
f = function of
TF = Thought and Feeling
RP = Reference Person
R = Resources
C = Culture

2. Snehandu B. Kar Theory of Health Behavior

B = f(BI,SS,AI,PA,AS)
B = Behavior
f = Function of
BI = Behavior Intention
SS = Social Support
AI = Availability of Information
PA = Personal Autonomy
AS = Action Situation
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 1. PRECEDE PROCEED Theory of Lawrence W. Green
B = f (PF,RF,EF)
B = Behavior
f = function of
PF = Predisposing Factors
RF = Reinforcing Factors
EF = Enabling Factors

2. The Health Belief Model

 Berasal dari Stimulus Respons Theory dan Cognitive Theory
 S-R Theory : Belajar adalah hasil dari pengalaman berbagai kejadian
yang mengurangi dorongan yang menggerakkan perilaku. Bila ada
suatu kejadian yang tidak mengenakkan akan mengurangi
kemungkinan bahwa pengalaman tersebut akan diulang. Demikian
pula sebaliknya. Oleh karena itu reward yang langsung dirasakan
akan memunculkan kemungkinan kegiatan yang mendatangkan
reward tersebut akan diulang.
Cognitive Theory menegaskan adanya nilai subjective harapan (expectation)
yang akan diterima akibat dari suatu tindakan. Nilai subyektif ini dapat positif
maupun negatif. Bila dikaitkan dengan perilaku kesehatan, menghindari sesuatu
yang

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  menyebabkan sakit merupakan nilai subyektif positif karena dapat
mengakibatkan tidak sakit.
 Harapan tersebut kemudian diterjemahkan kedalam kemungkinan
dirinya sakit (perceived susceptibility) dan seberapa parah
(perceived severity) akibat sakit tersebut. Theory ini dikembangkan
Hochbaum (1952) dengan meneliti sekitar 1200 orang di 3 kota
tentang kesediaan mereka dilakukan screening thdp Tuberkulosis.
Perceived susceptibility terdiri dari dua komponen yaitu (1)
responden percaya bahwa kemungkinan menderita tuberculosis
tidak hanya sekedar secara matematis mungkin tetapi kemungkinan
tersebut sangat realistis. (2) responden perccaya bahwa mereka
dapat mengidap tuberculosis tanpa diserta tanda-tanda spesifik atau
bahkan tanpa gejala sama sekali.
 Faktor lain adalah adanya harapan positif bila mereka melakukan
skrining tuberculosis (perceived benefits) yang terdiri dari dua
komponen yaitu (1) skrining foto dada bisa mendeteksi tuberculosis
walaupun tanpa gejala, dan (2) kepercayaan bahwa dengan
diketemukannya tuberculosis secara dini maka prognosis untuk
sembuh menjadi sangat besar. Harapan positif ini akan direduksi
dengan adanya perasaan adanya hambatan untuk melakukan
tindakan pencegahan (perceived barriers)
 Variabel lain yang ikut mempengaruhi persepsi individu terhadap
suatu kejadian penyakit yang secara tidak langsung juga
berpengaruh terhadap health-related behavior antara lain (1)
variabel sosiodemografi, (2) ‘tanda/gejala yan dilami atau dilihat
yang mengarah kepada tanda atau gejala penyakit (cues)

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02/06/2023 S1-Nov-21-RST-Social-Behavior 9
1. Theory of Reasoned Action
 Ajzen & Fishbein (1975) mengatakan bahwa tindakan menusia, termasuk tindakan dalam hal
kesehatan selalu ada alasannya (reasoned). Jadi perilaku kesehatan (health behavior)
merupakan suatu proses rasional.
 Munculnya tindakan ini selalu didahului adanya niat untuk bertindak atau berperilaku tertentu
(behavior intention)

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1. Theory of Planned Behavior (Icek Ajzen, 1982)
Perkembangan lebih lanjut dari Theory of Reasoned Action, Ajzen
mengatakan bahwa terdapat satu variabel lagi yang dapat mendorong
seseorang bertindak yaitu perasaan mampu mengendalikan perilaku yang
akan dilakukan (Perceived Behavior Control). Perceived Behavior Control
sangat mirip dengan dengan konsep Bandura mengenai Perceived self-
efficacy yaitu perasaan seseorang terhadap kemampuan dirinya melakukan
suatu tindakan atau perilaku dalam situasi tertentu (.... is concernned with
judgements of how well one can execute courses of action required to deal
with prospective situation....., Bandura 1982) . Perceived

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02/06/2023 S1-Nov-21-RST-Social-Behavior 12
 MAJOR CONCEPTS IN SOCIAL
COGNITIVE THEORY AND
IMPLICATIONS FOR
INTERVENTION

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 SOCIAL COGNITIVE THEORY
ITS-SLT-SCT-RST-2005

PERSON

BEHAVIOR ENVIRONMENT
RECIPROCAL
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 Concept Definition Implications
ENVIRON Factors physically Provide opportunities &
MENT
external to the social support
person
SITUATIO Person’s Correct misperceptions
N
perception of the & promote healthful
environment norms
BEHAVIOR Knowledge & skill Promote mastery
AL to perform a given
CAPABILI
learning through skills
behavior training
TY
EXPECTAT Anticipatory Model positive outcomes
IONS outcomes of a of healthful behavior
behavior
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 EXPECTA The values that the Present outcomes of
NCIES person places on a change that have
given outcome, functional meaning
incentives
SELF Personal regulation Provide opportunities for
CONTROL of goal-directed self-monitoring, goal
behavior or setting, problem solving
performance
& self-reward
OBSERVA Behavioral Include credible role
TIONAL - acquisition that
LEARNING
models of the targeted
occurs by watching behavior
the actions and
outcomes of others’
behavior

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Concept Definition Implications
REINFORC Responses to a Promote Self-initiated
EMENTS person’s behavior rewards and incentives
that increase or
decrease the
likelihood of
reoccurence
SELF- The Person’s Approach Behavioral
EFFICACY confidence in change in small steps to
performing a ensure success; seek
particular behavior specificity about the change
sought.
EMOTION Strategies or tactics Provide training in problem
AL that are used by a solving and stress
COPING person to deal with management; include
RESPONSE
S
emotional stimuli opportunities to practice
skills in emotionally
arousing situations.

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 EMOTION Strategies or tactics
Provide training in problem
AL that are used by a solving and stress
COPING person to deal with management; include
RESPONSE
S
emotional stimuli opportunities to practice
skills in emotionally
arousing situations.
RECIPROC The dynamic Consider multiple avenues
AL interaction of the to behavioral change
DETERMIN person, the behavior, including environmental,
ISM
and the environment skill, and personal change
in which the
behavior is
performed

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 EMOTION Strategies or tactics Provide training in problem
AL that are used by a solving and stress
COPING person to deal with management; include
RESPONSE
S
emotional stimuli opportunities to practice
skills in emotionally
arousing situations.
RECIPROC The dynamic Consider multiple avenues
AL interaction of the to behavioral change
DETERMIN person, the behavior, including environmental,
ISM
and the environment skill, and personal change
in which the
behavior is
performed

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BLUM’S
THEORY

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 BLUM’s THEORY
GE
NETIK
CONGENITAL
HEREDITER

LINGK: STATUS
FISIK,BIO, KES.
SOSEK.KUL.P0L SARANA YAN. KES
KLIEN

KLIEN:
Perilaku,
nilai,norm
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a
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 PERILAKU

PERILAKU : f ( P.S.T)
 (BEHAVIOUR): f ( K.A.P)
f : fungsi
K : Knowlegde (s) – Pengetahuan—SOSIALISASI—
KIE.
A : Attitude (s) – Sikap PEER EDUCATION
P : Practice (s) – Praktik ..Tindakan-
PELATIHAN/TRAINING
INGAT MATERI H.Education & H.Promotion!!!

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 PERILAKU

PERILAKU : f ( P.S.T)
 (BEHAVIOUR): f ( K.A.P)
f : fungsi
K : Knowlegde (s) – Pengetahuan—SOSIALISASI—
KIE.
A : Attitude (s) – Sikap PEER EDUCATION
P : Practice (s) – Praktik ..Tindakan-
PELATIHAN/TRAINING
INGAT MATERI H.Education & H.Promotion!!!

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 MATERI HE-HP: Five levels of Prevention
(Leavell & Clark)

Primary Prevention:
1. Health Promotion } Really Healthy People (DIET, Exercise, Vitamin
C, B compl, E, CavitD3, Feeling happy)
2. Specific Protection }
Secondary Prevention:
1. Early Diagnosis & Prompt Treatment – early sign/s of the
disease/s
2. Disability Limitation -- motivation to comply: Protokol Kes.
Tertiary Prevention:
1. Rehabilitation – income capacity building (Pandemi Covid!!!)
- physical/ social Rehabilitation

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 DAFTAR PUSTAKA

• DIGNAN, Mark B, Patricia A.Carr, 1992.

PROGRAM PLANNING FOR HEALTH
EDUCATION AND PROMOTION, 2nd ed.Lea &
Febiger, USA.
GLANZ, Karen, Barbara K,Rimer, K.Viswanath,
Editors, 2008. HEALTH BEHAVIOR AND
HEALTH EDUCATION, Theory
Research, and Practice, 4th Edition. Jossey-
Bass, San Franscisco

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