HEALTH PROMOTION

Basic Concepts of Health Promotion

Definition of health promotion                         

Health promotion is an effort to empower individuals, groups and communities to maintain, improve and protect their health through increasing knowledge, willingness, and ability as well as developing a supportive climate, carried out from, by and for the community in accordance with local cultural factors. (Depkes RI, 2006 quoted by Ferry Efendi and Makhfudi, 2009)

Health Promotion Limits

According to Soekidjo Notoatmodjo, (2007) Education in general is all efforts that are planned to influence other people, whether individuals, groups or communities, so that they do what is expected by educators. From this limitation, it is implied that the elements of education are:

• Inputs are educational targets (individuals, groups, communities) and educators (educational actors)
• Process (planned effort to influence others)
• Output (does what is expected or behavior)

While promotional education is the application or application of education in the health sector. The expected output of a health promotion is health behavior, or behavior to maintain and improve conducive health. Changes in behavior that are not yet or are not conducive to conducive behavior contain the following dimensions: (1) behavior change , (2) behavior development , (3) behavior development.

Health Promotion Goals

According to Soekidjo Notoatmodjo, (2007) the purpose of health promotion is inseparable from the Health Law No.23/1992, as well as the WHO, namely to increase the ability of the community to maintain and improve health status, both physically, mentally and socially so that they are economically and socially productive. To achieve this goal, efforts need to be made, these efforts can be formulated into 3 points:

• Advocate

Conduct advocacy activities for decision makers in various programs and sectors related to health. Advocating means making efforts to make decision makers or policy makers believe and believe that the health program offered needs to be supported through policies or political decisions.

• Bridging (Mediate)

Become a bridge and establish partnerships with various programs and sectors related to health.

• Enable (Enable)

Provide the ability or skills to the community so that they are able to maintain and improve their own health independently.

Health Promotion Strategy

Soekidjo Notoatmodjo (2007) quotes from WHO (1984), the Health Promotion Strategy, namely:

• Advocacy _ _ _

The goal is for decision makers to issue policies that benefit public health.

• Social Support ( social support)

The purpose of this activity is for health promotion activities to get support from community leaders and religious leaders.

• Community Empowerment ( empowerment )

The goal is for people to have the ability to maintain and improve their own health.

Soekidjo Notoatmodjo (2007) quotes from the Ottawa charter (1986) Health Promotion Strategy, namely:

• Health Insight Policy (Healthy public policy)

Policies aimed at decision makers or policy makers. So that health-oriented development policies are issued or developed.

• Supportive environment

This activity is aimed at leaders of community organizations as well as managers of public places. Their activities are expected to pay attention to the impact on the environment, both the physical environment and the non-physical environment that supports or is conducive to public health.  

• Reorient health services

Public health is not only a problem for service providers, both government and private, but also a problem for the community itself.

• Individual Skills (Personal skills)

Public health is aggregate health, consisting of groups, families, and individuals. Therefore, public health health is realized if the health of the group, the health of each family, and the health of the individual are realized. Therefore improving the skills of every member of the community to be able to maintain and improve their own health is very important.

• Community Movement (Community action)

Increasing community activities in seeking to improve their own health is a manifestation of the community movement.

Health Promotion Goals

According to Notoatmodjo (2003) the targets of health education are:

• Primary Target (Primary Target)

Society in general has a direct target for any education or health promotion efforts. In accordance with health problems, these targets can be grouped into: heads of household for general health problems, pregnant and lactating mothers for MCH issues, school children for adolescent health, and so on.

• Sasaran Sekunder (secondary target)

Community leaders, religious leaders, traditional leaders, and so on

• Tertiary target (Tertiary target)

Decision makers or policy makers both at the central and regional levels are tertiary targets for health promotion.

Scope of Health Promotion

According to Soekidjo Notoatmodjo (2007), the scope of health promotion, both as a science and an art, is very broad. The coverage can be seen from 2 dimensions, namely: the dimension of the aspect of health services, and the dimension of the order or place of implementation of health promotion.

• Scope Based on Health Aspect

It has become a general agreement that public health includes four main aspects, namely: promotive, preventive, curative, and rehabilitative. Other experts only divide it into 2 aspects, namely: a) promotive aspects targeting healthy groups of people, and b) preventive (prevention) and curative (healing) aspects targeting groups of people who are at high risk of disease and sick groups. In line with this description, the scope of health promotion is also grouped into two, namely:

• Health promotion on the promotive aspect

The target of health promotion in this aspect is a group of healthy people. So far, the healthy group of people has received less attention in public health efforts.

• Health promotion on prevention and cure aspects.

In this aspect, health promotion efforts include 3 efforts or activities, namely:

• First level prevention (primary prevention)

The targets of health promotion in this aspect are groups of people who are at high risk, for example groups of pregnant and lactating women, smokers, obesity and so on. The goal is that they do not fall sick or get sick.

• Second level prevention (secondary prevention)

The target of health promotion in this aspect is people with chronic diseases, such as asthma, DM, rheumatism, and so on. The goal is for patients to be able to prevent the disease from getting worse.

• Third level prevention (Tertiary prevention)

The target of health promotion in this aspect is a group of patients who have just recovered from an illness. The goal is for them to recover their health soon.

• Scope of Health Promotion Based on Implementation Order

Based on the order or place of implementation of health promotion, the scope of this health promotion can be grouped into:

• Health Promotion in the Family Order

The family is the smallest unit of society. Therefore, to achieve healthy community behavior, it must start from each family.

• Health promotion in school settings

Schools are an extension of health education for families. Therefore, the school environment, both a healthy physical environment and social environment, will greatly affect the healthy behavior of children.

• Health promotion in the workplace

The workplace is a place where adults earn a living for their families. A healthy work environment will support the health of workers or employees and the results will produce optimal productivity.

• Promotion in public places

The managers of public places are targets of health promotion so that they equip public places with facilities, in addition to making hygiene and health appeals for users of public places or the community through loudspeakers, posters, leaflets, and so on.

• Health care facilities

These health facilities include hospitals, health centers, polyclinics, maternity homes, and so on

• Scope Based on Service Level

Based on the dimensions of the level of health services, health promotion can be carried out based on 5 levels of prevention, namely:

• Health promotion

Health promotion activities include improving children's nutrition, repairing sewers, making healthy latrines for families.

• Special protection (Specific protection)

Special protection activities such as the provision of mandatory immunizations such as BCG, DPT<, polio, measles and hepatitis. Provision of recommended immunizations such as Mump, Rubella, influenza.

• Early diagnosis and prompt treatment

Finding early cases of various diseases in the community to avoid further consequences, such as finding cases of pulmonary TB, malnutrition and withered paralysis in several parts of Indonesia.

• Disability limitations

Health education is given to prevent further consequences on individuals from disability due to the disease they are experiencing.

• Rehabilitation (Rehabilitation)

Health education is given to targets who have treated certain diseases, so that it does not reoccur, it is necessary to complete rehabilitation so that individuals are able to carry out activities according to their abilities. 

Behavior in Health Promotion

According to Soekidjo Notoatmodjo (2007) behavior is the second largest factor after environmental factors that affect the health of individuals, groups or communities. In general, intervention on behavioral factors can be done through two conflicting efforts. Each of these efforts has advantages and disadvantages. Both efforts are carried out through:

• Pressure (Enforcement)

Efforts to make people change their behavior or adopt health behaviors by means of pressure, coercion. This effort can be in the form of laws or regulations, instructions, pressures (physical or non-physical), sanctions and so on.

• Education

Efforts to make people behave or adopt health behaviors by means of persuasion, persuasion, appeals, invitations, providing information, providing awareness and so on, through activities called health education or promotion. In order for these efforts to be effective, prior to intervention, it is necessary to diagnose or analyze the behavior problem. The general concept used to diagnose behavior is the concept of Lawrence Green (1980) quoted by Notoatmodjo (2007) behavior is influenced by 3 factors, namely:

• Predisposing factors (Predisposing factors)

These factors include: knowledge and attitudes of the community towards health, traditions and beliefs of the community on matters related to health, the value system adopted by the community, education level and socio-economic level. These factors, especially those that are positive, facilitate the realization of behavior, so they are often called facilitating factors.

• Enabling Factors

Includes the availability of facilities and infrastructure or health facilities for the community including health services such as health centers, hospitals, and so on. This facility essentially supports or allows the realization of health behavior so that it is called a supporting or enabling factor.

• Reinforcing factor (Reinforcing factor)

These factors include the attitudes and behavior of the community, religious leaders and the behavior of health workers, as well as laws, regulations from the central and regional governments related to health. To behave in a healthy manner, the community sometimes not only needs knowledge and a positive attitude and support for facilities, but also requires exemplary behavior from the community, religious leaders, health workers. Besides that, the law is also needed to strengthen people's behavior.

Health Promotion Method

According to Soekidjo Notoatmodjo, (2007) the material in health education must be adjusted to the target, as well as educational aids. For group targets, the method must be different from mass targets and individual targets, for mass targets must be different from individual targets and so on. The following will describe several methods of individual, group and mass (public) education.

• Individual education method (individual)

In health education, this individual education method is used to foster new behavior, or to foster someone who is starting to be interested in a behavior change or innovation. The basis for using this individual approach is because everyone has different problems or reasons in connection with the acceptance or new behavior. In order for health workers to know by knowing correctly and being able to help them, this method is needed. The forms of this approach include: 

• Guidance and counseling

In this way the contact between the client and the staff is more intensive. Every problem faced by the client can be researched and assisted in solving it.

• Interview (Interview)

Interviews between health workers and clients to obtain information on why they have not or have not accepted the change, to find out whether the behavior that has been or will be adopted has a strong basis of understanding and awareness. If not, then more in-depth counseling is needed.

• Group education method

In selecting the group education method, one must keep in mind the size of the target group and the level of formal education of the target group. For large groups, the method will be different with small groups. The effectiveness of a method will also depend on the size of the educational goals.

• Big group

What is meant by large group here is if the counseling participants are more than 15 people. Good methods for this large group include lectures and seminars.

• Small groupIf the activity participants are less than 15 people, it is usually called a small group. The methods for these small groups are group discussion, brainstorming, snowballing, small groups, role playing and simulation games
  • Mass education method

  The mass education method is suitable for communicating health messages to the public. Since the target of this education is general, in the sense that it does not differentiate between age group, gender, occupation, socioeconomic status, education level and so on, the health messages to be conveyed must be designed in such a way that they will be captured by the masses. This approach is usually used to raise public awareness of an innovation, and is not expected to lead to behavior change. In general, this form of mass approach is not direct, using or through the mass media. Some examples of methods suitable for the mass approach include:

  • Public lecture
  • Speeches/discussions about health through electronic media, both TV and radio.
  • Simulation, dialogue between patients and doctors or other health workers about a disease or health problem in a mass media.
  • Soap operas about health.
  • Writings in magazines or newspapers, both in the form of articles and questions and answers/consultation about health and disease.
  • Roadside billboards, banners, posters, and so on.

  Health Promotion Media

  Health promotion media are tools used by educators in delivering educational or teaching materials. Based on its function, this media is divided into three types, namely: (Soekidjo Notoatmodjo, 2007) 

  • 
    
  • print media

  Print media as a tool to convey health messages vary widely, including:

  • Booklet, is a medium to convey health messages in the form of books, both in the form of writing and pictures
  • Leaflet, is a form of delivering health information or messages through folded sheets. Information content can be in the form of sentences, pictures or a combination.
  • Flyer (leaflet), shaped like a leaflet, but not folded
  • Flif chart (back sheet), media for delivering health messages or information in the form of flipcharts. Usually in the form of a book where each sheet (page) contains a demonstration picture and the reverse sheet contains a sentence as a message or information related to the picture.
  • Rubric or writings in newspapers or magazines that discuss a health problem, or matters related to health.
  • Poster is a form of print media that contains messages or health information, which is usually pasted on walls, in public places, or on public transportation.
  • Photos that reveal health information.
  • Electronic media

  There are different types of electronic media as targets for delivering health messages or information, includin

• Television, delivery of health messages or information through television media can be in the form of plays, soap operas, discussion forums or questions and answers about health problems, speeches (lectures), TV spots, quizzes or quizzes, and so on.
• Radio, the delivery of information or health messages via radio can also take various forms, including chats, radio plays, lectures and so on.
• Videos, delivery of information or health messages can be via video
• Slides can also be used to convey messages or health information
• Film strips, film strips can also be used to convey health messages.
• Media board (billboard)

The billboards installed in public places are filled with messages or health information. The media board here also includes messages written on zinc sheets affixed to public vehicles.

Stages of Health Promotion Activities

Health promotion activities must go through scientifically careful stages. Azwar (1983) quoted by M. Adi Setiawan (2008), suggests the following stages:

• Sensitization Stage

Provide information and awareness to the public on important matters relating to health.

• Publicity Stage

This stage is a continuation of sensitization. Activities such as press releases are issued by the Ministry of Health to further explain the types or types of health services provided at health care facilities.

• Education stage

To increase knowledge, change attitudes and direct the behavior desired by the activity.

• Motivation Stage

Individuals or communities after attending health education actually change their daily behavior in accordance with the behavior recommended by health education at this stage.

Factors that influence the success of counseling

Cinta Lestari (2010) quoting from Effendi (1998), the factors that need to be considered against the target in the success of health education are:

• Level of education.

Education can affect a person's perspective on the new information he receives.

• Socio-Economic Level

The higher a person's socioeconomic level, the easier it is to receive new information.

• Customs

The influence of customs in receiving new information is something that cannot be ignored, because our society still values ​​and considers something that should not be ignored.

• Community Trust

People pay more attention to the information conveyed by people they already know, because public trust has arisen with the conveyer of information.

• Availability of Time 
• in the Community

The timing of the delivery of information must pay attention to the level of community activity to ensure the level of community attendance in counseling.

Expected results

The expected result in health promotion is a change in attitudes and behavior of individuals, families, special groups, and communities to be able to instill the principles of healthy living in daily life to achieve optimal health degrees (M.Ady Setiawan Syah, 2008 citing from Effendy, 1998)