THEORIES AND MODELS

OF HEALTH BEHAVIOUR

dr. Roro Rukmi Windi Perdani, M.Kes

Bag IKKOM/IKM
Fakultas Kedokteran Unila

THEORIES AND MODELS OF HEALTH BEHAVIOUR

1. Precede-Procede model/ Theory of L.Green
2. Theory of L.Blum
3. Theory of Reasoned action
4. Theory of Planned Behaviour
5. Social Learning theory
6. Theory of Behaviour Application analysis
7. Theory diffusion innovation
8. Transtheoritical model
9. The Stages of substances use theory
10. Communication/persuasion theory
11. Theory A-B-C
12. Health Belief Model
13. Basics of protection motivation theory
14. Social cognitive theory
15. Cognitive consistency theory

PRECEDE-PROCEDE Model/ Theory

of L.Green

Phase 5
Phase 4
Administrative and Educational and
Policy diagnosis
Organizational
diagnosis

Phase 3
Phase 2
Phase
Behavioral and
Epidemiological1
Environmentaldiagnosis
Social
diagnosis
diagnosi
s

Predisposing
Predisposing
Factor
Factor
HEALTH
HEALTH
PROMOTION
PROMOTION
Health
Health
Education
Education

Policy
Policy
Regulation
Regulation
organization
organization

Reinforcing
Reinforcing
Factor
Factor

Behaviour
Behaviour
And
And
Lifestyle
Lifestyle
Health
Health

Enabling
Enabling
Factor
Factor

Quality
Quality
Of
Of life
life

Environment
Environment

Phase 6 Implementation
Phase 7 ProcessPhase 8 Impact

Phase 9 Outcome

ecede-Proceed model for health promotion planning and evaluation

Behaviour
Behaviour

Health
Health
Environment
Environment
Behavioral
Environmental
Indicators :
Indicators :
-Compliance
-Economic
-Consumption pattern
-Physical
-Coping
-Services
-Preventive action -Social
-Self-care
-Utilization
Dimensions :
-Access
Dimensions:
-Affordability
-Frequency
-Equity
-Persistence
-Promptness
-Quality
-Range

Quality
Quality of
of
life
life

Vital Indicators :
-Disability
-Discomfort
-Fertility
-Fitness
-Morbidity
-Mortality
-Physiological risk
factors
Dimensions :
-Distribution
-Duration
-Functional level
-Incidence
-Intensity
-Longevity
-Prevalence

Social
indicators
-Absenteeism
-Achievement
-Aesthetics
-Alienation
-Comfort
-Crime
-Crowding
Discrimination
-Happiness
-Hostility
-Illigitimacy
-Performance
-Riots
-Self-esteem
-Unemployme

Direct
Communicati
on
To public,
Patients,
Employees,
etc

Health
education
Component
of health
Promotion
program

Policy
Regulation
organization

Indirect
Communicat.
Through staff
Training,
Supervision,
Consultation
feedback

Predisposing
Predisposing
Factors:
Factors:
-Knowledge
-Knowledge
-Attitudes
-Attitudes
-Beliefs
-Beliefs
-Values
-Values
-Perception
-Perception
Reinforcing
Factors:
-Attitudes and
behavior of
health
personnel
and other,
peers,
parents,employ
Enabling
ers,
factors:
etc
-Availability

Training
Community
organization

of
resources
-Accessibility
-Referrals
-rules and
laws

Behavior
Behavior
(Actions)
(Actions)
of
of
individuals
individuals
,,
groups,
groups, or
or
communiti
communiti
es
es
Environmental
Environmental
factors
factors

Precede = Pendahulu
P = Predisposing
R = Reinforcing
E = Enabling
C = Constructs in
E = Educational
Environmental
D = Diagnosis
E = Evaluation

Proceed = Proses yang

berlangsung
dan hasilnya
P = Policy
R = Regulatory
O = Organizational
C = Constructs in
E = Educational and
E = Environmental
D = Development

Precede :
Menjamin sebuah program yang akan dilaksanakan sesuai
dengan kebutuhan dan Keinginan individu/masyarakat

Proceed :
Menjamin program yang akan dijalankan akan :
-tersedia sumber dayanya
-Mudah diakses/dicapai
-Dapat diterima secara politik dan peraturan yang ada
-Dapat dievaluasi oleh policy makers, consumers, dan
administrators

Theory of Reasoned action

Theory of Planned Behaviour

THE
THE THEORY
THEORY OF
OF REASONED
REASONED ACTION
ACTION

Believe
Believe about
about
outcomes
outcomes
Evaluation
Evaluation of
of
these
these outcomes
outcomes

Believe
Believe about
about
important
important others
others
Attitudes
Attitudes to
to the
the
Behaviour
Behaviour

Motivation
Motivation to
to comply
comply
with
with important
important others
others

Attitudes
Attitudes towards
towards
The
The behaviour
behaviour

Important
Important
norms
norms

Subjective
Subjective
Norms
Norms

Behaviour
Behaviour
Intention
Intention

Behaviour
Behaviour

THE
THE THEORY
THEORY OF
OF PLANNED
PLANNED BEHAVIOUR
BEHAVIOUR

Believe
Believe about
about
outcomes
outcomes
Evaluation
Evaluation of
of
these
these outcomes
outcomes

Attitudes
Attitudes towards
towards
The
The behaviour
behaviour

Believe
Believe about
about
important
important others
others
Attitudes
Attitudes to
to the
the
Behaviour
Behaviour
Motivation
Motivation to
to comply
comply
with
with important
important others
others

Internal
Internal control
control factors
factors

Behaviour
Behaviour
Intention
Intention
Subjective
Subjective
Norms
Norms

Behavioural
Behavioural
External
control
External control
control factors
factors control

Behaviour
Behaviour

Social Learning Theory

Social learning theory

PERSON/INDIVIDU
PERSON/INDIVIDU

a
ct
pe
ex

Se
lfef
ca

cy

e
om
tc
Ou
n
tio

PERILAKU
PERILAKU

LINGKUNGAN
LINGKUNGAN
Reinforcement

 1941, Neil Miller & John Dollard

Kita belajar (learn) meniru perilaku orang lain, bukan
semata
karena
instink

social
learning
(pembelajaran sosial)
Perilaku peniruan (imitative behavior) terjadi karena
kita merasa mendapat imbalan bila meniru perilaku
orang lain dan mendapat hukuman ketika kita tidak
menirunya
1959, 1963, Albert Bandura & Richart Walters
Kita
belajar
dengan
observational
learning,
pembelajaran melalui pengamatan. Misal : perilaku
agresif anak setelah mengamati perilaku agresif
dalam film kartun
1971, Bandura
Teori pembelajaran sosial tidak hanya menggunakan
pendekatan perilaku, namun perlu pertimbangan
proses mental

Menurut Bandura
Social Learning Theory
1.Bagaimana kita dipengaruhi oleh lingkungan
melalui
penguatan
(reinforcement)
dan
observational learning
2.Cara pandang & cara pikir yang kita miliki
terhadap informasi
3.Sebaliknya,
perilaku
kita
mempengaruhi
lingkungan kita dan menciptakan penguatan
(reinforcement) dan observational opportunity,
peluang bisa diamati oleh orang lain

 Teori Bandura memfokuskan pada hubungan

segitiga antara orang (menyangkut proses
kognitif), perilaku dan lingkungan yang saling
mempengaruhi
Learning
didapat melalui 3 proses :
1.
2.
3.

Direct experience (pengalaman langsung)

Indirect or vicarious experience from observing other
(modelling)
The storing and processing of complex information in
cognitive operation
that enable one of complex
information the concequences of actions, represent goals
in thought and weight evidence from various sources to
asses oness own capabilities (penyimpanan & pemrosesan
informasi
yang
kompleks
dalam
kognitif
yang
memungkinkan
seseorang
untuk
mengantisipasi
konsekuensi tindakan, merepresentasikan tujuan pemikiran
& pembuktian bermacam-macam sumber untuk menaksir
kemampuannya sendiri)

 Perilaku sebagai akibat adanya self efcacy

(kemampuan diri) dan harapan terhadap hasil
dari perilaku tersebut.
Pengalaman
dan
suatu
perilaku
yang
mendukung kognitif seseorang
Pemahaman terhadap pengalaman orang lain.
Proses pemahaman terhadap
(vicarious learning)
Memperhatikan model

orang

Mengingat apa-apa yang telah diobservasi

Meniru perilaku
Memperkuat perilaku

lain

Modeling : penambahan dan atau pengurangan

tingkah laku yang teramati, menggeneralisir berbagai
pengamatan sekaligus melibatkan proses kognitif

Proses modelling :

Perhatian : dipengaruhi oleh asosiasi pengamat

terhadap model, sifat model & arti penting tingkah
laku yang diamati
Representasi : tingkah laku yang akan ditiru harus
disimbolisasikan dalam ingatan
Peniruan tingkah laku : pengamat harus punya
kemampuan menirukan perilaku model
Motivasi
Penguatan
Resiprocal determinism : seseorang akan bertingkah
laku dalam situasi yang dia pilih secara aktif

Social Learning Theory

Se
lf

Ef

e
om on
tc ati
Ou ct
pe
ex

ca
cy

Person / Individu

Perilaku

Reinforceme
nt

Lingkungan

Person / Individu
- Pengetahuan
- Sikap
- Persepsi
- Niat

am

k
pa
m g n
Da an pka
y
ra
ha
di

m
Ke
ri
di

T
R ing
en gi
da
h

an
pu

Perilaku / action /
tindakan

Penguatan
Positif
Negatif

Lingkungan
- Teman
- Keluarga
- Tetangga
(lebih pada norma
group)

TRANS THEORETICAL MODEL OF

BEHAVIOUR CHANGE

TRANS THEORETICAL MODEL OF BEHAVIOUR

CHANGE
1.
1. Precontemplation
Precontemplation
Not intending to make any changes
changes
2.
2. Contemplation
Considering a change
3.
3. Preparation
Preparation
Make small changes
changes
4.
4. Action
Action
Actively
Actively engaging
engaging in a new behaviour
5.
5. Maintenance
Sustaining
Sustaining the
the change
change overtime
overtime

Health Believe Model

Basics of Health Belief Model

Cues to action
Susceptibility
Demographic
Variable

Severity
Benefits
Costs

Likelihood of
Behaviour

 Susceptibility
Susceptibility to
to illness
illness
(( My
My chances
chances of
of getting
getting lung
lung cancer
cancer are
are high)
high)
The
The severity
severity of
of the
the illness
illness
(( Lung
Lung cancer
cancer is
is a
a serious
serious illness)
illness)
The
The cost
cost involved
involved in
in carrying
carrying out
out the
the behaviour
behaviour
(( Stopping
Stopping smoking
smoking will
will make
make me
me irritable)
irritable)
The
The benefits
benefits involved
involved
(Stopping
(Stopping smoking
smoking will
will save
save me
me money)
money)
Cues
Cues to
to action
action
Internal
Internal (( The
The symptom
symptom of
of breathlessness)
breathlessness)
External
External (( Information
Information from
from leaflet)
leaflet)

End of the slide