Komunikasi kesehatan?
Seni dan teknik untuk memberikan informasi, mempengaruhi dan memotivasi individu, institusional dan audiens public tentang pentingnya masalah kesehatan (US Department of Health and Human Service, Steps to Healthier US, 2004)
Pendekatan multidisiplin untuk mensasar audiense yang berbeda dan berbagi informasi yang berkaitan dengan kesehatan dengan tujuan untuk:
mempengaruhi, melibatkan dan mendukung: individu, komunitas, profesi kesehatan, kelompok khusus, pengambil keputusan dan publik untuk memperkenalkan, mengadopsi, membertahankan perilaku, praktek dan kebijakan yang bertujuan meningkatkan kesehatan*
Karakteristik Effective Health Communication (Fertman & Allensworth. 2010)
Akurasi
Ketersediaan
Imbang
Konsisten
Peka budaya
Didasarkan bukti
Karakteristik Effective Health Communication (Fertman & Allensworth. 2010)
Mencapai sasaran
Reliabel
Repetisi
Pertimbangan waktu
Mudah dipahami
Tipe of Communication
Komunikasi verbal – non verbal
Komunikasi satu arah – dua arah
Komunikasi inter-personal dan komunikasi massa
Komunikasi internal dan eksternal
Tips untuk media cetak
Gunakan spasi dan hindari kepadatan tulisan
Pesan usahakan singkat
Gunakan judul yang jelas dan bullet –
Gunakan format tanya jawab – jawaban yang singkat
Gunakan kalimat dan kata aktif serba kata kerja yang kuat
Hindari istilah medis, dan gunakan bahasa percakapan
Gunakan desain yang akan mendorong pemahaman, termasuk gambar dan grafik yang menggambarkan hal-hal yang utama
Tambahkan materi/bahan/media tulis dengan media audiovisual atau percakapan/diskusi
Komunikasi efektif bila
Pesan yang dikirim oleh pengirim disampaikan secara lengkap seperti harapan pengirim dan diterima oleh penerima selengkap yang diinginkan pengirim, serta pengirim mendapatkan umpan balik dari si penerima bahwa pesannya telah tersampaikan lengkap
Agar pesan dapat tersampaikan dengan lengkap, harus ada dialog
Informasi
Pemasaran
Insentif
Restriksi
Indoktrinasi
Peraturan
Mengubah perilaku dengan informasi
Transtheoretical theory tahapan perubahan perilaku (Prochaska, 1988):
Prekontemplasi (belum mau berubah/sadar, ingin)
Kontemplasi (sudah sadar/ingin/berpikir tapi belum beraksi)
Persiapan (langkah awal utk bertindak)
Tindakan
Pemeliharaan
Tahapan Perubahan Perilaku transtheoretical theory
(Simon-Morton, Greene & Gottlieb, 1995)
Perubahan perilaku:
Komunikasi persuasif
Sumber:
Kredibilitas
Ketertarikan
Power
Pesan:
Tipe dan penampakan
Isi pesan
Diskrepansi
Saluran:
Media: tatap muka, audio visual, media interaktif
Modalitas:pandang, dengar, taktil
Penerima:
Demografis: umur, jenis kelamin, ras dsb
Psikologis: pengetahuan, kepercayaan dsb
Tujuan/hasil:
Waktu
Ruang lingkup:fakta atau perilaku
Target: perilaku, pengetahuan ???
Perubahan SIKAP : Komunikasi persuasif
Sumber:
Kredibilitas
Ketertarikan
Power
Pesan:
Tipe dan penampakan
Isi pesan
Diskrepansi
Saluran:
Media: tatap muka, audio visual, media interaktif
Modalitas:pandang, dengar, taktil
Penerima:
Demografis: umur, jenis kelamin, ras dsb
Psikologis: pengetahuan, kepercayaan dsb
Tujuan/hasil:
Waktu
Ruang lingkup:fakta atau perilaku
Target: perilaku, pengetahuan ???
Health Promotion & Communication Ethics
Dimensions of Biomedical*
Paternalism/Autonomy
Beneficence
Non-maleficence
Justice
* (Beauchamp & Childress, 1989, cited in Northhouse & Northhouse, 1992)
Biomedical ethics?*
Biomedical ethics is concerned with the application of ethical principles and theories to the problems that occur in the fields of health care and medicine
Etik biomedis merupakan aplikasi prinsip etik dan teori masalah yang terjadi di dalam area pelayanan kesehatan dan medis
*(Beauchamp & Childress, 1989, cited in Northhouse & Northhouse, 1992)
The distinctive challenge of health promotion ethics
Biomedics
Individually
Patient’ autonomy
The objectives of “treatment” is curing, no harm and beneficence
Health promotion
Group, community, local or national population
Initiated by professionals, not clients
The “ends” of health promotion are innately problematic and contested
The distinctive challenge of health promotion ethics
Biomedics
Takes place in social context, but they work through physical and biological process
Health promotion
Health promotion interventions work through both physical and social processes – human being in a variety of ways and cannot be as easily isolated from their cultural, economic and social contexts as can most therapeutic interventions
‘culture’ is frequently not only a context but also a working medium of health promotion
Ethics in health promotion:
Consider the concepts of:
Well-being/kesejahteraan
Integrity/integritas
Virtues/kebaikan
Autonomy/otonomi
Responsibility/tanggung jawab
Civility/keberadaban
Caring/perhatian
Solidarity/solidaritas
Challenges in Health Promotion Ethics
Promosi kesehatan kadang diinisiasi oleh profesional daripada “klien” atau masyarakatnya sendiri
Profesional tersebut melakukan “intervensi” pada kehidupan orang lain, yang kadang “tanpa mengundang terlebih dahulu”
Berbeda dengan intervensi terapetik “individual” à ada kontrak antara terapis dan klien/pasien sebelumnya
Challenges in Health Promotion Ethics
Promosi kesehatan ditujukan pada populasi lokal, bahkan nasional, tidak hanya individu.
Implikasinya:
Efek utk baik atau sakit akan lebih besar
Pelaksana program promosi kesehatan “sepertinya” lebih memikirkan orang-orang secara abstrak atau statistik daripada mengidentifikasi orang
Secara rutin pelaksana program promosi harus mengukur perbedaan kebutuhan dan prioritas dari kelompok dan individu
Pelaksana promosi kesehatan berhadapan dengan hubungan dengan “banyak-banyak” orang, daripada “hubungan satu satu”
Challenges in Health Promotion Ethics
Akhir dari promosi kesehatan kadang problematik
Ada pertanyaan tentang mentargetkan usaha dan distribusi manfaatnya (dan keadilan)
Ada juga pertanyaan tentang “apa yang dipromosikan” – issu tentang arti, dan dimensi berbeda dari kesehatan
Ada pertanyaan sulit tentang konsekuensi jangka pendek dan jangka panjang (apakah mungkin promosi kesehatan mempunyai “efek non kesehatan” sebagai indikator keberhasilan program
Challenges in Health Promotion Ethics
Promosi kesehatan ditujukan pada manusia yang tidak dapat diisolasikan dari konteks ekonomi, budaya dan ekonomi (seperti intervensi individual)
Intervensi promosi kesehatan dilakukan melalui proses fisik dan sosial
Challenges in Health Promotion Ethics
Budaya tidak hanya konteks, tetapi juga medium kerja promosi kesehatan
Bagaimana caranya menilai penerimaan secara etis tentang sesuatu yang disebut rekayasa sosial atau budaya
Seberapa jauh kemungkinan untuk melakukan evaluasi intervensi promosi kesehatan lepas dari pertimbangan kontribusi untuk iklim sosial secara luas
Issues in health promotion:
Does a particular approach respect autonomy?
Does it bring about some benefit?
Does it avoid harm?
What combinations of benefit and harm does it produce?
Dangerous to our own health à there is far less agreement on what can or should be done to make people less foolish
Where does personal choice and collective responsibility begin
How we reconcile two of our most prized social values, personal freedom and good health?
Issues in health promotion ethics:
What are the appropriate limits of the country/province/district in liberal society in regulating, restricting or prohibiting behaviors that lead to premature morbidity and mortality in shaping, molding or influencing the preferences and desires of its citizens, in protecting citizen from commercial influences that may encourage or sustain patterns of behavior that are an-ethical to the goals of public health?
A case
Pikirkan bahwa sebuah tim promosi kesehatan diminta untuk mempromosikan kesehatan pada kelompok remaja umur 16-18 tahun yang sudah tidak sekolah lagi, pengangguran, dan menggunakan sebagian besar waktunya untuk menonton televisi, pergi rame-rame, merokok, minum-minuman keras dan melakukan aktivitas seksual secara bebas.
Apa aktivitas prioritas yang akan dilakukan?
Harm principle
What about an injury that is threatened, on that is possible, or only remotely so, one that is merely statistical, smoking in an open-air café, for example?
What if the potential harm involves an annoyance, for example the smell of smoke in open-air?
What if act that is self-regarding in terms of injury is other-regarding in terms of economic cost, for example smoking alone?
Paternalism
We do not leave it to the discretion of consumers, however well informed, whether or not to drink grossly polluted water, ingest grossly contaminated foods, or inject grossly dangerous drugs
We simply prohibit such things on grounds of public … to a very large extent … the justification of public health measures, in general, must be baldly paternalistic
Their fundamental point is to promote the well-being of people who might otherwise be inclined cavalierly to certain sorts of diseases
Health Communication campaigns and the censorship of advertising
Health communication campaigns that discourage certain activities or encourage the adoption of others are the most common form of intervention designed to promote healthy behavior.
They would at first appear to pose no ethical challenges.
Messages targeted at those most at risk may open the way to stigmatization and hence to the imposition of inequitable burdens.
Health Communication campaigns and the censorship of advertising
Two examples illustrate this point. In the context of the AIDS epidemic efforts to counter the tendency toward marginalization of those most at risk led to the creation of campaigns that suggested that everyone was at risk for HIV infection.
The second case involved decision made by the New York State Health Department to require the posting of warning at bar about the potential hazards of alcohol consumption during pregnancy.
The ethics of social marketing :
Is not surprising that public health officials have come to recognize that they had much to learn from the advertising industry
If, for example, advertising could convince adolescents around the world that they wanted and needed nike running shoes could they not be convinced that cigarette smoking was bad? Could not the manipulative capacity of advertising be mobilized for public health goals?
Whatever the answer to those questions will be-and the challenges of using advertising for public health goals may be substantial-social marketing raises critical ethical issues.
The ethics of social marketing :
Is the subversion of autonomy implicit in the manipulation of desire and preference ever justifiable? Can the protection of individuals from the manipulative activity of commercial advertisers justify counter-manipulation in the name of public health? Does such manipulation simply attempt to level the playing field? And does such an effort at balancing provided the ethical warrant for what otherwise might be considered morally troubling?
In testimony before Congress the American Public Health Association stated, “Advertisements should be to promote good health products and not products that kill.”
References:
American Cancer Society. 2006 Smoke Free Track – Advocacy and Media Advocacy for Smoke free policies. San Fransisco: ACSU
Blundel, R. 2004 Effective Organizational Communication. Essex, England: Pearson Education Limited
Dignan, M.B., & Carr, P.A.(1992) Program Planing for Health Education and Promotion, Pennysylvania : Lea & Febiger
Fertman, CL., Allensworth, DD. 2010 Health Promotion Program – From Theory to Practice. USA: Society for Public Health Education
Galea, S., & Hadley, C. 2006 Disaster Preparadness. In: Gorin, SS., & Arnold, J. Health Promotion in Practice. San Fransisco, US: Jossey-Bass – A Wiley Imprint.
Keleher, H., MacDougall, C., & Murphy, B. 2007 Understanding Health Promotion. Victoria, Australia: Oxford University Press
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