Evaluation of older person health promotion in healt centers in south jakarta

EVALUATION OF OLDER PERSON HEALTH PROMOTION IN HEALTH CENTERS OF SOUTH JAKARTA 1997 TO 1999

Penyuluhan kesehatan adalah suatu upaya untuk memberikan pengalaman belajar atau menciptakan suatu kondisi bagi perorangan, kelompok dan masyarakat untuk menerapkan cara-cara hidup sehat.

Dimana untuk mencapai tujuan penyuluhan kesehatan sesuai yang diinginkan maka dapat direncanakan sesuai tahapan-tahapan yang meliputi, pengenalan masalah dan menentukan prioritas masalahnya; menentukan tujuan penyuluhan; menentukan sasaran penyuluhan, metode penyuluhan; media penyuluhan yang tepat, menentukan isi penyuluhan, rencana evaluasi dan jadwal pelaksanaan.

Dengan melakukan sesuai tahapan tersebut, diharapkan dapat dilakukan perbaikan-perbaikan yang dibutuhkan demi memperoleh suatu penyuluhan kesehatan masyarakat.

Health promotion is the first of five levels in disease prevention accor-ding to Leavel and Clark theory. In this first stage, health education in the community could be given to any person and at any situation. The basic concept of health education is as an adult learning process. This involves a changing process from immaturity or ignorance in healthy lifestyle behavior into maturity or empower-ment of individuals, groups or even communities.

The learning process could be done anywhere, anytime and to anyone. A person is said to have learned something if he/ she had a learning experience, from something formerly unknown into something known 1,3,4). Furthermore, the definition of Health Education is an activity for helping individuals, groups or communities through increasing their ability or behavior to achieve an optimum health state.

The World Health Organization defi-nition of health promotion is to incre-ase health status of individuals and the community. According to this de-finition, health promotion is a process to enable individuals to increase their control and to improve their health. Referring to this definition Health Education has two objectives namely (1) to channel peoples’ aspiration and to satisfy their life needs and (2) to change their present "unhealthy" li-ving environment. To increase their health status must be done through individual empowerment and com-munity support. Because to achieve this healthy condition all individuals and the society at large should be res-ponsible and involved in self-empo-werment of residents in the neigh-borhood to increase their quality of life.

Health promotion is also given to the elderly or older population. How-ever, older person due to their short memory for recent things must always be reminded to recall things in their memory related to health or wellness. At the community health center, it is done through elderly clubs, where health promotion activi-ties maybe done on any requested topic and followed by basic routine health examina-tion.(2)

The objective of this study was to eva-luate health promotion activities for older person at community health center in South Jakarta between 1997 to 1999. The parameters used to eva-luate health promotion activities we-re, (1) Topic, (2) Objectives of health promotion, (3) Target of health pro-motion, (4) Location/ time of activity, (5) Method of health promotion, (6) IEC Media used, and (7) Questions/ Answers during health promotion.

This study was a descriptive cross-sectional observation. Secondary data was taken from health promotion re-ports between 1997 to 1999. The acti-vity was done in four districts of South Jakarta namely Cilandak, Te-bet, Mampang Prapatan, and Pasar Minggu Health Centers. The health educators were medical students doing internship at The Community Health Department of Trisakti Uni-versity Medical School.

At the health center, older person clubs are formed and supervised by the health center, known as "elderly club" or "posyandu lansia". Every month, these elderly clubs had meet-ings at the health center. Members of the club received health examination and attended health promotion given by the health provider. Usually, the coordinator of the public health internship program gave the topic assignment, but occasionally older people based it on demand them-selves.

There were 5 themes of health promotion topics that were usually given during this internship period. These topics were (1) Degenerative diseases, such as Hypertension, Dia-betes Mellitus, Rheumatism, Demen-tia, (2) Nutrition, (3) Healthy life style (4) Oral hygiene and (5) Rational use of drugs.

There was slight fluctuation of num-ber of themes given in older person health promotion namely 5 themes in 1997, 3 themes in 1998, and 5 themes in 1999. In table 1, there was slightly lesser themes given to older person in 1998. If we would like to increase their health status, we must provide them with a series of topics that they must know and the topics should be related to common diseases in theelderly such as arthritis,

hypertension and osteoporosis (the 3 main illness complained by the eldery in the community) and Physical disability profile of the elderly such as poor eye sight, tooth loss and chewing problem (6).

In the three consecutive years, there was a total of 43 health promotions given to the elderly clubs. In 1999, there were twice as many themes given than the last 2 years. This was due to the fact that Pasar Minggu District health center joined the internship program of the medical school.

A lot of topics discussed were about degenerative disease in older people. The presentation usually began with an introduction of the disease, symp-toms of the disease, risk factors, com-plications, therapy and health main-tenance.

Content of the topic, generally were superficial not indepth, only impor-tant key messages were conveyed to them, so that older person had only limited knowledge on the IEC mate-rial given. Sometimes, the messages were too short, but considering that the audience was older persons, the health educator had to select specific IEC material and content to conform to older person concentration limi-tations.

Generally, all of the health promotion reports stated that their main objec-tives were to increase knowledge of the audience. First, the audience were given information on the importance of the topic, and secondly, informa-tion on how to alleviate or preventive action of a specific health problem. None of the topics directly increased health behavior of the audience. In the long term, it is hoped that there would be behavior changes of older persons towards a better healthy life style through adoption of healthy living habits.

In general, the target of health pro-motion was the elderly who come to the health center to examine their health or those who attended regular elderly club meeting. Usually, the age of the elderly member was 45 years old or above and mostly were women. It is not uncommon that civil service and armed forces retirees frequently attended these elderly clubs in the community. From the data of "posyandu lansia" members, almost 100% of the members were women participants.

The place of activity was mostly in the district health center (kecamatan) or subdistrict health center (kelurahan), depending on where the elderly club members gathered. Several activities were done at the elderly clubs, besides health exami-nation, there were potluck, holy Al-quran reading and morning elderly gymnastics. At several subdistrict health centers, they used the meetings at the sub district hall to discuss their group’s social activities, due to limited space at the subdistrict health center. All of the health promotion activities were done indoors.

The health promotion activities lasted for 0.5 - 1 hour and it usually began around 9.00 a.m. and ended at 11.00 a.m. If the activity was too late or too long, the elderly members were rest-less due to their limited attention and concentration.

There were two types of method that the health educator used. One, the didactic method, is a one way method and it is usually passive, because the audience just needs to listen. The audience can not ask questions, if they do not understand the messages given by the health educator. Secondly, the Socratic method is a two-way method and invites interactive participation from the audience. The audience could discuss the issue among them during this activity and ask questions to the health educator. In this method, there is always commu-nication between the audience and the health educator.

For promotional activity, it is better to use the Socratic method, because active participant communication as shown by interaction between au-dience and educator ensures that the audience has received the correct messages being conveyed. Further-more, this situation enables important messages to be transferred and cre-ates awareness and practice of he-althy lifestyle behavior by older per-sons.

98% of health promotions were done using the Socratic method, and only 2% were done by the Didactic me-thod. Talks or lecturing was the usual method used by the health educator and they used teaching media for IEC material presentation, which was later followed by Question/ Answer sessions.

Media was used as tools for rein-forcement of information presenta-tion. The tools were used as a channel to deliver information and to assist in message adoption through communi-cation to the audience. There are 3 types of media used in health promotion namely printed, electronic and billboard media. Me-dia can also be divided into visual, audio or audio-visual media.

62,8 % of health promotions used media during IEC material presenta-tion. 36,7% used printed media such as poster, leaflet and pamphlet; 53,3% used electronic media such as radio, OHP and transparency as well as microphone and speaker, and 20% used demonstration with real mate-rial. Some of the health educators used a combination of printed and electronic media.

Using media was very important in helping the audience to understand the meaning of the message being conveyed by the health educator. Dale stated that every media has dif-ferent intensity on an individual’s perception, because media help peo-ple to stimulate their perception on new ideas or information.

n	Printed media	n	%	Electronic media	n	%
1	Poster/Leaflet/ pamphlet	9	82	OHP&Transparency	12	75
2	Module	2	18	Mini radio broadcast	1	6
3	-	-	-	Micropone-speaker	3	19

In table 2, printed media mostly used in health promotion was posters, etc. (82%), while learning modules was only used in 18% of health promotion activities. Electronic media mostly used in health promotion was OHP and Transparency (75%) and micro-phone-speakers (19%).

After health promotion presentation, evaluation must be done on what messages were received by the audi-ence. By doing so, we can determine to what degree the audience has rece-ived the key message given by the health educator.

All of the communicators used the question and answer evaluation form, because it was an easy test for

rapid evaluation on audience com-prehension of the health promotion presentation. This form consisted of a list of items.

A lot of questions from the audience were focused on the subject material, and some were on prevention or maintenance of the specific degene-rative diseases.

Variation in themes in health promo-tion was still too few and sometimes was not according to the audiences’ request. On average there were only 5 themes in health promotion conveyed to elderly club members each year.

Only 62,8% of health promotion activities used media during IEC ma-terial presentation.

There is a need for more varied topics of health promotion and each topic could be designed periodically and serial health education modules could be developed.

Combination of Socratic method and various attractive IEC media could enhance health promotion activities. IEC media should be selected to conform to the ageing audience.

Variation in activity will make the elderly have pleasant thoughts and enjoy social gathering of the elderly club meetings. This activity could not only be on health information, but could include other topics such as developing informal small business or hobbies to fill one’s pastime.