PERUBAHAN PERILAKU MAKAN

(2 mgg pertemuan)

Sub Pokok Bahasan

 Determinan perilaku makan

 Masalah atau penyimpangan perilaku makan
 Pendekatan/model perubahan perilaku makan
 Peran layanan konsultasi gizi dalam perubahan
perilaku makan

1
FACTOR INFLUENCING FOOD CHOICES AND DIETARY BEHAVIORS
(Contento 2007)
Physical / food
environment

Experience with food Social

Intrapersonal environment
Factors
Biologically Physiological
determined conditioning Economic
presdispositions environment

Social
conditioning Interpersonal Informational
Factors environment

Preferences, Beliefs, Availabillity, and Food Choice and

sensory-affective attitudes, influences Diet Related
2
factors norms Behaviors
 Physical / food
environment
*Food availability
(under and over)
*Technology
Intrapersonal Factors Social
Experience with food
*Perceptions environment
*Associative conditioning
Biologically *Attitudes *Social influences
determined *Beliefs *Cultural practices
Physiological
presdispositions *Motivations and values *Social structures,
conditioning *Personal Meanings
*taste/ pleasure organizations
*Familiarity; *Knowledge and skills
*sweet,sour, salt , *Policy
learned safety *Social norms
bitter Economic
*Conditioned food *Cultural norms
*Hunger/ satiety environment
preferences
mechanisms *Resources
*Conditioned satiety
*Prices
Social conditioning Interpersonal *Time
*Models Factors Informational
*Rewards *Family and environment
*Sosial Affective social networks *Advertising
context *Education
*Media

Preferences, Food Choice and

Beliefs, Availabillity, Diet Related
sencory-affective
attitudes, and Behaviors
factors
norms influences 3
Masalah atau penyimpangan perilaku makan

Anak Balita
* Kesulitan makan: terlalu banyak jajan, terlalu
banyak minum susu, tidak mau sayur/buah,
kesenangan/ketidaksenangan thd jenis
makanan tertentu, memilih-milih makanan,
makanan di- emut, dimuntahkan, lama,
* Makanan jarang habis
* Terlalu banyak makan
* Alergi
4
Masalah atau penyimpangan perilaku makan

Remaja puteri :
* Diet ketat
* Tidak sarapan
* Terlalu banyak ngemil
* Terlalu banyak konsumsi: fast food, jajanan,
soft drink, food suplemen
* Tidak suka sayur
* Anoreksia Nervosa
* Bulimia
5
Masalah atau penyimpangan perilaku makan

Remaja putera :
* Tidak sarapan
* Terlalu banyak ngemil
* Terlalu banyak konsumsi: fast food,
jajanan, soft drink, food suplemen
* Diet
* Konsumsi kurang
* Tidak suka sayur
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Masalah atau penyimpangan perilaku makan

Wanita dewasa :
* Diet ketat
* Konsumsi pangan tidak seimbang: lemak
berlebih, gula berlebih, zat gizi mikro &
serat kurang
* Konsumsi suplement tidak proporsional
* Ngemil
* Konsumsi kurang/ terlalu banyak makan
* Makan tidak teratur
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 Three Topic in Talk about Behavior Change
Importance Confidence Readiness
Why? How? What? When?
Is it worthwhile? Can I Should I do it now?
Why should it? How will I do it? What about other
How will I benefit? How will I cope with priorities?
What will change? x, y and z?
At what cost? Will I succeed if..?
Do I really want to? What change….?
Will it make a
difference?
 Motivasi
• Motivasi secara umum didefinisikan sebagai kondisi internal sso yang
dapat membangkitkan dan memberi arah pada perilaku; motivasi
memberi energi dan arah pada perilaku yang berorientasi pada tujuan.
• Motivasi dapat berasal dari pengalaman mendapatkan sesuatu
bersamaan dengan pelaksanaan tugas /aktivitas tertentu untuk
memuaskan kebutuhan dasar
• Motivasi dapat berasal dari kepercayaan terhadap diri sendiri, orang lain
dan hasil dari perilaku
• Motivasi dari luar (extrinsic motivation) dapat berasal dari keinginan
untuk memenuhi harapan dari luar orang tersebut.
• Teori nilai-harapan (expectancy-value theories), yang merupakan dasar
teori psikologi sosial, menjelaskan bahwa kita akan melakukan suatu
perilaku jika kita percaya hal itu akan membawa hasil atau nilai yang
diinginkan. Hasil dapat berasal dari dalam atau dari luar (internal or
external).

• Motivasi = kepercayaan akan hasil perilaku yang diharapkan x nilai hasil

perilaku tsb ditempatkan
 Behavior Change Models and Approaches
Behavior Focus Key Concepts
Change Model/
Approaches
1. Health belief Perception of the • Perceived susceptibility
model health problem and • Perceived impact
appraisal of proposed
behavioral changes are • Perceived advantages of
central to a decision to change
change • Appraisal of barriers
• Self-efficacy
Health Belief Model
• The health belief model proposes that readiness
to take action is based on the following beliefs :
1. I am susceptible to this health risk or
problem
2. The threat to my health is serious
3. I perceive that the benefits of recommended
action outweigh the barriers
4. I am confident that I can carry out the action
successfully
5. Cues to action are present to remind me to
take action
 Behavior Change Models and Approaches
Behavior Focus Key Concepts
Change Model/
Approaches
2. Social People and their • Self-efficacy
cognitive environment • Knowledge and skills
theory/social interact required
learning continuously, each
theory influencing the • Learning occurs through
other taking action, observation of
others taking action, and
evaluation of the results of
those actions
 Social Cognitive Theory
• Social cognitive theory  behavior is the result of personal,
behavioral, and environmental factors that influence each other
in a dynamic and reciprocal fashion.
1. Personal factors involve people’s thoughts and feelings.
2. Behavioral factors include their food-, nutrition-, and health related
knowledge and skills, together called behavioral capability and their
skills in regulating and taking charge of their own behaviors, called
self-regulation skills.
3. Environmental factors include those factors external to individuals,
such as the physical and social environments.
• Environments shape behaviors, but individuals also have the
capacity to exert influence over the environment as well as their
own behaviors through self-reflection and self-regulatory
processes.
Social Cognitive Theory
• Social cognitive theory posits that our behavior is
influenced by a host of thoughts or beliefs about
ourselves.
• two major constructs that are important in
motivating behavior are:
1. outcome expectations
2. self-efficacy
Outcome Expectations
• Health outcomes are beliefs that certain actions can enhance
health outcomes or reduce risk of disease.
• Social outcomes are expectations of what others will think when
an individual performs the behavior.

Self-efficacy:
Researchers who have studied a variety of social behaviors have found that in
addition, individuals’ estimates of whether they will be able to perform the
behaviors or belief in ability to make a behavior change are extremely
important. This construct is central to many theories. Positive self-efficacy
increases probability of making a behavior change
Social cognitive theory states that we will choose to perform an action that
maximizes the anticipated positive outcomes and minimizes the anticipated
negative outcomes.
• Methods for Enhancing Self-Efficacy :
1. Personal mastery experiences
2. Social modeling
3. Social persuasion
4. Modification of emotional or physical
responses to the behavior
 Behavioral Factors

• Equally important
• These include food-related knowledge and
skills needed to engage in the behavior, when
desired.
• Initiation and maintenance of the behavior for
the long term requires self-regulation skills,
including individuals’ ability to exercise
influence and control over their own behavior.
• Health literacy  an individual’s ability to read,
understand, and use health care information to make
decisions and follow instructions for treatment.
It is especially important for nutrition counselor to
use appropriate literacy level, plain language, and
graphics with low-literacy audiences to ensure
understanding.
 Self-Regulation and Goal-Setting Processes

• Self-regulation or self-direction of behavior involves the

following components:
1. observe the behavior we seek to change. This provides the
information we need for setting realistic goals.
2. set specific behavioral change or action goals and learn the
food and nutrition skills needed to achieve them.
3. monitor our own progress toward achieving these action goals
and reward ourselves when we meet them. This reward may
be the satisfaction of doing the right thing for our health.

goal setting process

(Bandura 1986; Cullen, Baranowski, & Smith 2001; Shilts, Horowitz, & Townsend
2004a, 2004b, 2009).
Why goal-setting is important?
• Setting action goals or action plans increases
our motivation to act by building our
perceptions of our self-efficacy and mastery
• Creating self-satisfaction and a sense of
fulfillment from having achieved the goals
• Cultivating intrinsic interest through active
involvement in the process.
 Environmental Factors

• Social cognitive theory distinguishes between

situation, which is people’s perception or
cognitive representation of the environment,
and environment, which relates to the
objective factors affecting their behavior that
are external to them.
Evidence from research and intervention studies using
social cognitive theory

• Children
One study examined the three social cognitive
theory components for their usefulness in
predicting fruit and vegetable consumption in
elementary school children (Reynolds et al.
1999). The study found that availability and
motivation each had a significant direct effect on
consumption, but knowledge did not. Motivation
had a significant relationship to knowledge.
• Adults:
A study in adults examined the relationships of the
constructs of social environment, reinforcement,
modeling, knowledge, and outcome expectations to
the consumption of four beverages: whole milk, low-
fat/skim milk, regular soda, and diet soda (Lewis, Sims,
& Shannon 1989). They found that the factors
influencing consumption varied by forms of the
beverage and by the two age groups they studied,
students and adults. Clearly, then, both the behavior
and the intended audience are important
considerations when the theory is applied.
Using Social Cognitive Theory to Understand Fruit and
Vegetable Consumption by Elementary School
Children

• Source: Reynolds, K. D., A. W. Hinton, R. Shewchuk, et al. 1999. A social cognitive

model of fruit and vegetable consumption in elementary school children. Journal of
Nutrition Education 31(1): 23–30.
 EatFit: A Goal-Oriented
Intervention that
Challenges Adolescents to
Improve Their Eating and
Fitness Choices
 Behavior Change Models and Approaches
Behavior Focus Key Concepts
Change Model/
Approaches
3.Transtheore- Behavior change is • Behavior change is
tical model explained as a describes as a series of
readiness to change
change • Specific behavior change
strategies are identified
for each stage
 Transtheoretical Model and The Stages of
Change Construct

• The transtheoretical model (TMM) self-change in behavior is

a process that occurs through five stages and that individuals
use a variety of psychological and behavioral processes in
making changes  model of behavior change, not a model
predicting behavior
 The Stages of Change Construct
1. Precontemplation (PC)  the time during which individuals
are not aware of, or not interested in, a behavior or practice
that might enhance their health. Also are those who have
tried and failed to make the behavior change, perhaps many
times, and no longer want to think about it.
2. Contemplation (C)  the stage in which individuals are
considering making a change sometime in the near future,
usually defined as within the next six months. They are more
aware of the pros of changing but are especially aware of
the costs of changing. Individuals at this stage need
motivational activities rather than action-oriented,
behavioral change strategies.
3. Preparation (P)  the stage in which individuals intend to
make a change in the immediate future, usually defined as
one month, and may have already taken some steps in that
direction. Individuals in this stage are ready for action-
oriented strategies that will help them initiate action.
4. Action (A)  the stage in which individuals have started to
engage in the new behavior or practice (often defined as
within the previous six months). They may adopt the
practice on a small scale at first or try out alternative
practices, to find one at which they can be successful and
that fits into their usual routine. Action-oriented strategies
are particularly helpful here.
5. Maintenance (M) the period in which people have
performed the new behavior or practice for long
enough (usually defined as longer than six months) to
be comfortable with incorporating it as part of their
way of life Individuals may need to continue to exert
effort to maintain the behavior and avoid relapse.
• For addictive behaviors, a sixth stage, termination, is
included, during which individuals no longer succumb
to any temptation and feel total self-efficacy. For
dietary behaviors, this stage may not be practical or
applicable
 Different Stages for Different Behaviors

• Nutrition counselor should note that

individuals can be, and usually are, at different
stages of change for different diet-related
behaviors.
• There are also considerable spontaneous
changes in stages among people over time,
both forward and backward
• Changes in stage are not always linear
 Processes of Change at Different Stages
Precontemplation
• When people are in the precontemplation stage, they
use all of these processes significantly less than in all
the other stages.
Contemplation
• People become open to consciousness raising
strategies, and other strategies to raise awareness
about their behavior.
• People open to emotionally arousing experiences
• People evaluate the effects of their behaviors on those
around them and on the physical environment
Action
• People begin to take action when they believe
that they have the autonomy to make changes
through a self-liberation process, and then make
a firm commitment to change
Maintenance
• Successful maintenance of change involves the
use of behavioral processes to prevent relapse to
less healthy patterns of behavior.
• Nutrition education can assist individuals to
acquire and practice these skills.
 Enam Prinsip Teknik Perubahan
Perilaku Makan (PM)
• Memahami masalah PM &
1 konsekuensinya

• Meningkatkan motivasi utk

2 perubahan PM

• Mengupayakan perubahan PM
3
 ENAM PRINSIP ….Con’t

• Mengupayakan perubahan gaya hidup

4

• Menciptakan reward system (+/-)

5

• Pengendalian diri dan dukungan

6 sosial
 1. MEMAHAMI MASALAH PM DAN
KONSEKUENSINYA

• Outcome (status kes & gizi)

1

• Proses (perilaku yang berkaitan dgn

2 intake, kebiasaan makan, dll)

• Faktor-faktor terkait dgn perilaku

3
2. Meningkatkan motivasi utk perubahan
PM

• Memahami alasan & tujuan

1 perubahan

• Memberikan dukungan
2

• Memberikan kisah sukses & gagal

3
3. MENGUPAYAKAN PERUBAHAN PM

1 • Membuat rencana perubahan PM

1 (Proses yang memerlukan waktu)

2 • Membangun komitmen perubahan

2 PM
•Memulai dari yang sederhana dan
3 • 3. Memulai dari yang sederhana
mudah menuju PM sehat
dan mudah menuju PM sehat
3
3. MENGUPAYAKAN PERUBAHAN PM

• Memantau perubahan
PM
4
 4. PERUBAHAN GAYA HIDUP
• Merencanakan perubahan unsur gaya
hidup non-PM (tapi terkait PM =
1 kegiatan fisik/olahraga, stres, dll )

• Membangun komitmen utk

2 perubahan

• Memulai dari yang sederhana dan

3 mudah
4. PERUBAHAN GAYA HIDUP

• Memantau perubahan
unsur gaya hidup
terkait PM
4
 5. PENGHARGAAN & SANKSI

• Melibatkan orang dekat &

1 keluarga

• Melibatkan lingkungan
2

• Keterbukaan untuk dikritik

3
5. PENGHARGAAN & SANKSI

• Mengaitkan hal-hal
khusus (ULTAH dsb)
4
 6. PENGENDALIAN DIRI DAN
LINGKUNGAN

• Pengendalian diri (memelihara

komitmen diri, kegiatan
1 keagamaan, belanja dan makan)

• Pengendalian lingkungan (pesta,

kegiatan sosial, dll)
2
 Counseling Approaches
Counseling Concepts
Approaches
1. Person-centered • Counselor develop an environment of
therapy unconditional positive self-regard.
2. Behavioral therapy • Focus is on changing the environment
• Behavior modification techniques address
cues, substitutions, and consequences
3. Gestalt therapy • Client take responsibility for making
dietary changes
4. Cognitive therapy • Focus is on changing negative self-talk
and irrational ideas
 Counseling Approaches….con’t

Counseling Approaches Concepts

5. Family therapy • Significant relationships are
explored as a means to provide
support or to lessen the impact of
negative influences.
6. Solution-focused • Clients focus on identifying
therapy strengths and expanding on past
successes
7. Multicultural • Counselors appreciate multiple
counseling perspectives and provide culturally
appropriate interventions