Motivation ; A Psychological Force

I was saying "I'm the greatest” long before I believed it.
-Muhammad Ali

The word "motivation" is derived from the Latin "movere" which means "to move". Motivation refers to psychological forces which move people, bring them to an action and keep them going. Motivation explains the degree of the effort that is spent while performing an activity, the level of performance in achievement tasks and satisfaction and well-being that is derived from an activity and/or its outcome.

The three components of motivation as listed by Arnold et al (1991) are :
(i) Direction - what a person is trying to do
(ii) Effort - how hard a person is trying
(iii) Persistence - how long a person keeps on trying

There are two different categories of motivation theories such as content theories, and process theories. Content theory is also known as need theory. Another type of motivation theory is process theory. Process theories of motivation provide an opportunity to understand thought processes that influence behavior. The major process theories of motivation include Adams' equity theory, Vroom's expectancy theory, goal-setting theory, and reinforcement theory.


Need Theory
Also known as content theory, need theory of motivation mainly focuses on the internal factors that energize and direct human behavior. Maslow's hierarchy of needs, Alderfer's ERG theory, Herzeberg's motivator-hygiene theory (Herzeberg's dual factors theory), and McClelland's learned needs or three-needs theory are some of the major content theories.

- Maslow's Hierarcy of Needs -

- Herzberg’s Two-Factor Theory -

Expectancy Theory

Expectancy theory is about the mental processes regarding choice, or choosing. It explains the processes that an individual undergoes to make choices. This theory was originally contained in the valency-instrumentality-expectancy (VIE) theory, proposed by Victor Vroom (1964).

Motivation is only likely when a clearly perceived and usable relationship exists between performance and outcome, and the outcome is seen as a means of satisfying needs. Vroom suggests that “for a person to be motivated, effort, performance and motivation must be linked”.

Motivation can be expressed as ; M = f(E*V), or as function of valence times expectancy.

This theory was then developed by Porter and Lawler (1968) into a model.

Lawler/Porter Diagram

Instrumental Theory
Another approach is known as the instrumental theory, pioneered by Goldthorpe and his colleagues' who concluded that for some people, work is only a means to gain financial reward.It stresses that for certain people, extrinsic reward such as high economis gains are valued more than intrinsic rewards like job satisfaction.

Goal Theory
Although setting goals was nothing new, it wasn't until the 1960s that an American called Dr Edwin Locke began to formally examine the relationship between motivation and the setting of goals. His main conclusions were :

• specific goals are more motivating than vague goals.
• challenging goals are more motivating than easy goals.
• when people are given positive feedback, both during and after taking action on theor goals this spurs them to achieve even more.
  

Equity Theory
John Stacey Adams, a workplace behavioural psychologist, put forward his Equity Theory on job motivation in 1963. When people feel fairly or advantageously treated they are more likely to be motivated; when they feel unfairly treated they are highly prone to feelings of disaffection and demotivation.

Social Learning Theory
The social learning theory of Bandura emphasizes the importance of observing and modelling the behaviours, attitudes and emotional reactions of others.

"Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do. Fortunately, most human behaviour is learned observationally through modelling : from observing others one forms an idea of how new behaviours are performed, and on later occasions this coded information serves as a guide for action."
-Albert Bandura (1977))

More :
1. Wikipedia

2. Evolution of a Motivation Theory

3. Motivation Theory

4. Motivation by Leslie Radford

5. Handbook of Human Resource Management Practice

Across The Globe

I remembered we were told by our JPA agent to avoid from eating at the stalls beside the road when we first arrived Yogyakarta. The surrounding was not that clean, with its location near the dusty road, we could easily get diarrhea or food poisoning.

If centuries ago, less people travel out of their hometown, but as the modes of transportation nowadays varies, people can go anywhere in this world in just several hours, or even minutes. Travelling across countries has promote globalization around the world.

Generally, globalization can be defined as a process of interaction and integration among the people, companies, and governments of different nations, a process driven by international trade and investment and aided by information technology. In a way, globalization facilitates the spread of disease and increases the number of travelers who will be exposed to a different health environment.Travellers often experience abrupt and dramatic changes in environmental conditions(altitude, temperature and humidity), which may have negative effects on health and well-being.

Travel medicine is the discipline devoted to the maintenance of the health of international travelers through health promotion and disease prevention. Tropical infectious diseases are in a classical sense are limited geographically to areas where specific conditions of tropical climate and ecology must be present as a conditio sine qua non for the transmission and spread of the pathogen responsible (specific diseases of the tropics). Today, the problem of this tropical infectious diseases are not only a problem to the tropical countries, but to all other countries a sweell since any travellers who go to the tropical countries are at risk of getting it.

Figure : Causes of death in developed and developing world in 1997 (WHO, 1998)

In the last two decades infectious diseases have regained considerable significance and interest even in high-income countries. This is due to ;

• changes in modern lifestyles (travel, outdoor activities, drug abuse) have created new risks of acquiring certain infections.
• Emerging and re-emerging infectious diseases as well as emerging resistance against anti-infective drugs have clearly shown their potential global spread.
• Medical advances for the treatment of malignancies and chronic diseases have resulted in a growing population of immunocompromised patients susceptible to opportunistic infections that may limit severely the success of modern therapies ( e.g. transplantation)

Some of the modes of transmission of infectious diseases are as listed below :

1. Food borne and waterborne diseases - Examples of diseases acquired through food and water consumption are traveller's diarrhea, hepatitis A, thyphoid fever and cholera. Taking a hygienic precautions with all food, drink and drinking-water consumed when travelling and by avoiding direct contact with polluted recreational waters.
   
2. Vector-borne diseases - Insects such as mosquitoes and other vectors such as ticks can transmit serious infections. Examples of vector-borne diseases are malaria, dengue, yellow fever and chikungunya.
   
3. Zoonoses - Infections can also be transmitted to humans through animal bites or contact with animals, contaminated body fluids or feces, or by consumption of foods of animal origin, particularly meat and milk products. Rabies, tularaemia, brucellosis amd leptospirosis are some of the diseases of zoonoses.
   
4. Sexually transmitted diseases - STIs (HIV/AIDS, Hepatitis B and syphillis) can be reduced by avoiding casual and unprotected sexual intercourse and by use of condoms.
   
5. Blood borne diseases - Direct contact with infected blood or other fluid can trasmit blood borne diseases such as Hepatitis B and C, HIV/AIDS and malaria. Travellers should avoid direct contact with blood and body fluids, avoid the use of potentially contaminated needles and syringes for injection or any other medical or cosmetic procedures that penetrate the skin and avoid transfusion of unsafe blood.
   
6. Airborne diseases - Droplets nuclei (<5μm)>5μm) as a result of coughing, sneezing or even talking can transmit diseases such as severe acute respiratory syndrome (SARS), pneumonias, pertussis, mumps and meningitis.
   
7. Diseases transmitted via oil - In places where soil-transmitted infections are likely to be present, protect the skin from direct contact with the soil to reduce the risk of infections. Certain intestinal parasitic infections (ascariasis and trichuriasis) are transmitted via soil, and infection may result from consumption of soil-contaminated vegetables. Tetanus and anthrax are examples of bacterial diseases transmitted via soil. Fungal infections may be acquired by inhalation of contaminated soil.
   

Further readings :
1. International Travel and Health WHO 2010 ; Chapter 5 - Infectious Diseases of Potential Risk for Travellers

2. Travel Medicine by J. S. Keystone

3. Principles and Practice of Travel Medicine by Jane N. Zuckerman

Managing Disaster

Emergency management is necessary to improve public safety and security to a creation of disaster-resilient communities. This is accomplished by structuring programs based on the four pillars of emergency management :

1. Prevention-Mitigation ; Includes any activities that prevent emergency, reduce the chance of an emergency happening, or reduce the damaging effects of unavoidable emergencies. Mitigation phase take place before and after emergencies.
   
2. Preparedness ; This phase takes place before a disaster occurs. The activities include plans or preparation made to save lives and help to respond and rescue operations. Examples are evacuation plans and stocking food and water.
3. Response ; Responding safely to an emergency. This is when the preparedness plans are put into action during the disaster.
   
4. Recovery ; Activities that take place after an emergency which includes financial assistance to help pay for the repairs. The actions in recovery phase are taken to return to a normal or an even safer situation following disaster.

From the earthquake and tsunami in Acheh and Nias (2004), the people of Indonesia realized the importance of a proper disaster management system to anticipate the occurrence of disaster. Therefore, a National Agency for Disaster Management or known as Badan Nasional Penanggulangan Bencana(BNPB) is set up. Its mission is to prepare the nation's resilience in facing any kinds of disaster.

organizational structure of BNPB

Some of the policies and strategies are to plan an integrated, coordinated and organized disaster management which involves all parties (the government, the NGO's, the community) and the media as well at pre-disaster, during disaster and post disaster level. BNPB stresses more on disaster risk reduction, while still giving away a fast and precise treatment of emergency. Last but not least, BNPB support and promote voluntarism in the community in order to act when disaster strikes. Some of the programs prioritized by BNPB are :

1. Increase local capacity through; (i) training of community-based disaster management, (ii) implementation of the rehearsal or simulation preparedness and (iii) preparation of national disaster management plan.
2. Application of technical standards in; (i) analysis of disaster risk, (ii) disaster mitigation and (iii) early warning system.
3. Develop logistic systems and equipments to support disaster-relief operations.
4. Increase the capacity in facing a disaster by conducting an effective emergency response; (i) enables the operation control centers and (ii) quick reaction team.
5. Disaster relief efforts by mobilizing all the potentials and capabilities of sources.

So far BNPB (and the previous incarnations) has formed a partnership with several similar institutions, bilaterally and regionally. Bilateral cooperation includes :

• Ministry of Disaster Management, Cabinet Office of Japan
• Emergency Management Australia (EMA), Australia
• Civil Defense (DDSC), France
• Ministry of Emergency Situations (Emercom), Russia
• Federal Emergency Management Agency (FEMA), US

For regional organizations, BNPB has been cooperating with ASEAN Committee for Disaster Management (ACDM), Asian Disaster Risk Reduction (ADRC), and UN agencies such as UNDP, UNOCHA, WFP UNHCR, WHO, UNESCO and so forth.


Readings :
1. The Four Phases of Emergency Management

2. eMedicine : Disaster Planning

3. Badan Nasional Penanggulangan Bencana (BNPB)

Disaster : Emotional Effect

The impact of disaster is beyond what we can imagine. What's more is that it does not only affect physical, but mental as well. No one who experiences a disaster is untouched by it. Losing their loved ones and the properties they own (house, vehicle, livestock) in just a blink, has shattered their lives.

• Warning and Threat Phase : The length of this phase varies, depends on the event. For an instance, in flooding case, there are usually several days of warning that give people time to prepare.

• Impact/Inventory : . Disaster victims may be stunned or confused after the disaster occurred. Yet, they somehow quickly recover and start focus on protecting themselves and their family.Reactions to the impact of the disaster depend on warning and preparedness activities, the level of destruction and the success of the local and state emergency response. The inventory phase follows the event immediately as people start forming a preliminary picture of individual and community condition.

• Heroic : During this rescue or heroic phase, the victims work together to save lives and property. For those who have not lose their loved ones, this may be a period of euphoria and boundless altruism. They are willing to put forth energy to help others. However, this phase also likely to be a time of shock or denial, protecting the person from intense emotions.

• Honeymoon : For a brief time, a week to several months later, those who have experienced disaster are likely to share feelings of common purpose and mutual support. Relief efforts are in full swing and hope recovery run high.

• Disillusionment : This phase can range from two months up to two years. People experience feelings of frustration, disappointment, anger and bitterness especially if the promises for assistance and help are not fulfilled or are seen as too little or too late. The "shared community" feeling may gradually be lost as people concentrate on rebuilding their own lives and solving individual problems.

• Reconstruction/Recovery :For several years after the disaster, people start focusing in rebuilding their homes. businesses and life patterns although support systems may have helped them cope with their immediate needs and emotional responses.
  

The local condition should be assessed ; the victims' cultural aspect, local wisdom, their perception towards disaster and illness and their priorities. The evaluation of the mental status of the people who are affected need to be done regularly. Every single psychiatric symptoms finding should be considered as important and should be given a prompt treatment.

Dealing with one's emotions, is part of all health care workers' duty; be it doctors, nurses, or paramedics. It is important aspect need to be pointed out when handling disaster victims. A simple communication might boost the victims and help them to recover even better, with minimal emotional impact.


References :
1. Back to Business : Health Recovery - Stress Management

2. Psychosocial Issues for Older Adults in Disasters

3. Disaster Mental Health Primer : Key Principles, Issues and Questions

4. Lecture Note : Disaster Management in Mental Health by dr. Bambang Hastha Yoga, Sp. KJ

Disaster : When it strikes

• February 2010, Ciwidey - West Java landslide :

• October 2010, Tsunami in Mentawai :
  

Photo from Kompas

• October 2010, Merapi eruption :
  

photo from Detik

• November 2010, Bromo eruption :

photo in The Jakarta Post

The year 2010 has not been a great year for Indonesia after all. Indonesia reels from earthquake, landslide and flood, tsunami, and volcanic eruption. The impact is not only limited to its local people, but to the country as well. The massive damages have been an economic burden to Indonesia, to recover and stand again on its own.

Now now, let's google up the meaning of 'disaster'.

"sudden ecological phenomenon of sufficient magnitude to require external assistance" - WHO.

"Bencana adalah peristiwa atau rangkaian peristiwa yang mengancam dan mengganggu kehidupan dan penghidupan masyarakat yang disebabkan, baik oleh faktor alam atau non-alam maupun faktor manusia sehingga mengakibatkan timbulnya korban jiwa manusia, kerusakan lingkungan, kerugian harta benda, dan dampak psikologis" - UU Republik Indonesia no 24 tentang penanggulangan bencana.

A disaster can be classified into natural and manmade. However, these two types sometimes can be overlapping. Earthquake, tsunami, volcanic eruption, cyclone are some of the examples of natural disaster. Manmade disaster, on the other hand, is a consequence of their own activity, for an instance deforestation, setting of fires and war. Either natural or manmade, both situations need to be tackled wisely to minimize its impact.



More in :
1. Natural Disaster in Indonesia

2. Discovery Channel - Southeast Asia

3. What is Disaster

4. Psychosocial Issue For Older Adults in Disasters

5.Lecture note : Conceptual Framework of disaster and Disaster Management by dr Hendro Wartatmo

Share and Care

As you can see on top of the right column in my blog, there's a link where you can click and donate some money to Merapi's victims.

Just copy this link to your blog and help us to spread the words :

http://dl.dropbox.com/u/2501888/HTML%20code%20for%20PKPMI-CY%20Merapi%20Eruption%20donation.txt

"We can't help everyone, but everyone can help someone" - Dr. Loretta Scott

A simple action might means the world to them. Let's share and care :)

Getting Accessed

Picture : Motor Sehat Ibu & Anak

Motor Sehat sponsored by SIKIB (Solidaritas Istri Kabinet Indonesia Bersatu). It is somekind of extension of Mobil Sehat. Even a motorbike can deliver health care to the community. Talking about accessibilty? :)

Chronic Disease Management

Diabetes, hypertension, congestive heart failure and asthma are some of chronic diseases that are familiar to us. Nowadays the number of people who suffer from these diseases increased. Imbalanced diet, less physical activity and other bad habits such as smoking are major contributors to such diseases.

A guideline for chronic disease management therefore is essential.



Based on British Columbia's Expanded Chronic Care Model, there are several important aspects to manage chronic diseases.

• Community System
  

Its goal is to build healthy public policy, strengthen community action and create supportive environment.

• The Health System

In health system there are international CDM conference, CDM program information days, national chronic care network and CDM quality improvement. All of these programs work to create a culture, organization and mechanisms that promote safe, high quality care as well as to promote collaboration.

• Self-management Support

Each patient need to prepare themselves, set their minds

• Delivery System Design

Delivery System Design includes; living well with a chronic condition, chronic disease management for diverse population, nurse care management, complex chronic patients, targeted interventions (aboriginal populations, homeless populations and hutterites), health/illness and spirituality.The goal is to assure the delivery of effective, efficient clinical care and self-management support that suits with patient's cultural background.

• Decision Support

The aim of decision support is to promote clinical care that is consistent with scientific evidence and patient preferences. The academic detailing, physician education and disease management accreditation influence the decision making.

• Information System

This element focus on multiple sources in delivery of effective and efficient clinical care.

The main points of CDM are :

1. Comprehensive care : Multiprofessional, multidisciplinary, acute care, prevention and promotion
   
2. Integrated care, care continuum, and coordination of different components
3. Population orientation (defined by a specific condition)
   
4. Active client-patient management tools (health education, empowerment, self-care)
   
5. Evidence-based guidelines, protocols and care pathway
6. Information technology and system solutions
7. Continuous quality improvement

However, it is not that easy to implement the chronic care program. Many problems arise, complicate the success of the program. First and foremost, of course regarding the financial flow and incentives. Lack of incentives demotivate health professionals to get involved with CDM program. Research suggests that one of the central obstacles to improved care for patients with chronic disease is the lack of coordination in health care provision. Poor coordination will affect the continuity of care. Another problem is due to lack of efficient use of information and communication technology (ICT), maybe due to high costs and budget-overruns. Not every country can afford ICT iniatives to be put in all of the health care system. A proper evaluation is noteworthy to evaluate effectiveness and cost-effectiveness of various preventive and treatment interventions. If the evaluation is not well established, the policy makers thus are not optimally equipped to make informed decisions to form the future of CDM.


Read more :
1. Chronic disease management and remote patient monitoring - Eurohealth Vol. 15 No. 1, 2009

2. Are disease management programs (DMP) effective in improving quality of care for people with chronic condition? [August 2003]

3. The expanded chronic care model : An integration of concepts and strategies from population health promotion and the chronic care model

Being Insured

I was watching an English drama series, 'The Good Wife' where it discuss about laws, family and political issues. One of its episode has caught my attention. It was about a 23-months-pregnant woman who was trying to get her insurance company to cover the surgery cost of her fetus. The fetus need a balloon catheter to be inflated in the heart to keep it alive or else it won't survive. Well, it's not about the case that I'm going to write a review on, instead it's more about health insurance.

In Indonesia there are several insurance policies to cover the health care cost of its citizen.

• Jamsostek - A social security based program for private employers and employees where it consists of; Employment Injury, Death, Health Insurance, and a provident fund type Old Age Benefit. It also covers their families, therefore the premium paid by the employer for unmarried employee is only 3% while for the married employee is double(6%). Not all of the private companies have to join Jamsostek. For those companies with at least 10 employees and a monthly payroll of over one million rupiah, with no or poor social security scheme, they are mandated to enrol their employees in Jamsostek.
  

• Askes - As for civil servants, their health insurance cover is Askes. The members of Askes contribute 2% of their monthly salary. All of members are entitled to comprehensive benefits considered medically necessary regardless of their rank and income. Askes pay the provider, which usually consists of public health centers and public hospital. Prospective payment method is used by Askes to pay the providers.
  

• Asabri - It is a counterpart fund for the armed forces and police. It provides similar lump-sum retirement benefits and pensions.

In 2005, a new health card system for the poor, Askeskin is introduced to replace Kartu Sehat. Askeskin is designed to increase access to, and the quality of, health services for the poor. For as low as Rp. 5000 per month per card holder, these people can receive basic outpatient health care and third class hospital care for free. Those who are less poor pay for their own premiums. Askeskin covers obstetric service package, mobile health services and special services for remote areas and islands, immunization programmes and medicines.

With these health insurance schemes, more and more people are now covered. However some measurements need to be taken to extend health care insurance for a wider coverage. The government should increase the budget for health care aspect for the benefits of all.


REFERENCES :
1. Indonesia : Providing Health Insurance For The Poor

2. Health care System Country Notes Asian Region - Indonesia

3. Social Health Insurance for The Poor : Targeting and Impact of Indonesia's Askeskin Program

Abbreviation :
Jamsostek = Jaminan Sosial Tenaga Kerja
Askes = Asuransi Kesehatan
Asabri = Asuransi Sosial Angkatan Bersenjata Republik Indonesia
Askeskin = Asuransi Kesehatan Masyarakat Miskin

Systemic Thinking

We were assigned to write a report after our Systemic Thinking practical session to be submitted, unfortunately my group has to resubmitted it again due to some lackings. We just reviewed and sent our report two days ago. Hopefully this time, it is much better than the previous one!*finger crossing*

We are surrounded by systems all around us, and we are actually apart of it. We work and collaborate with each other to finish our task ( in my group case, to get done with the report). Now let's define the word 'system'.

A system is an organized, highly integrated, purposeful structure regarded as a 'whole' consisting of interrelated and interdependent elements. These elements continually influence each other to maintain their activity and existence of the system, in order to achieve the common purpose, the 'goal' of the system (BusinessDictionary.com).

A system should have :

1. Input
2. Process
3. Output - primary purpose of any system
   

There are many types of system, ranging from simple to complex. A complex system consists of many subsystems and it is called as 'open system' since it interacts with the environments.


Do not confuse systematic thinking, systems thinking and systemic thinking as each of them carries different explanation. Systematic thinking is about methodological thinking. Systems thinking means to be thinking about how things interact with each other while systemic thinking is a simple technique for finding system focus.

Systemic thinking combines analytical thinking and synthetical thinking. For first step (analytical), list as many elements you can think of. Then later (synthetical) step, find the common theme or repeating pattern across those elements. Just like what we have done during our systemic thinking practical session.

Read more in :
1. Systemic Thinking

2. Systemic Thinking - a simple thinking technique for gaining system focus by Gary Bartlett

Simply

For this Block 4.2; Health System and Disaster, we were given an opportunity to help ourselves in boosting up our grade. Yes, who doesn't want an A in examination right? Besides, let's preoccupied ourselves as much as we can about health system before we enter our co-ass for the next semester!

Hopefully by blogging, we can learn more about the content of the block and help each other out by sharing information. Any comment are very much welcomed :)