CHAPTER II LITERATURE REVIEW

2. 1. Healthy and Clean Living Behavior (PHBS)

Healthy and Clean Living Behavior (PHBS) based on Indonesia Health Minister Decision No. 1193/MENKES/SK/X/2004 is a national policy in promoting health living to support the vision achievement of Indonesia Healthy 2010. Here is the explanation about Healthy and Clean Living Behavior includes understanding, order and indicators.

2. 1. 1. Understanding of Healthy and Clean Living Behavior. Health and Clean Living Behavior is a set of behaviors practiced under consciousness as a learning product that make a person or a family able to help himself or herself in medical problem and actively embody public health (Indonesia Health Department, 2006). Health and Clean Living Behavior is a form of society-conscious willing and able to apply the Health and Clean Living Behavior in daily living. Health and Clean Living Behavior program efforts to give educational experience or create a situation for somebody, a family, a community and society. Society is expected to be able to recognize and solve its own problems, particularly in each framework and society can implement healthy living way by maintaining, preserving and improving health (Indonesia Health Department, 2006).

2. 1. 2. Health and Clean Living Behavior Order Order is a place where a community live, work, play, interact, etc. In this case there are five Health and Clean Living Behavior Order. They are household, school, working place, health facility and public space. In this research, the focus is on the educational institution which aim is evaluating the program implementation to behave cleanly and healthily (Health Department, 2006).

2. 1. 3. Health and Clean Living Behavior Indicator An indicator is required to assess whether the principal activities undertaken in accordance by the plan and produce the expected impact. Thus, the indicator is a measure to indicate a state or a tendency of a state of a thing that a main concern (Indonesia Health Department, 2006).

2. 2. Health and Clean Living Behavior in School Order

2. 2. 1. School School is a highly organized institution with all the activity planned deliberately drafted whish so-called curriculum. It is a place to hold a formal teaching and learning process, in which a transformation of knowledge from teachers to students happens. School takes an important role in education because its immense influence toward the psychology growth of the children, next to the family as central education, school also has the function as an educational center of children personalities growth (Ahmadi, 2003).

2. 2. 2. Health and Clean Living Behavior in School Health and Clean Living Behavior in schools is an attempt to empower students, teachers, and school neighborhood in order to know, willing, and able to implement Health and Clean Living Behavior and actively take a role in creating a healthy school.

2. 2. 3. Benefits of Health and Clean Living Behavior in Schools a. A clean and healthy school gives protection to students, teachers and school neighborhood from various disturbances and threats disease. b. It can increase the enthusiasm of teaching-learning process that impact the achievement of the students. c. The image of a school as education institution is getting better so can attract the interest of the parents (society).

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d. A better image of the local government in educational field. e. It could be an example of healthy school for other schools.

2. 3. Health and Clean Living Behavior Indicator at School

2. 3. 1. Washing Hand with Soap and in Flowing Water. Washing hand is an important step in preventing the spread of disease. Hands are one of the various transmission mediums of infectious disease such as intestinal and digestive disorders (diarrhea, vomiting) and other diseases that can potentially lead to mortality. Washing hands with water only is common but this thing is proved not effective enough in maintain health compare to washing hands with soap. Washing hands with soap takes more time, however using soap become more effective since fat and dirt are detached when we rub our hands. In the grease and dirt are living germs. Another is the fragrant effect on the hand after washing it with soap, and in some cases this effect that make washing hands be interesting to do. To overcome the bacteria needs the understanding of the importance of hand washing by anyone. Not just washing your hands but also the use of soap and carried out under running water because soap can reduce or weaken germs on hands. Hand washing with running water and soap is one of the measures of sanitation with clean hands and fingers with soap and water by humans to be clean and break the chain of germs. The United Nations has declared October 15 as the Day of Washing Hands with Soap Day. There are 20 countries in the world to participate actively in this, one of them is Indonesia. Handwashing with soap is necessary, in particular: 1. Before preparing food and before eating 2. Before feeding children 3. After defecation and urinate

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4. After sneezing, coughing, blowing your nose, after coming home from the flier 5. After the play / feed / pet hold

2.3.2 Eating Healthy Snacks in School Cafeteria Allowance for children is the most frequently performed and this can be harmful if they consume snacks that are not healthy. This is consistent with research conducted in Bogor where Salmonella paratyphi A was found in 25% 50% of the sample drinks sold at the sidewalk. These bacteria may have come from ice cubes that are not cooked first. In addition to microbiological contamination, chemical contamination commonly found in hawker food is the use of the Food Supplement Ingredients (BTP) illegal such as borax (pengempal Boron containing heavy metals), formality (preservatives used for the bodies), rhodamine B (red dye on textiles ) and methanil yellow (yellow dye on textiles) (Judwarwanto, 2008). Street food energy intake can contribute to the school children as much as 36%, protein 29% and 52% iron. Therefore, street food has an important role in the growth and achievement of school children. So, to reduce the exposure of school children to unhealthy snack food and unsafe, to do the business promotion of food security both to the school, teachers, parents, students, and merchants (Judarwanto, 2008). School children are generally time each day spent in school, as well as the effect on the child's diet. As parents we need to realize that maybe the food from outside the home (at school) contributes to the fulfillment of energy needs by 31.1% and 27.4% protein. The survey also showed that some 78% of school children eating snacks in the school, either in the cafeteria or from vendors around the school (POM, 2008). Because it can be understood an important role in the growth of street food and learning achievement of school children. Unhealthy snack food quality and result in a risk to health and long-term negative impact on the formation of generation. It is ironic, if we consider the

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school snack food only as a minor problem because the impact was so great for the nation's survival in the future. Increased attention to the health of school-age children through a healthy snack food is expected to create learners who are healthy, intelligent and accomplished people are an asset in the future.

2.3.3 Using a Clean and Healthy Latrine The most important and can be done by the school to prevent spreading infectious diseases such as diarrhea are safely dispose of human waste by using latrines. Location of latrine should not be too close to the classroom. Latrines between male students and female students should be separated so that hygiene can be maintained toilets and latrines hygiene inspection every day. Latrines are important basic sanitation should be owned by every society. The importance of small and large bowel movements in the toilet is clean is to avoid various kinds of diseases caused by poor sanitation. Therefore latrine latrine construction should follow a healthy standard which must be located at least 10 meters away from water sources and sewers have air so as not to contaminate the surrounding environment. Terms latrine healthy include: a. Do not contaminate water sources, for this lies the septic pit is at least 10 m from the source of drinking water. But if the state of chalky soil or clay cracks in the dry season, so if the location of the toilets next to the source of drinking water on the sloping ground, so the distance should be more than 15m. b. No smell and feces can not be touched by insects and rodents, for this stool should be sealed, for example by using a goose neck / cover the meeting. c. Easy to clean, safe to use, for this it must be made of materials that are strong and durable and to be more efficient should be made from materials available in the local area. d. Fitted wall and roof protective, impermeable walls and brightly colored. e. enough lighting f. Waterproof flooring

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g. Spacious room enough, the roof is not too low. h. Good ventilation. i. Available water purifier

2.3.4 Sporting a Regular and Measured Sport is a series of body movements were organized and planned to maintain motion (survival) and improve motor skills (improving quality of life). Exercise is a form of physical activity that involves structured terencanan and repetitive body movements and aimed to improve fitness jasmanin (MOH, 2002). Physical fitness is very important in supporting the activities of daily life, but the value of physical fitness of every person is different according to the tasks and their respective professions. Physical fitness consists of components that are grouped into groups related to health (Health Related Physical Fitness) and grouprelated skills (Skill Related Physical Fitness) (MOH, 2002). Benefits of exercise: 1. Improve the working and functioning of the heart, lungs and blood vessels characterized by: 2. Resting pulse rate decreases. 3. Stroke volume increase 4. Capacity increases. 5. Reduced lactic acid buildup 6. Improving the collateral vessels 7. Increases HDL Cholesterol. 8. Reduce atherosclerosis. 2. Increase muscle strength and bone density marked on: a. In children: optimizing growth b. In adults: strengthen bone mass, decrease chronic joint pain in hips, back and knees. 3. Increases elasticity (flexibility) of the body so as to reduce injuries. 4. Increasing the body's metabolism to prevent obesity and maintain a healthy weight.

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5. Reduce the risk of various diseases such as: a. High blood pressure: systolic and diastolic pressure reduces. b. Coronary heart disease: increasing HDL-cholesterol and reduce body fat. c. Diabetes: increase sensitivity to insulin. d. Infection: increased immune system. 6. Increase the hormonal system by increasing tissue sensitivity to hormones. 7. Increase the activity of the immune system against disease by improving immune regulation.

2.3.5 No Smoking Cigarettes contain more than 4000 elements and at least 200 are otherwise harmful to health. The main toxins in cigarettes are tar, nicotine and carbon monoxide. According to data from the National Social Economic Survey (NSES), that in 2004, approximately 3% of children start smoking since age less than 10 years. The percentage of the highest smoking rate of 64% at the adolescent age group (15-19 years). This means that the harmful effects of smoking on the vulnerable children and will impact on adolescence. Therefore, smoking should be avoided since the early start of primary school.

2.3.6 Considering Weight and Height Measuring Measuring height and weight is an effort to determine the growth and development of children. By knowing the rate of growth and development to provide input for the increased consumption of nutritious food for growing children. While to know the normal growth of a child or not can be known by comparing the body size of the child with the child's age, body size in general. If the child has a body size exceeds the size of the average age of children in general, it can be said to advance growth. Conversely, if the smaller size means slower growth. Growth considered normal when body size equal to the average size of other children his age (Asim, 1992).

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To determine the growth and development of students performed recording the results of weighing and measuring students' height in Card Towards Healthy Children School (KMS-US) regularly every 6 months will show the growth and development of students (nutritional deficiencies, obesity or nutrition). Children with good nutritional status will grow and develop optimally according to age. Students with signs of malnutrition: 1. Students look thin. 2. Not fresh, not cheerful. 3. Not excited / lazy to do the activity. 4. Tend often sick.

Signs of students with nutrition: 1.Students look fat. 2. Body look unbalanced. 3. Unable to move freely. 4. Breath easy breath when doing activities. 5. Easily tired. 6. Lazy activities

Signs of students with good nutrition: 1. Grow normally. 2. Fresh, strong, energetic and cheerful. 3. Clean and shining eyes. 4. Good appetite.

2.3.7 Disposal of Waste in Place Garbage is included that affect the sustainability of the environment, because the garbage affects the natural environment and social environment, if there is an error in the garbage disposal it would be fatal for the environment in the present and in the future to come. As the garbage to landfill (TPA), which

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without any further processing, which ultimately resulted in the buildup. When garbage piled up will lead to a catastrophe that makes environmental damage, for example like megakibatkan floods, landslides and other disasters. Disposing of waste in place is a simple way that is very beneficial to keep the environment clean, but very difficult to implement. The results are consistent with the statement by mentioning that Andang Binawanyang littering habits conducted in almost all societies, not just the poor, that they are highly educated did so (Kartiadi, 2009).

2.3.8 Flick Eradicate Mosquitoes 1. Reasons to eradicate mosquito larvae in school

In order wiggler free schools, students and the public school environment protected from various diseases are transmitted by mosquitoes. 2. Understanding eradicate mosquito larvae

Eradicate mosquito larvae in school is examining activities shelters clean water at school (bathtub, swimming, etc.), whether free of mosquito larvae or not. 3. Activities eradicate mosquito larvae

Mosquito nest eradication (PSN) by 3 M plus (Drain, Close, Bury, plus Avoiding mosquito bites). PSN is a combat activity eggs, larvae and pupae of mosquitoes transmitted the disease Dengue Fever, Dengue fever, Chikungunya, Malaria, Filariasis (Elephant Foot) at the breeding places. 3 M Plus is a three-way plus that done when PSN as: 1. Drain and brush shelters like bath water, ponds, flower pots placemats, etc. 2. Sealed water reservoirs like air hole control, tree holes, indentations that can collect rain water.

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3.

Burying or get rid of second-hand goods that can hold water such as old tires, tin cans, plastics are discarded carelessly (former bottle / glass of mineral water, plastic, etc..)

4.

Plus Avoiding mosquito bites such as: Take medications that can prevent mosquito bites, such as wearing insect repellent ointment / rubbed into the skin, etc.. Seek adequate lighting and ventilation Improving channels and guttering damaged. Sprinkle larvacide (larva killer powder) in places that are difficult depleted eg guttering or in hard water areas. Maintaining larvae-eating fish in the pond / water tank, for example Betta fish, tilapia, etc.. Planting mosquito repellent plants, for example, zoddia, lavender, rosemary, etc..

2.4 School Health Enterprises

2.4.1 Understanding Business School Health School Health Enterprises (UKS) is any effort made to improve the health of school-age children in each lane, the type, level of education from Kindergarten (TK) to the upper secondary level (SMA / SMA / MA). UKS Program is an integrated effort across programs and across sectors to improve the health and shape PHBs school-age children who are in public schools and religious character of the school. According to Sonja Purnomo, et al (1991), UKS is a public health effort that is run in schools with students as well as the environment as the main target. According Djone Soetomo (1982), UKS is a part of public health in the school run.

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2.4.2 UKS destination The general objective of the program is to improve the UK's school children clean and healthy behavior, improve health and create a healthy environment to allow growth and development of harmonious and optimal (MOH, 2008). Specific objectives UKS is as follows: 1. Improve knowledge, attitudes and skills of learners. 2. Learners to implement PHBs.

3. Increasing the role of the learners in improving health in schools. 4. Increasing healthy life skills of students to be able to protect themselves from the effects of drug abuse, juvenile delinquency, free sex and sexually transmitted diseases including HIV / AIDS (Decree RI, 2007). UKS program organized through the integration of three (3) courses UKS, namely health education, health care and fostering the healthy school life. Related to the number of children in school, especially at primary level and secondary schools, UKS is effective means to promote programs of disease control and environmental health, medicine, nutrition, reproductive health and other programs. At school, UKS program comes with a small physician activities. Small physician program is mobilizing efforts of students in a school that meets the criteria and trained to participate in an effort perform maintenance and improvement of health for yourself, friends, family and the environment.

2.4.3 Target UKS Target Activity UKS is as follows: 1. Primary Objectives: learners 2. Secondary target: teachers, civil learning or tutor parents, educational administrators and managers kesehata, and TP UKS at every level. 3. Tertiary Target: educational institutions ranging from preschool level to the upper secondary school level, including the unit outside of

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school and college education as well as religious boarding school and its environment (TP UKS Center, 2007).

2.4.4 Scope of UKS and Development UKS The scope of activities includes Tri UKS Business School Health Program (UKS Trias) which include: a. Implementation of health education b. Health service delivery c. Fostering healthy scope of school life While coaching UKS scope includes: 1. 2. 3. 4. 5. 6. 7. Health education Health services Maintenance of a healthy school life environments Workforce Means UKS Research and development Management and organization

3.1 Knowledge Knowledge is the result of "know", and it occurred after the conduct of a particular object sensing (through sight, hearing, smell, taste and touch) (Soekidjo Notoatmodjo, 2007). It can be defined as the capacity to acquire, store and use information, as well as a mixture of understanding, experience and expertise. Criteria of knowledge centered on thoughts that make one can distinguish right from wrong. Education is a prerequisite of the knowledge (Badran, 2000). Knowledge or cognitive domain is very important for the formation of a person's actions because of the experience and behavior that turns research based knowledge will be more lasting. Research Rogers (1974) revealed that prior to adopting the new behavior in that person happens sequential process, namely : 20

1. Awareness (consciousness), which is the state the person is aware of in the sense of knowing prior to stimulation. 2. Interest (feel attracted) to the stimulus or object. Here the attitude of the subject has begun to emerge. 3. Evaluation (to weigh) the good and whether or not the stimulus for him. This suggests that the attitude of the respondents have been better. 4. Trial, the subject has already started trying to do things according to what is desired by the stimulus. 5. Adoption, the subject has been behaving in accordance knowledge, awareness and attitudes towards the stimulus (Soekidjo Notoatmodjo, 2007).

However, from further research, Rogers concluded that the change in behavior does not necessarily pass through these stages. The knowledge possessed the cognitive domain covered in 6 levels, namely: 1. Know (know) Know interpreted as remembering a previously learned material. Therefore, the "know" this is the low level of knowledge. 2. Understanding (comprehension) Understanding is defined as the ability to correctly describe what is known about the object, and can correctly interpret the material. People who have understood the object or material must be able to explain, cite examples, infer, predict and so the object being studied. 3. Applications (application) Application is defined as the ability to use a material that has been studied in a situation or condition of the real (actual). 4. Analysis (analysis) Analysis is the ability to describe an object or material into components, but still within an organizational structure and still have something to do with one another.

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5. Synthesis (synthesis) Synthesis refers to the ability to place or connect the parts in a whole new form. In other words, the synthesis is the ability to develop new formulations of existing formulations. 6. Evaluation (evaluation) Evaluation relates to the ability to conduct an assessment of the justification or a material or object. These ratings were based on a selfdetermined criteria, or using criteria that already exist (Soekidjo Notoatmodjo, 2007).

3.2 Attitude Attitude is a reaction or response to someone who is covered to a stimulus or object. Attitude clearly shows connotations of correspondence reactions to certain stimuli. Newcomb (a social psychologist) stated that it is the attitude of readiness or willingness to act. The attitude is not an act or event, but a "predisposition" action or behavior (Soekidjo Notoatmodjo, 2007). In other respects, Allport (1954) explains that attitudes have three principal components, namely: 1. Faith (belief), the idea and the concept of an object. 2. Emotional life or the emotional evaluation of an object. 3. The tendency to act (trend to behave). These three components together to form the whole attitude (total attitude). In determining this whole attitude, knowledge of thought, conscience and emotions play an important role. As well as knowledge, attitudes also consists of several levels, namely: 1. Receive (receiving) Mean that people are willing to accept and pay attention to a given stimulus. 2. Responding (responding) 22

Answer when asked, doing and completing assigned tasks is an indication of the attitude. 3. Respect (valuing) Invite others to do something or discuss with others about a problem is an indication of the attitude of the three levels. 4. Responsible (responsible) Responsible for everything that has been chosen with all the risk is the highest attitude (Soekidjo Notoatmodjo, 2007). Theory suggests that attitudes can be changed through three processes, namely the willingness, identification and internalization. Factors that are considered highly influential in directing attitudes to the desired shape is an external factor, namely that there are factors outside of the individual who deliberately intended to influence human behavior, so that the conscious or unconscious individuals concerned will adopt a certain attitude. This factor basically rests on a process called persuasion strategies to change attitudes (Saifuddin Anwar, 2009). Persuasion is an attempt changing individual attitudes by incorporating ideas, thoughts, opinions, and even new facts through communicative messages. The message conveyed by deliberately intended to cause contradictions and inconsistencies among the components of individual attitudes or between attitudes and behavior, thus destabilizing the attitude and open opportunities for the desired change (Saifuddin Anwar, 2009).

3.3 Behavioral Health Behavioral health is essentially a person's response to stimuli related to pain and illness, health care systems, food, and environment. This limitation has two main elements, namely the response and stimulus (Soekidjo Notoatmodjo, 2007). Human response or reaction can be passive (knowledge, perceptions and attitudes) and active (real or practical action), while the stimulus or stimuli

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consisted of four basic elements, namely illness and disease, health care systems, food and the environment. Thus, a more detailed health behaviors include: 1. Attitudes towards illness and disease, that is how people respond, either actively or passively, are made in relation to illness and disease. This behavior is by itself according to the levels of disease prevention, namely: a. Behavior with respect to the improvement and maintenance of health (health promotion behavior), such as eating nutritious foods and exercise. b. Conduct disease prevention (health prevention behavior), that the response to the prevention of disease, as well as behavior to not transmit the disease to others. c. Conduct disease prevention (health prevention behavior), that the response to the prevention of disease, as well as behavior to not transmit the disease to others. d. Behavior with respect to the search of treatment (health seeking behavior), the behavior of doing or seeking treatment, either by way of treating the disease itself, or seek treatment to modern health facilities or traditional. e. Behavior with respect to the restoration of health (health rehabilitation behavior), the behavior associated with health recovery efforts after recovering from an illness. 2. The behavior of the health care system. This behavior is related to the response to the service facilities, how to care, health and medicine embodied in knowledge, perceptions, attitudes, and use of facilities, personnel and drugs. 3. Attitudes toward food (nutrition behavior), that person's response to food as a vital necessity for life. This behavior includes knowledge, perceptions, attitudes and practice towards food as well as the elements contained in it, the management of food and so on with respect to our needs.

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4. Conduct environmental health (environmental health behavior), that person's response to the environment as a determinant of human health.

Robert Kwick (1974) says that the behavior is an action or actions of an organism that can be observed and can even be studied. The behavior is similar to the attitude. Attitude is a tendency to hold action on an object, in a way that suggests any signs to favor or not favor such objects. The attitude is just part of human behavior (Soekidjo Notoatmodjo, 2007). Learning is defined as a process of behavior change resulting from the practices in the spheres of life. Learning is a change in behavior based on past behavior. It can be concluded that the behavior was formed through a process and takes place in human interaction with the environment. Factors that influence the formation of behavior can be divided into two, namely internal and external factors. Internal factors include the knowledge, intelligence, perception, emotion, motivation and so that function to process external stimuli, whereas external factors include the environment, both physical and non-physical, such as climate, socio-economic, cultural, and so forth (Soekidjo Notoatmodjo, 2007) .

3.3.1

Domain Behavioral Health

Human behavior is very complex and has a very broad scope. Benjamin Bloom (1908) divides the behavior into three domains (domains / regions), although these areas did not have a clear and firm boundaries. This division is made for educational purposes. The three domains are cognitive behavioral (cognitive domain), the affective (affective domain) and psychomotor domains (psychomotor domain). The above three domains measured: 1. Knowledge of learners to education materials provided (knowledge). 2. Attitude or response learners to educational material provided (attitude). 3. Practices or actions taken by learners in relation to a given educational materials (practice).

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The formation of a new behavior, especially in adults began in the cognitive domain, in the sense that the subject knows in advance of the stimulus in the form of materials or objects outside. This will lead to new knowledge on the subject and then cause a response in the form of an inner attitude of the subject to the object known it. Finally stimuli, ie objects that are known and fully realized, will lead to further response, in the form of action with respect to the earlier stimulus. Stimulus received by the subject can directly lead to action. This means that someone can act or behaving without knowing in advance the meaning of the stimulus it receives. In other words, a person's actions should not be based on knowledge or attitudes (Soekidjo Notoatmodjo, 2007).

3.3.2 Practice or action An attitude not automatically manifest in action. For the realization of attitude required to be a real difference contributing factor or a condition that allows, among other facilities and factors support from other parties, such as family (Soekidjo Notoatmodjo, 2007). Practice has several levels, namely: 1. Perception (perception) Identify and select different objects with respect to actions to be taken are first-rate practice. 2. Response guided (guided responses) Can do things according to the correct sequence in accordance with the examples is an indicator of the level of the two practices. 3. The mechanism (mechanism) If someone has done something right automatically, or something is a habit, then he has reached level three practices. 4. Adaptation (adaptation) Adaptation is a practice or action that is already well developed. This means that the act itself was modified without compromising the truth of such action (Soekidjo Notoatmodjo, 2007).

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3.3.4 Behavior Change It is important in health behavior change is a matter of the formation and behavior, because behavior change is the goal of education or health education to support other health programs. One theory that explains the behavior change theory is stimulus-organismresponse (SOR). This theory is based on the assumption that the cause of the behavior changes depending on the quality of the stimuli (stimulus) that berkomunisasi the organism. That is, the quality of the source of communication, such as credibility, leadership and speaking style will determine the success of behavioral changes in a person, group, or community (Soekidjo Notoatmodjo, 2007). Hosland, et al (1953) say that the behavior change process is essentially the same as the process of learning. The process of behavior change illustrates the learning process of individuals consisting of: 1. Stimulus (excitatory) were given organism can be accepted or rejected. If the stimulus is not accepted, then it is not effective stimulus affect individual attention. When the stimulus is received, there is a concern of the individual and the stimulus is effective. 2. If the stimulus has gotten the attention of the organism, so he understands this and continued stimulus to the next process. 3. After that process the stimulus organism causing the willingness to act in the stimulus that has been received. 4. With support and encouragement from the facility, then the stimulus has the effect of individual actions (behavior change). reinforcement memegang peranan penting (Soekidjo Notoatmodjo, 2007). Furthermore, the theory says that behavior can be changed only when a given stimulus actually exceeded the previous stimulus. Stimulus that may exceed the original stimulus means a given stimulus must be able to convince the organism.

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In these organisms convincing, reinforcement factor plays an important role (Soekidjo Notoatmodjo, 2007).

3.3.5 Forms of Behavior Change According to WHO, behavioral changes that can be grouped into three, namely: 1. The changing nature. Some behavioral changes in humans caused by natural events. If in the event of a change in the surrounding physical environment or the social, cultural and economic development, the members of the community that is in it will also change. 2. Change of plans. This behavior occurs because the change was planned by the subject. 3. Willingness to change. In the event of an innovation or development programs in the community, then what often happens is that some people are very quick to accept innovation or change, but some others were very slow to accept innovation or change. This is because everyone has a willingness to change (readiness to change) different (Soekidjo Notoatmodjo, 2007). In health programs, in order to obtain a change of behavior in accordance with the norms of health, it is necessary concrete efforts and positive. Several strategies to obtain these behavioral changes by WHO grouped into three, namely: 1. Using power or encouragement. In this case, behavioral changes imposed on the target or the society that he wanted to do or behave as expected. 2. Provision of information. By providing information about healthy way of life, way of health care, how to avoid disease and so on, will increase public knowledge about these things. Furthermore, knowledge-knowledge that will lead to their consciousness and will eventually cause people to behave in accordance with that knowledge. The results or changes in behavior in this way will take a long time, but the change would be achieved lasting because it is based on self-awareness.

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3. Discussion and participation. This method is as an increase in the second way in which to provide information about health is not unidirectional, but bidirectional. Thus, the knowledge-health as a basic knowledge of their behavior and steadily acquired greater depth, and ultimately their behavior will be more steady, it can even be an example for others. This method will take longer than the latter. Discussion participation is one good way in order to provide information and health messages (Soekidjo Notoatmodjo, 2007).

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