PRECEDE Analysis: Application of GERMAS in the Workplace

Rina Tri Agustini

, Lies Permana

and Nur Wahyidillah

Faculty of Public Health, Mulawarman University, Sambaliung Street, Samarinda City, Indonesia

Faculty of Public Health, Hasanuddin University, Perintis Kemerdekaan Street, Makassar City, Indonesia

Keywords: GERMAS, PRECEDE Model, Workplace.

Abstract: The workplace is one of the locations to implement the healthy living community movement (GERMAS).

Central Mamuju District Health Office is a health sector institution and has a cross-sectoral function in

involving other institutions in the successful implementation of GERMAS. This study has aimed to analyse

the application of the GERMAS-based PRECEDE model. This was a descriptive qualitative study involving

a case study approach in Mamuju District Health Office related to GERMAS implementation. Data was

collected with problem identification through in-depth interviews with section representatives and observation.

Data analysis has used components in the PRECEDE model. The main findings of this study are reviewing:

(1) Social Diagnosis: workplace facilities and worker interaction; (2) Epidemiological Diagnosis: physical

activities and mortality rates due to non-infectious diseases; (3) Behavioural and Environmental Diagnosis:

risk behaviour, preventive and treatment behaviour, risk environment; (4) Educational and Ecological

Diagnosis: predisposing, reinforcing, and enabling factors; (5) Administration and Policy Diagnosis:

regulations on GERMAS in the workplace. The follow-up plan is planning GERMASoptimisation such as

making a Stretching Tutorial Video for employees and Printed Media (Flyer). Need to increase physical

activity, healthy canteen, arrangement of working tables and chairs, and optimisation of media about

GERMAS.

1 INTRODUCTION

The Healthy Living Community Movement

(GERMAS) by the Ministry of Health is an effort to

prevent and decrease health problems and mortality

rates. The government reduced the number of

infectious and non-communicable diseases through

Presidential Instruction Number 01 of 2017 about

GERMAS. There was still a need to increase public

awareness of a healthy lifestyle, many people who

have risk factors, and a lack of information related to

GERMAS.

There was still low cross-sectoral support and

motivation for health promotion especially

forGERMAS (Yarmaliza & Zakiyyudin, 2019).The

results of the program evaluation of GERMAS

conducted in Bengkulu City were needed to increase

the implementation program of GERMAS which can

be supported by the government, especially in

providing affordable health checks (Utama,

Himalaya, & Rahmawati).

The workplace is one of the locations to

implement GERMAS. The relevant government and

company management can provide socialisationof

theimplementation program of GERMAS,especially

in the workplace, so it can increase healthy workers'

productivity (Juhanto, Genisa, & Idris, 2021).

Because refer to a past study, there was a relationship

between GERMASbehaviour and the occurrence of

hypertension at 20-60 years old in the working area

of the Pahandut Public Health Center, Palangka

Raya City (Rahmadita et al., 2023).

Government institutions including the Health

Office have a duty to monitor the success of the

GERMAS program in the community through the

percentage of morbidity and mortality rates

(Pangalila, Kaawoan, and Kumayas, 2019).Central

Mamuju District Health Office is a health sector

institution that has a cross-sectoral function involving

other institutions and is expected to be an example in

the GERMAS implementation.

The PRECEDE PROCEED model provides a

framework for planning health interventions,

especially in screening contexts. Given the

complexity of the behaviour change process, several

important prognostic factors could be measured in

future research and health intervention planning

(Saulle et al., 2020). Besides,the implementation

theory of the PRECEDE-PROCEED model is

Agustini, R. T., Permana, L. and Wahyidillah, N.

PRECEDE Analysis: Application of GERMAS in the Workplace.

DOI: 10.5220/0012898000004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 9-13

ISBN: 978-989-758-727-6; ISSN: 2975-8297

themost commonly used system/population-level

theory (Allen et al., 2019).

Therefore, it was necessary to conduct a study

related to the GERMASimplementation in the Central

Mamuju District Health Office based on the

PRECEDE Model. So, this study aimed to analyze the

application of the GERMAS-based PRECEDE

model.

2 SUBJECTS AND METHODS

This was a descriptive qualitative study with a case

study approach in the Central Mamuju District Health

Office. Data was collected by in-depth interviews

with representatives from the fields of Environmental

Health, Occupational Health and Sport, and Health

Promotion. In addition, observations were made in

the office environment which is also a triangulation

method as scientific rigour of this study.

This study used the PRECEDE model which

focuses on factor analysis of health problems to

identify the GERMAS implementation. There are 5

phases which we can refer to below.

a. Social Diagnosis

b. Epidemiological Diagnosis

c. Behavioural and Environmental Diagnosis

d. Educational and Ecological Diagnosis

e. Administration and Policy Diagnosis

3 RESULTS

Here are the details of the results of this study which

are presented in 5 stages in the PRECEDE model.

3.1 Social Diagnosis: Workplace

Facilities and Worker Interaction

a. Narrow workspace (Crowding)

b. Irregular table (Aesthetics)

c. Work Duration 8 hours sometimes more in a day

(Absenteeism / Attendance)

d. Interaction between employees is well established

(Happiness)

e. Employees need to stretch but there is no one to

guide them because the stretching reminder and

media do not exist (Welfare)

f. Employees choose to order food or snacks outside

more often because there is no healthy canteen in

the office (Votes)

3.2 Epidemiological Diagnosis: Physical

Activities and non-Infectious

Diseases

a. During the pandemic never do fitness gymnastics

(Fitness)

b. The NCD rates are high in Central Mamuju

District (Hypertension)

3.3 Behavioural and Environmental

Diagnosis: Risk Behaviour,

Preventive and Treatment

Behaviour, Risk Environment

a. Here are the factors frombehaviour and non-

behaviouraspects that cause health problems in

the employees.

Table 1: Behavioral and non-behavioral factors that cause

health problems.

Cause of Health

Problems

Risk Factors

Obesity Lack of exercise, eating fatty foods,

not consuming vegetables and fruits

Hypertension Consuming excess salt, less physical

activit

, smokin

Musculoskeletal Work attitudes such as the back

being too bent, the neck being too

tense when typing on the computer,

sitting in front of the computer for 8-

10 hours every day

Information

Media

Lack of information media about

physical activity and stretching at

wor

Workplace

Condition

Workspaces that have air

conditioning (AC) can reduce

worker agility, sensitivity and

strength.

The Role of

People Around

Lack of attention from the manager

to invite employees to do physical

activities, especially stretching.

b. On the bellow are the preventive and treatment

behaviours for the health problems experienced

by the employees.

Table 2: The preventive and treatment behaviour of the

health problems.

Preventive Behavior Treatment Behavior

Do not buy food/snacks

outside carelessl

Quit smoking (or don't

start

)

Start getting used to eating

healthy (bringing fruits

and ve

etables

)

Reduce Salt, Sugar, Fat

ICSDH 2023 - The International Conference on Social Determinants of Health

Preventive Behavior Treatment Behavior

Increase awareness of the

importance of physical

activit

Routine Employee Health

Check

Create health promotion

media.

Routinely do gymnastics

and stretchin

at wor

c. Sort behavioural and environmental problems

based on their influence on health is presented in

the following table.

Table 3: The behavioural and environmental problems

based on their influence on health.

Behaviour Environment

Important:

• Healthy eating

• Routinely do

gymnastics and

stretching at work

• Weak immune s

ste

Important:

• Healthy Canteen

• Health Promotion

Media

Less Important:

Buy food outside

carelessl

Less Important:

Tidying up the workspace

d. The below are behavioural and environmental

issues based on the likelihood of change.

Table 4: Matrix based on urgency and ease of change.

Behaviour Important Less Important

Easy to

change

Initiation of

stretching at work

Tidying up the

workspace

Difficult to

change

Increase

awareness of

sical activities

Start getting used

to eating healthy

foods

3.4 Educational and Ecological

Diagnosis: Predisposing,

Reinforcing, and Enabling Factors

a. Predisposing Factors: The knowledge of

Mamuju Tengah District Health Office employees

towards the GERMAS program is very good and

several GERMAS programs have been

implemented but awareness to carry out some

indicators is still lacking.

b. Reinforcing Factors: lack of motivation from the

manager to invite employees to do physical

activities such as gymnastics and stretching at

work and consume healthy foods.

c. Enabling Factors: lack of health media to

improve and always remind employees of the

importance of doing physical activities such as

gymnastics and stretching at work and eating

healthy foods.

3.5

Administration and Policy Diagnosis:

Regula

tions on GERMAS in the

Workplace

a. Presidential Instruction Number 1 of 2017 about

GERMAS

b. Letter Rules of the Central Mamuju Regency No.

0095/2932/VI/2019 concerning GERMAS within

the Central Mamuju Regency Government.

4 CONCLUSIONS

Workplaces includethe office as a potential

institution to increase the prevention and control

drills efforts like in the Pandemic Covid-19. The

workplace can support community campaigns,

raise scientific knowledge, andencourage

individual self-protective behaviours among the

employees and people around them (Xie et al.,

2020).

Based on previous studies employees’

perception of the workplace and the right

workplace for their work is influenced by the type

of office the employee has and the time the

employee spends each week. There may also be an

effect of age or ethnicity (Boge et al. 2019). The

workplace environment increases productivity.

Therefore, workplace design should include

natural internal and external conflicts such as

worktime stress to maximise employee impact and

achieve integrated sustainable productivity

(Sadick & Kamardeen, 2020).

Institutions including health offices should be

able to inform promptly about the current

epidemiological situation that can be obtained

from routine health checks of employers related to

early vigilance and reduced risk of non-

communicable diseases (Apshay, 2021). Health

checks which facilitated by the workplacemay

reduce health disparities because workers with less

education are more likely to use them than workers

with higher education(Anne et al., 2020).

Important considerations in the workplace are

the safety of others, overtime work, irregular

shifts, and lack of employee rest. In addition to

occupational factors the health of workers is also

determined by lifestyle factors such as smoking

which plays a major role in creating a high risk of

hypertension in risk assessment.So, the

commitment that must be made by workers is to

maintain a healthy lifestyle and routine medical

checks (Burt, 2020).

PRECEDE Analysis: Application of GERMAS in the Workplace

A study conducted on office workers in

Jakarta found that 59% had insufficient physical

activity. Health interventions and promotions

aimed at reducing perceived barriers increasing

perceived benefits of physical activity and

supporting physical activity among employees

should be increased (Abadini & Wuryaningsih,

2019).

A primary goal of integrated workplace

programming is to design complementary

behavioural and environmental interventions that

have a synergistic effect on workplace health

issues (David&David, 1999). Occupational safety

and health (OSH) research also can be done to create

suitable training for employees based on their

occupation's characteristics (Quandt & Arcury,

2017).

5 CONCLUSIONS

The institution needs to increase:

a. physical activity for workers (periodic

stretching)

b. healthy canteen initiation

c. arrangement of working tables and chairs

d. optimisation of health promotion media about

GERMAS.

The follow-up plan as a recommendation for the

institution is planning GERMAS optimisation such as

making Stretching Tutorial Videos for employees and

Printed Media (Flyer) for health education.

ACKNOWLEDGEMENTS

We give the acknowledgement to the Faculty of

Public Health that facilitated this study and Central

Mamuju District Health Office as the study location.

REFERENCES

Abadini, D., & Wuryaningsih, C. E. (2019). Determinan

Aktivitas Fisik Orang Dewasa Pekerja Kantoran di

Jakarta Tahun 2018. Jurnal Promosi Kesehatan

Indonesia, 14(1), 15-28. https://doi.org/10.14710/

jpki.14.1.15-28

Allen, C. G., Barbero, C., Shantharam, S., & Moeti, R.

(2019). Is Theory Guiding Our Work? A Scoping

Review on the Use of Implementation Theories,

Frameworks, and Models to Bring Community Health

Workers into Health Care Settings. Journal of public

health management and practice: JPHMP, 25(6), 571–

580. https://doi.org/10.1097/PHH.0000000000000846

Anne C. van der Put, Jornt J. Mandemakers, John B.F. de

Wit,& Tanja van der Lippe. (2020). Worksite health

promotion and social inequalities in health. SSM -

Population Health, Vol. 10. 100543, ISSN 2352-8273,

https://doi.org/10.1016/j.ssmph.2020.100543.

Apshay, Vera. (2021). Group Work as a Means of

Increasing the Effectiveness of Training for Medical

Students. ZESZYTY NAUKOWE WSA w Łomży 83, s.

120-135.

Boge, K., Temeljorov Salaj, A., Bakken, I., Granli,

M. and Mandrup, S. (2019), "Knowledge workers

deserve differentiated offices and workplace

facilities", Facilities, Vol. 37 No. 1/2, pp. 38-

60. https://doi.org/10.1108/F-01-2018-0002

Burt, A. (2020). Occupational Risk Factors For

Correctional Workers In The Volga Federal District. In

I. V. Kovalev, A. A. Voroshilova, G. Herwig, U.

Umbetov, A. S. Budagov, & Y. Y. Bocharova (Eds.),

Economic and Social Trends for Sustainability of

Modern Society (ICEST 2020), vol 90. European

Proceedings of Social and Behavioural Sciences (pp.

1620-1628). European Publisher. https://doi.org/10.

15405/epsbs.2020.10.03.186

David M. Dejoy, &David J. Southern. (1999). An

Integrative Perspective on Worksite Health

Promotion. Directions in Person-Environment

Research and Practice (Routledge Revivals) (1

Eds).Routledge.e-ISBN: 9781315542553

Glanz, K., Rimer, B. K., & Viswanath, K. (2008). Health

behaviour and health education: Theory, research, and

practice (4th ed.). Jossey-Bass.

Juhanto A., Genisa, J., & Idris, A. A. (2021). {rogram

Gerakan Masyarakat Hidup Sehat (GERMAS) terhadap

Peningkatan Motivasi Kerja pada Karyawan PT.

Maruki Internasional Indonesia Makassar. Jurnal

Kesehatan Masyarakat dan Lingkungan Hidup, 6(2),

75-82. https://doi.org/10.51544/jkmlh.v6i2.2151

Pangalila, Y., Kaawoan, J., & Kumayas, N. (2019).

Implementasi Kebijakan Program Gerakan Masyarakat

Hidup Sehat di Kota Tomohon. JURNAL

EKSEKUTIF, 3(3). Retrieved from https://ejournal.

unsrat.ac.id/v3/index.php/jurnaleksekutif/article/view/

23872

Quandt, S. A., & Arcury, T. A. (2017). Developing

occupational safety and health training programs for

immigrant workers: Translating research to practice. In

F. T. Leong, D. E. Eggerth, C.-H. (D.) Chang, M. A.

Flynn, J. K. Ford, & R. O. Martinez (Eds.),

Occupational health disparities: Improving the well-

being of ethnic and racial minority workers (pp. 161–

180). American Psychological Association. https://

doi.org/10.1037/0000021-008

Rahmadita, A., Alexandra, F. D., Ratnasari, A., Widodo, T.,

& Arifin, S. (2023). The relationship between the

Healthy Living Community Movement (GERMAS)

and the occurrence of hypertension at the age of 20-60

years in the Pahandut Public Health Center Palangka

Raya. Barigas: Jurnal Riset Mahasiswa, 1(1).

ICSDH 2023 - The International Conference on Social Determinants of Health

Retrieved from https://e-journal.upr.ac.id/index.php/

medica/article/view/7883

Sadick, Abdul-Manan, & Kamardeen, Imriyas. (2020).

Enhancing employees’ performance and well-being

with nature exposure embedded office workplace

design. Journal of Building Engineering, Vol. 32.

101789. ISSN 2352-7102. https://doi.org/10.1016/

j.jobe.2020.101789.

Saulle, R., Sinopoli, A., De Paula Baer, A., Mannocci, A.,

Marino, M., de Belvis, A. G., Federici, A., & La Torre.

(2020). The PRECEDE–PROCEED model as a tool in

Public Health screening: a systematic review.La

Clinica Terapeutica, 171 (2). 10.7417/CT.2020.2208

Utama, T., Himalaya, D., & Rahmawati, S. (2020).

Evaluasi Penerapan Program Gerakan Masyarakat

Hidup Sehat (GERMAS) di Kota Bengkulu. Journal of

Nursing and Public Health, 8(2), 91-99. https://

doi.org/10.37676/jnph.v8i2.1204

Xie, K., Liang, B., Dulebenets, M. A., & Mei, Y. (2020).

The Impact of Risk Perception on Social Distancing

during the COVID-19 Pandemic in China.

International Journal of Environmental Research and

Public Health, 17(17), 6256. https://doi.org/

10.3390/ijerph17176256

Yarmaliza, Yarmaliza, and Zakiyuddin Zakiyuddin.

(2019). "Pencegahan Dini Terhadap Penyakit Tidak

Menular (Ptm) Melalui GERMAS." Jurnal Pengabdian

Masyarakat Multidisiplin, vol. 2, no. 3, 16 Jun. pp. 93-

100, doi:10.36341/jpm.v2i3.794

PRECEDE Analysis: Application of GERMAS in the Workplace