SATUAN ACARA PENYULUHAN

Pokok Bahasan : ...............................................................................................

Sub Pokok Bahasan : …...........................................................................................

Sasaran : …...........................................................................................

Tempat : …...........................................................................................

Hari/Tanggal : …...........................................................................................

Jam/Waktu : …...........................................................................................

Penyuluh : ...............................................................................................

A. Analisa Situasi
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B. Diagnosa Keperawatan
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C. Tujuan
1. Tujuan Instruksional Umum
Setelah dilaksanakan pendidikan kesehatan selama ....... menit, ........ .........
mampu: ..........................................................................................................................
........................................................................................................................................
........................................................................................................................................
........................................................................................................................................
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 ........................................................................................................................................
..............
2. Tujuan Instruksional Khusus
Setelah dilaksanakan pendidikan kesehatan ….................. mampu:
a. .................................................................................................................................
b. .................................................................................................................................
c. .................................................................................................................................
d. ............................................................................................................................dst

D. Metode
1. ........................................................................................................................................
2. ...................................................................................................................................dst

E. Media
1. ................................................................................................
2. ................................................................................................
3. ............................................................................................dst

F. Pengorganisasian :
1. Presentator : ..............................................................
2. Moderator : ..............................................................
3. Fasilitator : ..............................................................
4. Operator : ..............................................................
5. Dokumentator : ..............................................................

G. Setting Tempat
(silahkan menggunakan simbol ataupun gambar, untuk menggambarkan setting tempat
yang diinginkan saat proses penyuluhan)

Keterangan :
 (berisi keterangan dari simbol atau gambar yang digunakan untuk menggambarkan
setting tempat).

H. Strategi kegiatan penyuluhan

No Tahap Waktu Kegiatan Penyuluhan Kegiatan Peserta Media

2 Pelaksanaan menit

3 Evaluasi menit

4 Penutup menit
I. Materi Penyuluhan
Terlampir

J. Evaluasi
1. Evaluasi Struktur
a. ...............................................................................................................................
b. ...............................................................................................................................
c. ...........................................................................................................................dst
2. Evaluasi Proses
a. ................................................................................................................................
b. ................................................................................................................................
c. ............................................................................................................................dst
3. Evaluasi Hasil
a. .................................................................................................................................
b. ................................................................................................................................
c. ............................................................................................................................dst