MODELS OF PREVENTION

SUNIL.M.B

What is a model?

A modelIs a theoretical way of understanding a

concept or idea

Represent different ways of approaching complex issues

What is health Belief?

Health beliefs - are a person’s ideas, convictions, and attitudes about health and illness

These health beliefs usually influence health behavior & they can be positive or negative affect a client’s health

One of the Positive Health behaviour is ‘Prevention’ Common positive health behaviours

include –immunizations, proper sleep patterns, adequate exercise, nutrition

Concept of Prevention "...prevention is any activity which

reduces the burden of mortality or morbidity from  disease."

The act of preventing or impeding. A hindrance; an obstacle.

Definition of health• Traditional medicine - "absence of disease absence

of disease".• "Health is a state of complete physical, social and

mental well-being, and not merely the absence of disease or infirmity"- WHO(1948)

• Murray &  & Zentner –"state of well-being (where)…person uses purposeful, adaptive responses…to maintain relative stability and comfort strive for personal objectives & cultural goals"

New philosophy of healthHealth is:

Fundamental right Essence of productive life Intersectoral Integral part of development Central to the concept of quality of life Involves individual, state and

international responsibilities World wide social goal Major social investment

1.MILLENNIUM DEVELOPMENT GOAL:

In the millennium declaration of September 2000, member states of the United Nations made a most passionate commitment to address the “crippling poverty and multiplying misery” that grip many areas of the world.

Government sets a date of 2015 by which they would meet the millennium development goals

Goals of Millennium Development Goal :

1. Eradicate extreme poverty and hunger2. Achieve universal primary education3. Promote gender equality and empower women4. Reduce child mortality5. Improve maternal health6. Combat HIV/AIDS, malaria and other disease7. Ensure environmental sustainability8. Develop a global partnership for development

2.CLINICAL MODEL

In this model, • the absence of signs and symptoms of

disease indicates health • illness would be the presence of signs and

symptoms of disease• people who use this model of health to guide

their use of healthcare services may not seek preventive health services, or they may wait until they are very ill to seek care

• clinical model is the conventional model of the discipline of medicine

3.ROLE PERFORMANCE MODEL

In this model, health is indicated by the ability to perform social roles.

Role performance includes work, family and social roles, with performance based on societal expectations.

Illness would be the failure to perform a person’s roles at the level of others in society.

This model is basis for work and school physical examination and physician – excused absences.

The sick role, in which people can be excused from performing their social roles while they are ill, is a vital component of the role performance model.  

4.ADAPTIVE MODEL

Here, the ability to adapt positively to social, mental, and physiological change is indicative of health.

Illness occurs when the person fails to adapt or becomes in-adaptive toward these changes.

As the concept of adaptation has entered other aspects of culture, this model has become widely accepted.

5.AGENT – HOST – ENVIRONMENTAL MODEL

- by Leavell and Clark(1965)

This is useful for examining causes of disease in an individual.

The agent, host and environment interact in ways that create risk factors, and understanding these is important for the promotion and maintenance of health.

An agent is an environmental factor or stressor that must be present or absent for an illness to occur.

A host is a living organism capable of being infected or affected by an agent. The host reaction is influenced by family history, age, and health habits.

6.HIGH LEVEL WELLNESS MODEL

- by Dunn(1961): This model recognizes health as an ongoing process toward a person’s

highest potential of functioning. This process involves the person, family and the community. He describes high-level wellness as “the experience of a person alive with

the glow of good health, alive to the tips of their fingers with energy to burn, tingling with vitality – at times like this the world is a glorious place”.

The wellness – illness continuum (Travis and Ryan 1988) is a visual comparison of high-level wellness and traditional medicine’s view of wellness.

High level wellness according to Ardell (1977) is a lifestyle focused approach which you design for the purpose of pursuing the highest level of health within your capability.

7.HOLISTIC HEALTH MODEL

-by Edelman and Mandle, 2002

Holism acknowledges & respects the interaction of a person’s mind, body and spirit within the environment. Holism is an antidote to the atomistic approach of contemporary science. An atomistic approach takes things apart, examining the person piece by piece in an attempt to understand the larger picture.

Holism is based on the belief that people (or their parts) can not be fully understood if examined solely in pieces apart from their environment.

Holism sees people as ever charging systems of energy.

In this model, nurses using the nursing process consider clients the ultimate experts regarding their own health and respect client’s subjective experience as relevant in maintaining health or assisting in healing.

In holistic model of health, clients are involved in their healing process, thereby assuming some responsibility for health maintenance.

Nurses using the holistic nursing model recognize the natural healing abilities of the body and incorporate complementary and alternative interventions, such as music therapy, reminiscence, relaxation therapy, therapeutic touch, and guided imagery because they are effective, economical, noninvasive, non-pharmacological complements to traditional medical care.

8.NIGHTINGALE’S THEORY OF ENVIRONMENT

Florence Nightingale’s environmental theory has great significance to nursing and community health nursing specifically, because it focuses on preventive care for populations.

Her observations suggested that disease was more prevalent in poor environments and that health could be promoted by providing adequate ventilation, pure water, quiet, warmth, light and cleanliness.

The crux of her theory was that poor environmental conditions are bad for health and that good environmental conditions reduce disease.

This model views health as a constantly changing state, with

high level wellness and death being on opposite ends of a

graduated scale, or continuum.

This continuum illustrates the dynamic state of health, as a

person adapts to changes in the internal and external

environments to maintain a state of well-being.

A patient with chronic illness may view himself/herself at

different points of the continuum at any given time,

depending on how well the patient believes he/she is

functioning with.

9.MILIO’S FRAMEWORK FOR PREVENTION

Nancy Milio developed a framework for prevention that includes concepts of community – oriented, population – focused care

Milio’s basic treatise (thesis) was that behavioural patterns of the populations – and individuals who make up populations – are a result of habitual selection from limited choices.

She challenged the common notion that a main determinant for unhealthful behavioural choice is lack of knowledge.

Milio’s framework described a sometimes neglected role of community health nursing to examine the determinants of a community’s health and attempt to influence those determinants through public policy.

10.LEVELS OF PREVENTION MODEL

• This model, advocated by Leavell and Clark in 1975, has influenced both public health practice and ambulatory care delivery worldwide.

• This model suggests that the natural history of any disease exists on a continuum, with health at one end and advanced disease at the other.

• The model delineates three levels of the application of preventive measures that can be used to promote health and arrest the disease process at different points along the continuum.

• The goal is to maintain a healthy state and to prevent disease or injury.

LEVELS OF PREVENTION MODEL

It has been defined in terms of four levels:Primordial preventionPrimary preventionSecondary preventionTertiary  prevention

Primordial Prevention

• Primary prevention in its purest form – prevention of the emergence or development of risk factors in population or countries in which they have not yet appeared.

• Here, efforts are directed towards discouraging children from adopting harmful lifestyles

Primary PreventionAn action taken prior to the onset of disease,

which removes the possibility that the disease will ever occur.

It includes the concept of positive health, that encourages the achievement and maintenance of an “acceptable level of health that will enable every individual to lead  a socially and economically productive life”.

A holistic approach

Secondary PreventionAction which halts the progress of a

disease at its incipient stage and prevents complications.

The domain of clinical medicineAn imperfect tool in the transmission of

diseaseMore expensive and less effective than

primary prevention

Tertiary PreventionAll measures available to reduce or limit

impairment and disabilities, minimize suffering caused by existing departures from good health and to promote the patient's adjustment to irremediable conditions

Modes of intervention Health promotion Specific protection

Health promotion The process of enabling people to in areas to control over and to improve health

Immunization

Specific protection Health education Specific nutrients

Early diagnosis and treatment

Environmental modifications Chemoprophylaxis

Disability limitation Nutritional interventions Protection against occupational hazards

Rehabilitation Lifestyle and behavioral changes Protection from carcinogens

Avoidance of allergens

Rehabilitation

• The combined and coordinated use of medical, social, educational and vocational  measures for training and retraining the  individual to the highest possible level of functional ability.

Examples – schools for blind, reconstructive surgery in leprosy, provision of aids for the crippled

Intervention approaches

• Individual – focused (personal health)

• Community – focused (population or subgroup)

• System – focused (procedures, rules, regulations, policy and law)

11.The Health Belief Model

• This mode is one of the oldest attempts to explain health behaviour.

• It is based on the premise that for a behavioral change to succeed, individuals must have the incentive to change, feel threatened by their current behaviour, and feel that a change will be beneficial and be at acceptable cost.

• They must also feel competent to implement that change

• HBM is a good model for addressing problem behaviors that evoke health concerns (e.g., high-risk sexual behavior and the possibility of contracting HIV) (Croyle RT, 2005)

Purpose of the Model:

• to explain and predict preventive health behavior

History

• The Health Belief Model (HBM) was one of the first models that adapted theory from the behavioral sciences to health problems, and it remains one of the most widely recognized conceptual frameworks of health behavior.

• It was originally introduced in the 1950s by psychologists working in the U.S. Public Health Service (Hochbaum, Rosenstock, Leventhal, and Kegeles).

The health belief model proposes that a person's health-related behavior depends on the person's perception of

four critical areas:

• the severity of a potential illness,

• the person's susceptibility to that illness,

• the benefits of taking a preventive action, and

• the barriers to taking that action.

• HBM is a popular model applied in nursing, especially in issues focusing on patient compliance and preventive health care practices.

• The model postulates that health-seeking behaviour is influenced by a person’s perception of a threat posed by a health problem and the value associated with actions aimed at reducing the threat.

• HBM addresses the relationship between a person’s beliefs and behaviors. It provides a way to understanding and predicting how clients will behave in relation to their health and how they will comply with health care therapies.

THE MAJOR CONCEPTS AND DEFINITIONS OF THE HEALTH PROMOTION MODEL

There are six major concepts in HBM:

• 1.      Perceived Susceptibility

• 2.      Perceived severity

• 3.      Perceived benefits

• 4.      Perceived costs

• 5.      Motivation

• 6.      Enabling or modifying factors

• Perceived Susceptibility: refers to a person’s perception that a health problem is personally relevant or that a diagnosis of illness is accurate.

• Perceived severity:  even when one recognizes personal susceptibility, action will not occur unless the individual perceives the severity to be high enough to have serious organic or social complications.

• Perceived benefits: refers to the patient’s belief that a given treatment will cure the illness or help to prevent it.

• Perceived Costs: refers to the complexity, duration, and accessibility and accessibility of the treatment.

• Motivation: includes the desire to comply with a treatment and the belief that people should do what.

• Modifying factors: include personality variables, patient satisfaction, and socio-demographic factors.   

Criticisms of HBM

• Is health behaviour that rational?

• Its emphasis on the individual (HBM ignores social and economic factors)

• ·The absence of a role for emotional factors such as fear and denial.

• Alternative factors may predict health behaviour, such as outcome expectancy (whether the person feels they will be healthier as a result of their behaviour) and self-efficacy (the person’s belief in their ability to carry out preventative behaviour) (Seydel et al. 1990; Schwarzer 1992.

APPLICATION OF HEALTH BELIEF MODEL

The model in action: an example

• A parent will organize immunization for a child if he/she:

• believes there is a danger of the child contracting the disease (perceived susceptibility)

• believes that immunization is effective in eliminating the danger (perceived benefits)

• trusts that the method is safe and has an acceptable level of risk (possibly through education and media information)

• has the means to access the vaccination service (no barriers to behavior change)

12.Tannahill Model of Health Promotion

• Health Education: communication activity aimed at enhancing well-being and preventing ill-health through favorably influencing the knowledge, beliefs, attitudes and behavior of the community

• Health Protection: refers to the policies and codes of practice aimed at preventing ill-health or positively enhancing well-being, for example, no smoking in public places. Health Protection is responsible for the development and implementation of legislation, policies and programs in the areas of Environmental Health Protection, Community Care Facilities, and Emergency Preparedness

• Prevention: refers to both the initial occurrence of disease and also to the progress and subsequently the final outcome

13.The Social Model

• A social health model, that is, one aimed at incorporating the social and economic, as well as biophysical context of health status, is now acknowledged as having greater impact on the determinants and generation of health. However, the political and theoretical framework must also be present for the change to a social health model to occur. It is:

• based on knowledge of the experience, views and practices of people with disabilities.

• locates the problem within society, rather than within the individual with a disability

• Rules are determined within a framework of choice and independent living with strong support from organized disability communities

• The biases of the social model include:

• limiting the causes of disability either exclusively or mainly to social and environmental policies and practices, or

• advancing perceptions of disability in mainly industrialized countries that emphasize individual rights rather than advancing broader economic rights that may reflect the needs of impoverised developing countries.

14.Social-Ecological Model 

• The ultimate goal is to stop violence before it begins.

• Prevention requires understanding the factors that influence violence.

• CDC uses a four-level social-ecological model to better understand violence and the effect of potential prevention strategies.

• This model takes into consideration the complex interplay between individual, organization, community and societal factors, public policy.

• It allows us to address the factors that put people at risk for experiencing violence.

15.Mental Health Promotion Model

• purpose of mental health promotion for people with mental illness is to ensure that individuals with mental illness have poor choice, and control over their lives and mental health, and that their communities have the strength and capacity to support individual empowerment and recovery.

• The person with mental illness is the central focus: participating in her/his community, involved in decision-making about mental health services, and choosing which supports are most appropriate.

• There are four key resources which should be available to the person to support their mental health:

• a) mental health services;

• b) family and friends;

• c) consumer groups and organizations; and

• d) generic community services and groups.

AIDS Risk Reduction Model

• It believes change is a process.

• Individuals must go through with different factors

affecting movement.

• This model proposes that the further an intervention helps clients to progress on the stage continuum, the more likely they are to exhibit change.

• Individuals must pass through three stages;

• A) Labeling - Three elements are necessary

• Knowledge about how HIV is transmitted and prevented,

• Recognition of personal susceptibility to contracting HIV

• Perceiving themselves as susceptible for HIV and

• Believing HIV is undesirable.  

• B) Commitment – this decision-making stage may result in one of several outcomes

• Making a firm commitment to deal with the problem• Remaining undecided, • Waiting for the problem to solve itself, or • perception that behavior change does not interfere with

enjoyment of sex (or drugs)• belief that behavior change will lower risk of getting

HIV/AIDS (response efficacy)• belief in one's own ability to change the behavior (self-

efficacy)• presence of social support for the behavior change

• C) Enactment – This includes three stages:• Seeking information, • Obtaining remedies, and • Enacting solutions.o presence of social networks, support groups, and self-help

resourceso success with problem-solving in other domainso sufficient self-esteemo ability to communicate verbally with sex (or drug-use)

partnerso having sex (or drug-use) partners who also value safer

behaviors

Summary• Nursing must expand its efforts to design and

implement interventions which support promotion of health and prevention of disease/illness and disability.

• Preventing illness and staying well involve complex, multidimensional activities focused not only on the individual, but also on families, groups and populations.

• Approaches to prevention should be comprehensive, encompass primary, secondary and tertiary levels of prevention and involve consumers in their formulation.

• Prevention strategies are more likely to be adopted by citizens who participate in influencing and developing such strategies.

• Nurses have developed many health models to understand the client’s attitudes and values about health and illness so that effective health care can be provided.

• These nursing models allow nurses to understand and predict client’s health behaviour, including how they use health services and adhere to recommended therapy.

• Prevention has long been part of nursing's scope of practice.

• Nurses delivering care to clients across the life span in a variety of practice areas can support individuals and coalitions structured to promote health and prevent disease.

• Nurses have involved themselves in activities that move individuals, families, groups and communities toward higher levels of health and wellness.

• In all direct or indirect practice areas nurses must continue a strong orientation toward prevention