MODELS OF PREVENTION

SUNIL.M.B

What is a model?
A model Is a theoretical way of understanding a concept or idea Represent different ways of approaching complex issues

What is health Belief?

Health beliefs - are a persons ideas, convictions, and attitudes about health and illness These health beliefs usually influence health behavior & they can be positive or negative affect a clients 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 responsesto maintain relative stability and comfort strive for personal objectives & cultural goals"

New philosophy of health Health 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. 2. 3. 4. 5. 6. 7. 8.

Eradicate extreme poverty and hunger Achieve universal primary education Promote gender equality and empower women Reduce child mortality Improve maternal health Combat HIV/AIDS, malaria and other disease Ensure environmental sustainability 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 persons 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 persons 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 medicines 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 persons 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 clients 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.NIGHTINGALES THEORY OF ENVIRONMENT

Florence Nightingales 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.MILIOS FRAMEWORK FOR PREVENTION

Nancy Milio developed a framework for prevention that includes concepts of community oriented, population focused care Milios 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. Milios framework described a sometimes neglected role of community health nursing to examine the determinants of a communitys 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 prevention Primary prevention Secondary prevention Tertiary 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 Prevention An 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 Prevention Action which halts the progress of a disease at its incipient stage and prevents complications. The domain of clinical medicine An imperfect tool in the transmission of disease More expensive and less effective than primary prevention

Tertiary Prevention  All 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

Health promotion  The process of enabling people to in areas to control over and to improve health  Health education  Environmental modifications  Nutritional interventions  Lifestyle and behavioral changes

Specific protection  Immunization

Specific protection Early diagnosis and treatment Disability limitation Rehabilitation

 Specific nutrients  Chemoprophylaxis  Protection against occupational hazards  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 healthrelated 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 persons 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 persons 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 persons 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 patients 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 persons 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 wellbeing, 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 (selfefficacy) presence of social support for the behavior change

 o o o o o

C) Enactment This includes three stages: Seeking information, Obtaining remedies, and Enacting solutions. presence of social networks, support groups, and self-help resources success with problem-solving in other domains sufficient self-esteem ability to communicate verbally with sex (or drug-use) partners 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 clients attitudes and values about health and illness so that effective health care can be provided. These nursing models allow nurses to understand and predict clients 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