MODELS
OF PREVENTION
This page was
last updated on
16-03-09
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Outline
Introduction
A model is a theoretical way of
understanding a concept or idea. Models
represent different ways of approaching complex
issues. Health beliefs are a person’s ideas,
convictions, and attitudes about health and
illness. Because health beliefs usually
influence health behaviour, they can positively
or negatively affect a client’s health.
‘Prevention’of illness is a positive health
behaviour. Common positive health behaviours
include immunizations, proper sleep patterns,
adequate exercise, and nutrition. There are
different models of health.
Preventing illness
is one aspect of wellness care that focuses on
detection or prevention of disease. Primary
prevention focuses on the health of a person or
population. Secondary prevention includes
screening for those at risk to develop an
illness or those who could have disease
diagnosed early in the process for prompt
treatment. Tertiary prevention occurs when
diagnosis of a long term disease/disability has
already been made. The goal is to minimize
complications and maximize function many way
possible for these clients.
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 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
Millennium development
goal
Goals
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
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.
Clinical model
In this model, the
absence of signs and symptoms of disease
indicates health. Illness would be the presence
of conspicuous 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.
Role performance model
Here, 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 future 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.
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 inadaptive toward these
changes. As the concept of adaptation has
entered other aspects of culture , this
model has become widely accepted.
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.
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.
Holistic Health Model
by Edelman and Mandle, 2002
Holism
acknowledges and 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.
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 is one way to measure a person’s level of
health. 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 .
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
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.
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.
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
Specific protection
Early diagnosis and treatment
Disability limitation
rehabilitation
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 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)
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
Purpose of the Model.
-method 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 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)
Tannahill Model of
Health Promotion
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
will and theoretical framework must also be
present for the change to a social health model
to occur. It
is:
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
impoverished developing countries
.
The 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,
relationship, community and societal factors. It
allows us to address the factors that put people
at risk for experiencing or perpetrating
violence.
Mental Health
Promotion Model
purpose of mental
health promotion for people with mental illness
is to ensure that individuals with mental
illness have power, 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 - one must label
their actions as risky for contracting HIV (i.e.
problematic). Three elements are necessary
-
Knowledge about how HIV is transmitted
and prevented,
-
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
-
Resigning to the problem: Weigh cost and
benefits-
giving up pleasure (high risk) for less pleasure
(low risk)
C) Enactment – This includes
three stages:
-
Seeking information,
-
Obtaining remedies, and
-
Enacting solutions.
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 strat
egies.
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 arenas nurses must continue a
strong orientation toward prevention.
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