HEALTH AND ILLNESS

RONARICA B. DIONES, RN, RM, MAN

 CONCEPTS OF HEALTH AND ILLNESS

Health is state of complete physical, mental and

social well-being, and not merely the absence of
disease or infirmity.

- WHO 1974
 Most people define and describe
health as:
• Being free from symptoms of disease and pain
as much as possible
• Being able to be active and able to do what they
want or must
• Being in good spirits most of the time
 WELLNESS AND WELL-BEING

• Wellness is well-being. It involves engaging in attitudes and behaviors

that enhance quality of life and maximize personal potential.
(Anspaugh, et al. 1991.p.2)
• Well-being is a subjective perception of balance, harmony and vitality
(Leddy and Pepper, 1993, p.221)
• Wellness is a choice.
• Wellness is a way of life.
• Wellness is the integration of body, mind and spirit.
• Wellness is the loving acceptance of one’s self
DIMENSIONS OF WELLNESS
PHYSICAL
 1. PHYSICAL

• The ability to carry out daily tasks, achieve fitness ( eg,

Pulmonary, cardiovascular, gastrointestinal), maintain
adequate nutrition and proper body fat, avoid abusing
drugs and alcohol or using tobacco products, and
generally to practice positive life-style habits.
SOCIAL
 2. SOCIAL

• The ability to interact successfully with people

and within the environment on which each
person is a part, to develop and maintain
intimacy with significant others, and to develop
respect and tolerance for those with different
opinions and beliefs.
EMOTIONAL
 3. EMOTIONAL

• The ability to manage stress and to express

emotions appropriately. Emotional wellness
involves the ability to recognize, accept, and
express feelings and to accept ones’ limitations.
INTELLECTUAL
 4. INTELLECTUAL

• The ability to learn and use information

effectively to personal , family ,and career
development. Intellectual wellness involves
striving for continued growth and learning to deal
with new challenges effectively.
SPIRITUAL
 5. SPIRITUAL

• The belief in some force (nature, science,

religion, or a higher power) that serves to unite
human beings and provide meaning and purpose
to life. It includes a person’s own morals, values,
and ethics.
6. FINANCIAL
7. OCCUPATIONAL
8. ENVIRONMENTAL
MODELS OF HEALTH AND
ILLNESS
RONARICA B. DIONES, R.N., R.M.
 MODELS OF HEALTH AND ILLNESS

• The Health-Illness Continuum

• Health Belief Model (HBM)
• Smith’s Models of Health
• Leavell and Clark’ Agent – Host – Environment
Model (Ecologic Model
• Health Promotion Model
 1. THE HEALTH-ILLNESS CONTINUUM (Dunn)

• Dunn’s Theory on “Health-Illness Continuum” describes interaction of

the environment with well-being and illness.
ENVIRONMENT

Protected poor health in HLW in favorable environment

favorable environment
ILLNESS HEALTH

Precursor to Illness

Poor health in unfavorable Emergent HLW in unfavorable

environment environment
THE HEALTH-ILLNESS CONTINUUM
 HIGH LEVEL WELLNESS

• An integrated method of functioning that is

oriented towards maximizing one’s potentialities
within the limitations of his environment.

• This concept connotes ability to perform ADL or

to function independently.
 PRECURSOR OF ILLNESS

• These are the factors which impinge on the

individuals to lead towards the illness spectrum:
1. Heredity
2. Behavioral factors
3. Environmental factors
 2. HEALTH BELIEF MODEL

• The health belief model is concerned with what people perceive, or

believe, to be true about themselves in relation to their health.

• This model is based on three components of individual perceptions of

threat of a disease:
(1) Perceived susceptibility to a disease,
(2) Perceived seriousness of a disease, and
(3) Perceived benefits of action.
 A. Perceived susceptibility to a disease

• The belief that one either will or will not contract a disease. It
ranges from being afraid of contracting a disease to
completely denying that certain behaviors will result in illness.
• For example, one person who smokes cigarettes may believe
he or she is at danger for lung cancer and may stop smoking,
while another person may believe smoking poses no serious
threat and continues to smoke.
 B. Perceived seriousness of a disease

• This component is related to how much the person

knows about the disease and can result in a change in
health behavior.
• If a person who smokes believes that lung cancer can
lead to physical disability or death and would,
therefore, affect his or her ability to work and care for
the family, the person is more likely to stop smoking.
 C. Perceived benefits of action
• Is concerned with how effective the individual believes measures will
be in preventing illness. This factor is influenced by:
a. the person's conviction that carrying out a recommended action will
prevent or modify the disease .
b. the person's perception of the cost and unpleasant effects of
performing the health behavior.
• For example, the person may believe that stopping smoking will
prevent future breathing problems and that the initial withdrawal
symptoms can be overcome; therefore, the person may stop smoking.
 Modifying factors for one's health beliefs include:

1. Demographic variables (such as age and gender),

2. Socio-psychological variables (such as personality and peer group
pressure),
3. Structural variables (such as knowledge and prior contact with the
disease).

• These factors interact to influence the perceived benefits of preventive

action minus the perceived barriers to preventive action.
 Cues to action are also modifying factors and are
provided by activities such as:

1. Others' advice,
2. Mass-media campaigns,
3. Literature,
4. Appointment-reminder telephone calls or postcards,
5. Illness of a significant other.
 Individual characteristics and
experiences
• It can be useful in predicting if an individual will
incorporate and use health-related behaviors.
• If a behavior has been used before and becomes a habit, it is
more likely to be used again.
• Personal biologic, psychological, and sociocultural
factors, including age, gender, strength, self-esteem,
perceived health status, definition of health,
acculturation, and socioeconomic status are all
predictive of a given health-related habit.
 Behavior-specific knowledge, beliefs, and
relationships.
• These include the belief that there will be a positive outcome from a
specific health behavior that one has the skill and competence to
engage in health behaviors, and that one is affected by the
interpersonal influences of others (especially family, peers, and
healthcare providers).
• Situational influences, such as no-smoking policies, also influence
health behaviors.
• Barriers to action, which include perceptions of unavailability,
inconvenience, expense, difficulty, or time, usually result in avoidance
of a behavior.
 3. THE AGENT-HOST-ENVIRONMENT MODEL
(LEAVELL AND CLARK)
• It is useful for examining the causes of disease in an individual.
• An agent is an environmental factor or stressor that must be
present or absent for an illness to occur.
• For example, the factor may be bacteria or a virus, a chemical
substance, or a form of radiation whose presence, excessive
presence, or absence (such as in a vitamin-deficiency disease) is
necessary for an illness.
• 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.
 THE AGENT-HOST-ENVIRONMENT MODEL

• The environment includes all the factors external to the host that
make illness more or less likely. The factors can include any that
influence health, including physical, social, biologic, and cultural
factors.
• For example, a person who has poor nutritional habits and gets little
sleep is at increased risk for infection during an outbreak of influenza.
If that person also immune deficient (as in AIDS), the risk is even
greater.
 THE AGENT-HOST-ENVIRONMENT MODEL
the agent –hot-environment triangle
The triangle in (Fig. 2)
illustrates how each of the
agent –host–environment
factors affects and is affected
by the other these factors are
constantly interacting, and a
combination of factors may
increase the risk of illness.
When the factors are
balanced, health is
maintained; when they are out
of balance, disease occurs.
Thus, health is an ever-
changing state.
 4. SMITH’S MODEL OF HEALTH

A. Clinical Model – views people as physiologic system with

related functions and identifies health as the absence of
signs and symptoms of disease or injury.
B. Role Performance Model – defines health in terms of
individual’s ability to fulfill societal roles such as
performing work.
C. Adaptive Model – focuses on adaptation. Views health as
creative process; and disease as a failure in adaptation
or mal-adaptation.
D. Eudamonistic Model – this model avers that the highest
aspiration of people is fulfillment and complete
development – actualization.
 5. HEALTH PROMOTION MODEL

• The health promotion model (HPM) proposed by Nola J Pender (1982;

revised, 1996) was designed to be a “complementary counterpart to
models of health protection.”
• It defines health as a positive dynamic state not merely the absence of
disease. Health promotion is directed at increasing a client’s level of
well being.
 HEALTH PROMOTION MODEL (CONT.)

• The health promotion model describes the multi dimensional nature of

persons as they interact within their environment to pursue health.
 The model focuses on following three areas:

• Individual characteristics and experiences

• Behavior-specific cognitions and affect
• Behavioral outcomes
• The health promotion model notes that each person has unique
personal characteristics and experiences that affect subsequent
actions.
• The set of variables for behavioral specific knowledge and affect have
important motivational significance.
• These variables can be modified through nursing actions.
• Health promoting behavior is the desired behavioral
outcome and is the end point in the HPM.
• Health promoting behaviors should result in improved
health, enhanced functional ability and better quality of life
at all stages of development. The final behavioral demand
is also influenced by the immediate competing demand and
preferences, which can derail an intended health promoting
actions.
 THE MAJOR CONCEPTS AND DEFINITIONS
OF THE HEALTH PROMOTION MODEL

• Individual Characteristics and Experience

• Prior related behaviour
• Frequency of the similar behaviour in the past.
Direct and indirect effects on the likelihood of
engaging in health promoting behaviors.
 PERSONAL FACTORS

• Personal factors categorized as biological, psychological and socio-

cultural.
• These factors are predictive of a given behavior and shaped by the
nature of the target behaviour being considered.
 Personal biological factors

• Include variable such as age gender body mass index pubertal status,
aerobic capacity, strength, agility, or balance.
 Personal psychological factors

• Include variables such as self esteem self motivation personal

competence perceived health status and definition of health.
 Personal socio-cultural factors

• Include variables such as race ethnicity, accuculturation, education

and socioeconomic status.
• Behavioural Specific Cognition and Affect
 PERCEIVED BENEFITS OF ACTION

• Anticipated positive out comes that will occur from health behaviour.
 PERCEIVED BARRIERS TO ACTION

• Anticipated, imagined or real blocks and personal costs of

understanding a given behaviour.
 PERCEIVED SELF EFFICACY

• Judgment of personal capability to organise and execute a

health-promoting behaviour. Perceived self efficacy
influences perceived barriers to action so higher efficacy
result in lowered perceptions of barriers to the performance of
the behavior.
 INTERPERSONAL INFLUENCES

• Cognition concerning behaviours, beliefs, or attitudes of the

others. Interpersonal influences include: norms (expectations
of significant others), social support (instrumental and
emotional encouragement) and modelling (vicarious learning
through observing others engaged in a particular behaviour).
• Primary sources of interpersonal influences are families,
peers, and healthcare providers.
 SITUATIONAL INFLUENCES

• Personal perceptions and cognitions of any given situation or

context that can facilitate or impede behaviour.
• Include perceptions of options available, demand
characteristics and aesthetic features of the environment in
which given health promoting is proposed to take place.
• Situational influences may have direct or indirect influences
on health behaviour.
 Behavioural Outcome

• COMMITMENT TO PLAN OF ACTION

• The concept of intention and identification of a planned
strategy leads to implementation of health behaviour.
 IMMEDIATE COMPETING DEMANDS AND
PREFERENCES

• Competing demands are those alternative behaviour over

which individuals have low control because there are
environmental contingencies such as work or family care
responsibilities.
• Competing preferences are alternative behaviour over which
individuals exert relatively high control, such as choice of ice
cream or apple for a snack
 HEALTH PROMOTING BEHAVIOUR

• Endpoint or action outcome directed toward attaining

positive health outcome such as optimal well-being,
personal fulfillment, and productive living.
 ILLNESS AND DISEASE

• Illness is a personal state in which the person feels unhealthy.

• Illness is a state in which a person’s physical , emotional, intellectual,
social, developmental or spiritual functioning is diminished or impaired
compared with previous experience.
• Illness is not synonymous with disease.
• Disease is the alteration in body functions resulting in reduction of
capacities or a shortening of the normal life span.
 COMMON CAUSES OF DISEASE

1. Biologic agents (eg, microorganisms)

2. Inherited genetic (eg, cleft palate)
3. Developmental defects (eg, imperforated anus)
4. Physical agents (eg, heat and cold substances, radiation, ultraviolet
rays)
5. Chemical agents (eg, lead, emissions from smoke belching cars)
 COMMON CAUSES OF DISEASE

6. Tissue response to irritation/injury (eg, fever, inflammation)

7. Faulty chemical/metabolic process (eg, inadequate insulin in
diabetes mellitus, inadequate iodine causing goiter)
8. Emotional/physical reaction to stress (eg, anxiety, fear)
 STAGES OF ILLNESS

1. Symptom Experience
2. Assumption of Sick Role
3. Medical Care Contact
4. Dependent Patient Role
5. Recovery/Rehabilitation
 1. Symptom Experience

• Transition stage
• The person believes something is wrong
• Experiences some symptoms
• 3 aspects
– Physical (fever, muscle aches, malaise, headache)
– Cognitive (perception of “having flu”
– Emotional (worry on consequence of illness)
 2. Assumption of Sick Role

• Acceptance of the illness

• Seeks advice, support for decision to give up some activities.
 3. Medical Care Contact

• Seeks advice of health professionals for the following reasons:

– Validation of real illness
– Explanation of symptoms
– Reassurance or prediction of outcomes
 4. Recovery/Rehabilitation

• Gives up the sick role and returns to former roles and functions
 RISK FACTORS

• A risk factor is any situation, habit, social or environmental condition,

physiological or psychological condition, developmental or intellectual
condition, or spiritual or other variable that increases the vulnerability
of an individual or group to an illness or accident
• The presence of risk factors does not mean that the disease will
develop, but risk factors increase the chances that the individual will
experience a particular dysfunction.
 RISK FACTORS OF A DISEASE

1. Genetic and Physiological Factors

❑ Heredity, or genetic predisposition to specific illness, is a major
physical risk factor.
❑ For example, a person with a family history of diabetes mellitus is at
risk for developing the disease later in life
 RISK FACTORS OF A DISEASE

2. Age
❑ Age increases or decreases susceptibility to certain illnesses ( eg,
risk of heart diseases increases with age for both sexes)
❑ The risk of birth defects and complications of pregnancy increase in
women bearing children after age 35
 RISK FACTORS OF A DISEASE

3. Environment
❑ The physical environment in which a person works or lives can
increase the likelihood that certain illnesses will occur.
❑ For example, some kinds of cancer and other diseases are more
likely to develop when industrial workers are exposed to certain
chemicals or when people live near toxic waste disposal sites.
 RISK FACTORS OF A DISEASE

4. Lifestyle
❑ Many activities, habits and practices involve risk factors. Lifestyle
practices and behavior can also have positive or negative effects on
health.
❑ Other habits that put a person at risk for illness include tobacco use,
alcohol or drug abuse and activities involving a threat of injury, such
as skydiving or mountain climbing
 RISK FACTORS OF A DISEASE

4. Lifestyle
❑ Stress can be a lifestyle risk factor if it is severe or prolonged, or if
the person is unable to cope with life events adequately.
❑ Stress can threaten mental health (emotional stress), as well as
physical well-being (physiologic stress)
❑ The goal of risk factor identification is to merely assist clients in
visualizing those areas in their life that can be modified or even
eliminated to promote wellness and prevent illness.
 LEAVELL AND CLARK’S THREE LEVELS OF
PREVENTION
1. Primary Prevention
2. Secondary Prevention
3. Tertiary Prevention
 1. Primary Prevention

• To encourage optimal health and to increase the person’s resistance

to illness. Seeks to prevent a disease or condition at a pre-pathologic
state; to stop something from ever happening.
– Health promotion
– Specific protection
 1. Primary Prevention
• Behaviors associated with primary prevention:
– Quit smoking
– Avoid/limit alcohol intake
– Exercise regularly
– Eat well-balanced diet
– Reduce fat and increase fiber in diet
– Take adequate fluids
– Avoid over exposure to sunlight
– Maintain ideal body weight
– Complete Immunization Program
– Wear hazard devices in work site
 2. Secondary Prevention

• It is also known as health maintenance.

• Seeks to identify specific illnesses or conditions at an early stage with
prompt intervention to prevent or limit disability; to prevent
catastrophic effects that could occur if proper attention and treatment
are not provided.
– Early diagnosis/ detection/ screening
– Prompt treatment to limit disability
 2. Secondary Prevention

• Behaviors associated with primary prevention:

– Have annual physical examination
– Regular Pap’s test for women
– Monthly BSE for women who are 20 years old and above
– Sputum examination for Tuberculosis
– Annual stool guaiac test and rectal examination for client over age
50 years
 3. Tertiary Prevention

• To support the client’s achievement of successful adaptation to known

risks, optimal reconstitution, and/or establishment of high level
wellness.
• Occurs after a disease or disability has occurred and the recovery
process has begun; intent is to halt the disease or injury process and
assist the person in obtaining an optimal health status.
• Rehabilitation
 3. Tertiary Prevention

• Self-monitoring of blood glucose among diabetics.

• Physical therapy after CVA (stroke); participation in Cardiac
Rehabilitation after MI (myocardial infarction or heart attack).
• Attending self-management education for diabetes.
• Undergoing speech therapy after laryngectomy.
 TYPES OF HEALTH PROMOTION PROGRAMS

1. Information Dissemination
2. Health Appraisal and Wellness Assessment Programs
3. Lifestyle and Behavior Change Programs
4. Worksite Wellness Program
5. Environmental Control Program
 ACTIVITIES TO PROMOTE HEALTH AND
PREVENT ILLNESS
1. Have a regular (yearly) physical examination.
2. Women:
3. Men:
4. Annual dental examination and prophylaxis
5. Regular eye exam (every 1-2 years)
6. Exercise regularly at least 3x per week for 30 minutes
7. Do not smoke: avoid second hand smoke
8. Avoid alcohol and “recreational drugs”
9. Reduce fat and increase fiber in diet
 ACTIVITIES TO PROMOTE HEALTH AND
PREVENT ILLNESS
10.Sleep regularly 7-8 hours/night.
11.Eat breakfast.
12.Eat regular meals with few snacks.
13.Maintain Ideal Body Weight.