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 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 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. Eradicate extreme poverty and hunger

2. Achieve universal primary education
3. Promote gender equality and empower women
4. Reduce child mortality
5. Improve maternal health
6. Combat HIV/AIDS, malaria and other disease
7. Ensure environmental sustainability
8. 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 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

Health promotion  The process of enabling people to  Immunization

in areas to control over and to
improve health

Specific protection  Health education  Specific nutrients

Early diagnosis and  Environmental modifications  Chemoprophylaxis
treatment

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
resources
o success with problem-solving in other domains
o sufficient self-esteem
o ability to communicate verbally with sex (or drug-use)
partners
o having sex (or drug-use) partners who also value safer
 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