MODES OF INTERVENTION

MODES OF INTERVENTION
• “Intervention” can be defined as any attempt
to intervene or interrupt the usual sequence
in the development of disease in man.
• This may be by the provision of treatment ,
education , help or social support.
• Five modes of intervention have been
described which form a continuum
corresponding to the natural history of any
disease.
1.Health Promotion
2.Specific Protection
3.Early Diagnosis and Treatment
4.Disability Limitation
5.Rehabilitation
 Health Promotion
• Health Promotion is ‘ the process of enabling
people to increase control over,and to
improve health’.
• It is not directed against any particular
disease,but is intended to strengthen the host
through a variety of approaches
(Interventions)
 Health Education
• This is one of the most cost effective
interventions.A large number of diseases could
be prevented with little or no medical
intervention if people were adequately informed
about them and if they were encouraged to take
necessary precautions in time. Recognizing this
truth,the WHO’s constitution states that ‘the
extension to all people of the benefits of
medical, psychological and related knowledge is
essential to the fullest attainment of health.
 Environmental Modifications
• A comprehensive approach to health
promotion requires environmental
modifications,such as provision of safe
water;installation of sanitary latrines;control
of insects and rodents;improvement of
housing etc.
• Environmental interventions are non-clinical
and do not involve the physician.
 Nutritional Interventions
• These comprise food distribution and
nutrition improvement of vulnerable groups;
child feeding programmes; food fortification;
nutrition; education etc.
 Lifestyle & Behavioural Changes
• The action of Prevention in this case,is one of individual
and community responsibility for health,the physician and
in fact each health worker acting as an educator than a
therapist.
• Health education is a basic element of all health activity.It is
of paramount importance in changing the views,behaviour
and habits of people.
• A well-conceived health promotion programme would first
attempt to identify the ‘target groups’ or at risk individuals
in a population & then direct more appropriate message to
them.Goals must be defined.Means and alternative means
of accomplishing them must be explored.
 Specific Protection
• The following are some of the currently available interventions
aimed at specific protection
• A) Immunization
• B) Use of specific Nutrients
• C) Chemoprophylaxis
• D) Protection against occupational hazards
• E) Protection against Accidents
• F) Protection from Carcinogens
• G) Avoidance of Allergens
• H) The Control of Specific Hazards in the general Environment
e.g.,air pollution, noise control
• I) Control of Consumer Product Quality & Safety of Foods,Drugs,
Cosmetics etc.
 Health Protection
• Health Protection is defined as “ The provision of
conditions for normal mental & physical
functioning of the human being individually and
in a group.It includes the promotion of health,
the prevention of sickness and curative and
restorative medicine in all its aspects.”
• Health Protection is conceived as an part of an
overall community development programme,
associated with activities such as literacy
campaigns, education and food production.
 Early Diagnosis & Treatment
• Early detection of Health impairment as “the detection of
disturbances of homoeostatic and compensatory
mechanism while biochemical, morphological and
functional changes are still reversible.”
• In order to prevent overt disease or disablement , the
criteria of diagnosis should,if possible,be based on early
biochemical , morphological and functional changes that
precede the occurrence of manifest signs and symptoms.
• Early detection and treatment are the main interventions
of disease control.
• Since early diagnosis and treatment intercepts the disease
process, it has been included in the schema of prevention.
• Early diagnosis and treatment though not as
effective and economical as “Primary Prevention”
maybe critically important in reducing the high
morbidity and mortality in certain diseases such
as essential hypertension;cancer , cervix and
breast cancer.
• Early effective therapy has made it possible to
shorten considerably the period of
communicability and reduce the mortality from
acute communicable diseases.
 Mass Treatment
• The rationale for a mass treatment
programme is the existence of atleast 4-5
cases of latent infection for each clinical case
of active disease in the community.
• Mass treatment is a critical factor in the
interruption of disease transmission.
 Disability Limitation
• When a patient reports late in the
pathogenesis phase, the mode of intervention
is disability limitation.The objective of this
intervention is to prevent or halt the
transmission of the disease process from
impairment to handicap.
 Concept of Disability
• Disease – Impairment – Disability - Handicap
 Impairment
• An Impairment is defined as “ any loss or
abnormality of psychological, physiological or
anatomical structure or function.”
• An impairment maybe visible or
invisible,temporary or permanent,progressive
or regressive.Further,one impairment may
lead to the development of ‘secondary ’
impairments.
 Disability
• Because of an impairment,the effected person
maybe unable to carry out certain activities
considered normal for his age,sex etc. This
inability to carry out certain activities is
termed “disability”.
• A disability has been defined as “ any
restriction or lack of ability to perform an
activity in the manner or within the range
considered normal for a human being.
 Handicap
• As a result of disability,a person experiences
certain disadvantages in life and is not able to
discharge the obligations required of him and
play the role expected of him in society.
• This termed “Handicap” and is defined as “a
disadvantage for a given individual,resulting
from an impairment or a disability,that limits
or prevents the fulfilment of a role that is
normal.
 Disability Prevention
• This relates to all the levels of Prevention
• A) Reducing the occurrence of impairment
viz.,immunization against Polio (Primary
Prevention)
• B) Disability limitation by appropriate
treatment (Secondary Prevention)
• C) Preventing the Transition of Disability into
handicap.
 Rehabilitation
• Rehabilitation has been defined as “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”.
• It includes all measures aimed at reducing the impact
of disabling and handicapping conditions and at
enabling the disabled and handicapped to achieve
social integration.
• Social integration has been defined as the active
participation of disabled and handicapped people in
the main stream of community life.
• The following areas of concern in rehabilitation
have been identified :
• A) Medical Rehabilitation – restoration of
function
• B) Vocational Rehabilitation – restoration of the
capacity to earn a livelihood
• C) Social Rehabilitation – restoration of family
and social relationships
• D) Psychological Rehabilitation – restoration of
personal dignity and confidence
• Examples of Rehabilitation are :

• Establishing schools for the blind,

• Provisions of aid for the crippled,
• Reconstruction surgery in leprosy,
• Muscle re-education
• Graded exercises in neurological disorders like polio,
• Change of profession for a more suitable one
• Modification of life in general in the case of tuberculosis,
cardiac patients and others.
• The purpose of Rehabilitation is to make productive
people.
• It is now recognised that Rehabilitation is a
difficult and demanding task that seldom gives
totally satisfactory results; but needs
enthusiastic cooperation from different
segments of society as well as expertise,
equipment and funds not readily available for
this purpose even in affluent societies. It is
further recognised that interventions at earlier
stages are more feasible, will yield results and
are less demanding of scarce resources.