Models of Prevention
Models of Prevention
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
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. 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
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.
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.
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.
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
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 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)
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)
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.
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)
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.
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