Models of Prevention

Introduction

• A model is a theoretical way of understanding a concept or idea.
• Models represent different ways of approaching complex issues.
• There are different models of health.

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

• 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

• 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

• 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 model 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 represents the interaction of a person’s mind, body and spirit within the environment.
• Holism is an antidote to the atomistic approach of contemporary science.
• 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.
• Application of this model in nrsing 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

• Prevention of the emergence or development of risk factors in population or countries in which they have not yet appeared.
• 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 model 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 .
• The purpose of the model is to explain and predict preventive health behavior. 

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

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:

• 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 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 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.

Reference

 

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