MODELS OF PREVENTION

There are several theories and models that support the practice of health promotion and disease
prevention. Theories and models are used in program planning to understand and explain health
behavior and to guide the identification, development, and implementation of interventions.
When identifying a theory or model to guide health promotion or disease prevention programs, it is
important to consider a range of factors, such as the specific health problem being addressed, the
population(s) being served, and the contexts within which the program is being implemented. Health
promotion and disease prevention programs typically draw from one or more theories or models
Various models of prevention are

 Health belief model

 Holistic health model
 Agent host environmental model
 Level of prevention model
 Health Illness continumm model
 High level wellness model
 Milios Frame work model
 Role performance model
 Health promotion model
 Basic human need model
THE HEALTH BELIEF MODEL
The Health Belief Model is a theoretical model that can be used to guide health promotion and
disease prevention programs. It is used to explain and predict individual changes in health
behaviors. It is one of the most widely used models for understanding health behaviors.
Key elements of the Health Belief Model focus on individual beliefs about health conditions,
which predict individual health-related behaviors. The model defines the key factors that
influence health behaviors as an individual's perceived threat to sickness or disease (perceived
susceptibility), belief of consequence (perceived severity), potential positive benefits of action
(perceived benefits), perceived barriers to action, exposure to factors that prompt action (cues
to action), and confidence in ability to succeed (self-efficacy).

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HOLISTIC HEALTH CARE MODEL:
In the `80s, the reductionist method made famous by F.W. Taylor caused manufacturing
industry to lose perspective of their overall factory. The approach, which focuses principally
on analyzing individual components, fails to accurately account for their interactions. This
narrow view was further compounded by the academic community which thrived on using
reductionism for analyzing complex systems, ever the while increasing the gap between their
research and actual practice. Throughout the `90s and still today, manufacturing is
increasingly focusing on the entire supply chain. In healthcare this evolution is lagging.
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 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 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.

AGENT-HOST-ENVIRONMENTAL MODEL
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
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 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.
Secondary prevention
 Action which halts the progress of a disease at its incipient stage and prevents complications.
 The domain of clinical medicine.

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  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.

HIGH LEVEL WELLNESS MODEL

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.

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 HEALTH ILLNESS CONTINUMM MODEL

The health illness continuum is a graphic illustration of a well being ,concept first proposed
by John.W.Travis in 1972.It describes how wellbeing is more than simply an absence of
illness , but also incorporates the individuals mental and emotional health.Travis believed that
the standard approach to medicines , which assumes a person is well when there are no signs
or symptoms of disease ,was insufficient.

Movement to the right to the arrows (toward the high level of wellness) equals an increase in level
of health and wellbeing
Achieved in three steps ,
 Awareness
 Education
 Growth
Movement to the left to the arrows (towards premature death) equates a progressively decreasing
state of health.
Achieved in three steps,
 Signs
 Symptoms
 Disability
Most important is the direction is the individual facing on the pathway.If towards high level of
health , a person has genuinely optimistic or positive out look despite his/ her health status.If towards
premature death , a person has a genuinely pessimistic or negative out look about his or her health
status.
MILIO’S FRAMEWORK FOR PREVENTION
Milio’s Framework for Prevention
 Nancy Milio developed a framework for prevention that includes concepts of community –
oriented, population- focused care.
 Milio stated that behavioural patterns of the populations-and individuals who make up
populations – are a result of habitual selection from limited choices.

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 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

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.

TANNAHILL MODEL OF HEALTH PROMOTION

The three aspects to Health Promotion suggested by Tannahill (Downie et.al. 1996)
are: Prevention – reducing or avoiding the risk of diseases and ill health. Positive
Health Education – communication to enhance well-being and prevent ill-health
through improving knowledge and attitudes.

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 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

BASIC HUMAN NEEDS MODEL:

The Human Needs Model of Nursing adapts Maslow's concept of human needs to create such
a conceptual framework for practice. It places equal emphasis on those patient problems
which arise as the result of unmet needs at higher levels as well as those at lower levels,
thereby acknowledging the holistic and dynamic nature of man.

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CONCLUSION:
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.

BIBLIOGRAPHY

1.Brat Kaur Navdeep , Rawat HC ,textbook of Advanced Nursing Practice 1st

edition,Haryana : Jaypee Brother’s Medical Publisher Pvt Ltd.2015

2.Soni Samta , Textbook Avance Nursing Practice 1st edition ,Haryana: Jaypee Brother’s
Medical Publisher Pvt Ltd.2013

3. Perry CL, Kelder SH. Models for effective prevention. The Journal of adolescent health:
official publication of the Society for Adolescent Medicine. 1992 Jul 1;13(5):355-63.

4. Hillen T, Painter K. Global existence for a parabolic chemotaxis model with prevention of
overcrowding. Advances in Applied Mathematics. 2001 May 1;26(4):280-301.

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