Tamparong, Vanneza Trixzy V.

August 16, 2020

NCM113j-F

Milio’s Framework for Prevention

The framework provides that the health status existing in the population occurs due to too little
or excess critical health sustaining resources whereby people who are have enough and safe
food, shelter, water and environment are vulnerable to infectious diseases which too much food
will lead to obesity. Population behaviour patterns also affect health since knowledge and
perception is influenced by informal and formal learning and also by experience (Milio’s).
Health is also influenced by organizational behaviour which includes policy makers since they
provide options available to thus influencing selections made by individuals.

 Complements the health belief model.

 Emphasizes change at the community level.
 Identifies relationship between health deficits and availability of health-promoting
resources.
 Theorizes that behavior changes within a large number of people can ultimately lead to
social change.

COMMUNITY HEALTH NURSING THEORIES

- Systems thinking studies how an individual, or unit, interacts with other organizations or
systems. Systems thinking is useful in examining cause and effect relationships.

- Upstream thinking is used to focus on interventions that promote health or prevent illness, as
opposed to medical treatment models that focus on care after an individual becomes ill.

- Nursing theory provides the basis for care of the community and family. Theorists have
developed sound principles to guide nurses in providing high-quality care. Examples of nursing
theories appropriate for community health include the following.

Nightingale’s Environmental Theory

-Highlights the relationship between an individual’s environment and health.

- Depicts health as a continuum.

- Emphasizes preventive care.

Health Belief Model

- Purpose is to predict or explain health behaviors.

- Assumes that preventive health behaviors are taken primarily for the purpose of avoiding
disease.

- Emphasizes change at the individual level.

-Describes the likelihood of taking an action to avoid disease based on the following.

- Perceived susceptibility, seriousness, and threat of a disease

- Modifying factors (e.g., demographics, knowledge level)

-Cues to action (e.g., media campaigns, disease effect on family/friends, recommendations from
health care professionals)

-Perceived benefits minus perceived barriers to taking action.

Pender’s Health Promotion Model

- Similar to Health Belief Model.

- Does not consider health risk as a factor that provokes change.

- Examines factors that affect individual actions to promote and protect health.

- Personal factors (biological, psychological, sociocultural), behaviors, abilities, self-efficacy

- Feelings, benefits, barriers, and characteristics associated with the action

-Attitudes of others, and competing demands and preferences

Evidence-based practice shows achievement in their goals, programs or projects.

1. The choice-making of individuals at a given point in time concerning potentially health-

promoting or health damaging selections is affected by their effort to maximize valued resources.
Choice is therefore related to the type and amount of:

(a) their personal resources: their awareness, knowledge, beliefs and skills; those of family,
friends, and of other primary (small, face-to-face) groups; available money and time;
convenience concerning distance, travel, transportation; the urgency of other priorities; and

(b) societal (community and national) resources: the availability of health-sustaining services
and resources in terms of cost, distance or location, type, comprehensiveness, program outreach
components (e.g., food, housing, income maintenance, environmental protection, health
services); alternatives to formal services; penalties or losses incurred, or rewares given, for
selection or failure to select given options.

All of these resources implicitly or explicitly limit or widen the array of options available to
individuals for retaining or altering health-related habitual choices, and determine the ease with
which new, possibly more healthful choices may be made. Any change in pattern would involve
some effort or cost and some actual and/or perceived gain.

An example might be the $85,000 a year physician and the $6,000 a year aide, both of whom
have mild hypertension and each of whom would benefit by a more healthful life style. Given
that both are made aware of what shifts in behaviour would be most likely to have health-
enhancing effects, it is quite apparent that the physician has a potentially greater opportunity to
adopt a more health-promoting pattern of daily choices because of his personal resources.

The physician may conceivably slow the pace of his life by choosing to live closer to his work in
the urban medical center in a quiet townhouse. He may take more frequent vacations as a means
to relax and thereby diminish the need for cigarettes, alcoholic drinks, or other drugs. He would
have no serious financial problem in obtaining palatable meals within caloric-cholesterol-sodium
limits in restaurants or specially prepared for him alone. Medical center fringe benefits would
allow him ample sick leave, medical insurance, pension, and other supportive resources.

The aide earning $6,000, typically a woman, possibly with adolescent children, has fewer
options for making new choices. There is virtually no chance for her to find even a low-paying
job in a less hectic environment. Without rapid transit, moving the household to a less congested
area is out of the question, even if such housing were available. To work fewer hours is not an
option since her husband is sporadically employed at best. Besides, taking too much time off
may risk herjob security. There is little extra time or money to change the family's customary
diet, and food and cigarettes are two of the very few options left for relaxation and pleasure.
Neither friends nor family, though willing, have enough resources to share to make a difference.
The medical clinic which diagnosed her condition has no consistent methods to intervene and
offer help in her home situation.

For either individual, the physician or the aide, the personal and societal resources will not
determine whether or not they will alter their life patterns. But those resources will make the
likelihood that each one can change-given an initial moderate willingness to do so-either more or
less a possibility. This is because of the array of options before them, and because some of those
options, health-promoting or health-damaging in their net effects, are easier to choose than
others.

2. Alteration in patterns of behaviour resulting from decisions making of significant number of

people in a population can result in social change.
Example: Some behaviours such as tobacco have become difficult to maintain in many setting or
situations in response to organizational and public policy mandates.

3. Individual choices related to health-promoting or health-damaging behaviours is influenced by

efforts to maximize valued resources.

Example: choices and behaviours are strongly influenced by desires, values and beliefs. For
example the use of barriers protection during sex by adolescents is often dependent on peer
pressure and the need for acceptance, love and belonging.

References:

- https://www.augusta.edu/nursing/documents/maevepp.pdf
- https://www.homeworkforyou.com/static_media/uploadedfiles/Focused_Review-11.pdf
- https://prezi.com/s1jbkq19buxu/milio039s-framework-for-prevntion/
- https://ajph.aphapublications.org/doi/pdfplus/10.2105/AJPH.66.5.435