HEALTH AND ILLNESS

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Definitions of Health
"Health is a state of complete physical, mental, and social wellbeing and not merely the absence of disease" (WHO, 1947, p. 1)  "Health is not a condition, it is an adjustment. It is not a state, but a process. The process adapts the individual not only to our physical, but also our social, environments" (President’s Commission, 1953, p. WDQUIJENCIOJR HEALTH AND ILLNESS 4)

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Definitions of Health

most individuals define health as the following:

being able to be active and able to do what they want or must do being free of symptoms of disease and pain as much as possible being in good spirits most of the time
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The ability of living things to maintain constancy of their internal milieu despite changes in the environment (Claude Bernard) An expression of vigor, freedom from discomfort (Jocano)

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Definition of Wellness

an active process by which an individual progresses towards maximum potential possible, regardless of current state of health

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Dimensions of wellness

  

physical, e.g.:
ability to carry out daily tasks achieve fitness maintain nutrition and proper body fat avoid abusing drugs, alcohol, or using tobacco products generally to practice positive lifestyle habits
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sociocultural, e.g.:
ability to interact successfully with people and within the environment of which each person is a part develop and maintain intimacy with significant others develop respect and tolerance for those with different opinions and beliefs
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emotional, e.g.:
ability to manage stress and express emotions appropriately ability to recognize, accept, and express feelings ability to accept one’s limitations

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intellectual, e.g.:
ability to learn and use information effectively for personal, family, and career development striving for continued growth and learning to deal with new challenges effectively

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spiritual, e.g.:
belief in some force (nature, science, religion, or a "higher power") that serves to unite human beings and provide meaning and purpose to life includes a person’s morals, values, and ethics
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DEFINITION OF DISEASE
pathologic change in the structure or function of the body or mind

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DEFINITION OF ILLNESS
the response a person has to a disease; it is an abnormal process in which the person’s level of functioning is changed compared with a previous level

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  

influenced by the following:
self-perceptions others’ perceptions the effects of changes in body structure and function the effects of those changes on roles and relationships cultural and spiritual values and beliefs
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TYPES OF ILLNESS

acute illness
has a rapid onset of symptoms that lasts for a limited and relatively short period of time

e.g., typically less than six months

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chronic illness
has a gradual onset of symptoms that lasts for an extended and relatively long period of time

e.g., typically six months or longer

characterized by periods of remission and exacerbation
   

remission symptoms disappear exacerbation symptoms reappear
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MODELS OF HEALTH AND ILLNESS

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BIOPSYCHOSOCIAL MODEL OF HEALTH AND ILLNESS

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Travis’ Illness-Wellness Continuum

composed of two arrows pointing in opposite directions and joined at a neutral point

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movement to the right on the arrows (towards high-level wellness) equals an increasing level of health and well-being

achieved in three steps:
  

awareness education growth
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movement to the left on the arrows (towards premature death) equates a progressively decreasing state of health

achieved in three steps:
  

signs symptoms disability
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most important is the direction the individual is facing on the pathway

if towards high-level health, a person has a genuinely optimistic or positive outlook despite his/her health status if towards premature death, a person has a genuinely pessimistic or negative outlook about his/her 36 HEALTH AND ILLNESS

compares a treatment model with a wellness model

if a treatment model is used, an individual can move right only to the neutral point

e.g., a hypertensive client who only takes his medications without making any other life-style changes

if a wellness model is used, an individual can move right past the neutral point

e.g., a hypertensive client who not only takes his medications, but stops smoking, looses weight, starts an exercise program, etc.
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JAHODA

Conceptualizes health and illness along separate but co-existing continua Reflects the fact that people exhibit health and illness in varying degrees at the same time

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HALBERT DUNN’S HIGH LEVEL WELLNESS GRID
 

High-level wellness in favorable environment –(healthy lifestyles) Emergent high-level wellness in an unfavorable environment (healthy lifestyle not implemented because of family, job etc) Protected poor health in favorable environment (ill person whose needs met by health care sy. Has access to medication, diet, & care) Poor health in unfavorable environment (child starving in drought-stricken HEALTH AND ILLNESS 41 country)

Concepts in Dunns’ Theory

TOTALITARITY

Biopsychosocial components

UNIQUENESS

Manner in which biopsychosocial components are integrated

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ENERGY
  

Physical energy Psychosocial energy Environmental elements Reflections of experiences with his past and present inner self with the outer world
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INNER AND OUTER WORLD

SELF-INTEGRATION

Reflections of the past and present are basis of behavior Inability to reintegrate results to illness and death

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LEAVELL AND CLARK
  

Agent-host-environment model Ecologic model Describes the cause and illness in other health areas Used in predicting illness rather than in promoting wellness

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EVOLUTIONARY BASED MODEL

Suggest that illness and health sometimes have an evolutionary function Interrelates elements

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LIFE EVENTS

Developmental variables and chance variables e.g. accidents or relocations

LIFESTYLE DETERMINANTS

Personal and learned strategies a person uses to make lifestyle changes

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EVOLUTIONARY VIABILITY

Reflects the extent to which people function to promote survival and well being

CONTROL PERCEPTIONS

Extent to which a person can influence life circumstances
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VIABILITY EMOTIONS

Affective reactions

HEALTH OUTCOMES

Physiological, behavioral, and psychological states resulting from viability emotions

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MASLOW’S HEIRARCHY OF NEEDS

Basic human needs for survival and health Some needs must be met before other needs Understand the relationship of different needs and the factors that determine the priorities for the client
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Rosenstock/Becker’s Health-Belief Model
 
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based on motivational theory composed of three components
INDIVIDUALS PERCEPTION MODIFYING FACTORS LIKELIHOOD OF ACTION

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  

an individual’s perceptions, e.g.:
of perceived susceptibility of perceived seriousness of perceived threat

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modifying factors (factors that modify an individual’s perceptions), e.g.:

demographic variables
e.g., age, gender, race, ethnicity, etc.


sociopsychologic variables
e.g., personality, social class, peer and reference group pressure, etc.
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structural variables

e.g., knowledge about the disease, prior contact with the disease, etc.

 

perceived threat cues to action

e.g., mass media campaigns, advice from others, reminder postcard from a physician or dentist, illness of family member or friend, newspaper or magazine article
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likelihood of action
perceived benefits of the action MINUS perceived barriers to action EQUALS likelihood of taking recommended preventive health action

 

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PENDER’S HEALTH PROMOTION MODEL

Describes the multidimensional nature of persons as they interact within their environment to pursue health Defines health as a positive, dynamic state nor merely the absence or disease Directed at increasing a client’s level of well-being ILLNESS HEALTH AND 62

Focuses on the following areas

Client’s cognitive perceptual factors (individual perceptions) Modifying factors (demographic and social) Participation in health promoting behaviors (likelihood of action)

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