MODELS OF

PREVENTION,PRIMARY HEALTH
CARE & HEALTH PROMOTION
1. MODELS OF PREVENTION
• 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 prevention.

 • The absence of signs and symptoms of
disease indicates health.
• Illness would be the presence of
conspicuous signs and symptoms of
disease.
1.Clinical • People who use this model of health to
model
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.
 • Health is indicated by the ability to
perform social roles.
• Illness would be the inability to perform a
person’s roles at the level of others in
2.Role society.
performance
model
• 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.
 • The ability to adapt positively to social,
mental, and physiological change is
indicative of health.
• Illness occurs when the person fails to
3.Adaptive adapt or becomes inadaptive toward
model
these changes.
• As the concept of adaptation has
entered other aspects of health care, this
model has become widely accepted.
 Leavell and Clark (1965)
•This model is useful for examining
causes of disease in an individual.
•The agent, host and environment
4.Agent host interact in ways that create risk factors,
environment and understanding these is important
model
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.
 Dunn(1961):

• This model recognizes health as an ongoing

process toward a person’s highest potential
of functioning.
5.High
Level • This process involves the person, family and
Wellness
Model the community.

• High level wellness is a lifestyle focused

approach which is design for the purpose of
pursuing the highest level of health within a
person’s capability.
 Dr. John Travis, 1972
• This is one way to measure a person’s
level of health
• Health as a constantly changing state,
6. Illness- with high level wellness and death being
Wellness
Continuum on opposite ends of a graduated scale.
model
• This illustrates the dynamic state of
health, as a person adapts to changes in
the internal and external environments to
maintain a state of wellbeing.
 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
7.Holistic can not be fully understood if examined
Health solely in pieces apart from their
Model environment.
• In this model, nurses consider clients the
ultimate experts regarding their own health.
• In holistic model of health, clients are
involved in their healing process, thereby
assuming some responsibility for health
maintenance.
 • Disease was more prevalent in poor
environments and that health could be
promoted by providing adequate
ventilation, pure water, quiet, warmth,
8.Nightingale’s light and cleanliness.
Theory of
Environment • Poor environmental conditions are
bad for health and that good
environmental conditions reduce
disease.
• This model views health as a
constantly changing state.
 • Nancy Milio developed a framework for
prevention that includes concepts of
community – oriented, population- focused
care.
• Behavioral patterns of the individuals who
make up the population are a result of habitual
9.Milio’s selection from limited choices.
Framework
for • Challenged the common notion that a main
Prevention determinant for unhealthful behavioural choice
is lack of knowledge.
• Milio’s framework described the neglected role
of community health nurse to examine the
determinants of a community’s health and
attempt to influence those determinants through
public policy.
 Leavell and Clark in 1975
• This model suggests that the natural
history of any disease exists on a
continuum, with health at one end and
10. Levels advanced disease at the other.
of • The goal is to maintain a healthy state
Prevention
Model 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.
• 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.
 • This model is based on the concept that for a
behavioral change to succeed, individuals
must have the incentive to change, feel
threatened by their current behaviour, and
11.The feel that a change will be beneficial and be at
Health
Belief acceptable cost.
Model
• They must also feel competent to implement
that change .
• The purpose of the model is to explain and
predict preventive health behavior.
 • Health Education: 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,
12.Tannahill ex: no smoking in public places.
Model of Health Protection is responsible for the
Health development and implementation of legislation,
Promotion 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.
2. PRIMARY HEALTH CARE
According to WHO,

“The essential health care made universally

accessible to individuals and families in the
community through their full participation and
at a cost of community and country can
afford.”
 Principles
1. EQUITABLE DISTRIBUTION

2. COMMUNITY PARTICIPATION

3. INTERSECTORIAL COORDINATION

4. APPROPRIATE TECHNOLOGY

5. HEALTH WORKFORCE
 Goals
 Reducing exclusion and social disparities in health

 Organizing health services around people's needs and

expectations

 Integrating health into all sectors

 Pursuing collaborative models of policy dialogue

 Increasing stakeholder participation.

 Extended Elements in 21st Century
• Expanded options of immunizations

• Reproductive Health Needs

• Provision of essential technologies for health

• Health Promotion

• Prevention and control of non-communicable diseases

• Food safety and provision of selected food supplements

 Millennium Development Goals
1. Eradicate extreme poverty and hunger
2. Achieve universal primary education
3. Promote gender equity
4. Improve maternal health
5. Reduce child mortality
6. Combat HIV/AIDS, malaria, and other communicable
diseases
7. Ensure environmental sustainability
8. Develop global partnership for development
 Primary health care approach
PHC approach consists of techniques known collectively under the
acronym "GOBI-FFF".
• Growth monitoring: the monitoring of how much infants grow
within a period, with the goal to understand needs for better early
nutrition.
• Oral rehydration therapy: to combat dehydration associated with
diarrhea
• Breastfeeding
• Immunization
• Family planning (birth spacing)
• Female education
• Food supplementation: for example, iron and folic acid
fortification/supplementation to prevent deficiencies in pregnant
women.
 Role of nurse in primary health care
 Health education

 Food supply and proper nutrition

 Water supply and basic sanitation

 Maternal and child health care including family planning

 Immunization

 Prevention and control of endemic disease

 Treatment of minor aliments

 Provision of essential drugs

Problems in implementing Primary health care
in India
 Resources
 Population problem
 Absence of political support
 Medical care problem
 Rising cost of health care
 Inadequate supervision and follow up
 Failure to restore medical supplies on a regular basis
 Lack of cooperation on the part of health services
 Increased globalization
 Poverty
 Climate changes
 Shortage of funds
 Lack of materials and equipment
 Shortage of appropriate staff
 Lack of commitment which can be at the individual or
government level.
 Lack of incentive
 Lack of information
 Inadequate community participation
 Inadequate intersectoral collaboration
 Rapid turnover of policy makers
 Lack of manpower training and development
 Inadequate utilization of services
 In appropriate staff recruitment
 Ill defined responsilities that is poor job description
 Ill defined authority.
3. HEALTH PROMOTION
Health promotion and disease prevention
programs focus on keeping people healthy.

Health promotion engages and empowers

individuals and communities to engage in
healthy behaviors, and make changes that
reduce the risk of developing chronic diseases
and other morbidities.
• Defined by the World Health
Organization, health promotion is: “The
process of enabling people to increase
control over, and to improve, their
health. It moves beyond a focus on
individual behavior towards a wide
range of social and environmental
interventions.”
 Health Promotion Interventions
1. Health education
2. Environmental modification
3. Nutritional interventions
4. Lifestyle and behavioural changes.
The Ottawa Charter for Health Promotion
Ottawa was the venue for an international conference
on health promotion in 1987. The resulting Ottawa
Charter proposed action "to achieve health for all" by
the year 2000. It included the following strategies:
• Building healthy public policy. This puts health on the
agenda for all policymakers, directing them to be aware
of the health consequences of their decisions
• Creating supportive environments. (e.g. encouraging
a family to support their relative who is trying to lose
weight) This recognized the importance of environment
for health, and proposed a socio-ecological approach to
health
• Strengthening community action. Health promotion
requires community empowerment and involvement in
setting priorities, planning and implementing strategies
to achieve better health
• Developing personal skills. Health promotion supports
personal and social development through providing
information and enhancing life skills
• Reorienting health services. Health promotion argues
for shifting health resources towards a more equal
distribution between health care and preventing
disease. Responsibility for health promotion services
should be shared among individuals, community
groups, health professionals, health services and
governments.
 Seven prerequisites for health promotion
(Ottawa charter )
1) Peace
2) Shelter
3) Education
4) Food
5) Income
6) Stable Eco-system
7) Sustainable Resources
 Values in Health Promotion
Health promotion is implicitly based on several values:
• equity and social justice
• a holistic definition of health
• covers the full range of health determinants
• recognizes the influence of environment on health
• empowers people and builds individual and collective
capacity
• seeks to enhance people's social participation
• involves intersectorial collaboration.
• Nursing must expand its efforts to design and implement
interventions which support promotion of health and
prevention of disease/illness and disability.

• 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.
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