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Models of Prevention

This page was last updated on November 10, 2010


 Introduction
 Millennium development goal
 Clinical model
 Role performance model
 Adaptive model
 Agent-Host-Environmental model:
 High Level Wellness Model
 Holistic Health Model
 Nightingale’s Theory of Environment
 Milio’s Framework for Prevention
 Levels of Prevention Model
 The Health Belief Model
 Tannahill Model of Health Promotion
 The Social Model
 The Social-Ecological Model
 Mental Health Promotion Model
 AIDS Risk Reduction Model
 Reference


A model is a theoretical way of understanding a concept or idea. Models

represent different ways of approaching complex issues. Health beliefs are a
person’s ideas, convictions, and attitudes about health and illness. Because
health beliefs usually influence health behaviour, they can positively or
negatively affect a client’s health. ‘Prevention’of illness is a positive health
behaviour. Common positive health behaviours include immunizations, proper
sleep patterns, adequate exercise, and nutrition. There are different models of

Preventing illness is one aspect of wellness care that focuses on detection or

prevention of disease. Primary prevention focuses on the health of a person
or population. Secondary prevention includes screening for those at risk to
develop an illness or those who could have disease diagnosed early in the
process for prompt treatment. Tertiary prevention occurs when diagnosis of a
long term disease/disability has already been made. The goal is to minimize
complications and maximize function many way possible for these clients.
Definition of health

 Traditional medicine - "absence of disease absence of disease".

 "Health is a state of complete physical, social and mental well-being,
and not merely the absence of disease or infirmity"- WHO(1948)
 Murray & & Zentner –"state of well-being (where)…person uses
purposeful, adaptive responses…to maintain relative stability and
comfort strive for personal objectives & cultural goals".

New philosophy of health

Health is:

 fundamental right
 Essence of productive life
 Intersectoral
 Integral part of development
 Central to the concept of quality of life
 Involves individual, state and international responsibilities
 World wide social goal
 Major social investment

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:


 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

Here, 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

Here, 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 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

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 acknowledges and respects the interaction of a person’s mind, body

and spirit within the environment. Holism is an antidote to the atomistic
approach of contemporary science. An atomistic approach takes things apart ,
examining the person piece by piece in an attempt to understand the larger

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.

Nurses using the holistic nursing model recognize the natural healing abilities
of the body and incorporate complementary and alternative interventions,
such as 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

It has been defined in terms of four levels:

 Primordial prevention
 Primary prevention
 Secondary prevention
 Tertiary prevention

Primordial prevention

Primary prevention in its purest form- prevention of the emergence or

development of risk factors in population or countries in which they have not
yet appeared. Here, 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 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


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 mode is one of the oldest attempts to explain health behaviour. It 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

Purpose of the Model.

-method to explain and predict preventive health behavior.


The Health Belief Model (HBM) was one of the first models that adapted
theory from the behavioral sciences to health problems, and it remains one of
the most widely recognized conceptual frameworks of health behavior. It was
originally introduced in the 1950s by psychologists working in the U.S. Public
Health Service (Hochbaum, Rosenstock, Leventhal, and Kegeles).

The model in action: an example

A parent will organize immunization for a child if he/she:

 believes there is a danger of the child contracting the disease

(perceived susceptibility)
 believes that immunization is effective in eliminating the danger
(perceived benefits)
 trusts that the method is safe and has an acceptable level of risk
(possibly through education and media information)
 has the means to access the vaccination service (no barriers to
behavior change)

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
 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


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


- 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.


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.

Prevention has long been part of nursing's scope of practice. Nurses

delivering care to clients across the life span in a variety of practice areas can
support individuals and coalitions structured to promote health and prevent
disease. Nurses have involved themselves in activities that move individuals,
families, groups and communities toward higher levels of health and wellness.
In all direct or indirect practice arenas nurses must continue a strong
orientation toward prevention.


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