Foundation of Health Care PDF

Preview

Summary

Health Care Topics for Public Health...

Description

Unit V: Models of Health and Illness (3 hours)

Presentation Contents

of

TOPIC I. Models of Health and Illness

Introduction Health is a fundamental right of every human being. It is a state of integration of the body and mind. It is a much sought-after state, a highly desirable state for most people and yet at times. It remains elusive for some people. Across the life span, man moves from the health spectrum to the illness spectrum. Some people think of themselves as healthy and well if they are not ill and ill if they are not well. However, there is no exact point at which health ends and illness begins as both are relative in nature. Health and illness are highly individualized perceptions. Meanings and descriptions of health and illness vary among people in relation to geography and to culture. In this unit, you will learn the eleven (11) models of health and Illness.

Learning Outcomes At the end of this unit, students will be able to: 

Different researchers have developed models or paradigms that explain health and in some instances its relationship to illness or injury. 1. Dunn’s Theory of HealthIllness Continuum- (Halbert Dunn) Describes the interaction of the environment with wellbeing & illness. High Level Wellness (HLW) an integrated method of functioning that is oriented towards maximizing one’s potentialities within the limitations of his environment. This concept connotes ability to perform or function independently. Dunn is known as the "father" of the wellness movement. He distinguished between good health —not being ill—and what he termed high-level wellness, which he defined as "a condition of change in which the individual moves forward, climbing toward a higher potential of functioning".

Apply models of health Figure 1. and illness in addressing particular health Very favorable concern. environment Environment Quadrant 1

Quadrant 2 Protected

Death

Health

Precursor of Illness

Peak Health wellness

High level wellness

Environment Quadrant 4- Emergent high level of wellness in unfavorable environment Quadrant 3 Quadrant 4  e.g., a woman who has the Very unfavorable Emergent high Poor health knowledge to implement healthy environment Dunn describes a health DUNN’s grid that life-style practices but does not WELLNESS GRID has a health axis and an implement adequate self-care environmental axis intersect. The practices because of family grid demonstrates the interaction of responsibilities, job demands, or the environment with the illnessother factors wellness continuum. The health axis extends from peak wellness to death, and the environmental axis Precursor of Illness: Is a definable pathologic state that extends from very favorable to very unfavorable. Environmental progresses directly wellness is related to the premise to disease without a known that humans must be at peace with intermediate step, and whose presence and guard the environment. substantially increases the likelihood X-axis is HEALTH- a health axes of disease. which ranges from peak wellness to death/illness. Y-axis is ENVIRONMENT an These are factors which impinge on environmental axis which ranges the individuals to lead towards from very favorable to very the illness spectrum: unfavorable. The two axis’s form four a. Heredity- e.g. family history for diabetes, diabetes mellitus, quadrants: hypertension, cancer. Quadrant 1- High-level wellness b. Behavioral factors- e.g. cigarette smoking, alcohol abuse, high in favorable environment animal fat intake  e.g., a person who implements c. Environmental factors healthy life-style behaviors and has e.g. overcrowding, poor the biopsychosocial spiritual sanitation, poor supply of resources to support this life-style potable water Quadrant 2- Protected poor health in favorable environment 2. Health – Belief Model –  e.g., an ill person whose needs are met by the health care system Addresses the relationship between a and who has access to appropriate person’s belief and behaviors. It medications, diet, and health care provides a instruction. Quadrant 3- Poor health in way of understanding and predicting how clients will behave in relation unfavorable environment to health  e.g., an ill person whose needs and how they will comply with health are met by the health care system care therapies. and who has access to appropriate medications, diet, and health care One's actions towards preserving instruction health is influenced by an individual's perception

of his/her susceptibility to illness, the seriousness of the illness and the benefits of his/her action. There are six constructs of the HBM . The first four constructs were developed as the original tenets of the HBM. The last two were added as research about the HBM evolved. 1. Perceived susceptibility- This refers to a person's subjective perception of the risk of acquiring an illness or disease. There is wide variation in a person's feelings of personal vulnerability to an illness or disease. E.g. lifestyle, exposure to other disease, no follow-up check-up and failure to comply medical advice, stressors. Modifying factors includes: 1. Demographic variable (age, sex, race etc.) 2. Socio-psychologic variables (social pressure or influence from peers) 2. Perceived severity - This refers to a person's feelings on the seriousness of contracting an illness or disease (or leaving the illness or disease untreated). There is wide variation in a person's feelings of severity, and often a person considers the medical consequences (e.g., death, disability) and social consequences (e.g., family life, social relationships) when evaluating the severity. 3. Perceived benefits of taking the necessary preventive measuresThis refers to a person's perception

of the effectiveness of various actions available to reduce the threat of illness or disease (or to cure illness or disease). The course of action a person takes in preventing (or curing) illness or disease relies on consideration and evaluation of both perceived susceptibility and perceived benefit, such that the person would accept the recommended health action if it was perceived as beneficial. 4. Perceived barriers - This refers to a person's feelings on the obstacles to performing a recommended health action. There is wide variation in a person's feelings of barriers, or impediments, which lead to a cost/benefit analysis. The person weighs the effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side effects), unpleasant (e.g., painful), time-consuming, or inconvenient. 5. Cue to action - This is the stimulus needed to trigger the decision-making process to accept a recommended health action. These cues can be internal (e.g., chest pains, wheezing, fatigue, uncomfortable symptoms etc.) These cues can be external (e.g., advice from others, illness of family member, newspaper article, mass media etc.). 6. Self-efficacy - This refers to the level of a person's confidence in his or her ability to successfully perform a behavior. This construct was added to the model most recently in mid-1980. Self-efficacy is a construct in many behavioral

theories as it directly relates to whether a person performs the desired behavior. Likelihood of taking recommended preventive health action depends on: 1. Perceived benefits to preventive action or Preventive health behavior may include lifestyle changes, increased adherence to medical therapies, search for medical advice or treatment. 2. Perceived barriers to preventive action may be due to difficulty in adhering to lifestyle changes; social pressures; physical symptoms such as fatigue; joints pain; economic factors; accessibility of health care facilities Limitations of Health Belief Model There are several limitations of the HBM which limit its utility in public health. Limitations of the model include the following: 





It does not account for a person's attitudes, beliefs, or other individual determinants that dictate a person's acceptance of a health behavior. It does not take into account behaviors that are habitual and thus may inform the decision-making process to accept a recommended action (e.g., smoking). It does not take into account behaviors that are performed for non-health related reasons such as social acceptability.







It does not account for environmental or economic factors that may prohibit or promote the recommended action. It assumes that everyone has access to equal amounts of information on the illness or disease. It assumes that cues to action are widely prevalent in encouraging people to act and that "health" actions are the main goal in the decision-making process.

The HBM is more descriptive than explanatory, and does not suggest a strategy for changing health-related actions. In preventive health behaviors, early studies showed that perceived susceptibility, benefits, and barriers were consistently associated with the desired health behavior; perceived severity was less often associated with the desired health behavior. The individual constructs are useful, depending on the health outcome of interest, but for the most effective use of the model it should be integrated with other models that account for the environmental context and suggest strategies for change. 3. Smith’s Models of Health. (M. Belloc & Breslo, 1972) a. Clinical model- views people as physiologic system with related functions & identifies health as the absence of signs & symptoms of disease or injury. The clinical model is narrowest interpretation of health. It is a medically oriented model. According to the model –



Health is seen as freedom from disease  Illness is seen as the presence of disease



b. Role performance model(Parsons’s 1958) - defines health in terms of individual’s ability to perform societal roles such as performing work.

4. Leavell & Clark Agent- HostEnvironment Model (Ecologic Model)

Illness is seen as the failure to actualize or realize one's Potential.

Figure 2.

Health is defined in term of the individual ability to perform work, which is fulfil the societal roles. According to the model –  Health is seen as the ability to fulfill societal roles  Illness is seen as the inability to fulfill societal roles c. Adaptive model- focuses on adaptation. views health as creative process; and disease as a failure in adaptation or mal adaptation. This model believes that the aim of treatment is to restore the ability of the person to adapt, that is to cope/manage. This model is biased on the ability to adapt to the environment and interact with it. According to the model –  Health is seen as adaptation  Illness is seen as a failure of adaptation, or maladaptation d. Eudemonistic model The Eudemonistic model is the most comprehensive, holistic, view of health. According to the model –  Health is actualization or realization of one's potential

The Epidemiologic Triangle The Centers for Disease Control and Prevention (CDC) defines an outbreak or epidemic as “the occurrence of more cases of disease, injury, or other health condition than expected in a given area or among a specific group of persons during a specific period.” When investigating how a disease spreads and how to combat it, the epidemiologic triangle can be an invaluable tool. This model is used primarily in predicting illness rather than in promoting wellness, although identification of risk factors that result from the interactions of agent, host and environment are in promoting and maintaining your health.

The epidemiologic triangle is made up of three parts: agent, host and environment or the three interactive factors or three components that affect health & illness.

agent’s ability to thrive, as might the quality of drinking water or the accessibility of adequate medical facilities.

Agent The agent is the microorganism that actually causes the disease in question. An agent could be some form of bacteria, virus, fungus, or parasite. Any factor or stressor that can lead to illness or disease. Host The agent infects the host, which is the organism that carries the disease. A host doesn’t necessarily get sick; hosts can act as carriers for an agent without displaying any outward symptoms of the disease. Hosts get sick or carry an agent because some part of their physiology is hospitable or attractive to the agent. Person who may or may not be affected by a disease. Environment Outside factors can affect an epidemiologic outbreak as well; collectively these are referred to as the environment. The environment includes any factors that affect the spread of the disease but are not directly a part of the agent or the host. Any factor external to the host that may or may not predispose the person to a certain condition and brings the host and agent together. For example, the temperature in a given location might affect an

Epidemiologic Examples

Triangle

The best way to understand the epidemiologic triangle is to see how epidemiologists use it to explain the spread of existing diseases. The human immunodeficiency virus (HIV). AGENT

HOST

ENVIRON MENT

HIV is a viral infection that targets a person’s immune system, making it more vulnerable to other forms of infection. Because the virus targets the immune system itself, the body cannot effectivel y fight HIV on its own. HIV is

Scientists theorize that HIV was originally carried by chimpanz ees and that humans who hunted these chimpanz ees for meat became infected with a mutated form of the virus upon contact with the chimpanz

There are a number of socioecon omic factors that can impact the spread of HIV within a community. Communities with higher concentration s of sexually transmitted diseases and lower incidences of reporting — due to social pressure or otherwise — allow HIV to flourish. Poverty limits access to care and treatment,

communic ated through direct contact with an infected person’s bodily fluids, and it primarily spreads through sexual contact or shared needles. Through placenta (in pregnant).

ees’ blood. HIV can be transmitt ed when a bodily fluid such as blood comes into contact with a mucous membran e or damaged tissue (such as an open wound or the mucous membran es found inside the mouth).

and discriminatio n can discourage individuals from being tested or seeking care.

5. PENDERS’s Health Promotion Model Pender advocates that health promotion involves activities that are directed toward increasing the level of well-being and selfactualization.

4. Includes the principles of selfresponsibility, nutritional awareness, stress reduction and management and physical fitness. 6.Travis’ Illness-Wellness Continuum or Health-Illness Continuum Model This is a grid or graduated scale that can be used to measure a person's perceived level of wellness. According to this model, health and illness can be viewed as the opposite ends of a health continuum. From a high level of health, a person's condition can move through good health, normal health and extremely poor health, eventually to death. People move back and forth within this continuum day by day. This illness-wellness continuum ranges from high-level wellness to premature death. It illustrates two arrows pointing in opposite directions and joined at a neutral point. Movement to the right of the neutral point indicates increasing levels of health and well-being for an individual. Figure 3.

1. Includes effort to assists individuals in taking control of and responsibility for their health risks and ultimately improve quality of life. 2. Encompasses activities to improve the health of those who are not initially healthy as well as the healthy individuals. 3. Includes individual and community activities to promote healthful lifestyle.

A. Composed of two arrows pointing in opposite directions and joined at a neutral point a. movement to the right on the arrows (towards highlevel wellness) equals an increasing level of health and wellbeing

1. a.

achieved in three steps: awar

eness b.

The preservation of health takes into account a holistic approach that integrates the mind, body and spirit.

educ ation

c.

grow th

movement to the left on the arrows (towards premature death) equates a progressively decreasing state of health 1. achieved in three steps: a. signs b. symp toms c. disab ility B. Most important is the direction the individual is facing on the pathway a. if towards high-level health, a person has a genuinely optimistic or positive outlook despite his/her health status b. if towards premature death, a person has a genuinely pessimistic or negative outlook about his/her health status C. Compares a treatment model with a wellness model a. 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 a. if a wellness model is used, an individual can move right past the neutral point.

Figure 4.

b.

7. Holistic Health Model

8. Stages of Change Model (TRANSTHEORETICAL MODEL) The Stages of Change Model , also called the Trans theoretical Model, explains an individual's readiness to change their behavior. It describes the process of behavior change as occurring in stages. These stages include: 1. Pre-contemplation — in this stage, the individual has no intention to change behavior within the next six months. The individual may lack knowledge or may have been unsuccessful with previous attempts at a change. 2. Contemplation — in this stage, an individual is considering a behavior change within the next six months. Ambivalence, however, may keep the individual from progressing to the next stage. 3. Preparation — in this stage, the individual takes some steps toward making a change and doing so within the next 30 days.

4. Action — an individual reach this stage once he or she has made an apparent behavior change for six months or less. 5. Maintenance — if the individual’s behavior change lasts for more than six months, he or she moves into the final stage, maintenance.

cyclical – individuals may progress to the next stage or regress to a previous stage. The Stages of Change model can be applied to health promotion and disease prevention programs to address a range of health behaviors, populations, and settings. It may be an appropriate model for health promotion and disease prevention programs related to worksite wellness, tobacco use, weight management, medication compliance, addiction, and physical activity, among other health topics. 9. Social Cognitive Th

Precontemplation • Educate the individual about obesity and the role exercise plays, including pros and cons of the change.

Contemplation • Help the individual identify barriers to physical activity and encourage them to develop exercise plans

Maintenance (SCT) gnitive Theory • Encourage scribes the influence of individuals Action to expand individual experiences, the actions • Help the individual of others, and their environmental Preparation physical identify • Support any factors activity on individual health strategies to increases in options and maintain SCTto supportprovides physical activity.behaviors. physical Help find others who support opportunities activity, addressfor social potential be barriers, and set through instilling may expectations, resources to considering goals. Support support exercise,self-efficacy, a behavior and using confidence to such as peer change. maintain the learning and other support systems,observational change. reminder cues, reinforcements to achieve behavior rewards. change.

Considerations for Implementation...