Theoretical Models/Approaches

TheoreticalModels/Approaches

TheoreticalModels/Approaches

HEALTH BELIEF MODEL

The Health Belief Model

PREMISE of HBM

Key concepts and definitions of theHealth Belief Model

Limitation of HBM

MILIO’S FRAMEWORK OF

PREVENTION

Milio’s Framework of Prevention

◦ Nancy Milio

◦ Includes concepts of community – oriented, population –focused care

◦ Basic treatise was that behavioral patterns of the population and individuals who

make up populations are a result of habitual selection from limited choices.

◦ Challenged the common notion that a main determinant for unhealthful behavioral

choice is lack of knowledge

◦ Milio’s framework described a sometimes neglected role of a community health

nursing to examine the detErminants of community’s health and attempt to influence

those determinants through public policy

6 PROPOSITIONS OF MILIO’S THEORY

1.Population health deficits result from deprivation and or excess of critical health resources.

2. Behaviors of populations results from selection limited choices; these arise from actual and perceived options available as well as beliefs and expectations resulting from socialization, education, and experience.

◦ Individuals and families living

in poverty have poorer

health status compared with

middle- and upper-class

individuals and families

◦ Positive and negative lifestyle

choices are strongly

dependent on culture,

socioeconomic status, and

educational level.

3. Organizational decisions and policies

dictate many of the options available to

individuals and populations and

influence choices.

4. Individual choices related to health

promotion or health damaging behaviors

are influenced by efforts to maximize

valued resources.

◦ Health insurance coverage and

availability are largely determined and

financed by the government through

the NHIC and private insurance.

◦ Choices and behaviors of individuals

are strongly influenced by desires,

values, and beliefs.

◦ Alteration in patterns of behavior

resulting from decision making of a

significant number of people in a

population can result in social change

◦ Without concurrent availability of

alternative health promoting options

for investment of personal resources,

health education will be largely

ineffective in changing behavior

patterns.

◦ Some behaviors such as tobacco use

have become difficult to maintain in

many settings or situations in response

to organizational and public policy

mandates.

◦ Without concurrent availability of

alternative health promoting options

for investment of personal resources,

health education will be largely

ineffective in changing behavior

patterns.

PENDER'S HEALTH PROMOTION

MODEL (HPM)

Pender's Health PromotionModel• NOLA J. PENDER (1982; revised, 1996) was designed to be a

“complementary counterpart to models of health protection.”

• It defines health as a positive dynamic state not merely the absence of disease. Health promotion is directed at increasing a client’s level of well being.

• The health promotion model describes the multi dimensional nature of persons as they interact within their environment to pursue health.

The model focuses on following three areas:

1. Individual characteristics and experiences

2. Behavior-specific cognitions and affect

3. Behavioral Outcomes

Pender’s HealtH Promotion level

1. Individual Characteristics and Experiences

• Each person's unique characteristics and experiences affect his or her actions. Their effect depends on the behavior in question.

2. Behavior-specific Cognitions and Affect

• These variables are considered to be very significant in behavior motivation. They are a "core" for intervention because they may be modified through nursing actions. Assessment of interventions-measuring the change in these variables.

3. Prior related Behavior

• Prior behaviors influence subsequent behavior through : perceived self-efficacy, benefits, barriers, and affects related to that activity. Habit is also a strong indicator of future behavior.

4. Personal Factors

• Biological factors such as age, body mass index, strength and agility; psychological factors include self-esteem, self motivation, and perceived self status; socio-cultural factors include race, ethnicity, acculturation, education, and socioeconomic status.

5. Perceived Benefit of Action

• The perceived benefits of a behavior are strong motivators of that behavior. These motivate behavior through intrinsic and extrinsic benefits. Intrinsic benefits include increased energy and decrease appetite. Extrinsic benefits include social reward such as compliments and monetary rewards.

6. Perceived Barriers to Action

• Barriers are perceived unavailability, inconvenience, expense, difficulty, or time regarding health behaviors

7. Perceived Self-efficacy

• Self-efficacy is one's belief that he or she is capable of carrying out health behavior. If one has high self-efficacy regarding a behavior, one is more likely to engage in that behavior than if one has low self-efficacy

8. Activity-related Affect

• The feelings associated with a behavior will likely affect whether an individual will repeat or maintain the behavior.

9. Interpersonal Influences

• In the HPM, these are feelings or thoughts regarding the beliefs or attitudes of others. Primary influences are family, peers,, and health care providers.

10. Situational Influences

• These are perceived options available, demand characteristics, and aesthetic features of the environment where the behavior will take place.

11. Commitment to a plan of action

• These are alternate behaviors that one considers as possible optional behaviors immediately prior to engaging in the intended, planned behavior. One has little control over competing demands, but one has great control over competing preferences

12. Health- promoting behavior

• This is the goal or outcome of the HPM. The aim of health promoting behavior is the attainment of positive health outcomes.

PRECEDE-PROCEED MODEL

P R O V I D E A M O D E L F O R C O M M U N I T Y

A S S E S S M E N T, H E A LT H

E D U C AT I O N , P L A N N I N G , A N D E VA L U AT I O N .

Dr. Lawrence W. Green

It provides a comprehensive

structure for assessing health and

quality of life needs , and for

designing , implementing, , and

evaluating health promotion and

other public health programs to

meet those needs

I N T H I S F R A M E WO R K ,

H E A LT H B E H AV I O R I S

R E G A R D E D A S B E I N G

I N F L U E N C E D B Y B OT H

I N D I V I D UA L A N D

E N V I R O N M E N TA L

FA C TO R S , A N D H E N C E

H A S T WO D I S T I N C T

PA RT S

FIRST EDUCATIONAL DIAGNOSIS

PRECEDE

•P REDISPOSING

•R EINFORCING and

• E NABLING

•C ONSTRUCTS in

• E DUCATIONAL DIAGNOSIS and

• EVALUATION

PRECEDE

Predisposing factors

refer to people’s

characteristics that

motivate them toward

health- related behavior.

Enabling factors-

conditions in people and

the environment that

facilitate or impede

health-related behavior.

REINFORCING

• factors refer to the feedback given by

support persons or groups resulting

from the performance of the health-

related behavior

COMMUNITY FACTORS

• Social assessment: Determine the social problems and needs of a given

population and identify desired results.

• Epidemiological assessment: Identify the health determinants of the

identified problems and set priorities and goals.

• Ecological assessment: Analyze behavioral and environmental determinants

that predispose, reinforce, and enable the behaviors and lifestyles are identified.

• Identify administrative and policy factors that influence implementation

and match appropriate interventions that encourage desired and expected

changes.

• Implementation of interventions.

PROCEED

P- olicy

R- egulatory

O- ganizational

C- onstruct in

E- ducational and

E- nvironmental

D- evelopment

IDENTIFICATION OF DESIRED OUTCOMES AND PROGRAM IMPLEMENTATION:

• Implementation: Design intervention, assess availability of

resources, and implement program.

• Process Evaluation: Determine if program is reaching the

targeted population and achieving desired goals.

• Impact Evaluation: Evaluate the change in behavior.

• Outcome Evaluation: Identify if there is a decrease in the

incidence or prevalence of the identified negative behavior or an

increase in identified positive behavior.