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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.