MODELS OF PREVENTION

OUTLINE

Introduction
Clinical model
Role performance model
Adaptive model
Agent-Host-Environmental model:
High Level Wellness Model
Holistic Health Model
Nightingales Theory of Environment
Milios 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

INTRODUCTION
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 health.
DEFINITION OF MODEL:A model is a theoretical way of understanding a concept or idea.
Represent different ways of approaching complex issues. Health beliefs are a persons ideas,
convictions, and attitudes about health and illness. Because health beliefs usually influence health behaviour, they
can positively or negatively affect a clients health.

Prevention of illnesses is a positive health behaviour.

Common positive health behaviours include immunizations, proper sleep patterns, adequate exercise, and
nutrition.
Preventing illness is one aspect of wellness care that focuses on detection or prevention of disease.
DEFINITION OF HEALTH:"Health is a state of complete physical, social and mental well-being, and not merely the absence of disease or
infirmity"- WHO (1948)

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
Worldwide 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.

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."

PRINCIPLES OF PREVENTION:The terms primary, secondary and tertiary prevention were first documented in the late 1940s by Hugh Leavell
and E. Guerney Clark from the Harvard and Columbia University Schools of Public Health, respectively.
Pioneers in Public Health thinking at that time, Leavell and Clark described the principles of prevention within
the context of the Public Health triad of Host, Agent and Environment commonly referred to as the epidemiologic
triangle model of Causation of diseases.
LEAVELL AND CLARKS THREE LEVELS OF PREVENTION

Primary Prevention

Seeks to prevent a disease or condition at a pre-pathologic

To stop something from ever happening, Health Promotion,

state;
health

education, marriage counselling, genetic screening, good

standard of nutrition, adjusted to developmental phase of

life,

Specific, Protection, use of specific immunization, attention

to

personal hygiene, use of environmental sanitation,

protection against occupational hazards, protection from
accidents, use of specific nutrients, protections from carcinogens, avoidance to allergens.

Secondary Prevention
Also known as Health Maintenance:

Seeks to identify specific illnesses or conditions at an early stage

with, prompt intervention to prevent or limit disability;

To prevent catastrophic effects that could occur if proper attention

and treatment are not provided,

Early Diagnosis and Prompt Treatment,

Case finding measures,

Individual and mass screening survey,

Prevent spread of communicable disease,

Prevent complication and squeal,

Shorten period of disability,

Disability Limitations,

Adequate treatment to arrest disease process and prevent further

complication and squeal, Provision of facilities to limit disability and prevent death.

Tertiary Prevention
Occurs after a disease or disability has occurred and the recovery process has begun; Intent is to halt the disease
or injury process and assist the person in obtaining an optimal health status. To establish a high-level wellness.
To maximize use of remaining capacities, Restoration and Rehabilitation, Work therapy in hospital, Use of
shelter colony

1. CLINICAL MODEL
The clinical model views health as the absence of physiological disease or the absence of disequilibrium. Persons
with clinical symptoms of disease are not considered healthy from this perspective. People are viewed as
physiologic system with related functions and symptoms are disease or injury.
Health is identified as the absence of signs and symptoms of disease or disability as identified by medical
science. Many medical practitioners use the clinical model. The focus of many medical practice is the relief of
signs and symptoms of disease and the elimination of malfunction and pain when the signs and symptoms of
disease are no longer present in a person, the medical practitioner often considers that the individuals health is
restored.
In the clinical model, the opposite end of continuum from health is disease. In this medical health is
motivated by the absence of diagnosable disease.
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.

11. ROLE PERFORMANCE MODEL

This model adds social and psychological standards to the concept of health. Health is defined in terms of the
individuals ability to fulfil societal roles, i.e., to perform work. This critical criterion of health is the persons
ability to fulfil his roles in society with the maximum {e.g., best, highest) expected performance. If a person is
unable to perform his expected roles, it can mean illness even though an X-Ray film of his lung indicates a
tumour.

Parson (1972) views health in this light. Health also been defined as the state of optimum capacity of an
individual for the effective performance of his roles and tasks. An emphasis in this definition is the capacity of
the individual rather than a commitment of roles and tasks.
The role performance model of health views health as the ability to perform social roles. Illness is
determined by the capacity to function and perform ones daily activities. It is assumed that sickness is the
inability to perform ones work. A problem of this model is the assumption that a persons most important role is
the work role. People usually fulfil several roles. E.g., mother, father, daughter, son, friend and certain individual
may consider nonwork roles and paramount in their lives.
In this model health is motivated by being able to fulfil responsibilities at work, play, home, community.

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 persons 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.

III. ADAPTIVE MODEL

The focus of the adaptive model is adaptation. Incorporating the clinical and role performance model is the
adaptive model. This model is derived from the writings of Dubos who views health as a creative process.
Individuals are actively and continually adapting to their environments.
Accordingly the individuals must have sufficient knowledge to make informed choices about their health and
also the income and resources to act on choices. They believe that complete wellbeing is unobtainable.
Health is perceived as a condition in which the person can engage in effective interaction with the physical
and social environment. There is an indication of growth and change in this model. i.e., health is a state of wellbeing in which the person is able to use purposeful, adaptive, responses and processes, physically, mentally,
emotionally, spiritually and socially in response to internal and external stimuli in order to maintain relative
stability and comfort and to strive for personal objectives and cultural goals. The adaptive model of health defines
health as the ability to interact effectively within the physical and social environment. The disease state thus
represents a failure in adaptation and ineffective coping with environmental changes. The aim of treatment is to
restore the ability of the person to adapt, i.e., to cope.
Ascending to this model extreme good health is flexible adaptation to the environment and interaction with the
environment to maximum advantage. The focus of this model is stability although there is also an element of
growth and change.

Siegel (1973) describes health as an outcome of interplay between the internal environment and external multienvironments. In the adaptive model health, the opposite end of the continuum from health is illness.
Accordingly health is motivated by altering oneself for the risks in the environment as situations changes (i.e.,
engaging in stress reduction, dietary or exercise programme, community recycling or reducing exposure to
environmental hazards.
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 in adaptive toward these changes.
As the concept of adaptation has entered other aspects of culture, this model has become widely accepted.

IV. Agent-Host-Environmental model: by Leavell and Clark (1965)

a. The agent-host-environment model of health and illness also called the ecologic model, originated in the
community health work of Leavell and Clark (1965) and has been expanded into a general theory of the multiple
causes of disease.
b. The 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 helpful in

promoting and maintaining health.
c. The model has three dynamic interactive elements:
1. Agent:
Any environmental factor or stressor (biological, chemical, mechanical, physical or psycho-social) that by its
presence or absence (e.g. lack of essential nutrients) can lead to illness or disease.
2. Host:
Person(s) who may or may not be at risk of acquiring a disease.
Family history, age and lifestyle habits influence the host's reaction.
3. Environment:
All factors external to the host that may or may not predispose the person to the development of disease.

IV. HIGH LEVEL WELLNESS MODEL:

a. Dunn (1959) describes a health grid in which a health axis and an environmental axis intersect.
b. The health axis extends from peak wellness to death, and the environmental axis extends from very favourable
to very unfavourable.

c. The intersection of the two axes forms four quadrants of

health and wellness:
1. High-level wellness in a favourable environment.
2. Emergent high-level wellness in an unfavourable
environment
3. Protected poor health in favourable environment.
4. Poor health in an unfavourable environment.

V.

Holistic Health Model by Edelman and Mandle, 2002

Holism represents the interaction of a persons mind, body and

spirit

within the environment.

Holism is based on the belief that people (or their parts) cannot

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 consider clients the ultimate experts
regarding their own health and respect clients 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.

VI.

Nightingales Theory of Environment

Florence Nightingales environmental theory focuses on

preventive care for populations.

She 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.
"Poor environmental conditions are bad for health and that

good

environmental conditions reduce disease."

This is one way to measure a persons 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..

VII. Milios Framework for Prevention

Nancy Milio developed a framework for prevention that includes concepts of community oriented,

population- focused care.

Milio stated 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.
Milios framework described a sometimes neglected role of community health nursing to examine the
determinants of a communitys health and attempt to influence those determinants through public policy.

VIII. 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 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.

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.

IX.

Tannahill Model of Health Promotion

1. Health Education: communication activity aimed at enhancing well-being and preventing ill-health
through favourably influencing the knowledge, beliefs,
attitudes and behaviour of the community
2. 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 Preparedness
3. Prevention: refers to both the initial occurrence of disease and also to the progress and subsequently the
final outcome

X.

The Social Model

A social health model is aimed at incorporating the

social

and economic, as well as biophysical context of

health

status,
It is based on knowledge of the experience, views

and

practices of people with disabilities.

It 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 that emphasize individual rights rather than advancing broader
economic rights.

XI.

The Social-Ecological Model: A Framework for Prevention

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 (Dahlberg & Krug 2002). This model considers 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.
Prevention strategies should include a continuum of activities

that

address multiple levels of the model. These activities should be

developmentally appropriate and conducted across the lifespan.

This

approach is more likely to sustain prevention efforts over time

than

any single intervention.

Individual
The first level identifies biological and personal history factors that increase the likelihood of becoming a victim
or perpetrator of violence. Some of these factors are age, education, income, substance use, or history of abuse.
Prevention strategies at this level are often designed to promote attitudes, beliefs, and behaviours that ultimately
prevent violence. Specific approaches may include education and life skills training.

Relationship
The second level examines close relationships that may increase the risk of experiencing violence as a victim or
perpetrator. A person's closest social circle-peers, partners and family members-influences their behaviour and
contributes to their range of experience. Prevention strategies at this level may include mentoring and peer
programs designed to reduce conflict, foster problem solving skills, and promote healthy relationships.

Community
The third level explores the settings, such as schools, workplaces, and neighbourhoods, in which social
relationships occur and seeks to identify the characteristics of these settings that are associated with becoming
victims or perpetrators of violence. Prevention strategies at this level are typically designed to impact the climate,

processes, and policies in a given system. Social norm and social marketing campaigns are often used to foster
community climates that promote healthy relationships.

Societal
The fourth level looks at the broad societal factors that help create a climate in which violence is encouraged or
inhibited. These factors include social and cultural norms. Other large societal factors include the health,
economic, educational and social policies that help to maintain economic or social inequalities between groups in
society.

XII. MENTAL HEALTH PROMOTION MODEL

Mental health is sometimes thought of as simply the absence of a mental illness but it is actually much broader.
Mental health is a state of successful mental functioning, resulting in productive activities, fulfilling relationships,
and the ability to adapt to change and cope with adversity. Mental health is indispensable to personal wellbeing,
family and interpersonal relationships, and one's contribution to
society
Medical Prevention Model:
The medical prevention model focuses on biological and

brain

research to discover the specific causes of mental illness,

with

primary prevention activities focused on the prevention

of

illness in the individual patient. This model consists of

the

following steps:
Identify a disease that warrants the development of a preventive intervention program. Develop reliable
methods for its diagnosis so that people can divided series of epidemiological and laboratory studies,
identify the likely cause of the disease.
Launch and into groups according to whether they do or do not have the disease.
By a revaluate and experimental preventive intervention program based on the results of those studies.
Nursing Prevention Model:
The nursing prevention model stresses the importance of promoting mental health and preventing mental
illness by focusing on risk factors, protective factors, vulnerability, and human responses.
In the nursing prevention model, the "patient" may be and individual, family, or community.
It is based on the understanding that mental disorders are the result of many causes, requiring that mental
illness prevention be thought of in a more behavioral way as the promotion of adaptive coping responses
and the prevention of maladaptive responses to life stressors.

 Stressors can include single-episode events, such as a divorce, or long-standing conditions, such as
marital conflict. They can reflect either an acute health problem or a chronic health problem.
The nursing prevention model thus assumes that problems are multicausal, that everyone is
vulnerable to stressful life events, and that any disability or problem may arise as a consequence.
For example: four vulnerable people can face a stressful life event, such as the ending of a marriage or
the loss of a job.
One person may become severely depressed, the second may be involved in an automobile accident, the
third may begin to drink heavily, and the fourth may develop coronary artery disease.
The nursing prevention model does not search for a cause of each problem. Rather, I involves the
following steps:
1. Identifying a stressor that appears to result in a maladaptive coping response in a significant portion of the
population. Develop procedures for reliably identifying people who are at risk for the stressor and
maladaptive response.
2. By epidemiological and laboratory methods, study the consequences of that stressor and develop
hypotheses related to how its negative consequences might be reduced or eliminated.
3. Launch and evaluate an experimental preventive intervention program based on these hypotheses

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:
1.
2.
3.
4.

mental health services

family and friends
consumer groups and organizations
Generic community services and groups.

XIII. AIDS Risk Reduction Model

It believes change is a process. Individuals

must

go through with different factors 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) Labelling - 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 outcomes

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.

XIV. Travis's illness-wellness continuum

The Illness-Wellness Continuum is a graphic illustration of

wellbeing concept first proposed by John W. Travis in

1972.

Concept:Travis believes that the standard approach to medicine,

which assumes a person is well when there are no signs or
symptoms of disease, was insufficient. This led to his
development of the Continuum. The right side of the

Continuum reflects degrees of wellness, while the left indicates degrees of illness. The Illness-Wellness
Continuum has been used to highlight how, even in the absence of physical disease, an individual can suffer from
depression, anxiety or other conditions indicating a lack of wellness.
While standard medicine (see "Treatment Paradigm"), typically treats injuries, disabilities, and symptoms, to
bring the individual to a "neutral point" where no illness is present, the Wellness Paradigm seeks to move the
individuals state of wellbeing further along the continuum towards optimal emotional and mental states. The
concept is premised on the idea that wellbeing is a dynamic rather than a static process. In this, the IllnessWellness Continuum reflects the view of the World Health Organization, which has defined health as "a state of
complete physical, mental and social well-being and not merely the absence of disease or infirmity."
The Illness-Wellness Continuum proposes that individuals can move further to the right, towards health and
wellbeing, through awareness, education, and growth. Conversely, worsening states of health are reflected by
signs, symptoms, and disability. In addition, a person's outlook plays a major role moving along the Continuum in
either direction. A positive outlook will enhance the individuals health and wellbeing, while a negative outlook
will hinder it, independent of present health status. For example, a person who demonstrates no symptoms of
disease, but is constantly complaining, would be facing the left side of the Continuum, toward an early death.
However, a person having a disability, but still maintaining a positive outlook, will be facing to the right, toward
a high level of wellness. It is less important where a person is on the continuum than which direction they are
facing.
The Illness-Wellness Continuum has been praised for promoting preventive treatmentimproving wellbeing
before an individual presents with signs or symptoms of illness, as well as educating people to be aware of, and
consequently avoiding risk factors, protecting against pathology and an early death.

a. The illness- wellness continuum developed by travis ranges from high-level wellness to premature death.
b. The model illustrates two arrows pointing in opposite directions and joined at a neutral point.
c. This is achieved in three steps:

1. Awareness
2. Education
3. Growth

XV. HEALTH BELIEFS MODELS

The Health Belief Model is a psychological model that attempts to explain and predict health behaviours. This is
done by focusing on the attitudes and beliefs of individuals. The HBM was first developed in the 1950s by social
psychologists of Hochbaum, Rosenstock and Kegels working in the U.S. Public Health Services. This model is an
intrapersonal (within the individual, knowledge and beliefs) theory used in health promotion to design
intervention and prevention programs. It was designed in the 1950s and continues to be one of the most popular
and widely used theories in intervention science. The focus of the HBM is to assess health behaviour of
individuals through examination of perceptions and attitudes someone may have towards disease and negative
outcomes of certain actions. The HBM assumes that behaviour change occurs with the existence of three ideas at
the same time:
An individual recognizes that there is

enough

reason to make a health concern relevant

(perceived

susceptibility and severity)

That person understands he or she may be

vulnerable

to a disease or negative health outcome.

(perceived

threat)
Lastly the individual must realize that

behaviour

change can be beneficial and the benefits of

that

change will outweigh any costs of doing so. (Perceived benefits and barriers).

Health Belief Model: Major Concepts

HBM is based on six key concepts. The following table, excerpted with minor modifications from "Theory at a
Glance: A Guide for Health Promotion Practice" (1997), presents definitions and applications for each of the six
key concepts. Examples of the concepts as they apply to sexuality education are presented after this table.
Concept

Definition

Application

1. Perceived
Susceptibility

One's belief of the chances of getting a

condition

Define population(s) at risk and their

risk levels

Personalize risk based on a person's

traits or behaviours

Heighten perceived susceptibility if

too low

Specify and describe consequences of

the risk and the condition

2. Perceived
Severity

One's belief of how serious a condition

and its consequences are

3. Perceived
Benefits

One's belief in the efficacy of the advised

action to reduce risk or seriousness of
impact

Define action to take how, where,

when

Clarify the positive effects to

expected

Describe evidence of effectiveness

4. Perceived
Barriers

One's belief in the tangible and

psychological costs of the advised
behaviour

5. Cues to
Action

Strategies to activate "readiness"

Provide how-to information

Promote awareness

Provide reminders

6. Self-Efficacy

Confidence in one's ability to take action

Identify and reduce barriers through

reassurance, incentives, and assistance

Provide training, guidance, and

positive reinforcement

1. Health locus of control model

2. Rosen stock's and Becker's health belief models, include
Individual Perceptions
Individual perceptions speak directly to the knowledge and beliefs that a person has about his behaviors and the
outcomes they could have. This section of the paper includes two main sections; Perceived
Susceptibility and Perceived Severity.
A. Perceived Susceptibility
Within the health field susceptibility refers to the risk a person has to a particular disease or health outcome.
Within the context of the HBM, perceived susceptibility examines the individuals opinions about how likely the
behaviours they partake in are going to lead to a negative health outcome. For example, look at an individual who
smokes. Smoking is known to have many complications such as lung cancer, bladder cancer, etc. If a smoker
does not feel that he is at risk of developing any of these diseases, he has no reason in his mind to make a
behaviour change. One of the Goals of the HBM is to change perceptions of susceptibility in order to move
towards behaviour change.
B. Perceived Severity
Most people are familiar with the word severity as how serious a situation or action can be. In the HBM
perceived severity addresses how serious the diseases that a person is susceptible to can be. In the case of a
smoker, lung cancer is one of the leading causes of death among the American population. A smoker may not
understand how difficult lung cancer can be to detect and how difficult it can be to treat. They also may not know

how painful and long lasting a disease it can be later in life. The HBM seeks to increase awareness of how serious
the outcomes of behaviours can be in order increase the quality of ones life.
Now that there is an understanding of Individual Perceptions it is important to understand how Modifying Factors
can affect some ones decision to change.
Modifying Factors
While Individual Perceptions were internalized, In the Health Belief Model Modifying Factors step outside the
body to examine and use outside influences to affect the how threatened a person feels by the outcomes of
continuing the same behaviours that put him at risk. As seen by the arrows in the diagram, perceived
susceptibility and severity do have their own impact on threat as well.
A. Perceived Threat
Susceptibility as stated before displayed how someone acknowledged that their behavior could lead to a specific
disease. Threat takes the idea one step further by examining just how likely it is that the disease could be
developed. To use lung cancer again, someone who has been smoking for a year may not feel threatened by
potential disease because they have not been doing it very long and if they quit their body can recover. On the
other hand, a smoker who has been doing so for 25 years may feel very threatened by lung cancer if he has
developed a strong cough. The cough could be a symptom that increases his level of threat and triggers his
decision to quit.
B. Environmental Factors
Environmental factors can add to the threat of disease. Demographic background can cause one to be more at risk
such as race, ethnicity, and socioeconomic status. Someone living in poverty would be more threatened by a
disease if they could not afford health care. Also Peers and other influential people can have an influence. If an
entire group of friends smoke together, it is going to be more difficult for one person to quit.
C. Cues to Action
Lastly cues to action are reasons why an individual realizes he could be threatened by serious disease. These
could be media or concerned loved ones. Cues to action are anything that triggers a decision to change behaviour.
The previous two categories have built on each other and lead to Likelihood of Action.
Likelihood of Action
After becoming aware of the potential for developing a disease if behaviour does not change, it is important to
weigh out the benefits and the barriers to taking action and determine if it is worth it.
A. Perceived Benefits
What are the benefits to change? In the HBM the goal is greater quality of life for an individual both mentally
and physically. Clearly a benefit to change would be increased health but there could be other factors that exist on
an individual level.

B. Perceived Barriers
What are the reasons that I cannot change my behaviour? Barriers could be anything from losing friends to not
having enough money or even self-efficacy problems such as not believing in ones self. For change to take place
the benefits must be stronger than the barriers.
Summary
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 clients attitudes and values about health
and illness so that effective health care can be provided.
These nursing models allow nurses to understand and predict clients health behaviour, including how
they use health services and adhere to recommended therapy.

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