This document discusses several models for health maintenance and disease prevention, including ecological models, the health belief model, relapse prevention model, stages of change model, social cognitive theory, and theory of planned behavior. It provides details on key concepts and components of each model. Additionally, it covers strategies for facilitating dietary change and assessing and treating pain.

1. Health maintenance and disease prevention models
by
Lecturer: Sehrish Naz
Lecturer: Shahla arshad
Rn, post rn, msn
Institute of nursing sciences, khyber medical university
Subject
Culture Health and Society
UNIT : 02

2. OBJECTIVES
At the end of the unit learners will be able to:
 Discuss health maintenance and disease prevention models
 Utilize health belief model in client care
 Identify reasons for non-adherence to treatment
 Identify strategies to facilitate dietary change
 Assess cultural specific aspects of pain experience
 Discuss various treatments for pain (home remedies)

3. Health maintenance and Disease Prevention
Theories and Models
There are several theories and models that support the practice of
health promotion and disease prevention. These theories and
models include:
Ecological Models
The Health Belief Model
Relapse Prevention Model
Stages of Change Model (Transtheoretical Model)
Social Cognitive Theory
Theory of Reasoned Action/Planned Behavior

4. Ecological Model
“Ecology is the branch of biology that deals with the
relations of organism to one another and to their
physical environment.”
It emphasizes multiple levels of influence and the core
concept that behaviors both shape and are shaped by
the social environment.
It highlights people’s interactions with their physical
and sociocultural environments.”Ecological models of
health behavior recognize multiple levels of influence
on a person's health, including:
Intrapersonal/individual factors, which influence
behavior such as knowledge, attitudes, beliefs, and
personality.

5.  Interpersonal factors, such as interactions with other
people, which can provide social support or create
barriers to interpersonal growth that promotes healthy
behavior.
 Institutional and organizational factors, including
the rules, regulations, policies, and informal structures
that constrain or promote healthy behaviors
 Community factors, such as formal or informal social
norms that exist among individuals, groups, or
organizations, can limit or enhance healthy behaviors.
 Public policy, including local, state, and federal
policies and laws that regulate or support health
actions and practices for disease prevention including
early detection, control, and management.

7. • Health Belief Model (HBM) is a tool that is used to try
and predict health behaviors.
• HBM provides a connection between the way a person
sees his/her state of health and his/her response to
health, illness, and treatment.
• HBM was originally developed in the 1950s by social
psychologists Rosenstock and Kegels, and updated in
the 1980s,

8. Health Belief Model
Perceived benefits of
preventive actions
Minus
Perceived barriers to
preventive actions
Modifying Factors Likelihood of ActionsIndividual Perception
Cues to actions
Mass media campaigns
Advice from others
Reminder postcard from physician or dentist
Illness of a family member or a friend
Newspaper or magazine articles
Demographic variables
(age, sex, race, ethnicity).
Socio-Psychological
variables (personality,
social class, peer and
reference group pressure).
Perceived
Susceptibility of
disease X
Perceives
Seriousness
(Severity) of
disease X
Perceived threat of
disease X Likelihood of
taking
recommended
preventive
health actions

9.  Perceived Susceptibility: A family history of a
certain disease like diabetes or heart disease may
make the individual feel at risk.
 Perceived Seriousness: If the output of a
disease is serious the person will be more alert as
in the case of AIDS.
 Perceived Threat: The combination of perceived
susceptibility and seriousness determines the total
perceived threat of an illness.
 For example, a person who perceives that many individuals
in the community have lung cancer may not necessarily
perceive a threat of the disease. But if the suffered
individuals are smokers , then the perceived threat of the
disease will likely to increase because of the combination.

10. .
Demographic variables: age, sex, race, etc.
E.g, toddler vs adolescent (regarding the importance of
diet).
Family vs peers.
Sociopsychologic variables: Social groups may
encourage or motivate others preventive behaviors.
Structural variables: Knowledge and prior contact
with a disease influence health and treatment
behavior
Cues to action: may be external or internal.
Internal cues are fatigue, uncomfortable symptoms,
or thought of others who are ill.

11.  The likelihood of a person’s taking recommended
preventive health action depends on the
perceived benefits of the action to prevent lung
cancer minus the perceived barriers to the action.
 Perceived benefits of the action include, for
example, refraining from smoking to prevent lung
cancer or eating nutritious food and avoiding
snacks to maintain weight.
 Perceived barriers to action include cost,
inconvenience, unpleasantness, and life-style
changes.

12.  The Health Belief Model has been applied to a
variety of preventive health behaviors including
smoking, dieting, exercise, breast feeding
examination.
 Health belief model addresses the relationship
between a person’s beliefs and behaviors. It
provides a way of understanding and predicting
how clients will behave in relation to their health
and how they will comply with health care
therapies.

13.  The health belief model helps nurses
understand factors influencing client’s
perception, beliefs and behavior in order to
plan care that will most effectively assist
clients in maintaining or restoring health and
preventing illness.

14. Commitment : people who have initially agreed to a
small request are subsequently more likely to
agree to a larger request
Prompts: people have to remember to perform the
desired actions.
Norms: social guidelines for behavior.
Incentives: particularly useful when motivation to
engage in action is low.

15.  Internal (lack of knowledge, absence of
motivation)
 External (changes that need to occur in order for
the behavior to be more convenient or affordable)

16.  Identifying risk factors is the first step in health
promotion, wellness education and illness
prevention.
 Discuss health hazards with the client following a
comprehensive nursing assessment; then the
client can decide if he or she wants to maintain or
improve his or her health status by taking risk
reduction actions.
 Attempts to change may be aimed at the
cessation of a health damaging behaviors e.g.
tobacco use or at the adoption of healthy behavior

17. Relapse Prevention
Relapse prevention (RP) is a cognitive-behavioral
approach to relapse with the goal of identifying
and preventing high-risk situations such as substance
abuse, obsessive-compulsive behavior, sexual offending,
obesity, and depression. This Model provides program
participants with coping skills.
Some of the key concepts are:
 Skills training
 Cognitive reframing
 Lifestyle rebalancing

19. Transtheoretical Model
The Stages of Change Model also called the
Transtheoretical Model, ) proposes that people are at
different stages of readiness to adopt healthful behaviors
and includes the five stages of change:

20. 5 stages of change:
 Pre-contemplation:
Individual has no intention to change behavior in the near
future, often considered as within the next 6 months.
 Contemplation:
Individual is aware of a problem and is considering making a
change sometime soon (within the next 6 months).
 Preparation:
Individual intends to take action in the next month and may
be doing small things to set up their environment to make
change easier.
 Action:
Individual is actively modifying their behavior, experiences, or
environment in order to change.
 Maintenance:
Individual continues to act and make efforts to prevent
relapse.

21. Theory of Planned Behavior
In psychology, the theory of planned behavior (abbreviated
TPB) is a theory that links beliefs and behavior. The concept
was proposed by Icek Ajzen to improve on the predictive power
of the theory of reasoned action by including perceived
behavioral control.
The Theory of Reasoned Action or the Theory of Planned
Behavior predict a person's health behavior by their attitude
towards performing a behavior.
Subjective norms are the result of social and environmental
surroundings and a person's perceived control over the
behavior. Generally, positive attitude and positive subjective
norms result in greater perceived control and increase the
likelihood of intentions governing changes in behavior.

22. Social Cognitive Theory
Social Cognitive Theory (SCT) focuses on how people
learn from individual experiences, the actions of
others, and their interaction with their environment. It
can be applied in different settings and populations.
SCT provides opportunities for social support through
instilling expectations, self-efficacy, and using
observational learning and other reinforcements to
achieve behavior change.
Key components of the SCT related to individual
behavior change include:
 Incentives :The belief that an individual has control
over and is able to execute a behavior.
 Behavioral capability: Understanding and having the

23.  Expectations: Determining the outcomes of behavior
change.
 Expectancies: Assigning a value to the outcomes of
behavior change.
 Self-control: Regulating and monitoring individual
behavior.
 Observational learning: Watching and observing
outcomes of others performing desired behavior.
 Reinforcements: Promoting incentives and rewards
that encourage behavior change

24. Strategies To Facilitate Dietary
Change
 Dietary Handouts explaining how to reduce
dietary fat salt sugar.
 Nutrient rich food consumer education program
 Individuals risk to benefit assessment
 Client centered approach
 Good Knowledge
 Food accessbility

25. experience
Assessment and treatment of pain is a universally
important health care issue, modern medicine still has no
accurate way of measuring it. Patients are often asked to
rate their pain on a scale from 1- 10:
 Mild (1-4)
 Moderate (5-6)
 Severe (7-10)
Sometimes smiling and frowning faces are used as visual
aids to help both doctor and patient convey what the
numbers signify.

27. Pain Response & Culture
Culturally based responses to pain are often divided into two
categories :
 Stoic
 Emotive
Stoic patients are less expressive of their pain and tend to
“grin and bear it.” They tend to withdraw socially.
Emotive patients are more likely to verbalize their expressions
of pain, prefer to have people around and expect others to react
to their pain so as to validate their discomfort.
We can make the broad generalization that expressive patients
often come from Hispanic, Middle Eastern backgrounds, while
stoic patients often come from Northern European and Asian
backgrounds.

28. American Culture & Pain Response
American culture generations of children, especially
boys, would be admonish for crying like babies. In
such cultures, children’s’ health is fretted over
constantly even a sneeze can be seen as illness.
Asian Culture & Stoicism
Patients from Asian cultures may often exemplify stoicism
in the face of pain, which relates directly to strong cultural
values about self-conduct. Behaving in a dignified manner
is considered very important, and a person who is
assertive or complains openly is considered to have poor
social skills

29. Putting Pain Into Words
Words such as “sharp,” “throbbing,” “stabbing,” or
“aching” make sense to most people in the U.S., but in
many tribal cultures very different words are used to
describe pain. Clinicians might be baffled by patients
explaining their pain in terms of natural symbols like
lightning, trees with deep spreading roots, spider
webs, or the tones of drums .
In cultures where evil spirits are believed to cause
illness and pain, patients may talk about their suffering
as punishment. some patients will need help in
understanding how to talk about pain in ways western
doctors and nurses can interpret.

30. Treatments For Pain (Home Remedies)
 Ginger Paste
 Cloves
 Vit-C
 Turmeric
 Green Tea
 Swim
 Cold-Hot Treatment
 Oil Massage
 Heat Pad

31.  Sniff Some Fragrant Spices like
(Lavender, Marjoram , Rosemary , Peppermint)
 Listening Music
 Walk Bare Foot
 Soak up Some Sun
 Consider Some Supplement like
(Fish Oil ,Vit-E)
 Inflammation Fighting Food
 Ginger Tea