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Health Belief Model

All research material evaluated reinforces key concepts associated with health beliefmodel. They reinforce the importance of predicting a persons behavior and justify the actions

taken to create the desired outcome. The components highlighted include: persons susceptibility

to a condition (falls), the; likelihood of the persons being affected by the condition (fallincidence), its perceived consequence severity (injury or death), perceived benefits of care (costreduction financially and non-financially), and barriers to the preventive action adopted (includes

attitudes of healthcare professionals, patient attitudes, and environment among others). The

diagram below best illustrates the scenario.

Demographic variables

Sociopsychological

variables

Perceived benefits of

preventive action lessperceived barriers to

preventive action

Perceived threat of

falls

Perceived

susceptibility lessperceived severity

of the condition

Likelihood of taking

recommended actions

Cues to actions

Professional nursesNursing rounds

Visual cues

Environment

Figure 1: Theoretical construct of the findings from past literature material

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it It is a conceptual framework that describes a person's health behavior as an expression of

health beliefs. The model was designed to predict a person's health behavior, including the use ofhealth services, and to justify intervention to alter maladaptive health behavior. Components of

the model include the person's own perception of susceptibility to a disease or condition, the

perceived likelihood of contracting that disease or condition, the perceived severity of theconsequences of contracting the condition or the disease, the perceived benefits of care and

barriers to preventive behavior, and the internal or external stimuli that result in appropriate

health behavior by the person.

Health Promotion Model

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The health promotion model (HPM) proposed by Nola J Pender (1982; revised, 1996) was

designed to be a complementary counterpart to models of health protection. It defines health asa positive dynamic state not merely the absence of disease. Health promotion is directed at

increasing a clients level of wellbeing. 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:

Individual characteristics and experiences

Behavior-specific cognitions and affect Behavioral outcomes

The health promotion model notes that each person has unique personal characteristics and

experiences that affect subsequent actions. The set of variables for behavioral specific

knowledge and affect have important motivational significance. These variables can be modifiedthrough nursing actions. Health promoting behavior is the desired behavioral outcome and is the

end point in the HPM. Health promoting behaviors should result in improved health, enhanced

functional ability and better quality of life at all stages of development. The final behavioraldemand is also influenced by the immediate competing demand and preferences, which can

derail an intended health promoting actions.

Precede Proceed Model

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The PRECEDE-PROCEED model provides a comprehensive structure for assessing health and

quality-of-life needs and for designing, implementing, and evaluating health promotion and otherpublic health programs to meet those needs. PRECEDE (P redisposing, R einforcing, and Enabling Constructs in Educational D iagnosis and Evaluation) outlines a diagnostic planning

process to assist in the development of targeted and focused public health programs. PROCEED

(Policy, R egulatory, and O rganizational Constructs in Educational and Environmental Development) guides the implementation and evaluation of the programs designed usingPRECEDE.

PRECEDE consists of five steps or phases. Phase one involves determining the quality of life or

social problems and needs of a given population. Phase two consists of identifying the health

determinants of these problems and needs. Phase three involves analyzing the behavioral andenvironmental determinants of the health problems. In phase four, the factors that predispose to,

reinforce, and enable the behaviors and lifestyles are identified. Phase five involves ascertaining

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which health promotion, health education and/or policy-related interventions would best be

suited to encouraging the desired changes in the behaviors or environments and in the factorsthat support those behaviors and environments.

PROCEED is composed of four additional phases. In phase six, the interventions identified in

phase five are implemented. Phase seven entails process evaluation of those interventions. Phase

eight involves evaluating the impact of the interventions on the factors supporting behavior, and

on behavior itself. The ninth and last phase comprises outcome evaluationthat is, determiningthe ultimate effects of the interventions on the health and quality of life of the population.

In actual practice, PRECEDE and PROCEED function in a continuous cycle. Information

gathered in PRECEDE guides the development of program goals and objectives in theimplementation phase of PROCEED. This same information also provides the criteria against

which the success of the program is measured in the evaluation phase of PROCEED. In turn, the

data gathered in the implementation and evaluation phases of PROCEED clarify the relationshipsexamined in PRECEDE between the health or quality-of-life outcomes, the behaviors and

environments that influence them, and the factors that lead to the desired behavioral and

environmental changes. These data also suggest how programs may be modified to more closely

reach their goals and targets.