Public health model

Public Health Model

Dr Soumya Swaroop Sahoo

Contents

• Public health-introduction

• What is a public health model (PHM)

• Types of PHM

• PHM examples

• PHM in India

• References

What is public health

• Public health refers to all organized measures toprevent disease, promote health, and prolong lifeamong the population as a whole

-WHO

• Its activities aim to provide conditions in whichpeople can be healthy and focus on entirepopulations, not on individual patients or diseases.

• Thus, public health is concerned with the totalsystem and not only the eradication of a particulardisease.

What is public health

• The span of public health is to look at some notable public health campaigns:– Vaccination and control of infectious

diseases– Safer and healthier foods– Safe drinking water– Healthier mothers and babies and access

to family planning– Decline in deaths from coronary heart

disease and stroke– Recognition of tobacco use as a health

hazard.– Motor-vehicle safety

Public health model(PHM)

• A model that addresses health or social problems ina comprehensive way.

• It considers human factors, characteristics of thesource of harm, and the environment, identifiescauses and suggests possible interventions.

• The public health model takes a populationapproach to health promotion and diseaseprevention.

Public health model focuses not only on traditional areas of diagnosis, treatment, and etiology, but also on

• epidemiologic surveillance of the health of the population at large,

• health promotion, • disease prevention, and • access to and evaluation of services

Public health model(PHM)

Public Health Approach

Public Health

Model

Medical

ModelVersus

PHM

• Public health models aim to prevent problemsby– targeting policies and interventions at the known risk

factors for the problem,– quickly identifying and responding to problems if

they do occur, and– minimising the long-term effects of the problems

-WHO, 2006• In the public health model of disease prevention,

preventative interventions are described as eitherprimary, secondary, or tertiary interventions .

• The public health model is a concept with application in many disciplines health, education social welfare.

• It is an epidemiological model that attempts to prevent or reduce a particular illness or social problem in a population by identifying risk factors.

PHM

Steps in designing a PHM

Define the problem

Identify risk and protective factors

Develop and test intervention strategies

Assure widespread adoption and evaluation

"who", "what", "when", "where" and "how" associated with it.

• magnitude of the problem by analyzing data like number of violence-related behaviours, injuries, and deaths

•Data demonstrates how frequently violence occurs, trends, and who the victims and perpetrators are.

Risk Factor - Characteristic that increases the likelihood of a person becoming a victim or perpetrator of violence.

•Protective Factor - that decreases the likelihood of a person becoming a victim or perpetrator of violence .

Research data and findings from needs assessments, community surveys for designing prevention programs.

• Once programs are implemented, they are evaluated rigorously to determine their effectiveness

programs having been proved effective, must be implemented and adopted broadly.

• Communities are encouraged to implement programs and to evaluate the success.

• Dissemination techniques to promote widespread adoption

PHM for violence preventionDefine the Problem

Identify Risk and Protective

Factors

Develop and Test Prevention

Strategies

Assure Widespread

Adoption

Public health pyramidTertiary

Provide

interventions for

those affected

Secondary

(Programs targeted at families in need to alleviate

identified problems and prevent escalation)

Primary (Universal)

(Programs targeted at entire population in order to provide support and education before

problems occur)

Primary prevention – Primary prevention consists of activities that are targeted

towards the whole community.– These activities are meant to impact families and communities

prior to any allegations of abuse and neglect. It includes:– Parent education programs and support groups that focus on

child development,and the roles and responsibilities ofparenting

– Family strengthening programs that enhance a family’s abilityto access existing services and resources to support positiveinteractions among family members

– Public awareness campaigns that provide information on howand where to report suspected child abuse and neglect

PHM for child welfare services

Secondary Prevention– consists of activities targeted to families that have one or

more risk factors such as poverty, mental health problems,marital discord, alcohol and drug use .

They include:– Parent support groups that help parents deal with their

everyday stresses and meet the challenges andresponsibilities of parenting

– Home visit programs that provide support and assistance– Early screening of children with special needs– Parent education programs focusing on teen parents, or

those undergoing substance abuse treatment programsand problem families.


Tertiary prevention– consists of activities targeted to families that have confirmed child

abuse and neglect reports.– These families have already demonstrated the need for

intervention for services under child welfare programs.They include:– Parent mentor programs with stable, non-abusive families acting

as "role models" and providing support to families in crisis– Intensive family preservation services with trained mental health

counsellors.– Parent support groups that help parents transform negative

practices and beliefs into positive parenting behaviours andattitudes

– Mental health services for children and families affected bymaltreatment to improve family communication and functioning


PHM: Uses

• Organize thinking

• Guide design of intervention

• Help us to evaluate the effects of intervention for the benefit of the community at large

Types of public health models

• Health belief model

• Trans-theoretical model /Model of change

• Socio-ecological model

• PATCH model

• PERI model

• PRECEDE-PROCEED model

Health belief model

• Health Belief Model (HBM) is a psychological model thatattempts to explain and predict health behaviors.

• This is done by focusing on the attitudes and beliefs ofindividuals.

• It was developed in response to the failure of a freetuberculosis (TB) health screening program.

• Since then, the HBM has been adapted to explore avariety of long- and short-term health behaviors,including sexual risk behaviors and the transmission ofHIV/AIDS.

• The HBM is based on the understanding that a personwill take a health-related action (i.e., use condoms) ifthat person:– feels that a negative health condition (i.e., HIV) can

be avoided,– has a positive expectation that by taking a

recommended action, he/she will avoid a negativehealth condition (i.e., using condoms will be effectiveat preventing HIV), and

– believes that he/she can successfully take arecommended health action (i.e., he/she can usecondoms comfortably and with confidence).

Health belief model

CONCEPT

Perceived susceptibility

Perceived severity

Perceived benefits

Perceived barriers

Cues to action

Self efficacy

DEFINITION

One’s opinion of chances of getting a condition

One’s opinion of how serious a condition and its consequences

are

One’s belief in the efficacy of the advised action to

reduce the risk

One’s opinion of the tangible and psychological costs of the advised action

Strategies to activate readiness

Confidence in one’s ability to take action

APPLICATION

Define population at risk, risk levels; personalize risk based on a person’s

behaviour

Specify consequences of the risk and the condition

Define action to take; how, where, when; clarify the positive effects to

be expected.

Identify and reduce barriers through reassurance, incentives, assistance.

Provide how-to do information,

promote awareness

Provide training, guidance in performing action.

concept

Perceived

Susceptibility

Perceived Severity

Perceived Benefits

Condom use education example

Youth believe they can get STIs or

HIV or create a unwanted pregnancy.

believe that the consequences of getting STIs or HIV or creating a

pregnancy are significant enough to try to avoid

recommended action of using condoms would protect them

from getting STIs or HIV or creating a pregnancy.

STI screening or HIV testing

Youth believe they may have been exposed to STIs or HIV.

believe the consequences of

having STIs or HIV without knowledge or treatment are significant enough to try to

avoid.

believe that the recommended action of getting tested for STIs and HIV would benefit them —by allowing them to get early treatment or preventing them

from infecting others

concept

Perceived barriers

Cues to action

Self efficacy

Condom use education example

Youth identify their personal barriers to using condoms (i.e.,

condoms limit the feeling or they are too embarrassed to talk to

their partner about it) and explore ways to eliminate or

reduce these barriers

Youth receive reminder cues for action in the form of incentives

(such as with the printed message "no glove, no love") or

reminder messages

Youth confident in using a condom correctly in all

circumstances

STI screening or HIV testing

Youth identify their personal barriers to getting tested (i.e.,

getting to the clinic or being seen at the clinic by someone they

know) and explore ways to eliminate or reduce these

barriers

receive reminder cues for action in the form of incentives (such as pencils that says, "Got sex? Get tested!") or reminder messages

(that say, "25% of sexually active teens contract an STI)

Youth receive guidance (such as information on where to get

tested) ,counselling and training

Trans theoretical model

• The transtheoretical model of behaviour change assesses anindividual's readiness to act on a new healthier behaviour,and provides strategies, or processes of change to guide theindividual through the stages of change.

• uses stages of change to integrate processes and principles ofchange from across major theories of intervention, hence thename 'Trans -theoretical’

Stages of change

It is common for people to change gradually —

from being uninterested, to considering a

change, to deciding and preparing to make a

change — over months and years.

Change is a Process Rather Than

an Event

Five Stages of Change

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

People in this Stage

1. No intent to change yet,

unaware or deny personal

relevance

2. Aware of the problem,

ambivalent about change

3. Getting ready to change,

choosing a plan

4. Trying to change, not yet

consistent in doing it

5. Practice being consistent,

avoid slipping back

1. “There’s nothing I

really need to change”

2. “It might be good for

me, but it’s too hard”

3. “I’ve started to make

small changes”

4. “I wish I was more

consistent”

5. “I’m working hard not

to lose the progress I’ve

made”

Stage of Change…Details

• Precontemplation- Stage of change in which people are unwilling to change behaviour

• Contemplation- Stage of change in which people consider to change behaviour

• Preparation- Stage of change in which people get ready to make a change

• Action- Stage of change in which people are actively changing a negative behaviour or adopting a new, healthy behavior

Transtheoretical model

• Maintenance - Stage of change in which people maintain behavioral change

• Termination/adoption stage-Stage of change in which people have eliminated an undesirable behaviour or maintained a positive behaviour

• Relapse-To slip or fall back into unhealthy behavior(s) or fail to maintain healthy behaviours

Transtheoretical model

Example: Physical inactivity

Socio-Ecological Model

• A model of health that emphasizes the linkagesand relationships among multiple factors(ordeterminants) affecting health.

• A rainbow-like figure of five bands representsthe SEM.

• At the core of the model is theindividual(intrapersonal), surrounded by fourbands of influence representing the– interpersonal,– organizational,– community, and– policy levels.

Socio-Ecological Model

individual

interpersonal

organizational

community

Public policy

PATCH Model

• P lanned• A pproach• T o• C ommunity • H ealth

• The Planned Approach to Community Health(PATCH) was developed in 1983 bythe United States Centers for DiseaseControl(CDC) in partnership with state andlocal health departments and communitygroups.

PATCH Model

PATCH: phases

• Phase I: Mobilizing the community• Phase II: Collecting and organizing data• Phase III: Choosing priorities• Phase IV: Developing a comprehensive

intervention plan• Phase V: Evaluating PATCH

PATCH Model: example

• In Baltimore, PATCH was implemented to improve the mental healthamong elderly people living in urban public housing developments.

• Health workers were trained to identify and refer residents who mayneed mental health care to a PATCH nurse.

• Psychiatric nurses, with consultation and supervision from psychiatrists,provided psychiatric evaluation and treatment in the residents’ homes.

• Investigators evaluated the PATCH program to determine whether it ismore effective than usual care in decreasing levels of depression andother psychiatric symptoms.

• A total of 945 (83%) of 1,195 residents in six public housingsites were screened for psychiatric illness

• 342 screened positive.• Residents in 3 building sites received the PATCH model

intervention; residents in the other 3 building sites receivedusual care (comparison group).

• Results:• Residents with mental disorders who lived in housing sites

where the PATCH program was available had significantlyfewer symptoms of depression and other psychiatricsymptoms at the end of 26 months than residents with mentaldisorders who lived in the randomly-selected comparisonhousing sites where the PATCH program was not available.

PATCH Model: example

PERI Model

• Problem- What is the health problem?• Etiology- What is/are the contributory

cause(s)?• Recommendations- What works to reduce the

health impacts?• Implementation- How we get the job done?

PERI Model

Problem

Etiology

Recommendation

Implementation

PRECEDE –PROCEED Model

• PRECEDE/PROCEED is a community-oriented, participatory model for creating successful community health promotion interventions

• By Green and Kuerter(2005)• PRECEDE: Predisposing, Reinforcing &

Enabling Constructs in Educational/Ecological Diagnosis & Evaluation

• PROCEED: Policy, Regulatory & Organizational Constructs in Educational and Environmental Development

PRECEDE: :4 Phases• Phase 1: Social diagnosis• Phase 2: Epidemiological

diagnosis• Phase 3: Educational and

ecological diagnosis• Phase 4: Administrative and

policy diagnosis

PROCEED : 4 Phases• Phase 5: Implementation• Phase 7: Process evaluation• Phase 8: Impact evaluation• Phase 9: Outcome

evaluation

PRECEDE –PROCEED Model

PHM:INDIA’s SUCCESS STORY

Society for Education, Action and Research in Community Health (SEARCH), Gadchiroli, Maharashtra

• SEARCH was founded in Gadchiroli district in 1986.

• Its founders, Dr Abhay Bang and Dr Rani Bang, received their medical training in India and their training in public health at Johns Hopkins University.

• 3 Missionsi) providing health care to local populations,ii) training and education in health

iii) research to help shape health policies.SEARCH conducted a field trial in Gadchiroli on home-

based neonatal care from 1993 to 1998. They trained village health workers (aarogyadoot) to

make home visits and manage birth asphyxia, premature birth or low birth weight, hypothermia, breast-feeding problems, in addition to diagnosing and treating neonatal sepsis.


• 39 Intervention and 47 control villages were selected in Gadchirolidistrict

• SEARCH's strategy to curb infant deaths relies on training communityhealth workers to diagnose and treat newborn diseases and has beendramatically successful in reducing IMR.

• Over a span of 15 years, SEARCH has been able to reduce IMR in itsintervention area by 75% to 30, by providing home-based newborn care(HBNC)

• A 1999 Lancet research paper by Abhay Bang and his colleagues atSEARCH, based on their interventions in Gadchiroli, showed for the firsttime how very sick newborn babies could be saved even in poor nationswith a novel cost-effective strategy. Bang's paper found a place in a 2005compilation of "vintage papers" in the 180-year-old history of Lancet.


Gadhchiroli: Turning the tide

Selecting a Specific Model to apply will be

based on:

The preferences of stakeholders (e.g., decision makers, program partners, consumers);

How much time is available for planning purposes;

How many resources are available for data collection and analysis;

The degree to which clients are actually involved as partners in the planning process or the degree to which your planning efforts will be consumer-oriented (i.e., planning is based on the wants and needs of consumers)

Criteria for implementation

Fluidity: Steps in the planning process are sequential, or that they build upon one another

Flexibility: Planning is adapted to the needs of stakeholders

Functionality: the outcome of planning is improved health conditions, not the production of a program plan itself

Advantages

• Provides direction

• Non-biased approach

• Uncovers hidden problems

• Provides evaluation measures

Challenges

• Learning before doing• Understanding theory/model• Finding the data• Create problems for un-experienced program

planners• Takes time and resources before

implementation

References

• Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior andHealth Education. Theory, Research and Practice. San Fransisco:Wiley & Sons.

• www.cdc.gov/violenceprevention/overview/publichealthapproach.html

• Prochaska, James O., and Carlo C. DiClemente. "Stages AndProcesses Of Self-change Of Smoking: Toward An IntegrativeModel Of Change.." Journal of Consulting and Clinical Psychology51.3 (1983): 390-395.

• http://www.hindustantimes.com/news-feed/chunk-ht-ui-trackinghunger-intro/gadchiroli-s-trudging-doctors-spell-hope/article1-842172.aspx#sthash.BdWqznng.dpuf

• National Institutes of Health. Theory at a Glance: A Guide for Health Promotion Practice. Bethesda, MD: National Institutes of Health, National Cancer Institute; 1995.

Public health model

Health & Medicine

Transcript of Public health model