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Public health model


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Public health model

  1. 1. Public Health Model Dr Soumya Swaroop Sahoo
  2. 2. Contents • Public health-introduction • What is a public health model (PHM) • Types of PHM • PHM examples • PHM in India • References
  3. 3. What is public health • Public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole -WHO • Its activities aim to provide conditions in which people can be healthy and focus on entire populations, not on individual patients or diseases. • Thus, public health is concerned with the total system and not only the eradication of a particular disease.
  4. 4. 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
  5. 5. Public health model(PHM) • A model that addresses health or social problems in a comprehensive way. • It considers human factors, characteristics of the source of harm, and the environment, identifies causes and suggests possible interventions. • The public health model takes a population approach to health promotion and disease prevention.
  6. 6. 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)
  7. 7. Public Health Approach Public Health Model Medical ModelVersus
  8. 8. PHM • Public health models aim to prevent problems by – 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 either primary, secondary, or tertiary interventions .
  9. 9. • 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
  10. 10. Steps in designing a PHM Define the problem Identify risk and protective factors Develop and test intervention strategies Assure widespread adoption and evaluation
  11. 11. "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 prevention Define the Problem Identify Risk and Protective Factors Develop and Test Prevention Strategies Assure Widespread Adoption
  12. 12. Public health pyramid Tertiary 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)
  13. 13. 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 of parenting – Family strengthening programs that enhance a family’s ability to access existing services and resources to support positive interactions among family members – Public awareness campaigns that provide information on how and where to report suspected child abuse and neglect PHM for child welfare services
  14. 14. 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 and responsibilities 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 programs and problem families. PHM for child welfare services
  15. 15. 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 and attitudes – Mental health services for children and families affected by maltreatment to improve family communication and functioning PHM for child welfare services
  16. 16. PHM: Uses • Organize thinking • Guide design of intervention • Help us to evaluate the effects of intervention for the benefit of the community at large
  17. 17. Types of public health models • Health belief model • Trans-theoretical model /Model of change • Socio-ecological model • PATCH model • PERI model • PRECEDE-PROCEED model
  18. 18. Health belief model • Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviors. • This is done by focusing on the attitudes and beliefs of individuals. • It was developed in response to the failure of a free tuberculosis (TB) health screening program. • Since then, the HBM has been adapted to explore a variety of long- and short-term health behaviors, including sexual risk behaviors and the transmission of HIV/AIDS.
  19. 19. • The HBM is based on the understanding that a person will take a health-related action (i.e., use condoms) if that 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 negative health condition (i.e., using condoms will be effective at preventing HIV), and – believes that he/she can successfully take a recommended health action (i.e., he/she can use condoms comfortably and with confidence). Health belief model
  20. 20. 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.
  21. 21. 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
  22. 22. 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
  23. 23. Trans theoretical model • The transtheoretical model of behaviour change assesses an individual's readiness to act on a new healthier behaviour, and provides strategies, or processes of change to guide the individual through the stages of change. • uses stages of change to integrate processes and principles of change from across major theories of intervention, hence the name 'Trans -theoretical’
  24. 24. Stages of change
  25. 25. 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
  26. 26. 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
  27. 27. • 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
  28. 28. • 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
  29. 29. Example: Physical inactivity
  30. 30. Socio-Ecological Model • A model of health that emphasizes the linkages and relationships among multiple factors(or determinants) affecting health. • A rainbow-like figure of five bands represents the SEM. • At the core of the model is the individual(intrapersonal), surrounded by four bands of influence representing the – interpersonal, – organizational, – community, and – policy levels.
  31. 31. Socio-Ecological Model
  32. 32. individual interpersonal organizational community Public policy
  33. 33. PATCH Model • P lanned • A pproach • T o • C ommunity • H ealth
  34. 34. • The Planned Approach to Community Health (PATCH) was developed in 1983 by the United States Centers for Disease Control(CDC) in partnership with state and local health departments and community groups. PATCH Model
  35. 35. 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
  36. 36. PATCH Model: example • In Baltimore, PATCH was implemented to improve the mental health among elderly people living in urban public housing developments. • Health workers were trained to identify and refer residents who may need 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 is more effective than usual care in decreasing levels of depression and other psychiatric symptoms.
  37. 37. • A total of 945 (83%) of 1,195 residents in six public housing sites 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 received usual care (comparison group). • Results: • Residents with mental disorders who lived in housing sites where the PATCH program was available had significantly fewer symptoms of depression and other psychiatric symptoms at the end of 26 months than residents with mental disorders who lived in the randomly-selected comparison housing sites where the PATCH program was not available. PATCH Model: example
  38. 38. 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?
  39. 39. PERI Model Problem Etiology Recommendation Implementation
  40. 40. 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
  41. 41. 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
  42. 42. 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.
  43. 43. • 3 Missions i) 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. PHM:INDIA’s SUCCESS STORY
  44. 44. • 39 Intervention and 47 control villages were selected in Gadchiroli district • SEARCH's strategy to curb infant deaths relies on training community health workers to diagnose and treat newborn diseases and has been dramatically successful in reducing IMR. • Over a span of 15 years, SEARCH has been able to reduce IMR in its intervention area by 75% to 30, by providing home-based newborn care (HBNC) • A 1999 Lancet research paper by Abhay Bang and his colleagues at SEARCH, based on their interventions in Gadchiroli, showed for the first time how very sick newborn babies could be saved even in poor nations with a novel cost-effective strategy. Bang's paper found a place in a 2005 compilation of "vintage papers" in the 180-year-old history of Lancet. PHM:INDIA’s SUCCESS STORY
  45. 45. Gadhchiroli: Turning the tide
  46. 46. 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)
  47. 47. 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
  48. 48. Advantages • Provides direction • Non-biased approach • Uncovers hidden problems • Provides evaluation measures
  49. 49. Challenges • Learning before doing • Understanding theory/model • Finding the data • Create problems for un-experienced program planners • Takes time and resources before implementation
  50. 50. References • Glanz, K., Rimer, B.K. & Lewis, F.M. (2002). Health Behavior and Health Education. Theory, Research and Practice. San Fransisco: Wiley & Sons. • www.cdc.gov/violenceprevention/overview/publichealthapproach. html • Prochaska, James O., and Carlo C. DiClemente. "Stages And Processes Of Self-change Of Smoking: Toward An Integrative Model Of Change.." Journal of Consulting and Clinical Psychology 51.3 (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.