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 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

 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 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.
Public health model(PHM)
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
Approach
Public Health Medical
Model Versus Model
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 .
PHM
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.
Steps in designing a PHM

Define the problem

Identify risk and protective

factors

Develop and test intervention

strategies

Assure widespread adoption

and evaluation
 PHM for violence prevention
Identify Develop
Assure
Define the Risk and and Test
Widesprea
Problem Protective Prevention
d Adoption
Factors Strategies

"who", "what", Risk Factor - Research data and programs having

"when", "where" and Characteristic that findings from needs been proved
"how" associated increases the likelihood assessments,
of a person becoming a community surveys for
effective, must be
with it. victim or perpetrator of designing prevention implemented and
magnitude of the violence. programs. adopted broadly.
problem by analyzing Protective Factor - Once programs are Communities are
data like number of that decreases the implemented, they are encouraged to
violence-related likelihood of a person evaluated rigorously
behaviours, injuries, implement
becoming a victim or to determine their programs and to
and deaths perpetrator of effectiveness
Data demonstrates violence . evaluate the
how frequently success.
violence occurs, Dissemination
trends, and who the techniques to
victims and
perpetrators are.
promote
widespread
adoption
Public health pyramid
Tertiar
y
Provide
interve
ntions
for
those
Secondary
affecte
d
(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)
PHM for child welfare services
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 programsand support groups that focus
on child development,and the roles and responsibilities of
parenting
Family strengthening programsthat enhance a familys
ability to access existing services and resources to support
positive interactions among family members
Public awareness campaignsthat provide information on
how and 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 groupsthat help parents deal with
their everyday stresses and meet the challenges and
responsibilities of parenting
Home visit programsthat provide support and
assistance
Early screening of children with special needs
Parent education programsfocusing on teen parents,
or those undergoing substance abuse treatment
programs and problem families.
PHM for child welfare services
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 programswith stable, non-abusive families
acting as "role models" and providing support to families in crisis
Intensive family preservation serviceswith trained mental
health counsellors.
Parent support groupsthat help parents transform negative
practices and beliefs into positive parenting behaviours and
attitudes
Mental health servicesfor children and families affected by
maltreatment 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 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.
Health belief model
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
CONCE
DEFINITION APPLICATION
PT
Define population at risk,
Perceived Ones opinion of risk levels; personalize risk
chances of getting a
susceptibility based on a persons
condition
behaviour
Ones opinion of how
Perceived serious a condition Specify consequences of
and its consequences the risk and the condition
severity are
Ones belief in the Define action to take; how,
efficacy of the where, when; clarify the
Perceived positive effects to be
benefits advised action to
reduce the risk expected.
Ones opinion of Identify and reduce
Perceived the tangible and barriers through
barriers psychological costs reassurance, incentives,
of the advised assistance.
action Provide how-to do
Cues to Strategies to information,
action activate readiness promote awareness
Confidence in ones Provide training, guidance
Self efficacy ability to take in performing action.
action
 Condom
STI
use
screening
concept educatio
or HIV
n
testing
example
Youth believe they can
Perceived get STIs or Youth believe they may
have been exposed to
Susceptibility HIV or create a STIs or HIV.
unwanted pregnancy.

believe the
believe that the consequences of
consequences of getting
Perceived STIs or HIV or creating a having STIs or HIV
pregnancy are without knowledge or
Severity treatment are
significant enough to
try to avoid significant enough to
try to avoid.
believe that the
recommended action of
recommended action of getting tested for STIs
using condoms would and HIV would benefit
Perceived protect them from them by allowing
Benefits getting STIs or HIV or them to get early
creating a pregnancy. treatment or preventing
them from infecting
others
 Condom
STI
use
screening
concept educatio
or HIV
n
Youth identify their testing
example
personal barriers to
using condoms (i.e.,
Youth identify their
personal barriers to
getting tested (i.e.,
condoms limit the
getting to the clinic or
feeling or they are too
Perceived embarrassed to talk to
being seen at the clinic
barriers by someone they know)
their partner about it)
and explore ways to
and explore ways to
eliminate or reduce
eliminate or reduce receive reminder
these barrierscues
Youththese barriers
receive reminder for action in the form of
cues for action in the incentives (such as
form of incentives (such pencils that says, "Got
Cues to action as with the printed sex? Get tested!") or
message "no glove, no reminder messages
love") or reminder (that say, "25% of
messages sexually active teens
contract an STI)

Youth receive guidance

Youth confident in using (such as information on
Self efficacy a condom correctly in where to get tested)
all circumstances ,counselling and
training
Trans theoretical model
Thetranstheoretical modelof 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
Stages of change
Change is a Process Rather Than an
Event

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.
 Stage of ChangeDetails
Five Stages of Change People in this Stage

1. No intent to change yet, 1. Theres nothing I

1. Precontemplation unaware or deny personal really need to change
relevance 2. It might be good for
2. Contemplation 2. Aware of the problem, me, but its too hard
ambivalent about change 3. Ive started to make
3. Preparation 3. Getting ready to change, small changes
choosing a plan 4. I wish I was more
4. Action
4. Trying to change, not yet consistent
consistent in doing it 5. Im working hard not
5. Maintenance
5. Practice being consistent, to lose the progress Ive
avoid slipping back made
Transtheoretical model
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
Example: Physical inactivity
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.
Socio-Ecological Model
individual

interperson
al

organizatio
nal

community

Public
policy
PATCH Model
P lanned
A pproach
To
C ommunity
H ealth
PATCH Model
The Planned Approach to Community
Health (PATCH) was developed in
1983 by theUnited States Centers
for Disease Control(CDC) in
partnership withstate and local
health departmentsand community
groups.
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 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.
PATCH Model: example
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
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

Proble
m

Etiolog
Implementation
y

Recommendatio
n
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 PROCEED Model
PRECEDE: :4 Phases PROCEED : 4 Phases
Phase 1: Social
diagnosis Phase 5:
Phase 2: Implementation
Epidemiological Phase 7: Process
diagnosis evaluation
Phase 3: Educational Phase 8: Impact
and ecological evaluation
diagnosis
Phase 9: Outcome
Phase 4: Administrative
evaluation
and policy diagnosis
 PHM:INDIAs 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.
PHM:INDIAs SUCCESS STORY
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:INDIAs SUCCESS STORY
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.
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 and
Health Education. Theory, Research and Practice. San Fransisco:
Wiley & Sons.
www.cdc.gov/violenceprevention/overview/publichealthapproach.h
tml
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.