Models of Health and Illness

1. Dunn's Theory of Health-Illness Continuum - (Halbert Dunn - "father" of the wellness movement )
 Interaction of the environment with wellbeing & illness.
 high- level wellness – a condition of change in which the individual moves forward, climbing
toward a higher potential of functioning.
 DUNN's WELLNESS GRID - demonstrates the interaction of the environment with the illness-
wellness continuum.
 X-axis is HEALTH - a health axes which ranges from peak wellness to death/illness
 Y-axis is ENVIRONMENT - an environmental axis which ranges from very favorable to very
unfavorable.
o Quadrant 1 - High-level wellness in favorable environment
o Quadrant 2 - Protected poor health in favorable environment
o Quadrant 3 - Poor health in unfavorable environment
o Quadrant 4 - Emergent high level of wellness in unfavorable environment
 Precursor of Illness - Is a definable pathologic state that progresses directly to disease
o Heredity - e.g. family history for diabetes, diabetes mellitus, hypertension, cancer.
o Behavioral factors - e.g. cigarette smoking, alcohol abuse, high animal fat intake
o Environmental factors - e.g. overcrowding, poor sanitation, poor supply of potable water
2. Health - Belief Model - Addresses the relationship between a person's belief and behaviors.
 Six constructs of the HBM.
1. Perceived susceptibility - person's subjective perception of the risk of acquiring an illness or
disease.
o Demographic variable (age, sex, race etc.)
o Socio-psychologic variables (social pressure or influence from peers)
2. Perceived severity - person's feelings on the seriousness of contracting an illness or disease
o medical consequences (e.g., death, disability)
o social consequences (e.g., family life, social relationships)
3. Perceived benefits - person's perception of the effectiveness of various actions available to
reduce the threat of illness or disease
4. Perceived barriers - person's feelings on the obstacles to performing a recommended health
action.
5. Cue to action -stimulus needed to trigger the decision-making process to accept a
recommended health action.
o can be internal (e.g., chest pains, wheezing, fatigue, uncomfortable symptoms etc.)
o can be external (e.g., advice from others, illness of family member, newspaper article,
mass media etc.)
6. Self-efficacy - level of a person's confidence in his or her ability to successfully perform a
behavior.
3. Smith's Models of Health. (M. Belloc & Bresle, 1972)
a. Clinical model - views people as physiologic system with related functions & identifies health as the
absence of signs & symptoms of disease or injury. It’s narrowest interpretation of health. It is a
medically oriented model.
 Health is seen as freedom from disease
 Illness is seen as the presence of disease
b. Role Performance model- (Parsons's 1958) - defines health in terms of individual's ability to perform
societal roles such as performing work.
 Health is seen as the ability to fulfill societal roles
 Illness is seen as the inability to fulfill societal roles
c. Adaptive model - focuses on adaptation. views health as creative process: and disease as a failure in
adaptation or mal adaptation.
 Health is seen as adaptation
 Illness is seen as a failure of adaptation, or maladaptation
d. Eudemonistic model - most comprehensive, holistic, view of health.
 Health is actualization or realization of one's potential
 Illness is seen as the failure to actualize or realize one's potential.
4. Leavell & Clark Agent- Host-Environment Model (Ecologic Model)
  The Centers for Disease Control and Prevention (CDC) defines an outbreak or epidemic as "the
occurrence of more cases of disease, injury, or other health condition than expected in a given area or
among a specific group of persons during a specific period."
The Epidemiologic Triangle
 used primarily in predicting illness rather than in promoting wellness
 made up of three parts:
o Agent - microorganism that actually causes the disease in question; could be some form of
bacteria, virus, fungus, or parasite. (e.g., HIV is a viral infection that targets a persons immune
system, making it more vulnerable to other forms of infection.
o Host - the organism that carries the disease.
o Environment - outside factors can affect an epidemiologic outbreak as well
5. PENDERS’s Health Promotion Model
 Pender advocates that health promotion involves activities that are directed toward increasing the level
of well-being and self-actualization.
1. Includes effort to assists individuals in taking control of and responsibility for their health risks
and ultimately improve quality of life.
2. Encompasses activities to improve the health of those who are not initially healthy as well as the
healthy individuals.
3. Includes individual and community activities to promote healthful lifestvle.
4. Includes the principles of self-responsibility, nutritional awareness, stress reduction and
management and physical fitness.
6. Travis' Illness-Wellness Continuum or Health-Illness Continuum Model
 This is a grid or graduated scale that can be used to measure a person's perceived level of wellness.
 According to this model, health and illness can be viewed as the opposite ends of a health continuum.
A. Composed of two arrows pointing in opposite directions and joined at a neutral point
a. movement to the right on the arrows (towards high-level wellness) equals an increasing level of
health and well-being
1. achieved in three steps:
a. awareness
b. education
c. growth
b.movement to the left on the arrows (towards premature death) equates a progressively decreasing
state of health
1.achieved in three steps:
a. signs
b. symptoms
c. disability
B. Most important is the direction the individual is facing on the pathway
a. If towards high-level health, a person has a genuinely optimistic or positive outlook despite
his/her health status
b. If towards premature death, a person has a genuinely pessimistic or negative outlook about
his/her health status
C. Compares a treatment model with a wellness model
a. If a treatment model is used, an individual can move right only to the neutral point
b. If a wellness model is used, an individual can move right past the neutral point

7. Holistic Health Model

 The preservation of health takes into account a holistic approach that integrates the mind, body and
spirit.
 Physical, Emotional, Mental, Social, and Spiritual.
8. Stages of Change Model (TRANSTHEORETICAL MODEL)
 explains an individual's readiness to change their behavior. It describes the process of behavior
change as occurring in stages.
1. Pre-contemplation - the individual has no intention to change behavior within the next six
months.
2. Contemplation - an individual is considering a behavior change within the next six months.
3. Preparation - the individual takes some steps toward making a change and doing so within the
next 30 days.
 4. Action - an individual reach this stage once he or she has made an apparent behavior change
for six months or less.
5. Maintenance - if the individual's behavior change lasts for more than six months, he or she
moves into the final stage, maintenance.
 describes how an individual or organization integrates new behaviors, goals, and programs at
various levels.
9. Social Cognitive Theory
 describes the influence of individual experiences, the actions of others, and environmental factors
on individual health behaviors.
 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
 Self-efficacy: The belief that an individual has control over and is able to execute a behavior.
 Behavioral capability: Understanding and having the skill to perform a behavior.
 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 or modeling the
desired behavior.
 Reinforcements: Promoting incentives and rewards that encourage behavior change.
10. Theory of Reasoned Action/Planned Behavior
 suggest that a person's health behavior is determined by their intention to perform a behavior.
 A person's intention to perform a behavior (behavioral intention) is predicted by
1. a person's attitude toward the behavior, and
2. subjective norms regarding the behavior.
 Subjective norms are the result of social and environmental surroundings and a person's perceived
control over the behavior.
11. Socioecological Model
 addresses behavior change at multiple levels and considers the inter-relationship between behavior
and the environment.
 accounts for multiple factors that can influence the behavior change process.
The model identifies five levels of influence on health behavior:
1. Intrapersonal factors - these include individual characteristics such as knowledge, beliefs, and self-
concept.
2. Interpersonal processes and primary groups - these include the individual's social environment.
3. Institutional or organizational factors - these refer to workplaces, churches, and other organized
social institutions.
4. Community factors - these describe the relationships among organizations and institutions.
5. Public policies - these refer to policies or regulations concerning healthy practices.