SIBUGAY TECHNICAL INSTITUTE, INC.

Lower Taway, Ipil, Zamboanga Sibugay

COLLEGE OF MIDWIFERY

COURSE MODULE

PRIMARY HEALTH CARE I

Prepared By:

Sherlyn U. Viernes,RM,BSM,MPA
Course Facilitator

SY 2025-2026
STII, Lower Taway, Ipil, Zamboanga Sibugay Province
PRIMARY HEALTH CARE I

Image taken from Image taken from https://twitter.com

 Letter to the Students

My Beloved Students,
Greetings of Peace!
Welcome to school year 2025-2026 and thank you for entrusting your
college education with us at STII-College of Midwifery. The midwifery
course is both exciting and challenging. By now you should have developed
intense desire to work and serve different clients- individuals, families and the
community as a whole. You won’t regret it. After all, Midwifery is a
meaningful, nurturing and caring profession!
This course module is meant for you as you take the course Primary
Health Care I. To get the most from this course module, ensure that you don’t
miss any part of the learning materials and activities. Make sure to
accomplish all the activities and requirements to complete the course.
One of the principles in nature is the principle of balance. Input equals
output. What does that imply? The personal effort you put into this course is
equal to the learning output you acquire. If you want to get much out of this
course, you must be ready to give your time and effort.
Excited? Challenged? Then let’s get the ball rolling and face the
challenges of the new normal. Let’s learn and have fun!

Yours truly,
SHERLYN U. VIERNES,RM,BSM,MPA
Contact No: 09389797374
Email address: [email protected]
 Table of Contents
Contents Page Number
Cover page i
Preface/Letter to the Students iv
Table of Contents v
Course Outline vi
Week 1 - I. CONCEPT OF HEALTH AND ILLNESS
1. Definition of health 13
2. Views on health 13
3. Wellness 14
4. Wellbeing 14
5. Dimensions of health and wellness 14
Activity 1 38
Activity 2 39
Take Home Quiz 1 41
Week 2 – CONCEPT OF HEALTH AND ILLNESS – cont.
1. Disease 16
2. Terminologies 17
3. Types of disease 19
4. Main stages of illness 23
5. Identifying Risk Factors for Diseases and Illnesses 23
6. Illness behaviors 24
7. Impact of illness 25
Activity no. 3 42
Take Home Quiz 2 43
Week 3 – CONCEPT OF HEALTH AND ILLNESS – cont.
1. Models of Health 27
2. Illness-Wellness Continuum 28
3. Health Belief Model 30
4. Levels of Prevention 35
Activity no. 4 45
Activity no. 5 46
Take Home Quiz 3 48

SIBUGAY TECHNICAL INSTITUTE, INC.

Lower Taway, Ipil, Zamboanga City
 COLLEGE OF MIDWIFERY
____________________________________________________________________________________

COURSE OUTLINE

Course
Sherlyn U. Viernes
Facilitator
Course Code
PRIMARY HEALTH CARE I
and Title
Course Concepts and principles in the provision of basic services of health promotion/
Description maintenance and disease prevention at the individual and family level.
Course At the end of the course, the student will demonstrate beginning skills in providing
Objectives basic health care in terms of health promotion, maintenance and disease prevention
at the individual and family level guided by the health care process

Course credits 4 units

Contact hours 4 hours/week lecture

Pre-requisites None

Topic Outline I. Concept of Health and Illness

a. Definition of health, illness and wellness
b. Dimensions of health/wellness
c. Different Models of Health
d. Levels of Prevention

II. Health as a Multifactorial Phenomenon

a. Factors affecting health

III. The Philippine Health Care Delivery System

b. The National health Situation
c. Components of the Phil. Health Care Delivery System
d. Goals and Objectives
e. Organizational Structure
f. Levels of Health Care Facilities
g. Two-way Referral System
h. Multi-Sectoral Approach to Health
i. The National Health Plan

IV. Primary Health Care

a. Definition, Rationale and Goals
b. Principles of PHC
c. Strategies of PHC
d. Elements (Essential Services) of PHC
 V. Care Enhancement Qualities
a. Caring Behavior (Curative Elements)

V. Health Care Process as Applied to the Family

b. Assessment (Family Health Problems)
c. Planning (Family Health Care Plan)
d. Intervention (Family Health Care Strategies)
e. Evaluation

References: 1. Salvacion G. Bailon Reyes, Community Health Nursing - The Basics of

Practice, 2006
2. Erlinda Castro Palaganas, Health Care Practice In The Community, 2003
3. Araceli S. Maglaya, Nursing Practice in the Community, 2003
4. DOH, Community Health Nursing Services in the Philippines, 2000

Prepared By: Approved By: Noted By:

SHERLYN U. VIERNES,RM,BSM NANCY C. MAGBANUA, MSIT DR. EUFEMIO D. JAVIER, JR

Course Facilitator Academic Director College President

SIBUGAY TECHNICAL INSTITUTE, INC.

Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

To my students:
You are now about to start the Topic for Week 1. Read and understand the learning materials and
answer the comprehension check questions that follow. Do activity 1 and 2 and answer Take home
quiz 1.
 CONCEPT OF HEALTH AND ILLNESS

HEALTH

Health, according to Florence Nightingale, was defined as the absence of disease and illness.
Throughout the years, this definition has changed significantly. At the current time, the World Health
Organization (WHO) defines health as "a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity." The World Health Organization defines health
promotion as "the process of enabling people to increase their control over, and improve their health".
These definitions of health and health promotion have implications for nurses and the health care
profession.

Health Definition
 Health is a state of being well and using every power the individual possesses
 "Health is a state of complete physical, mental, and social well-being and not merely the
absence of disease" (WHO, 1974)
 "Health is not a condition, it is an adjustment. It is not a state, but a process. The process adapts
the individual not only to our physical, but also our social, environments" (President’s
Commission)
 Most individuals define health as the following
a. being free of symptoms of disease and pain as much as possible
b. being able to be active and able to do what they want or must do
c. being in good spirits most of the time
 Health is a dynamic state that continually change as a person adapts to changes in the internal
and external environment. Illness is an abnormal process in which functioning of a person is
diminished or impaired in one or more dimensions.
 H.S. Hayman defines “health as a state of feeling should in body, mind and spirit, with a sense of
reserve power”
 Health is a function of adjustment as adaptation (R. Dubois)

The American Nurses Association defined Health as a dynamic state of being in which the
developmental and behavioral potential of an individual is realized to the fullest extent possible

Philosophy regarding Health

 Health is a fundamental human right
 Health is the essence of productive life, and not the result of ever increasing expenditure of
medical care
 Health is inter-sectoral
 Health is an integral part of development
 Health is in central to the concept of quality of life
 Health involves international responsibility and individual state
 Health and its maintenance is a major social investment
 Health is worldwide social goal

View’s on Health

Biomedical scientists: they stress mainly on germ theory that is they believe disease occur as a result of
microorganisms’ invasion. Their thought is rejected as it doesn’t solve some major health problems as
malnutrition, accidents mental illness
Ecologists: they view health as a harmonious equilibrium between man and his environment. Disease is
said to be the individuals’ maladjustment to his environment.
Sociologists: they believe health is not only biomedical phenomenon but is also influenced by social,
psychological, cultural, economical and political factors

Holistic View: this view is synthesis of views of all experts. This views health as a multidimensional
process involving well-being of the whole person in the context of his environment.

WELLNES

Wellness is an active dimensional process of becoming aware of

making choices towards higher level of well- being and towards a more
successful existence. Wellness further describes health status. It allows
health to be placed on a continuum from one’s optimal level
(“wellness”) to a maladaptive state (“illness”). Wellness is a developing
awareness that there is no end point but that health and happiness are
possible in each moment here and now. It is holistic concept, looking at
the whole person, not just their blood pressure, body fat, exercise
behaviour or what a person had lunch and involves all possible
dimension.

The state of being in good health, especially as an actively pursued goal, measures of a patient’s
progress toward wellness. The health system focused on wellness not sickness. Wellness is a dynamic
process that is ever changing. The well person usually has some degree of illness and the ill person
usually has some degree of wellness. This concept of a health continuum negates the idea that wellness
and illness are opposite because they may occur simultaneously in the same person in varying degrees.

WELL-BEING

Well-being is the experience of health, happiness, and prosperity. It includes having good mental
health, high life satisfaction, a sense of meaning or purpose, and ability to manage stress. More
generally, well-being is just feeling well

“Well-being is a subjective perception of vitality (energy) and feeling well. It can be described
objectively, experienced, and measured and can be plotted on a continuum.” It is a component of health.
Wellbeing is vitality considered as a subjective perception of balance harmony and stability. It is state
rather than a process.

Dimensions of Wellness
1. Physical - the ability to carry out daily tasks, achieve
fitness (e.g. pulmonary, cardiovascular, gastrointestinal),
maintain adequate nutrition and proper body fat, avoid
abusing drugs and alcohol or using tobacco products, and
generally to practice positive lifestyle habits.
2. Social - the ability to interact successfully with people and
within the environment
3. Emotional - the ability to manage stress and to express
emotions appropriately, emotional wellness involves the
ability to recognize, accept, and express feelings.
4. Intellectual - the ability to learn and use information effectively for personal, family, and career
development
5. Spiritual - the belief in some force (nature, science, religion, or a higher power) that serves to
unite human beings and provide meaning and purpose of life
 6. Occupational - the ability to achieve a balance between work and leisure time. A person's beliefs
about education, employment, and home influence personal satisfaction and relationships with
others.
7. Environmental - The ability to promote health measures that improve the standard of living and
quality of life in the community

Components of High Level of Wellness

• High level of esteem and positive outlook
• A foundation philosophy and a sense of purpose
• A strong sense of personal responsibility
• A good sense of human and plenty of fun in life
• A concern for others and respect for the environment
• A conscious commitment to personal excellence
• A sense of balance and an integrated lifestyle
• Freedom from addictive behavior or negative health inhibiting nature
• A capacity to cope with whatever life presents and to continue to learn
• Highly conditioned and physically fit
• A capacity to love and an ability to nature
• A capacity to manage life’s demands
• A capacity to communicate effectively

Factors Influencing Health Status, Beliefs, and Practices

• Internal factors
• External factors

Internal factors
1. Biologic dimension - genetic makeup, sex, age, and developmental level all significantly
influence a person's health
2. Psychological dimension - emotional factors influencing health include mind-body interactions
and self-concept
3. Cognitive dimension- include lifestyle choices and spiritual and religious beliefs.

External factors
1. Environment
2. Standards of living
3. Reflecting occupation, income, and education.
4. Family and cultural beliefs, patterns of daily living and lifestyle to offspring ( children)
5. Social support networks. Family, friends, or confidant (best friend) and job satisfaction helps
people avoid illness

Health Care Adherence

Adherence (obedience) is the extent to which an individual's behavior for example, taking
medications, following diets or making lifestyle changes. Degree of adherence may range from
disregarding (ignoring) every aspect of the recommendations to following the total therapeutic plan.

Keep in Mind
 Health is a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity as defined by the World Health Organization.
  The holistic view of health refers to multidimensional process involving well-being of the
whole person in the context of his environment
 Wellness is a dynamic process that is ever changing.
 Well-being is a subjective perception of vitality (energy) and feeling well.
 There dimensions of wellness include physical, emotional, spiritual, intellectual, occupational,
social and environmental.

Comprehension Check:
1. What is health? Wellness? Wellbeing?
2. What is the sociologist’s view of health?
3. What are the external factors that affects health status?


Weekly Output:
1. Activity 1 and 2
2. Take home quiz 1

Keep them in your Portfolio and submit to your Course Facilitator during the face-to-face session
for Week 2.

End of Week 1

To my students:
You are now about to start the Topics for Week 2. Read the learning materials below then answer
the comprehension check questions that follow. Do Activity No. 3 and ANSWER take home quiz 2.

TOPIC 2 - DISEASE

Disease can be described as an alteration in body functions resulting in a reduction of capacities

or shortening of the normal life span.. A disease is a particular abnormal condition that negatively
affects the structure or function of all or part of an organism, and that is not due to any immediate
external injury. Diseases are often known to be medical conditions that are associated with specific
symptoms and signs. A disease may be caused by external factors such as pathogens or by internal
dysfunctions. For example, internal dysfunctions of the immune system can produce a variety of
different diseases, including various forms of immunodeficiency, hypersensitivity, allergies and
autoimmune disorders.

In humans, disease is often used more broadly to refer to any condition that causes pain,
dysfunction, distress, social problems, or death to the person afflicted, or similar problems for those in
contact with the person. In this broader sense, it sometimes includes injuries, disabilities, disorders,
syndromes, infections, isolated symptoms, deviant behaviors, and atypical variations of structure and
function.
The study of disease is called pathology. It involves the determination of the cause (etiology) of
the disease, the understanding of the mechanisms of its development (pathogenesis), the structural
changes associated with the disease process (morphological changes), and the functional consequences
of those changes. Correctly identifying the cause of a disease is necessary to identifying the proper
course of treatment.

Terminology on Disease and related Concepts

In many cases, terms such as disease, disorder, morbidity, sickness and illness are used
interchangeably; however, there are situations when specific terms are considered preferable.
Acquired disease - An acquired disease is one that began at some point during one's lifetime, as opposed
to disease that was already present at birth, which is congenital disease. Acquired sounds like it could
mean "caught via contagion", but it simply means acquired sometime after birth. It also sounds like it
could imply secondary disease, but acquired disease can be primary disease.

Acute disease - An acute disease is one of a short-term nature (acute); the term sometimes also connotes
a fulminant nature

Chronic condition or chronic disease - A chronic disease is one that persists over time, often
characterized as at least six months but may also include illnesses that are expected to last for the
entirety of one's natural life.

Congenital disorder or congenital disease - A congenital disorder is one that is present at birth. It is
often a genetic disease or disorder and can be inherited. It can also be the result of a vertically
transmitted infection from the mother, such as HIV/AIDS.

Genetic disease - A genetic disorder or disease is caused by one or more genetic mutations. It is often
inherited, but some mutations are random and de novo.

Hereditary or inherited disease - A hereditary disease is a type of genetic disease caused by genetic
mutations that are hereditary (and can run in families)

Iatrogenic disease - An iatrogenic disease or condition is one that is caused by medical intervention,
whether as a side effect of a treatment or as an inadvertent outcome.

Idiopathic disease - An idiopathic disease has an unknown cause or source. As medical science has
advanced, many diseases with entirely unknown causes have had some aspects of their sources
explained and therefore shed their idiopathic status.

Incurable disease - A disease that cannot be cured. Incurable diseases are not necessarily terminal
diseases, and sometimes a disease's symptoms can be treated sufficiently for the disease to have little or
no impact on quality of life.

Primary disease - A primary disease is a disease that is due to a root cause of illness, as opposed to
secondary disease, which is a sequela, or complication that is caused by the primary disease. For
example, a common cold is a primary disease, where rhinitis is a possible secondary disease, or sequela.
A doctor must determine what primary disease, a cold or bacterial infection, is causing a patient's
secondary rhinitis when deciding whether or not to prescribe antibiotics.

Secondary disease - A secondary disease is a disease that is a sequela or complication of a prior, causal
disease, which is referred to as the primary disease or simply the underlying cause (root cause). For
example, a bacterial infection can be primary, wherein a healthy person is exposed to a bacteria and
becomes infected, or it can be secondary to a primary cause, that predisposes the body to infection. For
example, a primary viral infection that weakens the immune system could lead to a secondary bacterial
infection. Similarly, a primary burn that creates an open wound could provide an entry point for
bacteria, and lead to a secondary bacterial infection.

Terminal disease - A terminal disease is one that is expected to have the inevitable result of death.
Previously, AIDS was a terminal disease; it is now incurable, but can be managed indefinitely using
medications.
Illness - The terms illness and sickness are both generally used as synonyms for disease; however, the
term illness is occasionally used to refer specifically to the patient's personal experience of his or her
disease. In this model, it is possible for a person to have a disease without being ill, and to be ill without
having a disease.

Disorder - A disorder is a functional abnormality or disturbance. Medical disorders can be categorized

into mental disorders, physical disorders, genetic disorders, emotional and behavioral disorders, and
functional disorders. The term disorder is often considered more value-neutral and less stigmatizing than
the terms disease or illness, and therefore is preferred terminology in some circumstances.

Medical condition - A medical condition is a broad term that includes all diseases, lesions, disorders, or
nonpathologic condition that normally receives medical treatment, such as pregnancy or childbirth.
While the term medical condition generally includes mental illnesses, in some contexts the term is used
specifically to denote any illness, injury, or disease except for mental illnesses. The term medical
condition is also a synonym for medical state, in which case it describes an individual patient's current
state from a medical standpoint.

Morbidity - Morbidity (from Latin morbidus, meaning 'sick, unhealthy') is a diseased state, disability, or
poor health due to any cause. The term may refer to the existence of any form of disease, or to the
degree that the health condition affects the patient.
.
Pathosis or pathology - Pathosis (plural pathoses) is synonymous with disease. Pathology is the study of
the causes and effects of disease or injury.

Syndrome - A syndrome is the association of several medical signs, symptoms, or other characteristics
that often occur together, often without a known underlying medical cause. Some syndromes such as
Down syndrome are known to have only one cause (an extra chromosome at birth

Predisease - Predisease is a subclinical or prodromal vanguard of a disease. Prediabetes and

prehypertension are common examples. Identifying legitimate predisease can result in useful preventive
measures, such as motivating the person to get a healthy amount of physical exercise.

Other Terminologies related to Concepts of Disease

Terminal phase - If a person will die soon from a disease, regardless of whether that disease typically
causes death, then the stage between the earlier disease process and active dying is the terminal phase.

Cure - A cure is the end of a medical condition or a treatment that is very likely to end it, while
remission refers to the disappearance, possibly temporarily, of symptoms. Complete remission is the
best possible outcome for incurable diseases.

Flare-up - A flare-up can refer to either the recurrence of symptoms or an onset of more severe
symptoms.

Relapse - is defined as a full return of symptoms once remission has occurred - but before recovery takes
place.
Recurrence - refers to return of symptoms after recovery has been attained.

Remission - Disappearance of the signs and symptoms of cancer or other disease. A remission can be
temporary or permanent. Remission is clinically defined as the experience of being symptom-free from
illness.

Exacerbation - A worsening. In medicine, exacerbation may refer to an increase in the severity of a

disease or its signs and symptoms. For example, an exacerbation of asthma might occur as a serious
effect of air pollution, leading to shortness of breath.

Four Main Types of Disease

• Infectious diseases
• Deficiency diseases
• Hereditary diseases (including both genetic diseases and non-genetic hereditary diseases)
• Physiological diseases.

Types of Disease by Body System

Mental Illness
Mental illness is a broad, generic label for a category of illnesses that may include affective or
emotional instability, behavioral dysregulation, cognitive dysfunction or impairment. Specific illnesses
known as mental illnesses include major depression, generalized anxiety disorders, schizophrenia, and
attention deficit hyperactivity disorder, to name a few. Mental illness can be of biological (e.g.,
anatomical, chemical, or genetic) or psychological (e.g., trauma or conflict) origin. It can impair the
affected person's ability to work or study and can harm interpersonal relationships. The term insanity is
used technically as a legal term.

Organic Disease
An organic disease is one caused by a physical or physiological change to some tissue or organ
of the body. The term sometimes excludes infections. It is commonly used in contrast with mental
disorders. It includes emotional and behavioral disorders if they are due to changes to the physical
structures or functioning of the body, such as after a stroke or a traumatic brain injury, but not if they are
due to psychosocial issues.

Types of Disease according to its Duration

• Acute disease - An acute disease is a short-lived disease, like the common cold.

• Chronic disease - A chronic disease is one that lasts for a long time, usually at least six months.
During that time, it may be constantly present, or it may go into remission and periodically
relapse. A chronic disease may be stable (does not get any worse) or it may be progressive (gets
worse over time). Some chronic diseases can be permanently cured. Most chronic diseases can
be beneficially treated, even if they cannot be permanently cured.

• Clinical disease - One that has clinical consequences; in other words, the stage of the disease that
produces the characteristic signs and symptoms of that disease.AIDS is the clinical disease stage
of HIV infection.
 • Progressive disease - Progressive disease is a disease whose typical natural course is the
worsening of the disease until death, serious debility, or organ failure occurs. Slowly progressive
diseases are also chronic diseases; many are also degenerative diseases. The opposite of
progressive disease is stable disease or static disease: a medical condition that exists, but does
not get better or worse.

• Refractory disease - A refractory disease is a disease that resists treatment, especially an

individual case that resists treatment more than is normal for the specific disease in question.

• Subclinical disease - Also called silent disease, silent stage, or asymptomatic disease. This is a
stage in some diseases before the symptoms are first noted.

Types of Disease according to its Scope

• Localized disease - A localized disease is one that affects only one part of the body, such as
athlete's foot or an eye infection.

• Disseminated disease - A disseminated disease has spread to other parts; with cancer, this is
usually called metastatic disease.

• Systemic disease - A systemic disease is a disease that affects the entire body, such as influenza
or high blood pressure.

Classification of Disease

Nosology (from Ancient Greek (nosos), meaning 'disease', and (-logia), meaning 'study of-') is the
branch of medical science that deals with the classification of diseases. Diseases may be classified by
cause, pathogenesis (mechanism by which the disease is caused), or by symptom(s). Alternatively,
diseases may be classified according to the organ system involved, though this is often complicated since
many diseases affect more than one organ. The most known and used classification of diseases is the
World Health Organization's International Classification of Diseases (ICD).

What Is Etiology?
Etiology in medicine is defined as the determination of a cause and origin of disease or
pathology. Its influence on the development of civilization can be traced back to several impressive
findings, ranging from the germ theory of pathology to the modern understanding of the source of
diseases and their control. Etiology focuses on the backstory of a disease. Generally, the etiology of
illness falls into one of three main categories, namely:
1. Intrinsic
2. Extrinsic
3. Idiopathic

Intrinsic means coming from within. Therefore, any pathological, or disease-causing, change that has
occurred from inside the body has occurred as a result of intrinsic factors. The following are examples of
intrinsic factors:
1. Inherited conditions, or conditions that are passed down to you from your parents. An example
of this is hemophilia, a disorder that leads to excessive bleeding.
2. Metabolic and endocrine, or hormone, disorders. These are abnormalities in the chemical
signaling and interaction in the body. For example, Diabetes mellitus is an endocrine disease that
causes high blood sugar.
3. Neoplastic disorders or cancer where the cells of the body grow out of control.
 4. Problems with immunity, such as allergies, which are an overreaction of the immune system..

Etiology is not only disease specific but also person specific. While a particular cause may lead
to a disease manifesting in an individual, a similar set of factors could lead to a different illness being
manifested in another individual.

Extrinsic etiologies - This means the cause of the disease, or pathological change, came from outside of
the body. The following are examples of extrinsic factors:

• Infectious agents like bacteria, viruses, fungi, and parasites

• Animal bites or stings
• Chemicals, electricity, and radiation
• Iatrogenic causes: relating to illness caused by medical examination or treatment

Idiopathic etiologies – unknown cause

Causes of Diseases

Types of causes

• Airborne - An airborne disease is any disease that is caused by pathogens and transmitted
through the air.

• Foodborne - Foodborne illness or food poisoning is any illness resulting from the consumption
of food contaminated with pathogenic bacteria, toxins, viruses, prions or parasites.

• Infection - Infectious diseases, also known as transmissible diseases or communicable diseases,

comprise clinically evident illness resulting from the infection, presence and growth of
pathogenic biological agents in an individual host organism. Included in this category are
contagious diseases—an infection, such as influenza or the common cold, that commonly
spreads from one person to another—and communicable diseases—a disease that can spread
from one person to another, but does not necessarily spread through everyday contact.

• Lifestyle - A lifestyle disease is any disease that appears to increase in frequency as countries
become more industrialized and people live longer, especially if the risk factors include
behavioral choices like a sedentary lifestyle or a diet high in unhealthful foods such as refined
carbohydrates, trans fats, or alcoholic beverages.

• Non-communicable - A non-communicable disease is a medical condition or disease that is non-

transmissible. Non-communicable diseases cannot be spread directly from one person to another.
Heart disease and cancer are examples of non-communicable diseases in humans.

Prevention - Many diseases and disorders can be prevented through a variety of means. These include
sanitation, proper nutrition, adequate exercise, vaccinations and other self-care and public health
measures.

Treatments
Medical therapies or treatments are efforts to cure or improve a disease or other health problem.
In the medical field, therapy is synonymous with the word treatment. Common treatments include
medications, surgery, medical devices, and self-care. Treatments may be provided by an organized
health care system, or informally, by the patient or family members.
 A treatment attempts to improve or remove a problem, but treatments may not produce
permanent cures, especially in chronic diseases. Cures are a subset of treatments that reverse diseases
completely or end medical problems permanently. Many diseases that cannot be completely cured are
still treatable.
.
ILLNESS

Illness is a highly personal state in which the person's physical, emotional, intellectual, social,
developmental, or spiritual functioning is thought to be diminished. Illness is usually associated with
disease but may occur independently of it. Illness is a highly personal state in which the person feels
unhealthy or ill.

There are many ways to classify illness and disease. Acute illness is typically characterized by
severe symptoms of relatively short duration. A chronic illness is one that lasts for an extended period,
usually 6 months or longer, and often for person's life.

Illness is an abnormal process in which any aspect of a person’s functioning is diminished or

impaired as compared with his previous condition. It refers not only refers to the presence of specific
disease, but also to the individual perception and behavior in response to the disease as well as the
impact of the disease on the psychosocial environment.

Illness is subjective state of the person who feels aware of not being well. It is just opposite to
health. It goes through certain stages which may occur slowly and are highly individualized. Main stages
of illness are:
a. Transition from health to illness
b. Acceptance of illness
c. Convalescence

Main stages of illness

Transition from Health to Illness

This stage starts when person considers that he or she might be ill and ends when others
acknowledge that the person is ill. Illness may begin with vague, nonspecific symptoms that a person
initially attempts to deny. The symptoms is a subjective indication of organic or psychic malfunctioning
or changes in a person’s condition that indicates some physical or mental state of disease.

When symptoms persists a person may seek medical consultation but still not admit to being ill.
• Recognition of symptoms (unpleasant sensations) pain, fever, rashes, indigestion etc.
• Loss of energy/stamina or feeling or weakness
• Decreased ability of function
• Fear of diagnosis or treatment

Acceptance of Illness
This stage occurs as the person stops denying illness and takes on a ‘sick role.’ This stage may
be a tie of considerable physiologic and psychological dependence, when the ill person becomes
unusually focused on the self.
• Define himself/herself as being sick
 • Seeks validation of this experience from others
• Gives up normal activities and assumes sick role
• On the basis of health belief and practice, the person may choose to do nothing, takes medication
to relieve symptoms and seeks medical care
• Expresses anger, guilt towards own illness
• Accepts the diagnosis – Increase dependency

Convalescence
As convalescence takes place a person passes through a transition from illness to health. Usually
resolution of physical illness proceeds the individual’s return to normal psychological and functioning.
The person new sense of worth and reduce anxiety enable him/her again to use those abilities typical of
health.
• Recovery and rehabilitation
• Gives up dependent role
• Resumes normal activities and responsibilities

Task of Convalescence
During this period of convalescence there is a great need of psychological adjustment. Following
are the tasks which completed to return the previous state
• Reassessment of life’s meaning
• Reintegration of body image
• Resolution of role change

Identifying Risk Factors for Diseases and Illnesses

Simply defined a risk factor is an intrinsic or extrinsic factor or force that could lead to an
illness, infection, a disease or disorder. An example of an intrinsic risk factor is the presence of
hypertension which places the patient at risk for other disorders and an example of an extrinsic risk
factor is contaminated food which places the person at risk for foodborne illnesses or infections.

Some risk factors can be decreased or eliminated and other risk factors cannot be changed or
eliminated. For example, genetics, age, ethnicity, and gender cannot be changed, however, other risk
factors, particularly those relating to poor life style choices like poor dietary habits and consumption
patterns can be eliminated.

Data and information about the patient's risk factors are collected during the admission health
history, during the physical examination, and throughout the course of care.

Approaches to health maintenance

• Health promotion
• Health protection
• Disease prevention

Illness Behaviors: Five Stages of Illness Behavior

Illness behavior is a coping mechanism when people become ill. They behave in certain ways, highly
individualized to describe, monitor, and interpret their symptoms, take medical actions, and use health
care systems. Suchman is the one who describes the five stages of illness behavior namely: Symptoms,
sick role, medical care contact, dependent client role, and recovery. But not all clients progress through
each stage. For example, the client who experiences a sudden heart attack is taken to the emergency
room and immediately enters 3 and 4, medical care contact and dependent client role.
Stage 1: Symptom Experiences
At this stage, the client is aware that there is something wrong by any means, either someone
significant mentions that the client looks unwell, or they experience some symptoms such as pain, rash,
cough, fever, or bleeding. During this stage, the un-well client usually consults others about the
symptoms of feelings, validating with a spouse or support people that the symptoms are real. In some
cases, client denies the symptoms or just ignore it while others try to self-medicate. This Stage 1 has
three aspects:
1. The physical experience of symptoms
2. The cognitive aspect or the interpretation of the symptoms in terms that have some meaning to
the person
3. The emotional response like fear or anxiety

Stage 2: Assumption of the Sick Role

This stage is the acknowledgement of the presence of health disturbance. The client is now
accepts the sick role and seeks confirmation from family and friends. Often people continue with self-
treatment and delay contact with health care professionals as long as possible. During this stage people
may be excused from normal duties and role expectations. Emotional responses such as withdrawal,
anxiety, fear and depression are not uncommon depending on the severity of the illness, perceived
degree of disability, and anticipated duration of the illness. When symptoms of illness persist or
increase, the person is motivated to seek professional help.

Stage 3: Medical Care Contact

The client now seeks for professional help either on their own initiative or at the urging of
significant others. When client seek professional advice, they are commonly asking for the confirmation
of real illness, the explanation of the symptoms in understandable terms and reassurance that they will
be alright or what that outcome will be. The health professional may determine that the client does not
have an illness or that an illness is present, and may even be life threatening. The client may accept or
deny the diagnosis. If the diagnosis is accepted, the client usually follows true prescribed treatment plan.
If diagnosis is not accepted, the client may seek the advice of other health care professionals or what
others usually called "second opinion."

Stage 4: Dependent Client Role

After accepting the illness and seeking treatment, the client becomes dependent on the
professional. In short, this stage is the dependence on health care professionals. People vary greatly in
the degree of ease with which they can give up their independence, particularly in relation to life and
death. Most clients accept their dependence on the physician, although they retain varying degrees of
control over their own lives. For example, some client request precise information about their disease,
their treatment and they delay the decision to accept treatment until they have all this information.
Others prefer that the physician proceed with treatment and do not request additional information.

Stage 5: Recovery and Rehabilitation

During this stage, the client is expected to give up the dependent role and resume former roles
and responsibilities. For clients with acute illness, the time as ill clients is generally short and recovery is
usually rapid. Thus most find it relatively easy to return to their former lifestyles. For those clients with
long-term illnesses and must adjust their lifestyles may find recovery more difficult. Those clients with a
permanent disability, this final stage may require therapy to learn how to make major adjustments in
functioning.
Eleven Stages of Illness proposed by Igun
1. Symptoms experience
• Experiencing the actual symptoms
• Becoming aware that there may be a problem
• Giving label and meaning to the symptoms
• Responding with fear or anxiety
2. Self-treatment
3. Communication significant with others
4. Assessment of symptoms
5. Assumption of the sick
6. Expression of concern
7. Assessment of probable efficacy of treatment or appropriateness of treatment sources
8. Selection of treatment plan
9. Implementation of treatment
10. Evaluation of the effects f the treatment
11. Recovery or rehabilitation

Impact of Illness

On the Client
• Behavioral and emotional changes
• Loss of autonomy
• Self-concept and body image changes
• Lifestyle changes

On the Family Depends on:

• Member of the family who is ill
• Seriousness and length of the illness
• Cultural and social customs the family follows

Impact of Illness: Family Changes

• Role changes
• Task reassignments
• Increased demands on time
• Anxiety about outcomes
• Conflict about unaccustomed responsibilities
• Financial problems
• Loneliness as a result of separation and pending loss
• Change in social customs

Keep in Mind
 The causation of a disease is called its etiology
 The three main stages of illness are: transition from health to illness, acceptance of illness and
Convalescence.
 Disease is objective while Illness is a highly personal state.
 An acute disease is one of a short-term nature; chronic disease persists overtime.
 Nosology deals with the classification of diseases.
 Comprehension Check:
1. What is a disease? Illness?
2. What are the types of disease according to duration? Scope?
3. What are the stages of Suchman’s health seeking behaviors?
To validate your answer, feel free to contact your course facilitator through any of the following:
 Sherlyn U. Viernes RM,BSM,MPA

Weekly Output:
 Activity 3
 Take home quiz 2
Keep them in your Portfolio and submit to your Course Facilitator during the face-to-face
session for Week 3.

End of Week 2

To my students:
You are now about to start the Topics for Week 3. Read the learning materials below then answer
the comprehension check questions that follow. Do Activity No. 4, 5 and ANSWER take home quiz
3.

TOPIC III - Models of Health

Health and illness are complex; that is dynamic. A model is theoretical way of understanding a
complex phenomenon. Health models help to understand client’s health behaviors and belief so that
effective health care can be provided. Health models helps health professionals to understand the
relationship between health of the client and various variables affecting it such as nutrition, life style,
health practice etc. Model represent various ways of approaching complex wishes. Models of health and
illness contain a combination of biological characteristics behavioral factors and social conditions.

There are a large number of theories and models that facilitate an understanding of health,
illness, and wellness. Some of these theories and models are very specific and highly concrete and others
are more general and more abstract.

Some of these theories and models that health care professionals find helpful in terms of health, health
promotion and illness prevention include:

Health – Illness Continuum Model

The individual’s state of health is one of
continual change. He moves back and forth from
health to illness and back to health again. His
condition is rarely constant. He may wake up feeling
great, develop a headache mid-morning, and feel fine
again by noon.

The health-illness continuum illustrates this

process of change, in which the individual experiences
various states of health and illness (ranging from extremely good health to death) that fluctuate
throughout his life.

As previously stated, health, just as life itself, is a process of continual change. And we must
continually adapt to these changes in our lives in order to maintain good health and well-being. It is our
adaptation or response to that change, rather than the change itself, that affects our health.

For example, two students just found out about a big test tomorrow, for which they are
completely unprepared. One student responds to this stressful situation (stressor) by going home, getting
his books out, and starting to study. The other student breaks out into a sweat, and spends most of the
evening fretting over this outrage and imagining what will happen to him if he doesn’t pass the test. No
doubt, this student is doing more damage to his health than is his friend. And, considering the time and
energy he is expending on worrying (and not studying), he may experience even more stress when they
receive their grades!

Adaptation and effective functioning, even in the presence of chronic disease, can be considered
a state of wellness. A person may be in perfect physical condition, but feel too tired to go to work, while
his co-worker, a diabetic, is at work, functioning fully and accomplishing his job. Which of these two
people is at a higher level on the health-illness continuum?

Death occurs when adaptation fails completely, and there is irreversible damage to the body.

Summary of Health-Illness Continuum

 Measure person’s perceived level of wellness

 Health and illness/disease opposite ends of a
health continuum
 Move back and forth (forward) within this
continuum day by day • Wide ranges of
health or illness
 Health and illness can be viewed as the
opposite ends of a health continuum
 From high level of health a person’s
condition can move through good health --
normal health -- poor health -- extremely
poor health -- to death.
 People move back and forth within this
continuum day by day.
 How people perceive themselves and how others see them in terms of health and illness will also
affect their placement on the continuum.

Characteristics of Health-Illness Continuum Model

 At any time any person’s health status holds a place on certain point between two ends of health-
illness continuum
 Any point on the health-illness continuum is a synthetically representation of various aspects of
individual in physiology, psychology and society.

Nurses Responsibilities
 To help the client to identify their place on the health-continuum.
 To assist the clients to adopt some measures in order to reach a well state of health.
VARIOUS MODELS OF HEALTH

1. Travis Illness–Wellness Continuum

The Health-Illness Continuum, put
forth by Ryan and Travis, describes health
and illness along a continuum with high
level health and wellness at one extreme
end of this continuum and high levels of
illness and poor health, including death
itself, at the other extreme end of this
continuum. Neither health nor illness is
depicted in the middle of this continuum which is sometimes referred to as the neutral zone.

This model is composed of two arrows pointing in opposite directions and joined at a neutral
point. Clients move along the continuum from illness toward health when they are successfully treated;
and clients move along the continuum from health to illness as the result of infection or trauma.

1. Movement to the right on the arrows (towards high-level wellness) equals an increasing level of
health and well-being. This movement is achieved in three Steps:
a. Awareness
b. Education
c. Growth

2. Movement to the left on the arrows (towards premature death) equates a progressively
decreasing state of health achieved in three Steps:
a. Signs
b. Symptoms
c. Disability

3. The most important movement in the continuum is the direction the individual is facing on the
pathway.
a. If movement is towards high-level health, a person has a genuinely optimistic or positive
outlook despite his/her health status
b. If movement is towards premature death, a person has a genuinely pessimistic or negative
outlook about his/her health status

4. This model 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.
Example: a hypertensive client who only takes his medications without making any other
life-style changes.
b. If a wellness model is used, an individual can move right past the neutral point.
Example: hypertensive client who not only takes his medications, but stops smoking,
looses weight, starts an exercise program, etc.

2. High Level Wellness Model

The High Level Wellness Model of Halbert Dunn is
somewhat similar to the Health-Illness Continuum of Ryan
and Travis. Rather than a continuum, however, the High Level
Wellness Model has 2 axes – the horizontal axis and the
vertical axis. As these axes cross each other as shown below,
four quadrants are formed. It shows a method of functioning
oriented towards maximizing the potential of an individual
while maintaining balance and purposeful direction with environment. This is holistic in nature. It
allows health practitioners to care for individual with regard to all dimensional factors. It emphasizes
health promotion and illness prevention rather than only treatment.

The four resulting quadrants of this model are the:

1. Poor health in an unfavorable environment quadrant

2. Protected poor health in a favorable environment
3. High level wellness in a very favorable environment and
4. Emergent high level wellness in an unfavorable environment

Poor health in an unfavorable environment is present when an ill person is in an unhealthy

environment. An example of poor health in an unfavorable environment is when a person with severe
immunosuppression is subjected to unsanitary conditions and contaminated drinking water; an example
of protected poor health in a favorable environment occurs when a client or a family, for example, has
support systems and accessibility to health care services when they are impacted with an illness, disease
or disorder; emergent high level wellness in an unfavorable environment can occur when a client is
committed to a regular exercise regimen, however, they are unable to do so because of their multiple
roles and responsibilities; and, finally, poor health in an unfavorable environment occurs when a client
with illness does not have the resources and services that they need to manage and correct their poor
health.

3. Agent-Host-Environment Model
The Agent – Host – Environment Model, developed by
Leavell and Clark, describes disease and illness as a function of the
dynamic interactions and interrelationships among the agent, the host
and the environment. The Agent – Host – Environment Model is
helpful for getting a fuller understanding of diseases and illnesses;
however, it is not helpful in terms of health and health promotion.

The agent in this model is the factor or force that leads to the disease
or disorder. The agent can be a physical, psychological, social,
chemical or mechanical force or factor. For example, bacteria, an
agent, can lead to an infectious disease when the host and the
environment interact with it and each other; and toxic chemicals can
lead to a disease or disorder when the host and the environment interact with it and each other.

The host is the person that could be affected with a disease or disorder when the client interacts with the
agent and the environment interacts with the client and each other. As discussed previously with the
Infection Control section, some clients are more susceptible hosts than other clients. For example, a
client's vulnerability and susceptibility to illnesses and diseases increase when they are affected by risk
factors associated with the disease or disorder such as gender, age and
life style choices.

The environment consists of all factors that are external to the client.
Some elements of the environment can place a person at risk for a
disease or illness; other environmental factors predispose the person
to wellness. For example, a social stressor, such as the loss of a loved
one, predisposes the host for disease and illness; and a physical
environmental force, such as healthy noise levels and adequate living
conditions can facilitate health.
4. Health Belief Model (HBM)
Rosenstock and Becker's Health Belief Model, a somewhat predictive model that is sometimes
used to determine if the particular client will or will not participate in the established and recommended
immunization schedule or another aspect of health maintenance and health promotion, as based on the
clients' perceptions and beliefs.

The Health Belief Model is based on

motivational theory. It addresses the relationship
of the client's perceptions, beliefs and other
factors as they relate to the clients' behaviors and
their health and health promotion behaviors. This
model can predict whether or not a person will
engage in screening tests, for example, as based
on their personal perceptions and beliefs. Some
of these beliefs and perceptions can include the
client's perceptions about the severity of the
health related threat and their susceptibility and
vulnerability in terms of it and some of the other factors that can impact on the client's behavior are
things like demographics like gender and culture, structural facilitators and barriers including those
related to the accessibility and affordability of health care services and psychosocial factors such as
support systems and economics.

HBM is concerned with what people perceive about themselves in relation to their health. The model
consider perceptions (influences individuals motivation towards results)
1. Perceived susceptibility
2. Perceived seriousness
3. Perceived benefit out of the action

Components of Health Belief Model

1. Perceived Severity
Perceived severity refers to the subjective assessment of the severity of a health problem and its
potential consequences. The health belief model proposes that individuals who perceive a given health
problem as serious are more likely to engage in behaviors to prevent the health problem from occurring
(or reduce its severity). Perceived seriousness encompasses beliefs about the disease itself (e.g., whether
it is life-threatening or may cause disability or pain) as well as broader impacts of the disease on
functioning in work and social roles. For instance, an individual may perceive that influenza is not
medically serious, but if he or she perceives that there would be serious financial consequences as a
result of being absent from work for several days, then he or she may perceive influenza to be a
particularly serious condition.

2. Perceived Susceptibility
Perceived susceptibility refers to subjective assessment of risk of developing a health problem.
The health belief model predicts that individuals who perceive that they are susceptible to a particular
health problem will engage in behaviors to reduce their risk of developing the health problem.
Individuals with low perceived susceptibility may deny that they are at risk for contracting a particular
illness. Others may acknowledge the possibility that they could develop the illness, but believe it is
unlikely. Individuals who believe they are at low risk of developing an illness are more likely to engage
in unhealthy, or risky, behaviors. Individuals who perceive a high risk that they will be personally
affected by a particular health problem are more likely to engage in behaviors to decrease their risk of
developing the condition.
 The combination of perceived severity and perceived susceptibility is referred to as perceived
threat. Perceived severity and perceived susceptibility to a given health condition depend on knowledge
about the condition. The health belief model predicts that higher perceived threat leads to higher
likelihood of engagement in health-promoting behaviors.

3. Perceived Benefits
Health-related behaviors are also influenced by the perceived benefits of taking action. Perceived
benefits refer to an individual’s assessment of the value or efficacy of engaging in a health-promoting
behavior to decrease risk of disease. If an individual believes that a particular action will reduce
susceptibility to a health problem or decrease its seriousness, then he or she is likely to engage in that
behavior regardless of objective facts regarding the effectiveness of the action. For example, individuals
who believe that wearing sunscreen prevents skin cancer are more likely to wear sunscreen than
individuals who believe that wearing sunscreen will not prevent the occurrence of skin cancer.

4. Perceived Barriers
Health-related behaviors are also a function of perceived barriers to taking action. Perceived
barriers refer to an individual’s assessment of the obstacles to behavior change. Even if an individual
perceives a health condition as threatening and believes that a particular action will effectively reduce
the threat, barriers may prevent engagement in the health-promoting behavior. In other words, the
perceived benefits must outweigh the perceived barriers in order for behavior change to occur.
Perceived barriers to taking action include the perceived inconvenience, expense, danger (e.g., side
effects of a medical procedure) and discomfort (e.g., pain, emotional upset) involved in engaging in the
behavior. For example, lack of access to affordable health care and the perception that a flu vaccine shot
will cause significant pain may act as barriers to receiving the flu vaccine.

5. Self-efficacy
This was added to the four components of the health belief model (i.e., perceived susceptibility,
seriousness, benefits, and barriers) in 1988. Self-efficacy refers to an individual’s perception of his or
her competence to successfully perform a behavior. Self-efficacy was added to the health belief model in
an attempt to better explain individual differences in health behaviors. The model was originally
developed in order to explain engagement in one-time health-related behaviors such as being screened
for cancer or receiving an immunization. Eventually, the health belief model was applied to more
substantial, long-term behavior change such as diet modification, exercise, and smoking. Developers of
the model recognized that confidence in one’s ability to effect change in outcomes (i.e., self-efficacy)
was a key component of health behavior change

Modifying Variables
Individual characteristics, including demographic, psychosocial, and structural variables, can
affect perceptions (i.e., perceived seriousness, susceptibility, benefits, and barriers) of health-related
behaviors. Demographic variables include age, sex, race, ethnicity, and education, among others.
Psychosocial variables include personality, social class, and peer and reference group pressure, among
others. Structural variables include knowledge about a given disease and prior contact with the disease,
among other factors. The health belief model suggests that modifying variables affect health-related
behaviors indirectly by affecting perceived seriousness, susceptibility, benefits, and barriers.

Modifying variables are factors that modify an individual’s perceptions. These variables include:
1. Demographic variables - age, gender, race, ethnicity
2. Sociopsychologic variables - personality, social class, peer and reference group pressure
3. Structural variables - knowledge about the disease, prior contact with the disease

Cues to Action
 The health belief model believes that a cue, or trigger, is necessary for prompting engagement in
health-promoting behaviors. Cues to action can be internal or external. Physiological cues (e.g., pain,
symptoms) are an example of internal cues to action. External cues include events or information from
others, illness of family member, newspaper, the media, or health care providers promoting engagement
in health-related behaviors. Examples of cues to action include a reminder postcard from a dentist, the
illness of a friend or family member, and product health warning labels. The intensity of cues needed to
prompt action varies between individuals by perceived susceptibility, seriousness, benefits, and barriers.

For example, individuals who believe they are at high risk for a serious illness and who have an
established relationship with a primary care doctor may be easily persuaded to get screened for the
illness after seeing a public service announcement, whereas individuals who believe they are at low risk
for the same illness and also do not have reliable access to health care may require more intense external
cues in order to get screened.

Health Belief Model Components

The major concepts of the Health

Behavior Model are perceived
susceptibility, severity, benefits,
barriers, and self-efficacy (middle
column). Modifying factors (left
column) affect these perceptions, as do
cues to action (right column).

The combination of beliefs and cues to

action leads to behavior. Perceived
barriers (red text) have been
demonstrated to be the single most
powerful predictor of health behavior

5. Holistic Models of Health and Wellness

Holistic approaches to health and wellness, more consistent with the holistic definition of health
put forward by the WHO as just stated, include the beliefs that the bio-psycho-social-spiritual person is
in the state of constant dynamic interaction with the environment; changes occurring in any of these
aspects create change in all the other aspects of the person and the environment within which the client
is.

6. Holistic Health Model

A comprehensive view of the person as a bio
psychosocial and spiritual being and sometime holistic health
model is said to be alternative medicine. The holistic health care
model comes from a variety of scientific philosophical, social
bases that describe similar phenomenon. The model empower
the patients to engage in their own healing power which
comprises of concepts of energy, holism, the mind body
connection, and balance in order to expand the definition of
health
 The holistic health model uses the different techniques that in the past the health community
viewed as experimental or alternative
Alone it is realized that personal health choice has intensive and powerful impact of an individual
health. Some of widely used holistic interventions include aromatherapy, meditation, music therapy, and
relation therapy, therapeutic touch, applied in health care setting such as meditation, breathing exercise.

7. Health Promotion Model

The Health Promotion Model (HPM) by Dr.

Nola Pender focuses on helping people achieve
a higher level of well-being and provide health
professionals with positive resources to help
patients achieve behavior specific changes.
Pender defines health as a positive, dynamic
state, not merely the absence of disease.

The model was proposed as a framework for

integrating the perspectives of nursing and
behavioural science and the factors that
influence health behaviour. Health promotion is
desire to increase well-being and actualize
human health potential, whereas health
protection is behaviour that is motivates by a desire to avoid illness, detect it early or maintain function
within the constraints of an illness

The goal of the HPM is not just about helping patients prevent illness through their beliefs and attitudes,
but also seek the means in which a person can pursue better health or ideals. According to Pender,
the HPM makes four assumptions:
1. Individuals strive to control their own behavior.
2. Individuals work to improve themselves and their environment.
3. Health professionals comprise the interpersonal environment, which influences individual
behaviors.
4. Self-initiated change of individual and environmental characteristics is essential to changing
behavior.

These assumptions can help

clients prioritize other needs,
especially health concerns. The
model describes the
multidimensional nature of
people as they interact in their
environment to pursue health. It
emphasize on the three function
of patients cognitive perceptual:
1. Individual characteristics
experiences
2. Behaviour specific
cognitions and affect
3. Behavioural outcome.
Other Models of Health

Clinical Model
• Provides the narrowest interpretation of health.
• People are viewed as physiologic systems
• Health identified by the absence of signs and symptoms of disease or injury
• State of not being “sick”
• Opposite of health is disease or injury

Adaptation Model
Adaptation models and theories of health define health as how well able the client is to adapt and
cope with changes. Disease and illness occur when the person is maladapting to the change; and health
is promoted when the client is able to cope successfully and in a healthy manner. The Adaptive Model
views of health:
• Creative process
• Disease is a failure in adaptation or maladaption
• Extreme good health is flexible adaptation to the environment
• Focus is stability
• The aim of treatment is to restore the ability of the person to adapt

Role Performance Model

Simply stated, a person is considered in good health and healthy when they are able to fulfill
their multiple roles without disruption; and a person is considered ill when they cannot fulfill their roles
and responsibilities. For example, a client who is able to continue to work and to perform their role as a
parent is considered healthy and not ill as they manage a chronic disorder such as heart disease or
diabetes. The Role Performance Model views health as:
• Ability to fulfill societal roles
• Healthy even if clinically ill if roles fulfilled
• Sickness is the inability to perform one’s role

Eudemonistic Model
• Comprehensive view of health
• Condition of actualization (make real) or realization of a person’s potential
• Illness is a condition that prevents self- actualization
• Actualization is the peak of the fully developed personality

The goal of tertiary prevention is to reduce the negative impact of an already-established disease by
restoring function and reducing disease-related complications.2 Tertiary prevention also aims to improve
the quality of life for people with disease. In medicine and dentistry, tertiary prevention measures
include the use of amalgam and composite fillings for dental caries, replacement of missing teeth with
bridges, implants, or dentures, or insulin therapy for Type II diabetes

Three Levels of Health Promotion/Disease Prevention - Levels of Prevention

In general, preventive care refers to measures taken to prevent diseases instead of curing or
treating the symptoms. Prevention, as it relates to health, is really about avoiding disease before it starts.
It has been defined as the plans for, and the measures taken, to prevent the onset of a disease or other
health problem before the occurrence of the undesirable health event. There are three distinct levels of
prevention.

Primary prevention
 Those preventive measures that prevent the onset of illness or injury before the disease process
begins. Primary prevention aims to avoid the development of a disease or disability in healthy
individuals. Most population-based health promotion activities, such as encouraging less consumption of
sugars to reduce caries risk or eating a balance diet, are primary preventive measures. .Examples
include immunization and taking regular exercise.

Secondary prevention
Those preventive measures that lead to early diagnosis and prompt treatment of a disease, illness
or injury to prevent more severe problems developing. Here health educators can help individuals
acquire the skills of detecting diseases in their early stages. Examples include screening for high blood
pressure and breast self-examination.

The focus of secondary prevention is early disease detection, making it possible to prevent the
worsening of the disease and the emergence of symptoms, or to minimize complications and limit
disabilities before the disease becomes severe Secondary prevention also includes the detection of
disease in asymptomatic patients with screening or diagnostic testing and preventing the spread of
communicable diseases. Examples include screening for breast and cervical cancer.

Tertiary prevention
These are preventive measures aimed at rehabilitation following significant illness. At this level
health services workers can work to retrain, re-educate and rehabilitate people who have already
developed an impairment or disability. Example include speech therapy after a stroke.

The goal of tertiary prevention is to reduce the negative impact of an already-established disease
by restoring function and reducing disease-related complications. Tertiary prevention also aims to
improve the quality of life for people with disease. In medicine tertiary prevention measures include
insulin therapy for Type II diabetes.

Health Education can be applied at all three levels of disease prevention and can be of great help in
maximizing the gains from preventive behavior. For example at the primary prevention level — you
could educate people to practice some of the preventive behaviors, such as having a balanced diet so that
they can protect themselves from developing diseases in the future. At the secondary level, you could
educate people to visit their local health center when they experience symptoms of illness, such as fever,
so they can get early treatment for their health problems. At the tertiary level, you could educate people
to take their medication appropriately and find ways of working towards rehabilitation from significant
illness or disability.

Keep in Mind:
 Health care professionals find the various models of health helpful in terms of health, health
promotion and illness prevention.
 Holistic Health Model is a comprehensive view of the person as a bio psychosocial and
spiritual being.
 The Agent – Host – Environment Model describes disease and illness as a function of the
dynamic interactions and interrelationships among the agent, the host and the environment.
 Travis’s Illness-Wellness continuum is composed of two arrows pointing in opposite directions
and joined at a neutral point.
 Cues to action are triggers necessary for prompting engagement in health-promoting
behaviors.
 Self-efficacy refers to an individual’s perception of his or her competence to successfully
 perform a behavior.
 There are 3 levels of preventive care- primary, secondary, tertiary.
Comprehension Check:
1. What are the 3 levels of prevention?
2. What are the components of health belief model?
3. What are examples of modifying factors that influence a person’s perception
towards health?


Weekly Output:
1. Activity 4
2. Activity 5
3. Take home exam 3

Keep them in your Portfolio and submit to your Course Facilitator during the face-to-face
session for Week 4.
End of Week 3

SIBUGAY TECHNICAL INSTITUTE, INC.

Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE 1

ACTIVITY 1: How healthy am I? A quick check!

Name: ____________________________________________ Date: _________________

Course – Year & Section: _____________________ Score: ________________

Directions: Do a quick personal health assessment, then write an essay on how healthy are you based
on your assessment using the different dimensions of health and wellness as guide.

How healthy am I?

____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
 SIBUGAY TECHNICAL INSTITUTE, INC.
Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE I

ACTIVITY 2: Health Check!

Name: _______________________________ Date: _________________

Course: _______________ Year & Section: _____________________
Score: ________________

You can do a lot to keep yourself healthy. Staying away from germs, eating a balanced diet, getting
enough rest—all these steps and others can put you on the road to good health. How much do you know
about preventing disease? Take this quiz and find out.

Direction: Read and understand each item and encircle the letter of your response.

1. How are infectious diseases, such as colds and influenza, most commonly spread?
a. Breathing viruses in air
b. Hand-to-face contact
c. Drinking infected water
d. Eating contaminated food

2. Which is the most important hygiene habit to teach young children?

a. Use a tissue to cover a sneeze
b. Don't share a glass or eating utensil
c. Wash hands frequently
d. Take a bath daily

3. Chronic stress has been linked to which of these health problems?

a. Headaches
b. Constipation
c. Depression
d. All of the above

4. Which of the following increases your risk for type 2 diabetes?

a. Not getting enough exercise
b. Eating too much sugar
c. Being overweight
d. Advancing age
e. A and C
f. All of the above

5. Which of these things can reduce the risk of getting genital herpes or other communicable sexual
diseases?
 a. Male latex condom
b. Female condom
c. Contraceptive foam
d. Birth control pills

6. According to the Center for Disease (CDC) , when should infants start vaccines against serious
diseases?
a. Birth
b. 2 months old
c. 6 weeks old
d. 6 months old

7. "Sleep hygiene" refers to the promotion of regular sleep. Which of these can help you develop
healthy sleep habits?
a. Eat a big meal late in the day
b. Go to bed and get up at the same time every day
c. Cut back on the amount of exercise you get
d. All of the above
 SIBUGAY TECHNICAL INSTITUTE, INC.
Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE 1

TAKE HOME QUIZ 1
Name: _____________________________ Date: _________________
Course________________ Year & Section: _____________________
Score: ______________

Directions: Answer the following questions. Encircle the letter of the best answer.

1. There are different ways to look on health and illness. When formulating a definition of “health,” a person
should consider that health, within its current definition, is:
a. A state of wellbeing involving the whole person
b. A function of the physiological state
c. The ability to pursue activities of daily living
d. The absence of disease

2. Which of these is not a definition of health?

a. Health as not ill
b. Health despite disease
c. Health means not seeing a doctor
d. Health as vitality

3. Which of these is not an example of a health behaviour?

a. Smoking
b. Taking regular exercise
c. Eating healthy food
d. Going to the gym
For items 4 to 10, identify the dimensions of health and wellness in the following items. Write your answer on the
space provided.
4. Encompasses a variety of healthy behaviors including adequate exercise, proper nutrition and abstaining
from harmful habits such as drug use and alcohol abuse _________________________________
5. Maintain harmonious relationship with other members of society in which he lives.
____________________
6. In touch with deeper self and exploration the purpose of life, as people believe in some force that
transcend physiology and psychology of human being __________________________________
7. Participates in the activities which are related to personal growth and his self- esteem
______________________________
8. Encourages creative, stimulating mental activities _________________________
9. Ability to interact successfully in our global community and to live up to the expectations and demands of
our personal roles _______________________________
10. Being involved in socially responsible activities to protect the environment _______________________
 SIBUGAY TECHNICAL INSTITUTE, INC.
Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE I

ACTIVITY NO. 3: Stages of Illness Behavior

Name: _________________________________ Date: _________________

Course: __________________ Year & Section: _____________________
Score: ________________

Direction: Part I - Arrange the stages of illness in order of occurrence using numbers 1 being the first
and 5 the last stage. Write the number on the space provided.

1. ___________Symptom experience
2. ___________Recovery
3. ___________Medical care contact
4. ___________Assumption of sick role
5. ___________Dependent client role

Part II: Complete this activity by filling in the table with TWO examples of illness behaviors that occurs
in every stage.

Stages of Illness Behavior Examples of Illness behaviors

Symptom experience 1.
2.

Dependent client role 1.

2.

Assumption of sick role 1.

2.

Medical care contact 1.

2.

Recovery 1.
2.
 SIBUGAY TECHNICAL INSTITUTE, INC.
Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE I

TAKE HOME QUIZ 2

Name: _________________________________ Date: _________________

Course: __________________ Year & Section: _____________________
Score: ________________

Directions: Choose the letter of the correct answer. Encircle the letter of your
answer.

1. The following are true with regards to aspect of the sick role EXCEPT;
a. One should be held responsible for his condition
b. One is excused from his societal role
c. One is obliged to get well as soon as possible
d. One is obliged to seek competent help

2. Refers to conditions that increases vulnerability of individual or group to

illness or accident
a. Predisposing factor
b. Etiology
c. Risk factor
d. Modifiable Risks

3. Term to describe the reactivation and recurrence of pronounced symptoms

of a disease
a. Remission
b. Emission
c. Exacerbation
d. Sub- acute

4. A type of illness characterized by periods of remission and exacerbation

a. Chronic
b. Acute
c. Sub- acute
d. Sub chronic
5. Diseases that results from changes in the normal structure, from
recognizable anatomical changes in an organ or body tissue is termed as:
a. Functional
b. Occupational
c. Inorganic
d. Organic

6. Excessive alcohol intake is what type of risk factor?

a. Genetics
b. Age
c. Environment
d. Lifestyle

7. Degenerative diseases like Osteoarthritis belong to what type of risk factor?

a. Genetics
b. Age
c. Environment
d. Lifestyle

8. In this stage, the person tries to find answers for his illness. He wants his illness to be validated,
his symptoms explained and the outcome reassured or predicted
a. Symptom Experience
b. Assumption of sick role
c. Medical care contact
d. Dependent patient role

9. What does the term 'morbidity' refer to?

a. Death
b. Illness
c. Health
d. Disease

10. The client states, “Heart disease runs in our family. My blood pressure has
been high.” The nurse determines that this is an example of the client’s:
a. Active strategy
b. Health beliefs
c. Negative health behavior
d. Risk factors
 SIBUGAY TECHNICAL INSTITUTE, INC.
Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE I

ACTIVITY NO. 4: Levels of Prevention

Name: _________________________________ Date: _________________
Course: __________________ Year & Section: _____________________
Score: ________________

Directions: Complete the activity by filling in the table with five examples of health activities or health
behaviors per level of prevention.

Level of Prevention 5 Examples of activity under each level

1. Primary prevention 1.
2.
3.
4.
5.
1. Secondary prevention 1.
2.
3.
4.
5.

2. Tertiary prevention 1.
2.
3.
4.
5.
 SIBUGAY TECHNICAL INSTITUTE, INC.
Lower Taway, Ipil, Zamboanga City
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE I

ACTIVITY NO. 5: Think and Ponder

Name: _________________________________ Date: _________________

Course: __________________ Year & Section: _____________________
Score: ________________

Direction: Part I: Read the list of the three levels of prevention again. Think about your experience of
health education, whether as an educator or recipient of health education. Briefly answer the questions
that follow.

1. How do you think health education can help with the prevention of disease?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. Do you think it will operate at all these levels?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

3. Note an example of possible health education interventions at each level where you think health
education can be applied.
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
______________________________________________________________________________
 ______________________________________________________________________________
______________________________________________________________________________

Part II: Find out the major health issues facing Filipinos today. Answer the following questions.

1. What are some of the most common conditions, and how are they related to one another?
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

2. What can we do to improve our health?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
 SIBUGAY TECHNICAL INSTITUTE, INC.
Lower Taway, Ipil, Zamboanga Sibugay
COLLEGE OF MIDWIFERY

PRIMARY HEALTH CARE I

QUIZ 3

Name: _________________________________ Date: _________________

Course: __________________ Year & Section: _____________________
Score: ________________

Directions: Part 1 - Choose the letter of the correct answer. Encircle the letter of
your answer.

1. Which of these is not an element of the Health Belief Model

a. Threat
b. Expectations
c. Cure
d. Socio-demographic factors

2. Tertiary prevention is needed in which stage of the natural history of disease?

a. Pre-pathogenesis
b. Pathogenesis
c. Prodromal
d. Terminal

3. Isolation of a child with measles belongs to what level of prevention?

a. Primary
b. Secondary
c. Intermediate
d. Tertiary

4. Operation Timbang is _____ prevention.

a. Primary
b. Secondary
c. Intermediate
 d. Tertiary

5. Which of the following activities would be considered to be an example of PRIMARY

prevention?
a. Clarifying the use and effects of prescribed medications with a pharmacist.
b. Receiving an immunization against influenza.
c. Receiving an annual mammogram.
d. Eliminating offending allergens from asthmatic patients.
e. Screening for renal, eye, and foot problems in a diabetic client.

6. Health Belief Model was developed by ______.

a. Rogers (1975)
b. Rosenstock (1966)
c. Pender (1991)
d. Fisher and Fisher (1992)

7. When assessing the external variables that influence a client’s health beliefs and practices, the
nurse must consider his:
a. Religious practices
b. Income status
c. Educational background
d. Reaction to the heart disease

8. A midwife is using a holistic approach with a client. To incorporate all of the factors that may
influence the client, the midwife should respond to the client as follows:
a. “I would like you to perform this exercise once a day.”
b. “Adapting your diet and activity will lower your blood glucose levels.”
c. “Your physician has left orders for you to follow.”
d. “The laboratory tests reveal the need to reduce your daily percentage of fat grams.”

9. The nurse incorporates the levels of prevention as a basis for the types of client needs that are
evident and the nursing care that is provided. Which of the following activities of the nurse is an
example of tertiary level preventive care giving?
a. Providing a class on hygiene for an elementary school class
b. Informing a client that immunizations for her infant are available through the health
department
c. Teaching a client how to irrigate a new colostomy
d. Arranging for a nursing home nurse to visit with the family of a client with cancer

10. In the Health Belief Model, the nurse recognizes that the focus is placed on the:
a. Functioning of the individual in all dimensions
b. Multidimensional nature of clients and their interaction with the environment
c. Relation of perceptions and compliance with therapy
d. Basic human needs for survival
11. Which of the following best describes the Illness-Wellness/Health Continuum?
a. A picture that patients can use to show their healthcare provider how they are feeling at
that moment.
b. An illustration that draws a connection between the treatment paradigm and the wellness
paradigm.
c. A tool used by health care practitioners to document how critical their patients are.
d. A visual reference for society to compare themselves overall to other societies.

12. Who was the original author of the Illness-Wellness Continuum?

a. Dr. John W. Travis in 1972
b. Florence Nightingale in 1875
c. Dr. Benjamin Carson in 1997
d. Dr. William S. Travis in 1972

13. Which one of these is an example of health promotion?

a. Safety course
b. Nutrition assessment
c. First aid training
d. All answers are correct

14. What is the focus of the Health Promotion Model?

a. It focuses on examining client health behaviors.
b. It focuses on helping people achieve higher levels of well-being and ideal health.
c. It focuses on behavior change mechanisms for smokers.
d. It focuses on behavioral intention.

15. Which of the following assumptions is FALSE about the HPM?

a. Health professionals, such as nurses and doctors, comprise the interpersonal environment,
which influences individual behaviors.
b. Individuals work to improve themselves and their environment.
c. Individuals have no control over their own behavior.
d. Self-initiated change of individual and environmental characteristics is essential to
changing behavior

Prelim EXAMINATION