In the discussion of the theoretical bases of health education and healthy lifestyle promotion, such terms as a model and theory are often met. In order to understand the application of the theories from the perspective of a military sexual assault, it is necessary to explain the meaning of the terms.
A theory is a set of the interconnected concepts, definitions and statements which represent a systematic view on events or phenomena, precisely defining the relations between the variables in order to explain and predict events. In other words, theory is a systematic arrangement of the fundamental principles which provide a basis for the explanation of a definite vital notion. Theories in health care are the tools, which help the health care instructors understand the factors influencing human health in a better way - the relatives, environment, approved types of behavior - and to develop the effective programs of influence directed at the strengthening of health.
A theory is characterized by three main features:
- major factors which influence the interest of a subject, for example, the factors which explain why some people lead an active way of life, and others do not;
- relations between these factors, for example, between knowledge, belief, social norms and types of behavior, such as physical activity;
- conditions under which these relations take place, for example, time, place and circumstances which define whether a person leads an active way of life or not.
A model differs from a theory being its subclass. Models are the generalized hypothetical descriptions based on analogy, used for analysis or explanation of something. Models are used in various theories to facilitate understanding of a specific problem in definite conditions. Unlike theories, models do not aim to explain the processes underlying knowledge but only describe them. Nursing is the social and labor process directed at medical competent revealing of the patient’s problems connected with the qualified help and social maintenance of the general state of health. Certainly, the ultimate goal of the advanced practice nurse (APN) is to help the patient. At the same time, the APN is the main executor of this process. The APN is the feet of the legless, eyes of the blind, a source of knowledge and confidence for young mother, lips of those who are too weak to speak. These words express the mission, the special calling of the APN. Nursing professionalism requires unified and adequate standards of medical assistance. All medical workers should contribute to the growth of medical health care accessibility. In any social system, medical workers should not discriminate people on the basis of intelligence, financial level, social status, gender, or race..
The behavioral, psycho-sociological and sociocultural factors, connected with behavior and the way of life, are the main investors in mortality. The efforts, changing the behavior for the sake of health, make the contribution to the therapy of the psychological frustrations, diabetes, cancer and HIV. Moreover, they successfully apply the strategy of behavioral and social science, reduce the risks and improve the quality of health, preventing the development of these frustrations. Nevertheless, these applications of behaviorism lagged behind the other approaches to the treatment of diseases, despite the appeals to a bigger involvement. The researchers and practicians have recently started applying the integrated behavioral approaches in the prevention of various diseases. Although physical and social environments play an essential role in the development or obstacles to health behavior, individual behavior gives rise to the illnesses, created by the ecological and personal factors which can be changed. Even the usage of the technological achievements demands behavioral consent and behavioral control. The behavioral medicine can help document the behavioral and social factors of risk, develop and estimate interventions influencing the standard beliefs (e.g., social norms), helping in the restoration from the psychological harm and creating a person and community through the preventive behavior.
The treatment of the patients, who experienced a military sexual assault, is a multilevel process of the adaptable activity of a human body in the conditions of army. It is accompanied by the tension of the mechanisms of self-control and fixing of specific adaptive psycho physiological changes. The APN should take into consideration that the process of treatment of the patients, experiencing military sexual assault, is an adaptation to the situation of a psychological stress as a complex of the reactions directed at the adaptation to the unusual incentives of army conditions, accompanied with such cardinal changes of mentality and the identity of a soldier, which allow surviving in an extreme situation of army. It is impossible to treat the patient, who experienced the military sexual assault without the elements of a change or behavior replacement, even with the presence of regulating law protecting the safety of people. A clear understanding of the central theories of behavior and health can facilitate these actions.
Military sexual assault is any kind of sexual assaults, occurring during serving in the army. Despite the fact that a military sexual assault is more widespread in army among women, more than a half of the patients, who suffered from it, are men. The most dangerous consequence of a military sexual assault is a posttraumatic stress. The role of APN is to treat such patients from the alarm and fear problems. The goal of this treatment is to find the new ways how to help the patients to cope with this trauma, and also to find new possibilities of its treatment. The APN can achieve the results of treatment using applying different health theories and models in practice. The PRECEDE/PROCEED and Health Belief Models help to treat the patients, teaching them to think and react to the fearing events in another way.
The PRECEDE/PROCEED uses mental images, records or visit of a place of the endured trauma to help the victims to face fear suppressing them and to take it under control. The Health Belief Model induces the victims of a military sexual assault to come up with depressing (often erroneous) ideas on the endured trauma, to challenge these thoughts and to replace them with more balanced and pleasant ones.
Personal behavior influences one’s health. Many people can improve their health by managing their chronic condition or engaging in health promotion behaviors. Persons with chronic conditions improve their health by managing specific health behaviors, a process that requires behavior change. Nurses and other healthcare professionals play a major role in identifying behaviors critical to health, assessing the needs of individuals and groups and recommending specific health behaviors, preparing and delivering interventions designed to enhance engagement in health behaviors, and evaluating the effectiveness of interventions for individuals, groups, communities, and the nation. To fulfill these role responsibilities, nurses and other healthcare professionals benefit from understanding the theory and science of health behavior change, what is known as well as the gaps and opportunities (Ryan, 2009).
The change of health behavior is impossible without the application of theories and models. The choice of the most effective model for the treatment of the patients, who experienced a military sexual assault, depends on the beliefs and peculiarities of behavior in the army.
The theoretical PRECEDE-PROCEED model describes and orders the stages of planning and realization of the treatment programs. The PRECEDE-PROCEED model was developed by a group of western researchers in the field of public health during the period from 1970 to 1991. The participation in planning and intervention of the representatives of a target group is one of the basic principles being the foundation of the model.
PRECEDE and PROCEED are acronyms (words in which each letter is the first letter of a word). PRECEDE stands for Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation. As its name implies, it represents the process that precedes, or leads up to, an intervention. PROCEED spells out Policy, Regulatory, and Organizational Constructs in Educational and Environmental Development, and, true to its name as well, describes how to proceed with the intervention itself.
The treatment of the patients, who suffered from a military sexual assault, includes the ways of reduction of alarm and ability to cope with it, helping to weaken the posttraumatic symptoms, and helps to correct the erroneous course of thoughts, connected with the endured sexual trauma. According to this model, the process of planning and implementation of the programs directed at the treatment of the military sexual assaults should pass the following stages:
1. A social assessment - requirements and aspirations of the representatives of a community, its ability to solve the problems in the health sphere, their strengths, resources and readiness to changes are estimated. The following data collection methods are used for the social assessment: individual interviews with the key representatives and focus groups with the other members of community, supervision, representative polls, etc. Community is any group of people possessing similar social characteristics, interests, values and norms. The goal of APN at this stage is to use the opinions of the representatives of a military community. It is better for the representatives of a military community to take part in preparation of the interventions at the program development stage. For this purpose, it is possible to hold military forums, focus groups and polls.
2. Epidemiological assessment - helps to define which health problems are the most vital for a definite community subgroup - a military group in the given case. At this stage the secondary analysis of available data on the state of health of the members of the military community is conducted, i.e. the analysis of statistical data, researches which are fulfilled at the state level and also available for the medical workers and administration of information about the state of health of a community. This data allows allocating subpopulations with the greatest degree of risk for health. For this purpose, such parameters as age, sex, ethnic origin, occupation, education level, income, family characteristic, the place of residence, etc. can be used by the APN. If the available data is insufficient, a separate research is carried out. At the stage it is necessary for the APN to analyze the values of those statistical figures which can become a basis for the statement of the purposes and problems of treatment of the patients, suffered from a military sexual assault. In order to treat the patients, who experienced a military sexual assault, the APN should define this issue.
3. Behavior and environment assessment - behavioral and environment factors making the greatest impact on the problem aspects of health chosen for the intervention are estimated. The behavioral factors are understood as the characteristics of individual behavior and lifestyle of the representatives of a risk group, having the greatest contribution to the emergence and expressiveness of the health problems. The APN should range the behavioral and environmental factors by the force of impact on the state of health of the patients.
4. Educational and ecological assessment - represent the factors which are necessary in order to begin and support the process of treatment. Three groups of such factors include Predisposing, Reinforcing, and Enabling. Predisposing factors are the factors preceding the actual behavior which forms a cognitive or motivational basis. Knowledge beliefs, personal preferences, skills and self-image belong to them. Reinforcing factors are the factors which follow the behavior and provide an award or encouragement for implementation or repetition of behavior. They include social support; influence of contemporaries and reinforcement with the other parties of significance. Enabling factors are the factors, which allow realizing the intentions. They can influence behavior directly or indirectly, through environment. This group includes factors, services and the resources influencing behavior and environment, and also, in certain cases, new skills are necessary for the change of behavior.
5. Management and policy assessment - information about policy, resources and circumstances, which can promote or interfere with the realization of treatment, are gathered. At this stage, the possible strategy of treatment of the patients is estimated from the point of view of the existence of the necessary resources (time, people, money) and existence of the barriers for the treatment (for example, shortage of people or areas). The APN should make a plan on the overcoming of these barriers. Besides, the APN should take into consideration the political and administrative features of the situation, which can affect the process of treatment.
6. Implementation of the program.
7. Process assessment - compliance of the treatment with the initial plan is assessed.
8. Influence assessment - the APN assesses the occurred changes of the contributing, supporting and facilitating factors and the changes of behavior and environment.
9. The assessment of results – the APN should assess the effect of the program and the change of indicators reflecting the quality of life in the community (military community in our case).