chapter 4 prevention and the promotion of health, wellness, and fitness

Copyright 2005 Lippincott Williams & Wilkins

Chapter 4Prevention and the Promotion of

Health, Wellness, and Fitness

The function of protecting and developing health must rank even above that of restoring it when it is

impaired — Hippocrates


The Context for Primary Prevention

Physical therapists are expected to participate actively in health and wellness practices.


Prevention, Health Promotion, and Health Education

Primary Prevention:

Includes health promotion, protection and preventative health services.

Takes place in the “prepathogenesis” period— before onset of disease.


Secondary Prevention

Includes screening for the purpose of early diagnosis and treatment of disease, as well as disability limitation.

Secondary prevention services take place after the onset of illness or injury, in the presence of pathology.

e.g., breast and prostate screening, osteoporosis screening, medical pre-placement evaluations.


Tertiary Care

Encompasses traditional physical therapy services. Health status of patient will determine if information falls under primary,

secondary, or tertiary care. e.g., A diabetic patient receiving rehabilitation for an amputation would be

receiving tertiary care.

Overall health status will determine which category the patient requires.


Differentiation of Primary, Secondary, and Tertiary Prevention

Prepathogenesis Period Period of Pathogenesis

Health Promotion

Health Protection

Preventative Health Services

Early Diagnosis and Prompt Treatment

Disability Limitation

Rehabilitation

Primary Prevention Secondary Prevention

Tertiary

Prevention


Health Promotion

A combination of educational and environmental programs or actions that are conducive

to health.

Factors/interventions are considered beyond the exercise program (e.g., nutrition).


Combination Component

Variety of learning experiences (interventions) are necessary to influence change.

Interventions from other healthcare providers may be enlisted.

e.g., Nutrition, hormone therapy, and therapeutic exercise are combined as part of the osteoporosis intervention program.


Education Component: Health Education

Any combination of learning experiences designed to facilitate voluntary actions conducive to help.

Health education activities are planned out and are voluntary.

Examples: Counseling patients on the risks of smoking. An osteoporosis program. Teaching children how to carry and load their backpacks

safely.


Environmental Component

Encompasses social forces that influence health: social, political, economic, organizational, policy,

and regulatory issues.Individual and social/regulatory activities are

included. Individual’s vocational policies must be

considered to assist with positive responses (e.g., nonsmoking policy at work).


Health Promotion = Health Education?

Not significantly different.

Health Promotion & Health Education:

Broad and varied set of strategies to:Influence individuals and their environmentImprove health behaviorEnhance health and quality of life


Health Protection/Preventative Health Services

Health Protection

Strategies dealing with engineering the

physical environment.

Preventative Health Services

Traditional medical system efforts to

prevent injury and illness.


Wellness and Lifestyle

Concepts that embrace positive health behaviors and promote a state of physical and mental

balance and fitness.


Wellness

1. Multidimensional concept.2. Has salutogenic focus (what causes

health).3. Uses a systems perspective.4. Size of each dimension within systems

theory represents the amount of wellness an individual possesses.


Dimensions of Wellness

PhysicalPsychologicalSocialEmotionalSpiritualIntellectual


The Wellness Model


Measurement of Wellness

Reflects the multidimensionality and systems orientation of the concept and has a health- causing (salutogenic) focus.

Includes perceptual tools when measuring wellness for all levels of prevention (primary, secondary, tertiary).


Perceptions that may be Assessed

General healthStatusSocial support

systemsRole and social

functioning

Functional status in self-care and home- management activities

WorkCommunityLeisure activities


Perceptual Measurement ToolsInstrument

SF-36 Satisfaction w/life scale Perceived wellness

survey NCHS general well-being

schedule Philadelphia Geriatric

Center morale scale Memorial University of

Newfoundland scale of happiness

Perceptual Construct General health perceptions Life satisfaction Perceived wellness General well-being Morale Happiness


Health Promotion and Wellness-Based Practices

Offering services beyond traditional patient–provider practices.

Change the focus:

Illness Wellness


From Illness to Wellness

Requires altering the approach to consider patients as “clients” who can be MORE well.

Patients convert to “members” after discharge and continue to use facility to continue their exercise program.


Establishing a Wellness-Based Practice

Facility is open and staffed at convenient hours.Staff has expertise in exercise prescription and

wellness.Educational classes (nutrition, exercise, etc.) tap

the intellectual aspect.Provider often assumes the role of a facilitator.


Use of Screening as an Examination Tool within a Wellness-Based Practice

Used to identify whether client has risks that require investigation before intervention program.

Examples:Satisfaction with life scalePerceived wellness surveyNHCS general well-being schedule


Starting a Wellness-Based Practice

1. Verify that “wellness” or “health promotion” is included in the definition and description of PT in the state practice act.

2. Check liability policy to ensure coverage.3. Become educated on identifying/understanding

the potential risks of a wellness-based practice. 4. Incorporate marketing and advertising programs

and success evaluations.


Summary

Classification of prevention – primary, secondary, tertiary.

Health promotion and wellness – primary prevention. Most rehabilitation – secondary or tertiary. The terms health promotion and health education are

often used interchangeably. Wellness is multidimensional salutogenic and requires a

systems perspective. Perceptual measures (screening) – good predictors of

general well-being. Wellness – Looking beyond physical domains and

biomedical model.

chapter 4 prevention and the promotion of health, wellness, and fitness

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