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Chapter 4 Prevention 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. - PowerPoint PPT Presentation
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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
Copyright 2005 Lippincott Williams & Wilkins
The Context for Primary Prevention
Physical therapists are expected to participate actively in health and wellness practices.
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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
Copyright 2005 Lippincott Williams & Wilkins
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).
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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).
Copyright 2005 Lippincott Williams & Wilkins
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
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
Wellness and Lifestyle
Concepts that embrace positive health behaviors and promote a state of physical and mental
balance and fitness.
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
Dimensions of Wellness
PhysicalPsychologicalSocialEmotionalSpiritualIntellectual
Copyright 2005 Lippincott Williams & Wilkins
The Wellness Model
Copyright 2005 Lippincott Williams & Wilkins
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).
Copyright 2005 Lippincott Williams & Wilkins
Perceptions that may be Assessed
General healthStatusSocial support
systemsRole and social
functioning
Functional status in self-care and home- management activities
WorkCommunityLeisure activities
Copyright 2005 Lippincott Williams & Wilkins
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
Copyright 2005 Lippincott Williams & Wilkins
Health Promotion and Wellness-Based Practices
Offering services beyond traditional patient–provider practices.
Change the focus:
Illness Wellness
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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
Copyright 2005 Lippincott Williams & Wilkins
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.
Copyright 2005 Lippincott Williams & Wilkins
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.