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

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 Health Preventative Early Disability Rehabilitation

Promotion Protection Health Diagnosis Limitation
Services and
Prompt
Treatment
Primary Prevention Secondary Tertiary
Prevention 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 environment
 Improve health behavior
 Enhance health and quality of life

Copyright 2005 Lippincott Williams & Wilkins

Health Protection/Preventative Health
Services
Health Protection Preventative Health
Services
Strategies dealing with Traditional medical
engineering the system efforts to
physical environment. 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

 Physical
 Psychological
 Social
 Emotional
 Spiritual
 Intellectual

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 health  Functional status in

 Status self-care and home-
 Social support management
systems activities
 Role and social  Work
functioning  Community
 Leisure activities

Copyright 2005 Lippincott Williams & Wilkins

 Perceptual Measurement Tools
Instrument Perceptual Construct
 SF-36  General health perceptions
 Satisfaction w/life scale  Life satisfaction
 Perceived wellness  Perceived wellness
survey  General well-being
 NCHS general well-being  Morale
schedule  Happiness
 Philadelphia Geriatric
Center morale scale
 Memorial University of
Newfoundland scale of
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 scale
 Perceived wellness survey
 NHCS 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.
Copyright 2005 Lippincott Williams & Wilkins