Health Maintenance and Promotion

Health Maintenance

• Health maintenance is medical practice in the community
• Health maintenance pertains to prospective aspects of health promotion
• Health maintenance also involves disease prevention

Learning Outcomes

• Recognize and describe suitable health practices based on age group along with basic recommendations
• Define and differentiate between health promotion and disease prevention
• Identify different levels of prevention in medical practice
• Describe and define activities related to health maintenance

Definition of Health

• Health is a state of complete physical, mental and social well-being
• Health is not merely the absence of disease or infirmity

Health Promotion

• Ref Ottawa Charter for Health Promotion (1986)
• Health promotion consists of providing the necessary means to improve population health and increase control
• Physical, economic, social, cultural, and environmental factors are determinants of health

Ottawa Charter Key Actions for Health Promotion

• Advocate for health
• Enable people to achieve their health potential
• Mediate between differing interests for health

Ottawa Charter Key Application Areas for Health Promotion

• Develop healthy public policy
• Create supportive environments
• Strengthen community action
• Develop personal skills
• Reorient health services

Five areas for health promotion

• Healthy public policy creation
• Favorable environments creation
• Increase community action
• Personal skills development
• Health service reorientation

Strategies for health promotion

• Fortify key healthy environments
• Facilitate community participation and empowerment, and civil society engagement
• Strengthen governance and intersectional work to improve health and well-being
• Resolve social determinants of health

Disease Prevention

• Disease prevention pertains to preparing and arranging in advance to avoid risk
• Disease prevention, according to the WHO 1998, involves measures to prevent disease onset
• Disease prevention reduces risk factors, halts disease progression, and lessens consequences

Levels of Prevention

• Primary prevention focuses on absence of the disease
• Secondary prevention focuses on biological manifestation
• Tertiary prevention focuses on clinical manifestation

Types of Prevention

• The description below refers to the Leavell and Clark Model

Primary Prevention

• Aims to prevent disease onset or decrease probability
• Activities to promote health
• Is completed during the prepathogenic phase

Secondary Prevention

• Halts disease progression
• Occurs during the pre-clinical (risk factors) and pathogenic period
• Is applied with review activities

Tertiary Prevention

• Manages treatment and rehabilitation of established diseases
• Slows progression, appearance, or worsening complications
• Is the results phase

Quaternary Prevention

• Designed to alleviate or prevent consequences of unnecessary or excessive interventions in the healthcare system

Primordial Prevention

• Targets the entire population through a focus on social and environmental conditions
• Implemented through laws and national policies
• Occurs during the prepathogenic period

Maintenance Activities

Screening

• Screening detects potential conditions or diseases in asymptomatic individuals

Screening Types

• Interview based
• Physical exam
• Lab tests
• Diagnostic imaging
• Diagnostic procedures

Considerations for Preventable Diseases

• Application of FRAME and CARLSON criteria
• Characteristics of nosological entities
• Attributes of screening tests

Criteria for Screening test for Health Problem - Disease

• High frequency and importance at community level (significant prevalence)
• Has a definitive effect on quality of life
• Recognizable natural history and presymptomatic phase
• Asymptomatic period during which early discovery and intervention reduces morbidity and mortality

Criteria for Diagnostic Test

• Must be sensitive, specific, and predictive
• Must be safe
• Must be applicable to anyone
• Must be economical (cost/benefit)
• Easy-to-administer, use readily available equipment, and human resources

Criteria for Program Application

• Most effective with early intervention
• Benefits outweigh risks
• Is readily available
• Accepted by patients and professionals

Immunoprophylaxis

• Utilizing artificial means to induce, enhance, or provide immune protection against disease
• Immunoprophylaxis can be active, using vaccines or toxoids
• It can also be passive, using immunoglobulins

Chemoprophylaxis

• Administering medications or biologics to asymptomatic individuals to lower the risk of developing a disease

Counseling

• Counseling includes imparting information, advice, and support for healthy lifestyle and behaviors

BATHE Technique

• The BATHE technique includes background/context, , affect, troubles, handling, and empathy

Motivational interviewing involves

• Resisting the urge to correct
• understanding patient values
• Listening attentively
• Encouraging and emphasizing patient’s choices

Egan's Model

• The patient's perspective is explored and the problem is clarified
• The therapist helps to develop an effective understanding of the situation
• The therapist provides encouragement and support for necessary actions
• Facilitating actions are developed to achieve the set objectives

Transtheoretical Model

• In precontemplation, patients are unaware of having a problem
• During contemplation, patients recognize their at-risk behaviors and are willing to make changes within six months
• Preparation involves planning to modify conduct within 30 days
• Action reflects actively improving behavior and healthy lifestyle
• Maintenance consists adoption of acquired behaviors and tolerating the occasional setback

5 A's Nutritional Counseling

• Ask: Start by asking permission
• Assess the patient through compassion and empathy
• Assess: Evaluate patient history, goals, and obesity level
• Advise: Give advice and create a plan with the doctor
• Assist: Give education and resources
• Agree: Plan personalized and sustainable goals