Week 1 Flashcards
What is the average percentage of Americans that don’t get the recommended daily activity?
80%
Define health, wellness, health literacy, and health promotion
Health: a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.
Wellness: a state of being that incorporates all facets and dimensions of human existence, including physical health, emotional health, spirituality, and social connectivity. (Active process)
Health literacy: The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.
Health promotion: Any effort taken to allow an individual, group, or community to achieve awareness of - and empowerment to pursue - prevention and wellness.
Define public health, health-related quality of life, and well-being
Public health: The practice of preventing disease and promoting good health by providing the resources and creating environments that help people stay healthy.
Health related quality of life: a broad multidimensional concept that usually includes self-reported measures of physical and mental health.
Well being: a positive outcome that is meaningful for people and for many sectors of society, because it tells us that people perceive that their lives are going well.
Define social determinants of health
SDOH:
“Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies, racism, climate change, and political systems.” - CDC
Big picture, these are the personal factors which can impact a person’s health: money, food, safety, friend circles, healthcare system, etc.
Example: a person wants to become fitter. They work two jobs and can barely pay rent. They do not have spare money for a gym and live in low-income housing which has a high crime rate. This individual, while wanting to improve, will be limited by their economic and environmental needs so their “basic needs” need to be met prior to them being able to learn and progress in their health.
Are cancer cases related to obesity and sedentary lifestyles?
about 25% of cancer cases are related to obesity and sedentary lifestyles
Studies are starting to examine and find correlation with improving mobility to decrease the risk of developing cancer.
How relevant are chronic, non communicable diseases?
Disease like cardiovascular disease, cancers, chronic respiratory diseases, and diabetes account for 7 out of the 10 leading causes of death in the United States each year.
According to the CDC (Center for Disease Control and Prevention), chronic diseases account for about 2/3 of deaths globally.
Identify risky behaviors that are associated with chronic conditions
Risky behaviors:
* Tobacco use and second-hand smoke
* Physical inactivity and lack of regular exercise
* Poor diet and nutrition
* Excessive alcohol use
* 1 drink per day for women, 2 drinks per day for men
Associated chronic conditions:
* Hypertension
* Stroke
* Obesity
* Diabetes
* Cardiovascular Disease
What is the prevalence of chronic conditions in the U.S.?
- About 78 million Americans are at increased risk for heart disease, diabetes, and cancer as a result of obesity alone.
- In 2013, 76% of adults had at least one chronic condition, 19% had 2-3 chronic conditions, and 4% had 4 or more chronic conditions.
The United States spends about twice as much on healthcare than other industrialized nations, yet our life expectancy ranks 24 out of 30 industrialized nations.
There is a big disconnect here between how much and where the money is spent versus expected
outcomes
Can an individual be health solely based on looking “skinny”?
Just because a person is “skinny” or looks fit, participating in the listed Risky Behaviors regularly can make you unhealthy.
What can we do as PTs to help create this more healthy society?
tailor health promotion and prevention interventions to meet the readiness of the patient.
include risk assessments as a part of our overall plan of care. This does not all have to be done on the very first visit. It can be interspersed throughout our plan of care with the patients.
Describe primordial, primary, secondary, and tertiary levels of prevention
Primordial: preventing conditions before birth
Ex: reducing poverty, education
Primary:
Activities such as health promotion designed to prevent disease in an at-risk population. (No disease onset)
Ex: nutritious eating for Type Il diabetes prevention in children.
Secondary:
Early diagnosis and reduction of the severity or duration of existing disease and sequalae.
Ex: self-testing instructions for the early detection of breast cancer.
Tertiary:
Use of rehabilitation to reduce the degree or limit the progression of existing disability and improve multiple aspects of function in persons with chronic, irreversible health conditions.
Ex: exercise classes hosted by the Houston Area Parkinson’s Society.
What are the high risk and population prevention approaches?
(Best treatment is a combo. Ex: for cardiovascular disease. Medication and exercise. As well as limiting smoking and unhealthy diets)
1) High risk:
Ex: X-ray, Rabies Vaccination
Advantages:
tailored, motivation high, cost-effective,
favourable benefit-risk
Disadvantages:
hard to identify underlying cause not addressed
more cases from people at lower risk
harder to do
2) population:
Ex: seatbelts
Advantages:
large overall effect could address root cause
behaviorally appropriate promotes health equity
Disadvantages:
requires multi-agency action benefit to individual small
low motivation
benefit may be outweighed even by a small risk
List the domains of wellness
- Social: Interacting and contributing to one’s community or environment.
- Occupational: “Personal satisfaction and enrichment in one’s life through work.”
- Spiritual: Finding and living a life that has meaning and purpose.
- Physical: Making appropriate nutritional choices and participating in regular physical activity.
- Intellectual: Actively using your mind to develop new skills and learn new information.
- Emotional: Accepting and managing our feelings in all personal interactions.
- Psychological: A general perception that one will experience positive outcomes to the events and circumstances of life.
- Medical: Partnering with your health-care provider to manage your medical care
- Nutrition: Making smart food choices and developing healthy eating habits.
How can a PT transform society?
Be the best PT you can be
Educate and Empower patients to achieve their goals
Influence public policy
Identify community resources for patients
Advocate for reduction in healthcare disparities
Identify risk factors and interventions to reduce risk in individuals and communities
Prevent or slow progression of functional decline and disability and enhance activity with a diagnosed condition
Reduce disability by restoring skills and independence in those with chronic conditions
Are people with higher levels of education more likely to live longer?
Yes
Healthy People 2030 focuses on providing high-quality educational opportunities for children and adolescents and on helping them do well in school.
Children from low-income families, children with disabilities, and children who routinely experience forms of social discrimination, like bullying, are more likely to struggle with math and reading. They are also less likely to graduate from high school or go to college. This means they are less likely to get safe, high-paying jobs and more likely to have health problems like heart disease, diabetes, and depression.
In addition, some children live in places with poorly performing schools, and many families can not afford to send their children to college. The stress of living in poverty can also affect children’s brain development, making it harder for them to do well in school. Interventions to help children and adolescents do well in school and help families pay for college can have long-term health benefits.
How many Americans have health insurance? What are the effects of that?
Many people in the United States do not get the health care services they need. Healthy People 2030 focuses on improving health by helping people get timely, high-quality health care services.
About 1 in 10 people in the United States do not have health insurance. People without insurance are less likely to have a primary care provider, and they may not be able to afford the health care services and medications they need. Strategies to increase insurance coverage rates are critical for making sure more people get important health care services, like preventive care and treatment for chronic illnesses.
Sometimes people do not get recommended health care services, like cancer screenings, because they do not have a primary care provider. Other times, it is because they live too far away from health care providers who offer them. Interventions to increase access to health care professionals and improve communication, in person or remotely, can help more people get the care they need.
Does the neighborhood one lives in impact their health and well being?
Yes
Many people in the United States live in neighborhoods with high rates of violence, unsafe air or water, and other health and safety risks. Racial/ethnic minorities and people with low incomes are more likely to live in places with these risks. In addition, some people are exposed to things at work that can harm their health, like secondhand smoke or loud noises.
Interventions and policy changes at the local, state, and federal level can help reduce these health and safety risks and promote health. For example, providing opportunities for people to walk and bike in their communities, like by adding sidewalks and bike lanes, can increase safety and help improve health and quality of life.
How can social and community interactions impact an individual’s health and well being?
Many people face challenges and dangers they cannot control, like unsafe neighborhoods, discrimination, or trouble affording the things they need. This can have a negative impact on health and safety throughout life.
Positive relationships at home, at work, and in the community can help reduce these negative impacts. But some people, like children whose parents are in jail and adolescents who are bullied, often do not get support from loved ones or others. Interventions to help people get the social and community support they need are critical for improving health and well being
How does economic stability affect health and well being?
In the United States, 1 in 10 people live in poverty, and many people cannot afford things like healthy foods, health care, and housing. Healthy People 2030 focuses on helping more people achieve economic stability.
People with steady employment are less likely to live in poverty and more likely to be healthy, but many people have trouble finding and keeping a job. People with disabilities, injuries, or conditions like arthritis may be especially limited in their ability to work. In addition, many people with steady work still do not earn enough to afford the things they need to stay healthy.
Employment programs, career counseling, and high-quality child care opportunities can help more people find and keep jobs. In addition, policies to help people pay for food, housing, health care, and education can reduce poverty and improve health and well-being.
List states of wellness (church health model)
Faith life
Medical
Movement
Work
Emotional
Nutrition
Friends and family
How is a pre participation screening of physical activity implemented?
Before implementing an activity, you want to ensure a participant’s safety with the activity. This could be from anything such as preventing further musculoskeletal damage, preventing heart/lung issues, etc.
Some questions you may want to ask include the following:
1. Have you ever been diagnosed with a heart condition?
2. Have you ever been advised that you should only do physical activity under the direction of a physician?
3. Do you experience chest pain when you do physical activity?
4. Have you been diagnosed with arthritis or osteoporosis or have you experienced increased pain in your joints when physically active?
5. Are you taking prescription for blood pressure or a heart condition
There are also tests that you can use, such as the Functional Movement Screen (FMS) or Selective Functional Movement Assessment (SFMA).
What is a crucial aspect that needs to be identified in pre activity screening?
Risk factors
Be sure to identify risk factors, such as those for Coronary Artery Disease (CAD) and osteoporosis. If risk factors for serious conditions like CAD are identified, refer the participant back to their medical provider before initiating the intervention. This is for the participant’s safety. If risk factors are minimal, monitor and progress the activities within established guidelines.
Define and list the domains of the social determinants of health
“Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”
1) education access and quality
2) healthcare access and quality
3) economic stability
4) neighborhood and built environment
5) social and community context
Describe the social cognitive theory
The individual must believe that they can change a particular behavior, and that making these changes will have positive outcomes that outweigh the negative outcomes. This individual will rely on modeling and coaching, and they need to have feedback on their performance to achieve the final outcome. The individual must have the correct knowledge and appropriate expectations to achieve their end-goals. For example, they would need to know that they cannot run a marathon after just 1 week of training. A big component of the Social Cognitive Theory is self-efficacy, with research supporting that positive self-efficacy is key to successful health promotion interventions.
Determines of behavior:
1) cognitive factors (personal factors):
Knowledge
Outcome expectations
Attitudes
2) behavioral factors:
Skills
Practice
Self efficacy
3) environmental factors:
Social norms
Social support
Access in community
Influence on others (ability to change own environment)
Describe the health belief model
(6 constructs: Perceived Susceptibility, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy)
This is one of the most influential and widely used psychosocial approaches to explaining health-related behaviors. this model says that the likelihood of taking a preventative action is determined by the perceived benefits minus the perceived barriers. There are modifying factors that can support either the perceived benefits or the perceived barriers, such as cues to action. These can be things like a promotional sale of healthy food services, reminder cards from a health care provider to come in for a check-up.
Health belief model - define: Perceived
Susceptibility, Perceived Severity, Perceived Benefits, Perceived Barriers, Cues to Action, Self-efficacy
Perceived Susceptibility: the subjective assessment of risk of developing a health problem. In other words, how much does the person believe they are going to develop a certain condition. This can be things like obesity, diabetes, skin cancer, arthritis, etc.
If a person believes that they are highly susceptible to developing a condition, then they are more likely to take steps to make a change.
Perceived Severity: the subjective assessment of the severity of a health problem and its potential consequences. In other words, if they really get the condition, how bad would it be
For example, if a person believes that skin cancer can just be scraped off, they may not perceive the severity of the condition as being a problem. They would be less likely to make changes.
Perceived Benefits: an individual’s assessment of the value or efficacy of engaging in a health-promoting behavior to decrease risk of disease. In other words, if a person believes that an action will either prevent/delay the susceptibility of a condition and/or decrease the seriousness, then they will be more likely to make a change.
Perceived Barriers: an individual’s assessment of the obstacles to behavior change. If the perceived barriers outweigh the perceived benefits, the action is not likely to happen. For example, a person can believe that there is benefit to physical activity in preventing diabetes, but if there is no affordable gym, no good sidewalks or parks available, and/or perceived danger in using the resources, then implementing physical activity is not likely to happen.
It can also be beliefs. For example, how many people have been told they have “a bad back and can’t lift anything.”
Cues to Action: internal or external variables that can either help the perceived benefit or perceived barriers to taking action. Cues to action that can help the perceived benefit include regular phone calls from providers checking in on people. Cues to action that are internal include how the patient perceives pain or symptoms. For example, pain with exercising may deter a patient from continuing a physical activity program to prevent osteoporosis.
Self-efficacy: an individual’s perception of his or her competence to successfully perform a behavior.
This is also a part of the affective learning domain, or the domain that relates to the value of what you learn. If you believe that you can be successful with a task, you are much more likely to be successful with the task.
Describe the transtheoretical model
(5 stages: pre contemplation, contemplation, preparation, action, maintenance)
It meets patients where they are. It meets the participant with their level of readiness to make the change. Being able to identify where the patient is helps you as a PT tailor your feedback, activities, and education to what the patient is ready to hear.
Describe the stages of the transtheoretical theory
pre contemplation: There is no intention of making any change within the next 6 months.
In this phase, providing education and letting the patient know that you are available and willing to help if they change their mind later. There are often deeper variables and barriers that significantly outweigh the perceived benefit. You may want to identify some of these barriers as the patient is willing to talk about it.
contemplation: The participant intends to make changes within the next 6 months.
In this stage, continue the education, and help the patient reduce perceived barriers. Help the patient recognize perceived benefits and improve self-efficacy.
preparation: The patient has befun to take steps toward making the desired change in behavior and plans to make the change within the next 30 days.
This is the time to really focus your efforts on helping reduce perceived barriers and highlight perceived benefits. Help the patient with logistics, and work with the patient to improve self efficacy. Help them cross the barrier quickly into action.
action: The participant has changed their behavior for less than 6 months.
Keep reminding the patient of perceived benefits. Encourage, support, and continue cues for action. Be open to talking about challenges, and work with your patient through these challenges.
maintenance: The journey is not over. The patient has changed their behavior for more than 6 months, but they are continuing on this track.
Cues for action, check-ins, and motivation to keep the progress are necessary in this stage.
What are the physical activity recommendations?
1) Children and adolescents (6-18 years old) should participate in at least 60 minutes of moderate to vigorous physical activity daily.
* At least 3 days per week, the activity level should be vigorous.
* Both bone and muscle strengthening activities should be included in daily activity at least 3
days per week.
* Activities should be both age appropriate and fun.
2) Adults should participate in moderate intensity physical activity for at least 150 minutes/week OR vigorous intensity for 75 minutes/week.
* Episodes of at least 10 minutes count toward daily totals.
* Muscle strengthening activities should be included at least 2 days/week.
3) older adults (65+)
* Participate in moderate intensity physical activity for a minimum of 150 min/week OR 75
min/week of vigorous-intensity activities.
* Include balance exercises to reduce fall risk.
* Episodes of at least 10 minutes count towards daily goals.
* Muscle strengthening should be included at least 2 days/week.
4) adults with disabilities
Follow the adult guidelines as you are able. If you are not able to meet the guidelines, you should:
* Engage in regular physical activity according to your abilities and avoid inactivity.
* Consult with health-care provider for an individualized program appropriate for your abilities.
How prevalent are disabilities?
People with disabilities encompass about 26% of the United States Population and about 15% worldwide.
people with disabilities are 2x more likely to find healthcare providers with inadequate skills and facilities, 3x more likely to be denied health care, and 4x more likely to be treated poorly in the healthcare system.
Individuals with disabilities experience greater health disparities than those without disabilities. Adults with disabilities or chronic conditions receive fewer preventative services and have a more poor health status than those without disabilities with the same condition. They are at higher risk of developing secondary conditions, including obesity, HTN, cardiac disease, stroke, diabetes, arthritis, depression, etc. They are more likely to engage in unhealthy behaviors like smoking, poor diet, and inadequate physical activity.
What are some good options to increase fitness adherence for proper with disabilities?
tools like implementing a buddy system with a friend or care giver, incorporating an exercise log. and using a reward system.
Also, be mindful that there needs to be variability in the program to account for different presentations of the disability, presence of comorbidities, and personal and environmental barriers to participation.
List the required steps needed to implement a successful idea
1) identify a need:
* Identify the intended audience
* Children
* Adults
* Older adults
* Industry-business
* School system
* Community
* Specific population
2) set goals and objectives:
* Identify the purpose of the program
* Identify the goals to be achieved
* Screening
* Education
* Exercise program
* Identify the objectives of the program
3) develop the intervention:
* Screenings: Identify valid and reliable right tools to use for the screening
* Education: Develop the program including handouts for participants
* Exercise: Develop the plan for each class
* Logistics
* Location, parking, access to facility
* Time and length of program
* Space for numbers
* Who will run program
* Presentation/hand outs
* Budget
4) implement the intervention:
* Recognize that even with the best of plans, it is important to be adaptable and prepare for the unexpected.
5) evaluate the results:
* Based on the interventions used, tailor the assessment tools.
* Ask participants, caregivers, family members to evaluate the program.
* Ask for feedback to improve program.
