🔍 SECONDARY PREVENTION
📋 What is Secondary Prevention?
In secondary prevention, actions are taken to identify and treat an illness or injury early with the aim of stopping or reversing the problem. 🎯 In the case of someone who has developed an ulcer, for example, secondary prevention activities include:
- 😣 The person's symptom-based behavior of seeking medical care for abdominal pain
- 👨⚕️ The physician's prescribing medication and dietary changes
- 💊 The patient's sick-role behavior of following the doctor's prescriptions
🏥 Examples in Different Settings
Instances of secondary prevention for other health problems can be found in many different settings:
- 🦷 Examination of the mouth and jaw regions for early cancer detection during dental visits
- 🩺 Free blood pressure measurements at shopping malls 🛒
- 👁️ Assessments of children's vision and hearing at school 🏫
🔬 Physical Examinations and Medical Tests
Many physicians and adult patients practice secondary prevention through complete physical examinations each year. 📅 These checkups are costly in time ⏰ and money 💰—they consist of a medical history, examination of the body, assessment of vital signs (blood pressure, 🩺 heart rate, etc.), and a variety of X-ray 🩻 and laboratory tests. 🧪
Because not all of these tests have proven useful in preventing illness, medical experts now recommend getting specific tests, each with recommended schedules ranging from 1 to 5 years, depending on the person's age. ⏳
🎗️ Cancer Screening Recommendations
For instance, the American Cancer Society recommends that:
- 👩 Women should have mammograms (breast X-ray) 📸 annually after the age of 40, but less frequently at younger ages.
- 👴 All adults over the age of 50 should have a sigmoidoscopy (colon inspection) 🔬 every 5 years or so.
Individuals who are not healthy or are considered to be at high risk—for example, because of past illnesses, 🤒 family history, 👨👩👧👦 or hazardous work conditions ⚠️—should be examined more often.
✅ Effectiveness of Screenings
These medical examinations are recommended because they detect the disease earlier and save lives. 🛟 In the case of mammograms, their accuracy in detecting breast cancer increased dramatically in the 1970s, and women who follow the recommended schedules for examinations after age 50 reduce their mortality rates by 26% in follow-ups of 10 years or so after diagnosis. 📊
But a national survey found that only about 60% of American women over 40 years of age had had a mammogram in the prior 2 years, 📉 and the rate was especially low for poor and less educated women. 💔
Women whose family histories put them at relatively high risk of developing breast cancer do not have more mammograms than other women, unless their risk is explicitly described to them. 🗣️ Among elderly middle- and upper-middle-class women, the main reasons for not having mammograms are fears of pain 😣 and radiation. ☢️
🏥 TERTIARY PREVENTION
📖 What is Tertiary Prevention?
When a serious injury occurs or a disease progresses beyond the early stages, the condition often leads to lasting or irreversible damage. 💔 Tertiary prevention involves actions to contain or retard this damage, prevent disability or recurrence, and rehabilitate the patient. 🔄
💪 Examples of Tertiary Prevention
For patients with severe arthritis, for instance, tertiary prevention includes:
- 🏋️ Doing exercises for physical therapy
- 💊 Taking medication to control inflammation and pain 💢
In the treatment of incurable forms of cancer, 🎗️ the goal may be simply to keep the patient reasonably comfortable 🛏️ and the disease in remission as long as possible. ⏰ And people who suffer disabling injuries may undergo intensive long-term physical therapy 💪 to regain the use of their limbs or develop other means for independent functioning. ✅
⚠️ PROBLEMS IN PROMOTING WELLNESS
🔄 The Prevention System
The process of preventing illness and injury can be thought of as operating as a system, 🔗 in which the individual, his or her family, 👨👩👧👦 health professionals, 👨⚕️ and the community 🏘️ each play a role. According to health psychologist Craig Ewart (1991), many interrelated factors and problems can impair the effectiveness of each component in the system, and each component affects each other. ⚖️ Let's look at some of these factors, beginning with those within the individual. 🧠
🧠 Factors Within the Individual
People who consider ways to promote their own health often face an uphill battle with themselves. ⛰️ One problem is that many healthful behaviors are less pleasurable than their unhealthful alternatives, which may produce a state of conflict. ⚖️ Many people deal with this conflict by maintaining a balance in their lives, setting reasonable limits on the unhealthful behaviors they perform. ✅ But most people probably do not—they opt too frequently in favor of pleasure, 😊 sometimes vowing to change in the future: "I'll go on a diet next week," 📅 for example. On the other hand, some people become obsessed with illness prevention, sometimes doing more harm than good. 😰
Another problem is that adopting wellness lifestyles may require individuals to change longstanding behaviors that have become habitual and may involve addictions, 🚬 as in cigarette smoking. Habitual and addictive behaviors are very difficult to modify. 🔄
A third problem is that people who are currently healthy often have little immediate incentive to practice healthful behavior, particularly if the behavior is unappealing or inconvenient. 🤷 The desirable consequences of wellness behavior—such as being healthier and more fit 💪—are not immediate, and the undesirable consequences of not practicing health behavior—that is, developing a serious illness 🤒—may never materialize. Moreover, even when individuals know they have health problems, all too frequently they drop out of treatment or fail to follow some of the recommendations of their physician. 👨⚕️❌
🧩 Additional Individual Factors
Several other factors within the individual are also important:
- Cognitive resources 🧠—People need to have certain cognitive resources, such as the knowledge and skills, to know what health behaviors to adopt, to make plans for changing existing behavior, and to overcome obstacles to change, such as having little time ⏰ or no place for exercise. 🏃
- Self-efficacy 💪—Individuals need sufficient self-efficacy regarding their ability to carry out the change. Without self-efficacy, their motivation to change will be impaired. ⚠️
- Health status and medications 💊—Being sick 🤒 or taking certain drugs can affect people's moods and energy levels, 😴 which may affect their cognitive resources and motivation.
👥 Interpersonal Factors
Many social factors influence people's likelihood to adopt health behaviors. 🤝 These factors include whether they have friends or family who model the behaviors and receive social support and encouragement for trying to change their lifestyles. 💪 People living in a family system may encounter problems in their efforts to promote wellness. 👨👩👧👦 Some problems come about because the family is composed of individuals, each with his or her own motivations and habits. 🎯
⚠️ Family Conflicts
Suppose, for instance, that a member of a family wants to consume less cholesterol, 🥗 but no one else is willing to stop eating high-cholesterol foods, such as butter, 🧈 eggs, 🍳 and red meats. 🥩 Or suppose the person has begun exercising three times a week, 🏃 but this disrupts the daily routine of another family member. The interpersonal conflicts that circumstances like these can create in the family may undermine preventive efforts that the majority of family members support. 😔 Similar interpersonal conflicts can undermine prevention efforts among friends, 🤝 classmates at school or college, 🎓 and fellow employees at work. 💼
🏘️ Factors in the Community
People are more likely to adopt health behaviors if these behaviors are promoted or encouraged by community organizations, such as governmental agencies 🏛️ and the health care system. 🏥
👨⚕️ Challenges for Health Professionals
Health professionals face unique problems in trying to promote wellness:
- Information accuracy 📊—One problem is that their knowledge regarding their patients' health-related behavior comes mainly from the patients, whose reports may be distorted. 🤥
- Incomplete knowledge 📚—The knowledge professionals need to help people lead more healthful lives is incomplete—they need more information to know when and how to intervene to change unhealthful behaviors effectively. ❓
- Treatment vs. prevention focus 💊—The background of focusing on treatment by the medical profession still has its influence; medical practitioners have traditionally focused their attention on treating, rather than preventing, illness and injury. 🏥 But this focus has begun to change, and physicians are becoming increasingly interested in prevention. ✅
⚖️ Economic vs. Public Health Priorities
Among the most difficult problems communities face is trying to balance public health and economic priorities. 💰 For example, in some industries, workers are subjected to potentially unhealthful conditions, such as toxic substances, 🧪☠️ which may also pose a threat to the community as a whole. Suppose a company with these conditions exists in a town that depends heavily on that industry for jobs 💼 and tax revenue, 💵 and that the cost of reducing the potential for harm would force the company out of business. What should the community do? 🤔 Many dilemmas of this type exist in most societies throughout the world. 🌍
🧠 WHAT DETERMINES PEOPLE'S HEALTH-RELATED BEHAVIOR?
📚 Understanding the Complexity
The "average" person can describe healthful behaviors and generate a fairly complete list: 📝
- 🚭 "Don't smoke"
- 🍺❌ "Don't drink too much, and don't drive if you do get drunk"
- 🥗 "Eat balanced meals, and don't overeat"
- 🏃 "Get regular exercise"
- And so on... ✅
But practicing these acts is another matter. ⚠️ The factors that determine people's health-related behaviors are not simple and straightforward; instead, they are very complex. 🧩 In this section we examine these complex factors that affect health-related behavior.
🧬 Biological Factors in Health-Related Behavior
Several processes affect people's health habits; one such factor is heredity. 🧬 Genetic factors influence some health-related behaviors, and excessive alcohol use provides a good example. 🍺 Twin studies and adoption studies have confirmed that heredity plays a role in the development of alcoholism. 📊 However, the exact nature of this role and the relative degree to which genetic and psychosocial factors are involved are unknown. ❓
🧠 Psychological and Behavioral / Learning Factors
People also learn health-related behavior, particularly by way of operant conditioning, whereby behavior changes because of its consequences. 🔄 Three types of consequences are important:
⭐ 1. Reinforcement
When we do something that brings a pleasant, wanted, or satisfying consequence, the tendency to repeat that behavior is increased or reinforced. 📈
Positive Reinforcement: 🎁 A child who receives something she wants, such as Rs. 10, 💵 for brushing her teeth 🦷 at bedtime is more likely to brush again the following night. The Rs. 10 in this example is a positive reinforcer partly because it was wanted and partly because it was added to the situation. ➕
Negative Reinforcement: 💊 But reinforcement can also occur in a different way. Suppose you have a headache, 🤕 you take aspirin, and the headache goes away. In this case, your headache was unpleasant and your behavior of taking aspirin removed it from the situation. The headache is called a "negative" reinforcer because it was unwanted or unpleasant and it was taken away from the situation. ➖ In both cases of reinforcement, the end result is a desirable state of affairs from the person's point of view. ✅
🚫 2. Extinction
If the consequences that maintain a behavior are eliminated, the response tendency gradually weakens. 📉 The process or procedure of extinction exists only if no alternative maintaining stimuli (reinforcers) for the behavior have supplemented or taken the place of the original consequences. 🔄
⚠️ 3. Punishment
When we do something that brings an unpleasant consequence, the behavior tends to be suppressed. 📉 A child who gets a scolding 😠 from his parents for playing with matches 🔥 is less likely to repeat that behavior, especially if his parents might see him. The influence of punishment on future behavior depends on whether the person expects the behavior will lead to punishment again. ❓
Take, for example, people who injure themselves 🤕 (punishment) while jogging 🏃—those who think they could be injured again are less likely to resume jogging than those who do not. 🤔
👀 4. Learning by Observing (Modeling)
We have seen before that people can learn by observing the behavior of others—a process called modeling. 👥 In this kind of learning, the consequences the model receives affect the behavior of the observer. If a teenager sees people enjoying and receiving social attention for smoking cigarettes, 🚬😊 these people serve as powerful models and increase the likelihood that the teenager will begin smoking, too. But if models receive punishment for smoking, such as being avoided by classmates at school, 🏫 the teenager may be less likely to smoke. 🚭
In general, people are more likely to perform the behavior they observe if the model is:
- 👥 Similar to themselves (same sex, age, or race)
- ⭐ A high-status person (physically attractive individual, movie star, 🎬 or well-known athlete 🏆)
Advertisers of products such as beverages know these facts and use them in their commercials. 📺
🔄 5. Habituation
If a behavior becomes firmly established, it tends to be habitual, that is, the person often performs it automatically and without awareness. 🤖 For example, a man who smokes 🚬 and has a head cold 🤧 might be engaged in an activity and respond to the sight of an open pack of cigarettes by automatically reaching out, taking one, and starting to smoke without at all being aware of what he has done. Only when the irritation produced in his nose and throat by the smoke 'captures his attention' is he likely to disengage in smoking behavior. ⚠️
Behaviors that become habitual can be very difficult to change. 🔄 Because habitual behaviors are hard to change, people need to develop wellness behaviors as early as possible and eliminate unhealthful activities as soon as they appear. 👶✅
👨👩👧👦 The Role of Families
Families play a major role in children's learning of health-related behaviors. 🏡 Children observe, for example, the dietary, 🥗 exercise 🏃 and smoking habits 🚬 of other family members and often receive encouragement to behave in similar ways. Children who observe and receive encouragement for healthful behavior at home are more likely than others to develop good health habits. ✅💪