FAMILY WELLNESS

PROGRAM
Marijen B. Uy, MD
History

2
Why is family
important?

3
Functions of
Families

4
Family as a
Unit of Care

5
Areas of
Family
Participation
in Prevention
6
Family Wellness
and Health
Consciousness
Program
7
Family
Wellness
Plan

8
Learning Objectives
• Familiarize the role of the
1 family in the health of
every member
• Explore the prevention
2 programs for families

• Formulate a family
3 wellness plan

9
HISTORY

10
GOOD HEALTH
World Health Organization (WHO):
A state of dynamic harmony between the BODY, MIND
and SPIRIT of a person and the SOCIAL and CULTURAL
influences which made up his or her environment

11
WELLNESS
• Maintaining the different components of
health in sufficient amount and in balance
with one another

Health promotion not only

Disease prevention

12
Vision of PAFP
• Promotion of optimum family health and
quality care

Family Health Development

and Advocacy through
Primary Health care initially
funded by UNICEF

13
1990s
PAFP: required accredited departments to
maintain as
and a which
will look into all levels of prevention

1994 Department of Health (DOH): declared

that all hospitals as
Preventive nephrology
Preventive cardiology
Health promotion in the workplace

14
14th WONCA World Conference
HongKong, June 1995

We must develop new methods for the

prevention and early detection of diseases.
-Dr. Robert Rakel

1995: WHO emphasized the

importance of promoting healthy
lifestyle and health education

15
Why is family
important?

16
Why is family important?

The family as a social group is universal and

persistent, even in the midst of continuing
changes, stresses and development.

17
Why is family important?
• The first social group to whom the
individual is exposed to
• The individual’s longest and earliest
experience takes place in the family setting

18
Why is family important?

The family is a very

close and intimate
group, in which the
most meaningful
relationship may grow.

19
Why is family important?
The family serves as link between the individual
and the larger society.

20
Functions of
Families

21
Functions of Families

1. REPRODUCTION
 stable satisfaction of sex
needs
 Procreation and rearing
of children

22
Functions of Families
2. BIOLOGIC MAINTENANCE
 Food, clothing, shelter and other basic needs
are provided by the family.

INCOME = NEEDS

23
Functions of Families
3. SOCIALIZATION
“Man is not born human but made man”
• A newborn baby became a human being
after they are socialized
• Personality is developed
• Learns what is right and wrong, good or bad
• Acquire good character

24
Functions of Families
3. SOCIALIZATION
 It is a lifelong process through which an
individual acquires the accepted
 Behavior of his group and society
 Norms
 Values
 Morals

25
Functions of Families

4. STATUS PLACEMENT
 It is the agent of stratification, transmitting
status and prestige and… even shame.

26
Family Social Class Patterns*
• Upper class (A)
• Middle class (B)
• Lower class (C-D)

27
Family Social Class Patterns
• Middle class (B)
– Believes in hard-work, initiative
– Independent, responsible
– Economic security
– Self-improvement through education and schooling

28
Family Social Class Patterns
• Lower class (C-D)
– Sees life as continuous struggle for survival
– Resigned to a life of frustration and defeat

29
Family Social Class Patterns
• Upper class (A)
– Much more closely knit
– Greater concern for maintaining family name and
prestige

30
Functions of Families
5. WELFARE AND PROTECTION
 It provides physical and psychological
protection and support
 It is the center of
 Love
 Affection
 Intimacy
 Companionship

31
Functions of Families
6. EDUCATIONAL
 Teach letters,
knowledge, skill and
trade secret to family
members
 Primary education to
mold career and
character

32
Functions of Families

6. EDUCATIONAL
 Informal
education
 Discipline
 Obedience
 Manners

33
Functions of Families
7. RELIGION
 source of basic
religious precepts
and teachings and
setting of religious
practice
 Rites
 Rituals
 practices

34
Functions of Families
8. ECONOMICS
 Ancient times: food,
clothing and housing
 Now: purchasing,
protecting and
maintaining property
 Equal distribution of
property among
members

35
Functions of Families
9. CITIZENSHIP AND POLITICAL BEHAVIOR
 child’s values on rules, laws and government
are developed and enhanced

36
Areas of
Family
Participation
in Prevention
37
 Family’s Function in Prevention

Tertiary
Prevention
Family Participation

Secondary
Prevention

Primary
Prevention

Levels of Prevention

38
PRIMARY PREVENTION

Occurrence of any clinical manifestations of

diseases is prevented through health
promotion and specific diseases prevention
39
SECONDARY PREVENTION
Implies early
intervention to detect
and treat
asymptomatic disease

The family decides

where, when, and to
whom to bring a sick
member

40
TERTIARY PREVENTION
Consists of intervention in the setting of
established disease to avoid complications
and disability and to assist in rehabilitation

41
PRIMARY PREVENTION
• The family shares a common lifestyle
• Health maintenance: screening activities and
immunization
Lectures on Rabies Prevention; Dengue Fever

Advise Immunization: Yearly Flu shots, Anti-

rabies, HPV vaccination, JE vaccination

Breast Self-examination; Mammograms

43
PRIMARY PREVENTION
• Family life education: sexuality, marriage,
prenatal care, problems of the aged, personal
hygiene or sanitation, health risk behavior and
disease prevention
Sex education for the adolescents

Pre-natal care and Child rearing programs for

the newly weds

PRIME-MD test for the elderly to assess

for mental disorders
44
SECONDARY PREVENTION
Implies early detection and prompt treatment of
disease in order to prevent complications

Diabetic and Hypertensive: monitor blood

sugar, lipid profile, creatinine (kidney
function), SGPT/SGOT (liver function)

Medical Health Workers: testing for HBV and HIV

Commercial Sex Workers: testing for HIV, STDs and cervical CA

45
SECONDARY PREVENTION
• Health is a shared responsibility between a
doctor, his patients and their family
• Encouraging sick members to seek appropriate
help
• Compliance monitoring regarding specific
management by the family

46
TERTIARY PREVENTION
• Balanced support between compliance
monitoring and appropriate independent activity
of members with chronic illness
• Adjustment of all members to changes
necessitated by chronic illness

Cerebral palsy in a child: Enrol in SPED and

Occupational Therapy sessions

Post-Stroke (CVA): Physical therapy and

rehabilitation sessions
47
TERTIARY PREVENTION
• Preventing further disability and providing
access to rehabilitation services
• Coping with crisis created by serious illness or
by dying family members

Terminally ill patients: Hospice care

Senior Citizens: form groups to provide activities

for socialization and physical activities

Terminally ill patients: counseling for the patient

and the family
48
Family as a
Unit of Care

49
FAMILY

• Plays a very vital role in society

– Basic unit of society
– Basic unit of care

50
FAMILY
Can be the cause of illness of problem

Can provide the solution to problems

Can be the key to prevention of illness

51
Family as a Unit of Care
1. The patient’s problem is the family’s problem.
Family is the social context for health care.

2. Therapeutic triad: The family is the greatest ally

in the patient’s treatment. Doctor’s and patient’s
families are present in most patient’s interview

52
The patient’s problem is the family’s problem

Patient Problem Family

Family is the social context for health care.

Family as a Unit of Care
1. The patient’s problem is the family’s problem.
Family is the social context for health care.

The effect of illness affects

not only the patient, but
also the family

• Reviewing the impact of illness show that from the

onset of illness up to to reaction to permanency of
outcome

54
 HEALTH

REACTION
ONSET TO
DIAGNOSIS

FAMILY
ADJUSTMENT MAJOR
TO PERMANANCY THERAPEUTIC
OF OUTCOME EFFORT

EARLY
ADJUSTMENT
TO OUTCOME

SYSTEM

55
Family Illness Trajectory
Stage 1 Onset of • Period from the time the
symptoms/ illness patient demonstrates
Stage 2 Impact phase – reaction physical symptoms to the
to diagnosis period consultation is
Stage 3 Major therapeutic sought
efforts
• Health beliefs and previous
Stage 4 Recovery phase – experiences help shape
adjustment to outcome
what patients and their
families do and how soon
they seek consult.

56
Family Illness Trajectory

Stage 1 Onset of symptoms/ • Where initial contact with

illness physician is established
Stage 2 Impact phase –
reaction to
• Diagnosis of curable
diagnosis diseases  acceptance
Stage 3 Major therapeutic and immediate movement
efforts to 3rd stage
Stage 4 Recovery phase – • Reaction to debilitating or
adjustment to outcome
terminal illness: denial,
anger, bargaining,
depression and acceptance

57
Family Illness Trajectory

Stage 1 Onset of symptoms/

illness • Period of great
Stage 2 Impact phase – reaction mobilization
to diagnosis – Family pursues avenues
Stage 3 Major therapeutic for treatment or
efforts palliation
Stage 4 Recovery phase – – Good support system
adjustment to outcome – A wealth of resources

58
Family Illness Trajectory

Stage 1 Onset of symptoms/ • Marked by the disappearance

illness of symptoms for acute, self-
Stage 2 Impact phase – limiting illness or returning to
reaction to diagnosis home environment and some
Stage 3 Major therapeutic degree of functionality for
efforts chronic illnesses
Stage 4 Recovery phase – • No problems anticipated if
adjustment to
full recovery without
outcome
incapacity is expected
• Crisis: partial recovery,
permanent disability or death

59
Family as a Unit of Care
1. The patient’s problem is the family’s problem.
Family is the social context for health care.

• Transmission of infectious diseases

• Hereditary diseases: genetic disposition
• Psychosocial stresses  physical symptoms
• Source of social and emotional support
• Help in health decisions

60
 Family as a Unit of Care
1. The patient’s problem is the family’s
problem.
• Medical crisis: disruption of responsibilities,
shifting of roles, disturbance in the
normative way of living
• To cope and stabilize equilibrium:
adjustments
• Financial, social and moral support
• Other family members step up to care for their
sick family member while others provide
financial assistance

61
Family as a Unit of Care
1. The patient’s problem is the family’s problem.

• Roles and rules: heads of families, authority

figures, go-betweens, financiers, coordinators
and facilitators

• Black, 2005: ROLE REORGANIZATION is a healthy

process that a family undergoes in response to
the illness or death of one of its members

62
 THERAPEUTIC
TRIAD
PHYSICIAN

PATIENT FAMILY
Family as a Unit of Care
2. Therapeutic triad: The family is the greatest ally
in the patient’s treatment. Doctor’s and patient’s
families are present in most patient’s interview

Since majority of consultations are

Out-patient basis (patients are sent home),

the management is carried out by the

family or the caregiver

64
Family as a Unit of Care
2. Therapeutic triad: The family is the greatest ally
in the patient’s treatment. Doctor’s and patient’s
families are present in most patient’s interview

• The family has influence of the patient’s

personality, values, beliefs and experiences
• Consider also the resources available to the
family
• Family-centered methods  better resources
allocation and greater patient/family satisfaction 
better health outcomes

65
Family as a Unit of Care
2. Therapeutic triad: The family is the greatest ally
in the patient’s treatment.
• Old perception: doctors are primary problem
solvers (traditional authoritarian approach)
• Fosters dependence
• Less problem-solving skills achieved by
families

66
Family Wellness
and Health
Consciousness
Program
67
OBJECTIVES STRATEGIES
1. For families to have • Brochures to be handed out
increased knowledge on with Self-administered
health issues questionnaires
• Home visits
• Training of family health
advocate
• Health education activities
in the community,
workplace and school

68
OBJECTIVES STRATEGIES
2. For very young children to • Immunization programs
have a good state of health • Nutrition programs
– Fully immunized
• Development monitoring
– Normal nutritional status
– Physical
– Breastfed
– Social
– Normal mental and physical
– mental
health development
– No existing intestinal • School health program
parasites • Control of parasitism
program

69
OBJECTIVES STRATEGIES
3. For adolescent children • Control of drug addiction
who are not involved in program
problems such as: • Sports program
– Drug addiction
• Sex education
– School truancy and
delinquency • Health risk assessment
– Premarital sex • School health program
• Out-of-school youth project

70
OBJECTIVES
4. For young growing families
of the reproductive age
group who have embraced
responsible parenthood,
thus practicing
– Family planning
– Maternity care
– Proper child care and rearing
practices
STRATEGIES
• Family planning
• Prenatal care
• Child rearing class
• Parenting seminars
• Nutrition program
71
OBJECTIVES
5. For all members of the
families have ceased to
indulge in health risk
behaviors such as:
– Smoking
– Drinking alcoholic beverages
– Eating fatty foods
– Gambling
– Drug addiction
– Has maintained good
environmental sanitation
STRATEGIES
• Health risk assessment
• Anti-smoking campaign
• Accident prevention
program
• Stroke and heart attack
prevention
• TB program
• Environmental protection at
household level
• Industrial health safety
72
OBJECTIVES STRATEGIES
6. For families practice to • Health education
anticipatory guidance thus • Family health monitoring
they come to the clinic • Health screen and health
regularly for health risk appraisal
maintenance

73
OBJECTIVES
7. During state of ill-health or
disease, families consult
their family physicians at
the earliest stage of illness
and have improved
compliance to
management
STRATEGIES
• Morbidity clinic
• Health education
• Family feud “contest”
• Hospice care
74
OBJECTIVES STRATEGIES
8. Members support each • Counseling program
other especially during ill-
health and rehabilitation

75
Family
Wellness
Plan

76
 HEALTH CARE CHILD 0-12 ADOLESCENT ADULT 22-60 ELDERLY
ISSUES YEARS 13-21 YEARS YEARS >61YEARS

BP Annual, Annual Annual

starting at 13
Cholesterol Annual at 40 Continue
Visual acuity/ VA at age 3-4 Annual for Continue
glaucoma for acuity & eye
amblyopia; pressure
done upto age Screen for
9, every 3 cataract at 40
years
Hearing Audiometric Once at high Depends on Audiometric
exam at age school work every year
3-4 yrs; once exposure
at grade
school

77
HEALTH CARE CHILD 0-12 ADOLESCENT ADULT 22-60 ELDERLY
ISSUES YEARS 13-21 YEARS YEARS >61YEARS

Breast Teach SBE at SBE starting at SBE and MD

examination age 9 age 12 exam
regularly after
age 35
Pap smear Annual after Continue
and pelvic age 40
exam
Rectal Annually after Continue
examination age 45 for
Colonic CA
and enlarged
prostate
Occult blood Annually after Continue
in stool age 50

78
 HEALTH CARE CHILD 0-12 ADOLESCENT ADULT 22-60 ELDERLY
ISSUES YEARS 13-21 YEARS YEARS >61YEARS

Fecalysis Annually for Continue Continue Continue

intestinal
parasites
Urinalysis Annual for Annual for Annual for Annual for
GUT disorder GUT disorder GUT disorder GUT disorder

PTB screening PPD/Direct PPD/Direct Annual CXR Annual CXR

BCG BCG
Annually Annually up
to age 16
CXR annually
from age 16
Periodic Annual Annual Annual Annual
physical exam

79
HEALTH CARE CHILD 0-12 ADOLESCENT ADULT 22-60 ELDERLY
ISSUES YEARS 13-21 YEARS YEARS >61YEARS

Assessment of Dental Dental Dental Continue

hygiene hygiene and hygiene and hygiene and
practices and monitoring monitoring monitoring
health Bathing Bathing Bathing
practices Nails Nails Nails
Lice Hand washing Hand washing
Hand washing Family Family
planning from planning up to
age 18 age 45 for
females and
up to 60 for
males
Immunization As scheduled dt dt dt
under EPI

80
HEALTH CARE CHILD 0-12 ADOLESCENT ADULT 22-60 ELDERLY
ISSUES YEARS 13-21 YEARS YEARS >61YEARS

Assessment of Accident Smoking Smoking Smoking

health risk exposure Alcohol Alcohol Alcohol
behavior Accident Accident Caffeine
Sex life Sex life Accident
Addiction Caffeine exposure
Nutrition/diet Occupational
hazard
Nutrition/diet

Medical Vitamin OTC for OTC for OTC for

supplements common common common
Meals ailments ailments ailments
Allergies Drug allergies HRT for Polypharmacy
females

81
HEALTH CARE CHILD 0-12 ADOLESCENT ADULT 22-60 ELDERLY
ISSUES YEARS 13-21 YEARS YEARS >61YEARS

Health Personal Personal Personal Proper

education hygiene hygiene hygiene medication
Sanitation Sanitation Sanitation use
issues issues issues Marital
Junk food Junk food Junk food relationship
Accident Accident Accident Family
prevention prevention prevention relationship
Sexual Sexual issues Sexual issues Retirement
development Health risks Health risks Overcoming
Father’s class loneliness
Mother’s class Life
Parent’s class enrichment
& child Diet
rearing Physical
Preparing for fitness
retirement Accident
prevention
82
 HEALTH CARE CHILD 0-12 ADOLESCENT ADULT 22-60 ELDERLY
ISSUES YEARS 13-21 YEARS YEARS >61YEARS

Physical Growth chart Growth chart Weight Weight

dev’tal & Nutrition & & Nutrition & Pre-
monitoring motor sexual menopausal
development development counseling
Mental Learning School Primary care Prime-MD
dev’tal disabilities teaching evaluation of
monitoring Language Mental
disorders
(Prime-MD)
Social dev’tal Emotional & Peer pressure Marital Marital
monitoring moral Sibling rivalry relationship relationship
development Parental rel Family Family
Lover & relationship relationship
courtship
Emotional &
mental
development
83
THANK YOU!

84