Wellness

The paper resents some of the accepted interpretations of wellness and defines "context" preparatory to an exploration of wellness. Secondly, it discusses a cultural shift in our society that brings forth the possibility of wellness as a context for living. Finally, it provides some thoughts about the potential for occupational therapy in the area of wellness and its implications for our practice.     

The Indian Family Wellness Project: An Application of the Tribal Participatory Research Model

This paper describes a family-centered prevention intervention for preschool-aged children—the Indian Family Wellness (IFW) project. The development, implementation, and evaluation of IFW has been based upon a tribal participatory research model, an approach that emphasizes full participation of tribes and tribal members in all phases of the research process and incorporates cultural and historical factors vital to strengthening American Indian and Alaska Native families. We present four mechanisms of tribal participatory research, describe how they have been applied in the IFW project, and consider the implications of this work for the field of family-centered prevention research.     

Wellness Programmes

The evidence suggests that there are benefits associated with wellness programmes but there are methodological limitations with the current state of studies which prohibit strong conclusions in favour of wellness programmes. Concepts of ‘holistic health’ and ‘traditional’ or ‘alternative health’ care have emerged in the past decade as challenges to conventional medical therapies. Wellness programmes may emerge as adjunctive or complementary modalities in primary care, both for the management of chronic illnesses and for the prevention of debilitating diseases. Although the scientific evidence in the form of randomised controlled trials is not conclusive, there is no doubt that a wide spectrum of ‘wellness’ activities are popular and attracting increased public interest. Further knowledge and understanding of wellness programmes, either as a whole or in their multitude of interventions, is important for primary-care physicians as these programmes may address many psychosocial and spiritual issues in patient care.     

Wellness:

The American health care system has gone through various stages of development over the past decades. The stages range from a physician dominated medical model to the currently emerging Wellness era in which alternative delivery systems are being designed. These changes in the direction of health care are designed to reduce health care costs and also to promote healthier life styles. Wellness, however, is not a new concept. Occupational therapy has espoused and practiced its principles since its inception as a profession over seventy years ago. This paper looks at the historical development of the health care system and relates the growth of the wellness movement to occupational therapy practice. It suggests that the profession was a forerunner to current wellness activity. Finally, it explores research projects and the creation of occupational therapy positions and curricular alterations to meet the needs of the current wellness movement.     

Wellness activities address inequities

The medical model is no longer accepted by many as the best means of achieving optimal health. Financial constraints are pushing more efficient and effective ways to deliver services. In Saskatchewan, greater emphasis is being placed on wellness activities (preventive medical counselling, clinical work with other professionals, training, teaching and research and institutional medical administrative duties). We sought to determine if predicted support for these activities was related to equity of income as perceived by physicians. The study design was a cross-sectional study of all 1462 physicians actively practising in Saskatchewan during 1991/1992. The data were originally collected by Lepnurm and Henderson during the summer of 1992. ANOVA tests were conducted between predicted support for wellness activities and income equity to determine if there were significant interactions. Predicted support for wellness activities was measured by four items: preventive medicine counselling activities during office visits, clinical work with other health professionals, teaching and research, and, institutional medical administrative duties. The first income equity construct was based on: satisfaction with income, fairness of fee-for-service between general practitioners and specialists, fairness of fee-for-service between cognitive and procedural/technical specialists, and the current method of payment reflected factors important to physicians. To increase sample size a second equity construct was created by dropping fairness of fee-for-service between cognitive and procedural/technical specialists. The main effect and significant interactions with control variables were subjected to further analysis using Tukey's test. Significant relationships were found between changes in wellness activities under fee-for-service and income equity (p = 0.001 and p = 0.033) and between changes in wellness activities under salary and income equity (p = 0.002 and p = 0.037). No significant relationships (p = 0.858 and p = 0.610) were found between support for wellness activities under capitation and income equity. The findings of this study demonstrate a relationships between perceived equity of income and predicted support for wellness activities. The authors suggest that these findings were not merely a reflection of the desire by physicians to modify their tasks to accommodate perceived inequity associated with their method of remuneration. Physicians were given the option of considering which method of payment (fee-for-service, salary or capitation) best reflected factors important to them. We suggest that many physicians value wellness activities and would prefer to modify their current patterns of practice, whether they are paid by fee-for-service or by salaried methods.