9.4 Health & Wellness Promotion
Key Takeaways
- Primary prevention prevents disease before it occurs (vaccines), secondary prevention detects disease early (screenings), and tertiary prevention limits disability from established disease (cardiac rehabilitation)
- USPSTF screening anchors: colorectal cancer begins at age 45; biennial mammography ages 40–74; cervical cytology every 3 years ages 21–29 and high-risk HPV testing every 5 years ages 30–65
- Annual low-dose CT lung screening is for adults 50–80 with a 20 pack-year or greater history who currently smoke or quit within the past 15 years
- Immunization anchors: annual influenza, recombinant zoster (2 doses) at 50+, Tdap once then Td/Tdap every 10 years, and pneumococcal conjugate vaccine for older or high-risk adults
- Motivational interviewing uses OARS — Open questions, Affirmations, Reflections, Summaries — to resolve ambivalence rather than confront resistance
Levels of Prevention
Every screening and counseling question can be anchored to one of three levels:
| Level | Purpose | Classic Examples |
|---|---|---|
| Primary | Prevent disease or injury before it occurs | Immunizations, smoking prevention, seat belts, diet and exercise counseling, sunscreen use |
| Secondary | Detect disease early, while asymptomatic, to allow early treatment | Mammography, colonoscopy, Pap testing, blood pressure screening, blood glucose screening, low-dose CT lung screening |
| Tertiary | Limit disability and restore function in established disease | Cardiac rehabilitation after myocardial infarction, stroke rehabilitation, diabetes foot care to prevent amputation, support groups for chronic illness |
Exam tip: screenings are always secondary, no matter how preventive they feel; vaccines are always primary; rehabilitation and complication prevention in existing disease are tertiary. Some authors add primordial prevention (preventing risk-factor development itself) and quaternary prevention (protecting patients from overmedicalization), but the classic three are what get tested.
USPSTF Screening Schedules Commonly Tested
The U.S. Preventive Services Task Force (USPSTF) recommendations below are the values most often referenced on certification exams:
| Screening | Recommendation |
|---|---|
| Colorectal cancer | All adults 45–75 (fecal occult blood annually, FIT-DNA every 1–3 years, colonoscopy every 10 years, or sigmoidoscopy every 5 years); ages 76–85 individualized |
| Breast cancer | Biennial mammography ages 40–74 (USPSTF 2024 update lowered the starting age from 50 to 40) |
| Cervical cancer | Ages 21–29: cytology (Pap) every 3 years; ages 30–65: high-risk HPV testing every 5 years (preferred), co-testing every 5 years, or cytology every 3 years; stop after 65 with adequate prior negative screening |
| Lung cancer | Annual low-dose CT for adults 50–80 with a ≥20 pack-year history who currently smoke or quit within the past 15 years |
| Hypertension | Screen all adults 18 and older; annually at age 40+ or with increased risk |
| Lipids / statins | Statin for adults 40–75 with one or more cardiovascular risk factors and a 10-year cardiovascular risk of 10% or greater |
| Diabetes | Screen adults 35–70 who are overweight or obese (USPSTF); the American Diabetes Association recommends screening all adults at 35 |
| Osteoporosis | Bone density (DEXA) for women 65 and older, and younger postmenopausal women at increased risk |
| Abdominal aortic aneurysm | One-time ultrasound for men 65–75 who have ever smoked |
Adult Immunization Highlights
- Influenza: annually for all adults
- Tetanus/diphtheria/pertussis: Tdap once, then Td or Tdap booster every 10 years; Tdap during every pregnancy (27–36 weeks)
- Zoster (shingles): recombinant zoster vaccine (Shingrix), 2 doses 2–6 months apart, at age 50+ — recommended even after prior shingles or the older live vaccine; also for immunocompromised adults 19+
- Pneumococcal: conjugate vaccine (PCV20 alone, or PCV15 followed by PPSV23) for adults 65+ — note that the CDC/ACIP lowered the routine age to 50+ in late 2024, though many exam resources still teach 65
- COVID-19: per current seasonal formulation guidance
- Hepatitis B: universally recommended for adults 19–59, and 60+ with risk factors
- HPV: routinely through age 26; shared clinical decision-making ages 27–45
Healthy Lifestyle Counseling
Tobacco — the 5 A's: Ask about use at every visit, Advise every user to quit in a clear personalized manner, Assess willingness to quit, Assist with a quit plan (nicotine replacement, bupropion, or varenicline plus counseling), and Arrange follow-up. For patients not ready to quit, use the 5 R's: Relevance, Risks, Rewards, Roadblocks, Repetition.
Alcohol: moderate drinking limits are up to 1 drink per day for women and 2 for men; screen with validated tools (AUDIT-C, or the CAGE questionnaire — Cut down, Annoyed, Guilty, Eye-opener; 2 or more positive answers is a positive screen).
Physical activity: at least 150 minutes per week of moderate-intensity aerobic activity (or 75 minutes vigorous), plus muscle-strengthening activity 2 days per week.
Nutrition: emphasize vegetables, fruits, whole grains, lean protein; limit sodium (DASH diet for hypertension), saturated fat, and added sugars; a standard weight-loss target is 5–10% of body weight over 6 months.
Motivational Interviewing Basics
Motivational interviewing (MI) is a collaborative, patient-centered counseling style that strengthens the patient's own motivation for change rather than lecturing. Core skills are OARS:
- Open-ended questions — "What concerns you most about your blood pressure?"
- Affirmations — recognize strengths and efforts
- Reflective listening — mirror what the patient says to show understanding
- Summaries — collect and hand back the patient's own change talk
MI pairs with the transtheoretical model (stages of change): precontemplation (not considering change — raise awareness, do not push), contemplation (ambivalent — explore pros and cons), preparation (planning — help set concrete goals), action (support the plan), and maintenance (prevent relapse). Arguing with a precontemplative patient triggers resistance; rolling with resistance and evoking the patient's own reasons for change is the MI way.
Pender's Health Promotion Model at a Glance
Pender's Health Promotion Model explains what motivates people to engage in health-promoting behavior. Its major concepts: individual characteristics and experiences (prior related behavior, personal factors), behavior-specific cognitions and affect (perceived benefits, perceived barriers, perceived self-efficacy, activity-related affect, interpersonal and situational influences), and behavioral outcome (commitment to a plan of action leading to the health-promoting behavior). Know the sound bites: perceived benefits motivate, perceived barriers block, and self-efficacy — belief in one's ability — predicts follow-through. For contrast, the Health Belief Model (Rosenstock) centers on perceived susceptibility, seriousness, benefits, and barriers, plus cues to action — do not confuse the two on the exam.
According to USPSTF criteria, which patient is eligible for annual low-dose CT lung cancer screening?
Which nursing activity is an example of tertiary prevention?
A nurse is counseling a 55-year-old patient about routine immunizations. Which recommendation is correct?