Health Promotion, Prevention and Management of Chronic Conditions

The prevention and management of chronic conditions is a national priority for improved quality of life and population health.¹ Programs and interventions that support positive health behaviors are needed to improve outcomes for diverse groups of people across a range of chronic conditions.  

• Chronic disease is defined by the World Health Organization (WHO) as non-communicable diseases that tend to be of long duration with a combination of causes including genetic, physiological, environmental, and behavioral.²  

• Chronic conditions are the leading cause of death and disability in the United States  impacting 7 out of 10 people.² 

• There are substantial racial and ethnic disparities in chronic diseases. Racial and ethnic minorities are 1.5 to 2 times more likely to have chronic diseases.³ 

• Centers for Medicare and Medicaid Services (CMH) identifies 21 chronic conditions that are prevalent for Medicare utilization and spending. A partial list of these include alcohol/substance abuse, asthma, Autism Spectrum Disorders, Stroke, Depression, Cancer, Heart Disease, Arthritis and Schizoprenia.4 Occupational Therapists serve people with almost all of the 21 conditions identified, although research on the long-term impact of OT is needed.  

• The recent COVID-19 pandemic has resulted in a new host of chronic conditions characterized as Long COVID. There are a number of new research initiatives to study Long COVID, as this is anticipated to become one of the next major public health crises. Although still being defined, the collective symptoms of Long COVID are referred to as Post-Acute Sequelae of SARS-CoV-2 infection (PASC) by the NIH.⁵ 

• Data gathering and prevention programs at both the individual and population level are needed to track trends and progress, develop healthy environments, design health care system interventions, and connect clinical and community services.⁶ 

Need and Relevance to Occupational Therapy 

Health promotion, prevention and management of chronic conditions has been identified as: 

• a critical issue for promoting health and well-being for many conditions and populations 

• an area in which evidence-based measures, programs and interventions are needed 

• an area where application of the unique expertise of occupational therapy would be highly beneficial   

Health behaviors may be defined as the “doing of everyday activities” that support wellbeing, including medication management, exercise, and healthy eating. Occupational therapy research seeks to understand the preventative and protective function of daily activities in promoting and maintaining health. Prevention and management of chronic conditions requires adoption and maintenance of daily habits and routines that promote health.  Making changes in health behaviors requires strategies that address both biomedical and sociocultural factors. Effective management of chronic conditions requires knowledge of how symptoms influence the ability to perform everyday activities and the habits, routines, and environmental supports that may be used to maintain health and quality of life.⁷   Partnerships and collaboration between providers and patients within an integrated system of care, inclusive of OT, is a key factor that needs further examination to understand the management and prevention of chronic care.  

OT research continues to advance and establish a knowledge base related to health behaviors and chronic conditions, although models of care and understanding of chronic conditions continues to evolve resulting in a continued need to advance the science to guide practice. Additionally, we need a coordinated network for occupational therapy research in this area and sufficient resources to train more occupational therapy researchers.  There are a number of models to guide interventions and supports for chronic disease management (i.e., Care Model, Improving Chronic Illness Care, Innovative Care for Chronic Conditions, Stanford Model, transitional Care model). We need to understand the impact and importance of the role of OT on the health care team within the various models of care. We believe a significant investment is needed to improve health behaviors for the prevention and management of chronic conditions in order to achieve better outcomes and improve quality of life.

1. Healthy People. Social determinants of health. Retrieved on August 11, 2022 from https://health.gov/healthypeople/priority-areas/social-determinants-health 

2. World Health Organization. Noncommunicable disease. (2021). Retrieved from  https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. 

3.  Price, J.H., Khubchandani, J., McKinney, M., Braun, R. (2013). Racial/ethnic disparities in chronic diseases of youths and access to health care in the United States. Biomed Res Int. doi: 10.1155/2013/787616.  

4. Centers for Medicare and Medicaid Services. (2021). Chronic disease. Retrieved from[Text Wrapping Break]https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html 

5. Collins, F. (2021). NIH Launches new initiative to study “Long COVID”. Retrieved from https://www.nih.gov/about-nih/who-we-are/nih-director/statements/nih-launches-new-initiative-study-long-covid).  

6. Bauer, U.E., Briss, P.A., Goodman, R.A., Bowman, B.A. (2014). Prevention of chronic disease in the 21st century: Elimination of the leading preventable causes of premature death and disability in the USA. Lancet. 384(9937): 45-52. doi: 10.1016/S0140-6736(14)60648-6. 

7. Hand, C. L., Letts, L. J., & von Zweck, C. M. (2011). An agenda for occupational therapy's contribution to collaborative chronic disease research. Canadian Journal of Occupational Therapy, 78(3), 147-155.