Whole-person Health Research Articles

A Perspective on the Measurement of Whole Person Health.

There is growing interest in moving away from a reductionistic view of the person and the health services they need to focus on improving the health of the whole person. However, there needs to be agreement about what this focus entails and how to measure its achievement. From this perspective, we offer suggestions for moving the measurement discussion forward. Our key suggestion is to separate the measurement of whole person health (WPH)-that is, the end goal or ultimate outcome we want to improve and/or maintain-from the measurement of WPH determinants-that is, the things that can be intervened upon to maximize WPH. We also offer some next steps toward developing a measure of WPH.

Health and Well-Being: Distinct and Intertwined Concepts.

The concepts of health and well-being are deeply intertwined and interdependent. Situating both health and well-being within a unified framework is important to ensure their inclusion in the full spectrum of health research and to achieve the crucial task of building a body of basic, translational, and clinical studies to guide the implementation of whole-person health care. This commentary proposes such a framework where an individual's own assessment of their physical, emotional, and spiritual well-being complements objective measures of their physical and psychological function and where social, environmental, economic, educational, and vocational well-being are located within positive determinants of health.

Towards active health: A study on the relationship between physical activity and body image among college students

AimsActive health is a new concept, model, and system for maintaining a state of whole-person health. In the context of the increasing severity of college students' mental health, it is of great significance to explore the relationship between physical activity and college students' body image based on an active health perspective. MethodsA survey was conducted among 853 college students in Zhejiang province using the physical activity rating scale, body image scale, sense of acquisition of sports body shaping scale and social adjustment scale. Using SPSS25.0 and Amos 24.0 software for data processing and analysis. Results(1) There is a significant positive correlation between physical activity, body image, sense of acquisition of sports body shaping, and social adjustment. There is a significant positive correlation between physical activity and body image among college students; The sense of acquisition of sports body shaping a significant mediating role between physical activity and the promotion of college students' body image. The effects of physical activity on body image were mainly achieved through the following three mediating pathways: (1) physical activity → sense of acquisition of sports body shaping → body image, the mediating effect value of this pathway was 0.18, which accounted for 31.6 % of the total effect, with a confidence interval of [0.08, 0.28], (2) physical activity → social adaptation → body image, the mediating effect value of this pathway was 0.09, which accounted for 15.8 % of the total effect of 15.8 %, with a confidence interval of [0.03, 0.15], and (3) physical activity → sense of acquisition of sports body shaping → social adaptation → body image, a pathway with a mediated effect value of 0.09, accounting for 15.8 % of the total effect, with a confidence interval of [0.01, 0.17]. ConclusionsPhysical activity is an important factor in promoting the body image of college students, and there is a chain intermediary effect between physical activity and body image. School sport has its own disciplinary value and unique strengths in advancing the development of body image in adolescents, and the significant mediating effects of sense of acquisition of sports body shaping and social adaptation in this process provide theoretical support for the body image turn to move from theory to practice in the field of school sport.

Humanistic Buddhism: Sammà-sati, Mindfulness, and Zhèngniàn

Sammà-sati refers to continuously focusing on wholesome dharma and maintaining inner clarity and alertness. Anapanasati (mindfulness of breathing and breathing) is a specific practical way to achieve sammà-sati (mindfulness). The word “Zhèngniàn” (Chinese; English: mindfulness) began as Buddhism entered Ancient China during the Han and Tang Dynasties around two thousands years ago. Until the 1970s, the word “Zhèngniàn” (Chinese; English: mindfulness) referred to sammà-sati (Pali). However, in the 1980s, the modern mindfulness stress reduction course such as Mindfulness-based stress reduction (MBSR) combining Eastern Buddhist meditation with Western psychotherapy (Kabat-Zinn pioneered) entered the Asian Chinese world (including China, Taiwan and Southeast Asian Chinese and so on). It was also translated as “Zhèngniàn” (Chinese; English: mindfulness). However, there are significant differences between the Buddhist “sammà-sati” and the mindfulness in the mindfulness stress reduction course(Kabat-Zinn pioneered). When the two concepts use the same Chinese word “ Zhèngniàn” as the same time, confusion often arises. Moreover, as Chinese Buddhists communicate with non-Buddhists, they have been talking at cross purposes. Western mindfulness removes the religious component and is adopted by psychologists, and medical scientists as a technique and tool to study and apply, focusing more on its potential benefits for mental health and treatment. Although modern mindfulness courses are essentially different from mindfulness in Buddhism, as an effective whole-person health practice, it has positive significance for relieving the stress of modern life and improving the quality of life.

Support for a Single Underlying Dimension of Self-Reported Health in a Sample of Adults with Low Back Pain in the United States

There is increasing interest in measuring “whole person” health and deriving an overall summary score. Underlying physical and mental health dimensions have been found consistently in prior studies of self-reported health, but it is unclear whether a single underlying health factor is supported across health domains. We examine the dimensionality of nine domains from the Patient-Reported Outcomes Measurement Information System (PROMIS®)-29 + 2 profile measure, the PROMIS social isolation scale, the Personal Wellbeing Index, and the EQ-5D-5L preference score in a sample of 1256 adults with back pain in the United States: mean age was 55 (range 18–94), 52% female, 74% non-Hispanic White, 61% were married or living with a spouse, and the highest level of education completed for 35% of the sample was a high school degree or general education diploma. The sample reported substantially more pain intensity, pain interference, and worse physical function than the U.S. general population. Product-moment correlations among the measures ranged from 0.25 to 0.83 (median correlation = 0.52). A bifactor model showed that a general health factor accounted for most of the covariation among measures, but physical function, pain interference, and pain intensity loaded slightly more on the physical health group factor than on the general health factor. The study provides some support for combining multiple aspects of self-reported health into an overall indicator of whole-person health.

Okada Health and Wellness Program, a Whole-person Health Program with Diet, Art, and Biofield Therapy, to Support Integrative Medicine in Japan

The authors previously reported that the three components of the Okada Health and Wellness Program - diet, art, and biofield therapy - are likely to improve quality of life and contribute to whole-person health when practiced together.

Lessons Learned from Cross-Systems Approach to COVID-19 Pandemic Response in Juvenile Justice System, Colorado, USA.

The global COVID-19 pandemic illustrates the importance of a close partnership between public health and juvenile justice systems when responding to communicable diseases. Many setting-specific obstacles must be navigated to respond effectively to limit disease transmission and negative health outcomes while maintaining necessary services for youth in confinement facilities. The response requires multidisciplinary expertise and collaboration to address unique considerations. Public health mitigation strategies must balance the risk for disease against the negative effects of restrictions. Key aspects of the COVID-19 response in the juvenile justice system of Colorado, USA, involved establishing robust communication and data reporting infrastructures, building a multidisciplinary response team, adapting existing infection prevention guidelines, and focusing on a whole-person health approach to infection prevention. We examine lessons learned and offer recommendations on pandemic emergency response planning and managing a statewide public health emergency in youth confinement settings that ensure ongoing readiness.

The relationship between physical activity and the health of primary and secondary school teachers: the chain mediating effects of body image and self-efficacy

BackgroundActive health is a new concept, model, and system to maintain the state of whole-person health. In the context of the increasingly serious health problems of primary and secondary school teachers, it is of great significance to explore the relationship between physical activity and primary and secondary school teachers’ health based on the active health perspective.MethodsThe survey involving 741 primary and secondary school teachers across representative provinces in China utilized the International Physical Activity Scale, Body Imagery State Scale, and General Self-Efficacy Scale. Data analysis employed SPSS 25.0 and Amos 24.0 software.ResultsWhile no significant gender disparities were observed in body image and self-efficacy, age groups exhibited a bipartite and “V” shaped distribution. Female teachers demonstrated higher physical activity levels (2456.46) and superior physical fitness compared to males (2297.86). A positive correlation emerged between physical activity, body image, self-efficacy, and health status. Importantly, body image and self-efficacy partially mediated the relationship between physical activity and health status, accounting for 82.31% of the total effect.ConclusionsPrimary and secondary school teachers have real problems such as teachers’ physical activity is generally insufficient, teachers’ body image status is generally poor, and teachers’ self-efficacy is low; physical activity is an important factor in promoting primary and secondary school teachers’ health status, and low, medium, and high levels of activity all have a promoting effect on the health of primary and secondary school teachers, and the more active primary and secondary school teachers are in terms of physical activity, the better their body image, self-efficacy, and health status are, and the more active primary and secondary school teachers are in terms of physical activity, the more positive the physical activity, self-efficacy, and health status are. The more physically active primary and secondary school teachers are, the better their physical intention, self-efficacy and health status are.Suggestionsimprove the quality and effectiveness, promote the concept of active health among teachers; empower teachers, strengthen the institutional protection of teachers’ health; reduce the burden and increase the quantity,and optimise the supply of health services for teachers.

Tai Chi and Whole-Person Health.

Tai Chi and Whole-Person Health.

Examining standardized consumer-generated social determinants of health and resilience data supported by Omaha System terminology.

Nursing terminologies like the Omaha System are foundational in realizing the vision of formal representation of social determinants of health (SDOH) data and whole-person health across biological, behavioral, social, and environmental domains. This study objective was to examine standardized consumer-generated SDOH data and resilience (strengths) using the MyStrengths+MyHealth (MSMH) app built using Omaha System. Overall, 19 SDOH concepts were analyzed including 19 Strengths, 175 Challenges, and 76 Needs with additional analysis around Income Challenges. Data from 919 participants presented an average of 11(SD = 6.1) Strengths, 21(SD = 15.8) Challenges, and 15(SD = 14.9) Needs. Participants with at least one Income Challenge (n = 573) had significantly (P < .001) less Strengths [9.4(6.4)], more Challenges [27.4(15.5)], and more Needs [15.1(14.9)] compared to without an Income Challenge (n = 337) Strengths [13.4(4.5)], Challenges [10.5(8.9)], and Needs [5.1(10.0)]. This standards-based approach to examining consumer-generated SDOH and resilience data presents a great opportunity in understanding 360-degree whole-person health as a step towards addressing health inequities.

Using data visualization to characterize whole-person health of public health nurses.

To characterize patterns in whole-person health of public health nurses (PHNs). Survey of a convenience sample of PHNs (n = 132) in 2022. PHNs self-identified as female (96.2%), white (86.4%), between the ages 25-44 (54.5%) and 45-64 (40.2%), had bachelor's degrees (65.9%) and incomes of $50-75,000 (30.3%) and $75-100,000/year (29.5%). Simplified Omaha System Terms (SOST) within the MyStrengths+MyHealth assessment of whole-person health (strengths, challenges, and needs) across Environmental, Psychosocial, Physiological, and Health-related Behaviors domains. PHNs had more strengths than challenges; and more challenges than needs. Four patterns were discovered: (1) inverse relationship between strengths and challenges/needs; (2) Many strengths; (3) High needs in Income; (4) Fewest strengths in Sleeping, Emotions, Nutrition, and Exercise. PHNs with Income as a strength (n = 79) had more strengths (t = 5.570, p < .001); fewer challenges (t = -5.270, p < .001) and needs (t = -3.659, p < .001) compared to others (n = 53). PHNs had many strengths compared to previous research with other samples, despite concerning patterns of challenges and needs. Most PHN whole-person health patterns aligned with previous literature. Further research is needed to validate and extend these findings toward improving PHN health.

Paradigm Shift in Medicine: Integrating Naturopathic Care in the Treatment of Chronic Disease: Want to follow best practices in chronic disease treatment? Look to naturopathic physicians.

The current healthcare system too often relies on prescription drugs, leading to increased opioid use and addiction, despite major medical organizations recommending non-drug approaches as the primary treatment in many conditions. The importance of lifestyle changes to achieving whole-person health is increasingly recognized. Nature-based medicine, as routinely practiced by naturopathic physicians provide a valuable and noteworthy alternative approach featuring lifestyle intervention to chronic pain and disease management. These physicians undergo extensive training in holistic models of care and apply a systematic approach called the Therapeutic Order, which focuses on addressing the underlying cause of symptoms and using the least force necessary for treatment. Improved outcomes are realized with multifactorial personalized treatment plans including lifestyle, nutrition, stress management, and physical activity. Integrative medicine is on the rise and we support the shift to the inclusion of a patient-centered approach in the management of chronic pain and disease. Nothing in the practice of natural, holistic medicine precludes respect for science, and the reliance on evidence. Rather, medicine is at its best when practice can draw from the best offerings of all pertinent fields.

Human well-being responses to species’ traits

People rely on well-functioning ecosystems to provide critical services that underpin human health and well-being. Consequently, biodiversity loss has profound negative implications for humanity. Human–biodiversity interactions can deliver individual-level well-being gains, equating to substantial healthcare cost savings when scaled up across populations. However, critical questions remain about which species and/or traits (for example, colours, sounds and smells) elicit well-being responses. The traits that influence well-being can be considered ‘effect’ traits. Using techniques from community ecology, we have analysed a database of species’ effect traits articulated by people to identify those that generate different types of well-being (physical, emotional, cognitive, social, spiritual and ‘global’ well-being, the latter being akin to ‘whole-person health’). Effect traits have a predominately positive impact on well-being, influenced by the identity and taxonomic kingdom of each species. Different sets of effect traits deliver different types of well-being. However, traits cannot be considered independently of species because multiple traits can be supported by a single species. Indeed, we have found that numerous effect traits from across the ecological community can elicit multiple types of well-being, illustrating the complexity of biodiversity experiences. Our empirical approach can help to implement interdisciplinary thinking for biodiversity conservation and nature-based public health interventions designed to support human well-being.

Focusing on Whole-Person Health: A Conversation Between Hélène Langevin and Ramsey Badawi.

![Figure][1]</img> Hélène Langevin, MD Ramsey Badawi, from the University of California Davis, talked with Hélène Langevin, director of the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH; Bethesda, MD), about her career-long

The Time Is Now for a Whole-Person Health Approach to Public Health.

The Time Is Now for a Whole-Person Health Approach to Public Health.

The CREATION Health Assessment Tool for Patients (CHAT-P): Development & Psychometric Testing.

The CREATION Model is a whole-person wellness model facilitating patient-provider partnerships for health promotion. CREATION is an acronym that represents eight whole-person health principles: Choice, Rest, Environment-Interpersonal Relationships, Activity, Trust, Outlook, and Nutrition, all focusing on the relationship between individual choice and physical, psychological, social, and spiritual health. This study develops and tests the psychometric properties of the CREATION Health Assessment Tool for Patients (CHAT-P). A 125-item-bank using a 5-point Likert scale with 1 to 5 rating was generated through focus-groups of clinicians, patients, and healthcare leaders. An expert panel assessed content adequacy, reducing items to 82. Patient survey data (n = 599) from 15 inpatient medical units were randomly divided into two datasets. Exploratory Factor Analysis applied to Dataset 1 resulted in a 7-factor (Choice/Rest/Environment-Interpersonal Relationships/Activity/Trust/Outlook/Nutrition) and 28-item tool with factor loading 0.47-0.86. The model structure was confirmed by Structural Equation Modeling on Dataset 2 with goodness-of-fit test results: X2/df = 2.41 < 5.0, RMSEA = 0.05 < 0.08, GFI = 0.91 and AGFI = 0.90. Cronbach's Alpha = 0.83 showed satisfactory reliability. The final CHAT-P totals ranged from 28-140 (higher scores indicating better health/well-being). When assessing the effectiveness of educational/behavioral interventions, this tool can measure the improvement of a patient's overall mind-body-spirit well-being or measure well-being for individual CREATION principle(s). It fills that gap and facilitates healthcare providers' ability to assess and plan interventions to support holistic well-being.

Continuing Professional Development Using Infographics Improves the Familiarity of the Social Determinants of Health

Context Secondary school athletic trainers (ATs) may not be aware of health care delivery strategies for the social determinants of health (SDOH). Specifically, secondary school ATs have demonstrated the lowest knowledge and practice of the SDOH. Objective The purpose of this study was to determine whether infographics as a continuing professional development method changed patient-centered–care screening considerations and familiarities with the SDOH. Design Randomized controlled trial. Setting Online survey with infographic intervention. Patient or Other Participants In total, 34 participants in the intervention group and 46 participants in the control group were included for the analysis. Intervention(s) The intervention group received a different SDOH infographic weekly for 12 weeks. The control group did not receive any infographics. Main Outcome Measure(s) The survey asked participants to rate their patient-centered–care tasks, screening consideration, and familiarity with the SDOH. Results A significant change-score improvement was identified for the intervention group relative to providing whole-person health care (P = .024) and recognizing the SDOH (P ≤ .001). No statistical differences were noted for screening and practices between the groups. However, familiarity with screening for 4 SDOH areas improved for the intervention group, including access to primary care (P = .007), poverty (P = .048), environmental conditions (P = .036), and social cohesion (P = .025). Conclusion The ATs improved their familiarity with screening for some SDOH after engaging in professional development using infographics, but screening practices and considerations did not change over the course of the study.

Using data visualization to detect patterns in whole-person health data.

Data visualization techniques are useful for examining large multidimensional data sets. In this exploratory data analysis (EDA) study, we applied a visualization pattern detection and testing process to deidentified data to discover patterns in whole-person health for adults 65 and older. Whole-person health examines a person's environmental, psychosocial, and physical health, as well as their health-related behaviors; and assesses their strengths, challenges, and needs. Strengths are defined as assets and capabilities in the face of short-or long-term stressors. We collected data using a mobile application that delivers a comprehensive whole-person assessment using a simplified version of a standardized instrument, the Omaha System. The visualization pattern detection process is iterative, includes various techniques, and requires visualization literacy. The data visualization techniques applied in this analysis included bubble charts, parallel coordinates line graphs, box plots, and alluvial flow diagrams. We discovered six patterns within the visualizations. We formulated and tested six hypotheses based on these six patterns, and all six hypotheses were supported. Adults 65 and older had more strengths than challenges and more challenges than needs (p < 0.001). Strengths and challenges were negatively correlated (p < 0.001). Unexpectedly, a subset of adults 65 and older who had many, but not all, strengths had significantly more needs (p = 0.04). The use of standardized terminology with its inherent data interrelationships was key to discovering patterns in whole-person health. This methodology may be used in future EDA research using new data sets.

Within-Person Associations Among Physical Activity, Sleep, and Well-being in Situ: Opportunities for Whole-Person Well-being

Background Digital tools can help cultivate states of well-being through psychological interventions. Interventions and policies with the most promise of influencing individual and population health and well-being in real-world contexts require understanding the dynamic relationships between different domains of well-being in daily life. Objective This study aimed to consider multiple components of the health behavior–well-being system to identify potential targets for designing ecologically relevant interventions in everyday life. Methods We used self-reported affective states, purpose in life, and physical activity collected via smartphone-based experience sampling twice per day over 28 days as participants (N=226 young adults; mean age 20.2, SD 1.7 years; 76% women and 25% men) went about their daily lives. We used a multilevel vector autoregressive model to isolate within- and between-person relationships among daytime physical activity, nighttime sleep duration, nighttime sleep quality, happiness, sadness, anger, anxiousness, and purpose in life. This approach generates 3 networks describing the relationships among variables of interest: (1) a directed temporal network revealing within-person, time-lagged, previous-day relationships among variables; (2) a contemporaneous undirected network revealing within-person same-day relationships among variables; and (3) an undirected between-person network identifying between-person differences in how variables are associated with one another. Results Our complex-system approach to the health behavior–well-being system revealed significant interplay among physical activity, sleep, affect, and purpose in life. We found that when an individual had higher than their usual levels of physical activity on a particular day, they experienced an increase in happy affect the next day. Higher sleep quality on a particular day also predicted a decrease in negative affective states the next day. We found that purpose in life predicted decreased sad, anxious, and angry affect up to 2 days later. For contemporaneous relationships, higher than usual happiness predicted increased purpose in life and lower anger, anxiety, and sadness on the same day. We found that people who, on average, were happier tended to endorse a higher sense of purpose in life and experience increased sleep quality, whereas people who, on average, were sadder tended to have increased anxiety and anger. Conclusions Collectively, these findings suggest that behavioral interventions targeting sleep and physical activity may observe shorter-term (up to 1 day) effects on well-being, whereas interventions cultivating a sense of purpose in life can have slightly longer effects on well-being, bleeding into the next few days. Our findings suggest that approaches simultaneously considering whole-person well-being rather than just one domain of well-being hold promise for informing the design of behavior interventions with the most promise of influencing health in real-world contexts. Moving forward, digital health tools should incorporate tracking multiple domains of well-being in daily life to increase opportunities for whole-person health approaches in virtual care settings. Conflicts of Interest None declared.

An International Research Collaborative to Examine Global Health Resilience Using the MyStrengths+MyHealth Application.

International organizations have called for the development of programs to strengthen global health resilience. This poster describes the development of an international research collaborative to examine whole-person health and resilience using the web-based application MyStrengths+MyHealth (MSMH). MSMH enables individuals to self-report strengths (resilience), challenges, and needs using simplified terms that have been community validated and at the fourth grade US reading level.