Primary prevention in health promotion.
A major role of community health nursing is prevention. Prevention means to avert problems. There are three levels of prevention: primary, secondary, and tertiary. Of the three, the basic level of prevention is called primary prevention. This level of prevention is applied to generally healthy people, before disease, injury, or dysfunction occurs. "Primary prevention may include increasing people's resistance to illness (as in the case of immunization), decreasing or eliminating the causes of health problems, or creating an environment conducive to health rather than health problems" (Clark, 2008, p. 30). Allender and Spradley (2005) state, "primary prevention obviates the occurrence of a health problem; it includes measures taken to keep illness or injuries from occurring" (p. 14).
Ervin (2002) emphasizes the importance of the ability of nurses to identify patterns as they emerge and before they are officially identified. This pattern identification leads to primary prevention. Identifying patterns relies upon astute knowledge of disease occurrence, transmission, and incubation. By identifying risk factors, prevention of injury can occur. Primary prevention involves anticipatory planning and actions. Nurses must envision potential needs and problems and then plan so that they don't occur.
General Systems Theory supports community health nursing practices and primary prevention interventions. "General Systems Theory states that a change in any one part of the health care system, no matter how small, will create a change of some degree in the total system. This theory also stresses the importance of reciprocal feedback within the system and outside the system" (Harris, 2007, para. 5). Therefore, with primary prevention interventions, a complete feedback loop would facilitate a health change not only for the individual but the entire family and the community as well.
Impact on health programs
Primary prevention will have a positive impact on comprehensive health programs. This approach however, will require a paradigm shift. Members of communities will be expected to take an active role in their health, by increasing their health knowledge, changing lifestyles to enhance wellness, and manage self care practices (Allender & Spradley, 2005).
The importance of primary prevention in program development is the fact that it is easier and less expensive to prevent an illness, disease, or dysfunction by promoting healthy choices and behavior in the first place. Education and immunizations are research based and outcomes are tracked. Primary prevention means treating a generally healthy population so program development would require finding suitable aggregates to treat. This includes understanding the dynamics of the community involved.
It is unreasonable to think that one healthcare professional can give all the necessary information and support to implement primary prevention programs. From a multidisciplinary standpoint, all healthcare providers must show a genuine commitment to help foster health promotion and prevention. This includes giving community members health information in the language of choice and at the level of understanding they need. Repeat information and the ability to ask questions are important for proper understanding and retention of learned material. It is very important to notify vulnerable (low-income, the elderly, handicap, shut-ins, etc.) community members about the resources available within the community. Support from other community members will promote lasting change as well.
Currently, the healthcare system in America focuses on disease and illness rather than prevention. Health care costs are skyrocketing due to the tertiary level of prevention often used in healthcare which is more expensive than primary prevention. Unfortunately, physicians are reimbursed based on disease and illness treated rather than preventive measures taken. Since the current system values disease and illness, prevention is secondary.
With limited healthcare resources and the expense of treating existing disease and illness, programs that use primary prevention are not allotted the appropriate resources for the impact these services can make to the health of the population. Unfortunately, "Health promotional nursing activities such as comprehensive prenatal, maternal, and infant care; health education; childhood immunizations; and home services to the elderly to live independently have not been covered by most insurers" (Allender & Spradley, 2005, p. 145).
Primary prevention programs that entail mass prevention can be seen as an investment to communities. These programs will reduce mortality and morbidity rates. Primary prevention such as programs that educate school aged children about effects of drugs, alcohol and smoking, sex education, nutrition and exercise, all are considered cost-effective. It is much more effective to prevent unhealthy habits that will later burden society with the ill-effects of abuse. The National Institute on Drug Abuse NIDA (2003) "estimates that every dollar invested in prevention of substance abuse in children and adolescents, for example, saves up to $10 in treatment costs. This figure does not even consider the reduction in costs for law enforcement and lost productivity" (Clark, 2008, p. 940).
Immunization programs and education aimed at parents that prevents childhood accidents and injury are other examples of cost effective primary prevention programs. Watkins, Edwards, and Gastrell add that parenting programs aimed at enhancing parents' confidence and self-esteem lead to improvements in "children's health and educational attainment, reduces juvenile delinquency and mental health problems later in life" (2003, p. 240).
Primary Prevention Impacting Teen Alcohol Use Community health issues
One of the populations at highest risk for substance abuse is adolescents, who are particularly vulnerable to peer pressure and have a tendency to be impulsive (Allender & Spradley, 2005). Johnston, O'Malley and Bachman (2003) state by the time young people complete high school, 78% have consumed alcohol (Allender & Spradley, 2005). Early drinkers have more academic problems, use other substances, and display delinquent behavior in middle and high school (Allender & Spradley, 2005). This is why programs have been developed to educate children as young as first grade about drugs and alcohol use. Primary prevention includes risk assessment and data collection.
There are widespread, research-based programs that educate school aged children about the effects of alcohol and how to say no to peer pressure. This form of primary prevention not only decreases rates of alcohol use and abuse, but benefits the greater community since alcohol use is linked to crimes, accidents, physical and mental abuse, decreased job productivity, increased absenteeism, and acute and chronic health problems.
Another form of primary prevention that communities use to prevent teen alcohol use is providing alcohol-free entertainment, such as after-parties for such occasions as prom, home-coming, and graduation. Parents and community members rally to seek resources to fund such activities. Communities enforce strict carding procedures for purchasing alcohol where ever it is sold. Random checks are done and promotional ads let teens know the community is behind alcohol free entertainment. This partnership between families, school members, church members, local media and other community members strengthens relationships within the community.
Primary prevention in healthcare will create many benefits for community stakeholders in terms of costs averted, quality of life, and productivity. The challenge is to educate, empower, support and coach members of the community to become proactive in healthy lifestyle choices and behaviors. This paradigm shift will not be easy; it will take a multidisciplinary approach with support from all aspects of the community. Benefits such as a reduced burden on medical care systems, a reduction of costs associated with absenteeism, and reduced productivity and achievement, benefits a wide range of community members. An example of the positive effects of primary prevention can be seen in the school environment where children are educated about the affects of alcohol, given support on how to deal with peer pressure, and use the resources within the community.
Helen Williams is a registered nurse in Helena. She prepared this article as part of the requirements to earn her Masters of Science in Nursing through the University of Phoenix on-line. All references are available upon request from the MNA office.
by Helen Williams, RN, BSN
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|Date:||Apr 1, 2008|
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