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Five Levels of Prevention

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Introduction

This activity will give you a chance to identify and apply the various levels of prevention within your practice. We utilize the concept of “going upstream” to help delineate each level of prevention.

Upstream Interventions

Sometimes, our efforts are focused on more than one area of prevention at a time, so that we can achieve a significant degree of prevention and protection. However, experts indicate that the farther “upstream” we can intervene, the better the outcome. In other words, a primordial prevention represents as far as we can go “upstream” to keep the problem or scenario from moving downstream.

Levels of Prevention

Scenario

As the school nurse at your local elementary school, you realize that many of the students have developed upper respiratory symptoms with persistent wheezing after going outside for afternoon recess. You suspect that the respiratory distress is being caused by the fertilizer plant, which is upwind from the school. They process an ammonia component every afternoon. You decide to act.

Levels of Prevention

Primordial Prevention

If you work with state and local governments to pass legislation banning the use of ammonia during times of the day when large populations are exposed. In addition, if you propose additional legislation that does not allow a fertilizer plant to be within 25 miles of a large population, then you are engaging in primordial prevention.

Primary Prevention

If you approach the local fertilizer plant, which is upwind from the school, asking that they alter their processing schedule to avoid school hours, you are engaging in primary prevention. You are getting rid of the hazardous exposure, and thus preventing the respiratory symptoms in the first place.

Secondary Prevention

If you ask each teacher to list all the students who are exhibiting respiratory symptoms while students are returning to class from recess, so that they can be treated right away, you are engaging in secondary prevention. You are not doing anything to prevent the runny nose, cough, and wheezing from occurring, but by treating the symptoms you are reducing the impact that the symptoms have on the children and are helping them to regain their baseline health as soon as possible.

Tertiary Prevention

Now, if you set up support groups and programs for children who have developed the symptoms, helping them to learn how to live without being able to go out for recess, you are engaging in tertiary prevention. You have not done anything to prevent the respiratory symptoms, nor have you attempted to treat the symptoms right away, but you are helping the children deal with the impact.

Quaternary Prevention

Finally, despite reaching a resolution with the fertilizer plant, the school board determined that it would be best that all students be kept inside. No one can be outside during school hours; all windows and doors are shut, and children are taken to and from the buses/cars wearing masks. All outdoor activities are canceled. As the school nurse, you intervene by providing data related to the benefits of being outdoors, physical activity, and the changes that the fertilizer plant has made, along with the facts that the students are no longer having any symptoms or concerns when coming in from recess. You provide evidence that the school board’s rule change is causing more harm than good, and they reverse their decision. You have then engaged in quaternary prevention.

Check Your Understanding Part 1

Select all the preventions that apply to the following list of preventions.

1. Which of the following represent primordial preventions? (Select all that apply.)
2. Which of the following represent primary preventions? (Select all that apply.)
3. Which of the following represent secondary preventions? (Select all that apply.)
4. Which of the following represent tertiary preventions? (Select all that apply.)
5. Which of the following represent quaternary preventions? (Select all that apply.)

Check Your Understanding Part 2

For each intervention listed, Identify the level of prevention it represents.

1. Banning advertisements for vaping products.
2. Vaccinations
3. Changes to prostate specific antigen (PSA) screening guidelines
4. Rehabilitation
5. Mammography
6. Regular blood pressure testing to help monitor the effectiveness of medication
7. Risk of overmedicalization
8. Access to safe “green” spaces, walking trails, bike paths, and so on
9. Test designed to screen for complications
10. Making changes to risky behaviors

Check Your Understanding Part 3

Lung Cancer caused by tobacco and products containing tobacco, such as e-cigarettes is the main cause of lung cancer related deaths in the United States. Imagine that you work for the CDC as a consultant to the governor of your state. She has called you to meet and propose in broad strokes the five levels of prevention you plan to use to dramatically reduce lung cancer deaths in your state.

Here are the major preventions you should provide.

  • Primordial Prevention - Legislation to promote truthful ads about smoking targeting younger audiences who have never smoked.
  • Primary prevention - Increase the offering of tobacco cessation programs to include online support, online education and, 24/7 call-in help lines.
  • Secondary Prevention - Provide screening to identify lung cancer in early stages before the onset of symptoms.
  • Tertiary Prevention - Use Chemotherapy for post-diagnosis to slow or stop the progression of lung cancer.
  • Quaternary Prevention - Cessation of Chemotherapy and radiation treatment when it is causing more harm than good.

Other Resources

Watch the Determinants of Health and Five Levels of Prevention located in this week’s learning materials. Also review Prevention Strategies from the National Center for Biotechnology Information (NCBI). These resources will help you understand how to apply the levels of prevention.

References

Kisling, L. A., & M Das, J. (2020). Prevention Strategies. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK537222/

Martins, C., Godycki-Cwirko, M., Heleno, B., & Brodersen, J. (2018). Quaternary prevention: Reviewing the concept. The European Journal of General Practice, 24(1), 106–111. doi:10.1080/13814788.2017.1422177.

Preventive healthcare. (2020). In Wikipedia. https://en.wikipedia.org/w/index.php?title=Preventive_healthcare&oldid=937554451

Primary, secondary and tertiary prevention. (n.d.). Retrieved February 11, 2020, from https://www.iwh.on.ca/what-researchers-mean-by/primary-secondary-and-tertiary-preventionhttps://www.cdc.gov/pictureofamerica/pdfs/picture_of_america_prevention.pdf

Secondary Prevention. (2017, January 5). HealthLink BC. https://www.healthlinkbc.ca/physical-activity/secondary-preventionhttps://bmcfampract.biomedcentral.com/articles/10.1186/s12875-017-0667-4

Activity is complete.