Levels of

Prevention
Joshi Abhishek Ashvinbhai
S.Y.P.B.B.Sc.Nursing
Gov. College of Nursing
Jamnagar
 Quote of the Day
If You don’t Fight for
What You want
Then
Don’t Cry for what You
Lost…!
 Content
• Introduction
• Definition
• Levels of Prevention
i. Primordial Prevention
ii. Primary Prevention
iii. Secondary Prevention
iv. Tertiary Prevention
• Strategy Of Prevention
• QUIZ
 Introduction
• Nurses have 4 Fundamental responsibilities
followed below ,
 Promotion of Health
 Prevention of illness
 Restoration of Health
 Alleviation of Suffering

• Two phases of Disease are

 (i) Pre Pathogenesis &
 (ii) Pathogenesis
 Definition of Disease
Prevention
• “Activities designed to protect patients or o
ther members of the public from actual or pot
ential health threats and their
harmful consequences.”
• OR
• “Prevention is the action aimed at
eradicating, eliminating or minimizing the
impact of disease and disability.”
 Levels of Prevention
• 1) Primordial Prevention
• 2) Primary Prevention
• 3) Secondary Prevention
• 4) Tertiary Prevention
 Prevention
is better Than
Cure…!
1) Primordial Prevention
• “This is a prevention of Development of risk
Factors in a Population group , which they
have not yet appeared.”
• Special Attention is Given in preventing
Chronic Disease.
• Main Intervention is Health Education.
• In this efforts are dedicated towards
Discouraging people from adopting Harmful
Life styles/Habits through Individual & Mass
Education.
Cont…
• Primordial prevention, a relatively new concept,
is receiving special attention in the prevention
of chronic diseases. Ex., many adult health
problems (e.g. obesity, hypertension) have their
early origins in childhood, because this is the
time when lifestyles are formed(Ex., smoking,
eating patterns, physical exercise).

• Primordial prevention begins in childhood when

health risk behavior begins. Parents, teachers
and peer groups are important in imparting
health education to children.
 Examples of Primordia
prevention l
National programs and policies on:

• Food and nutrition

• Comprehensive Policies for discourage
smoking , Alcohol & Drugs
• To promote regular physical activity
• Making major changes in lifestyle
 Lifestyle Factors

“Genes load the gun.

Lifestyle pulls the
trigger
”
Dr. Elliot Joslin
 2) Primary Prevention
• “Primary prevention can be defined as the
action taken prior to the onset of disease,
which removes the possibility that the
disease will ever occur.”
• In this Action are taken before the onset of
Disease.
• It signifies intervention in the pre-
pathogenesis phase of a disease or health
problem.
Cont…
• It includes the concept of "positive health", a
concept that encourages achievement and
maintenance of "an acceptable level of
health that will enable every individual to
lead a socially and economically productive
life".
 Primary
Prevention
Achieved by Achieved by

Specific
Health protection
promotion Immunization and seroprophylaxis
Health education
chemoprophylaxis
Environmental
Use of specific nutrients or
modifications
supplementations
Nutritional
interventions Safety of drugs and foods
Life style and behavioral Control of environmental hazards,
changes e.g. air pollution
 Approaches for Primary
Prevention:
• The WHO has recommended the
following approaches for the primary
prevention of chronic diseases where
the risk factors are established:

– A) Population (mass) strategy

– B) High -risk strategy
 A)Population (mass)
strategy
• “Population strategy" is directed at the
whole population irrespective of individual
risk levels.
• For example, studies have shown that even a
small reduction in the average blood
pressure or serum cholesterol of a
population would produce a large reduction
in the incidence of cardiovascular disease
• The population approach is directed towards
socio-economic, behavioral and lifestyle
changes
 B) High -risk strategy:
• The high -risk strategy aims to bring
preventive care to individuals at special risk.

• This requires detection of individuals at high

risk by the optimum use of clinical methods.

• Primary prevention is a “Holistic” approach

which relies on the measures teken to
Promote Health.
 Modes of Intervention

• (i).Health Promotion

• (ii). Specific Protection

 (i).Health Promotion
• “It is the process of enabling people to
increase control over the determinants of
health and thereby improve their health”.
• OR
• “ Health Promotion is directed towards
Strengthening the Host.”
• OR
• Process of enabling people to increase
control over and to improve health
Cont…
• Main Aims of Health promotion is To enable
people to increase control over Health & To
Improve the Over all Health.
• There Aim can be achieved by the following
Intervention :

 Health Education
 Environmental Modification
 Behavioral Changes
 Life Style change
 Nutritional Intervention
 Cont…
• Health education to improve healthy habits and
health consciousness in the community.
•
• Improvement in nutritional standards of the
community.
•
• Healthful physical environment (Housing, water
supply, excreta disposal etc.,)
• Good working condition

• Periodic Selective examination of risk

population.
 (i). Specific Protection
• “ Efforts directed toward protection against
specific diseases.”
• OR
• “ The provision of Conditions for normal
Mental & Physical Functioning of the Human
beings & in Group.it includes the Promotion
of Health , Prevention of Sickness , & Care of
Individuals .”
 Intervention
• Immunization
• Use of specific nutrients
• Chemoprophylaxis
• Protection against occupational hazards
• Protection against accidents
• Control of General Environment
• Avoidance of allergens etc.
Cont…
• Use of Specific immunization (BCG, DPT,MMR
vaccines)
• Chemoprophylaxis (tetracycline for Cholera,
dapsone for Leprosy, Chloroquine for
malaria,etc.,)
• Use of specific nutrients (vitamin A for
Children, iron folic acid tablets for Pregnant
mothers)
• Protection against accidents (Use of helmet,
seatbelt,etc.,)
• Protection against occupational hazards.
• Avoidance of allergens.
 3.Secondary Prevention
• It is defined as “ An Action which halts the
progress of a disease at its incipient stage
and prevents complications.”

• The specific interventions are:

 (i) early diagnosis (e.g. screening tests,

breast self examination, pap smear test,
radiographic examinations etc.)& Treatment

 (ii) Referral
 Cont…
• Secondary prevention attempts to arrest the
disease process, restore health by seeking out
unrecognized disease and treating it before
irreversible pathological changes take place,
and reverse communicability of infectious
diseases.

• It protects others in the community from

acquiring the infection and thus provide at once
secondary prevention for the infected ones and
primary prevention for their potential contacts.
 Objectives of Secondary
Prevention
Complete cure and prevent the progression
of disease process.

To prevent the spreads of disease by curing

all the known cases.

To prevent the complications and sequel of

disease.

To shorten the period of disability.

 (i) Early Diagnosis
• The Disease complications can be prevented &
Health can be Restored by Diagnosing the
Disease at it’s Early stages & by providing the
adequate Treatment according to the Health
problem. Includes :

 Arrests/Stops the Disease Process

 Restore the Health
 Treat the Disease before Irreversible
pathological changes occur.
 Reverse the Communicability of infectious
Disease.
 Early
Diagnosed

Better
Prognosis
Cont…
• Screening Surveys ( urine Examination for
Diabetes)

• Mass Treatment Approach includes :

 Juvenile Mass Treatment
 Selective Mass Treatment
 Total Mass Treatment

• The type of Approach used depends upon

Nature of Disease & Incidence of Diseaase.
Short Key To Remember
 4.Tertiary Prevention
• It is used when the disease process has
advanced beyond its early stages.
• It is defined as “all the measures available to
reduce or limit impairments and disabilities,
and to promote the patients’ adjustment to
irremediable conditions.”
• Intervention that should be accomplished in
the stage of tertiary prevention are disability
limitation, and rehabilitation.
• Intervention in Late Pathogenesis Phase.
 Disease

Impairment

Disability

Handicap
 (i) Disability Limitation
• To prevent or halt the transition of disease
process from Impairment & Handicap.
• Impairment: any loss or abnormality of
psychological, physiological or anatomic
structure or function.
• Disability: any restriction or lack of ability to
perform an activity in the manner considered
normal for a human being.
• Handicap: disadvantage for a given individual,
resulting from impairment or disability, that
limits or prevents the fulfillment of a role that
is normal for that individual
 Impairment: Loss of an
anatomical structure
ACCIDENT

Disability: Lack of ability to Handicap: Prevents

perform an activity fulfillment of normal role
Disease - dental caries Impairment – loss of
tooth

Disability – cant talk Handicap – cant socialize

 (ii) Rehabilitation
• Rehabilitation is “ the combined and
coordinated use of medical, social, educational,
and vocational measures for training and
retraining the individual to the highest possible
level of functional ability.”

• Requires cooperation from different sections of

society.
 Types of Rehabilitation

Rehabilitation

Medical Vocational Social Psychological

rehabilitation rehabilitation rehabilitation rehabilitation
Cont…
• Medical rehabilitation: (restoration of Bodily
Function).

• Vocational rehabilitation:( restoration of the

capacity to earn a livelihood)

• Social rehabilitation: (restoration of family

and social relationship).

• Psychological rehabilitation: (Restoration of

personal dignity and confidence).
 Examples of
Rehabilitation
• Establishing schools for the blind.

• Exercises in neurological disorders

• Prosthetic restoration of lost tooth

• Reconstructive surgery in Leprosy.

• Change of profession for a more suitable one

and modification of life in general in the case of
TB,etc.,
 Principles of
Rehabilitation
Enable
timely
recovery

Re-integrate Re-stabilize
TERTIARY
PREVENTION
Re-socialize Re-train

Re-motivate
Strategy of Prevention
Identify
Populations
Modify Existing at High
Disease Risk
Intervention (based on
Programs demography /
family history,
host factors..)

Evaluate Assess
Intervention Exposure
Programs

Conduct
Research on
Apply Mechanisms
(including the study of
Population-Base genetic susceptibility)
Intervention
Programs
 Mr. Rushi is referred to a
cardiac rehabilitation
program after Coronary
artery bypass surgery?
 This is
My
Thank
You
Dance..!