Public Health Nutrition: Focus on Prevention

Focus on Prevention: Strategies for Affecting Nutritional Health

How do public health/community nutritionists affect nutritional health?

• Community nutrition professionals conduct needs assessments to define nutrition problems and their contributing factors, and to identify opportunities for intervention.
  
• For greatest impact on an important nutrition problem, intervention strategies are planned and selected to be comprehensive, complementary and reinforcing. A wide range of strategies is used.
  
• A matrix based on three levels of prevention and three approaches to intervention is used to arrive at a comprehensive plan for addressing important nutrition problems. This is illustrated in the Nutrition Intervention Matrix.
  
  
  
  [Source: Owen, Splett, and Owen, 1999]

  Levels of Prevention

• Prevention plays a dominant role in community nutrition practice. It is defined comprehensively to include an array of activities that prevent, delay the onset or reduce the seriousness of disease and its complications.
• Prevention is categorized as primary, secondary, and tertiary.
  [Source: Owen, Splett, and Owen, 1999]
  

1. Primary prevention
   Primary prevention activities promote health and protect against exposure to risk factors that lead to health problems. Primary prevention focuses on reducing or removing risk factors by changing the environment and the community, as well as, family and individual life styles and behaviors. This includes nutrition education and anticipatory guidance to develop and maintain healthful food and exercise behaviors.
   
2. Secondary prevention
   Secondary prevention focuses strategies to stop or slow the progression of disease. It includes screening and detection for early diagnosis, treatment and follow-up. Secondary prevention activities target those who are more susceptible to health problems because of family history, age, lifestyle, health condition, or environmental factors. Examples include blood lipid screening and referral, and nutrition and physical activity programs for overweight children.
   
3. Tertiary prevention
   Tertiary prevention is directed at managing and rehabilitating persons with diagnosed health conditions to reduce complications, improve their quality of life and extend their years of productivity. Feeding clinics for children with special health care needs is an example of tertiary prevention.
   

Levels of Intervention

Nutrition intervention is a purposefully planned activity, program, policy, or other action designed with the intent of changing a behavior, risk factors, environmental condition, or aspect of health status for an individual, target group, community, organizations, or the population at large. It includes a range of planned change efforts designed to ultimately improve the nutritional status of the population and prevent disease and disability.

Intervention approaches are also categorized into three levels

1. Individual-focused interventions aim to produce changes in knowledge, behavior or health outcomes of individuals either singly or in small groups. These interventions involve direct client contact including face to face visits and other personalized contact such as by telephone or by interactive computer program. They allow the greatest amount of tailoring and personalization to the client's needs. Examples include nutrition counseling, home health visits, and prenatal classes.
   
   
2. Community-focused interventions aim to reach and bring about changes in large numbers of the population. They are targeted to groups or subgroups of the community, but cannot be personalized. Examples include cholesterol screening clinic with referral, media campaign to promote breastfeeding, and building of bike paths.
   
   
3. System-focused interventions create changes in organizations, policies, laws or structures. The focus is not on individuals or communities, but on the systems that serve them. Examples include revised school lunch recipes to reduce fat content, food labeling regulations, standards for staffing of nutrition programs, and development of guidelines for practice such as Bright Futures.
   
   Effective community nutrition practice involves making appropriated and coordinated use of the levels of prevention and the approaches to intervention to address important nutrition problems. A coordinated, comprehensive plan for addressing a specific problem can be developed using the following Intervention Matrix.