Learning Outcomes
By the end of this section, you should be able to:
- 26.4.1 Recognize major diseases affecting adults.
- 26.4.2 Compare health outcomes between adults.
- 26.4.3 Create evidence-based educational interventions to promote self-care for health promotion, illness prevention, and illness management of adults.
- 26.4.4 Examine major risk factors influencing the health of adults.
- 26.4.5 Identify Healthy People 2030 goals established for adults.
- 26.4.6 Describe health promotion and disease prevention actions applicable to adults.
- 26.4.7 Discuss evidence-based strategies for integrating sociocultural and linguistically responsive health promotion and disease prevention interventions in the clinical practice of adults.
The prevention of chronic diseases has become a major public health concern. Cardiovascular disease, diabetes, and cancer are leading causes of death and disability in adults globally; in the United States, one in three deaths each year occurs due to heart disease, stroke, or other cardiovascular diseases (National Center for Chronic Disease Prevention and Health Promotion, 2022c). The good news is that many of these chronic diseases are preventable through efforts that target lifestyle modification and appropriate health behaviors. Therefore, promoting and maintaining good health practices among adults is critical for preventing chronic diseases and improving quality of life. While chronic diseases are a significant concern for adults, communicable diseases also substantially threaten public health. Influenza, tuberculosis, and STIs are only some illnesses caused by infectious agents that may spread from person to person. The COVID-19 pandemic demonstrated the importance of preventing the spread of infection (National Foundation for Infectious Diseases, 2023).
This section discusses various aspects of adult health promotion and disease prevention, including healthy lifestyle habits, recommended screenings and immunizations, the impact of communicable and noncommunicable diseases on vulnerable populations, and the importance of cultural competence in addressing these health issues. By understanding and implementing these activities into their lives, adults can protect themselves and their communities while also improving their overall health and well-being.
Major Diseases Affecting Adults
In the United States, several major diseases affect adults, leading to significant mortality (see Table 26.10). These diseases cause physical limitations, significantly impact quality of life, and increase health care costs. Nurses must understand the causes, risk factors, and preventive measures associated with these diseases to help reduce their burden on the population and promote healthy living. Of these 13 diseases, 11 are noncommunicable diseases.
| Mortality | |||
|---|---|---|---|
| Cause of Death Rank | Number of Deaths | Deaths per 100,000 Population | |
| Noncommunicable | |||
| Diseases of heart | 1 | 694,619 | 278.1 |
| Malignant neoplasms | 2 | 603,484 | 241.6 |
| Accidents | 4 | 215,485 | 86.3 |
| Cerebrovascular disease | 5 | 162,577 | 65.1 |
| Chronic lower respiratory diseases | 6 | 142,136 | 56.9 |
| Alzheimer’s disease | 7 | 119,398 | 47.8 |
| Diabetes | 8 | 103,135 | 41.3 |
| Chronic liver disease and cirrhosis | 9 | 56,576 | 22.7 |
| Nephritis, nephrotic syndrome, and nephrosis | 10 | 54,283 | 21.7 |
| Intentional self-harm (suicide) | 11 | 45,229 | 18.1 |
| Essential hypertension and hypertensive renal disease | 12 | 42,806 | 17.1 |
| Communicable | |||
| COVID-19 | 3 | 416,252 | 166.7 |
| Influenza and pneumonia | 13 | 41,653 | 16.7 |
Coronary Artery Disease
Coronary artery disease (CAD), also called coronary heart disease or ischemic heart disease (CDC, 2021j), occurs when plaque buildup in the wall of the coronary arteries (atherosclerosis) decreases blood supply to the heart. Risk factors for CAD include being overweight, eating poorly, and smoking tobacco. CAD also has genetic connections, particularly a family history of heart disease before age 50. For many, the first indicator of CAD is a heart attack.
Cancer
Cancer occurs when abnormal cells divide out of control and can invade other tissues (CDC, 2021f). Cancer cells can also spread to other body parts through the blood and lymph symptoms. There are more than 100 different types of cancer; some are preventable, and others are not. One of every five deaths in the United States is due to cancer (U.S. Cancer Statistics Working Group, 2022). One leading cause of cancer is smoking. In addition to lung cancer, smoking can cause cancer in the blood, bladder, cervix, colon and rectum, esophagus, kidney, larynx, liver, mouth and throat, pancreas, and stomach. Lowering one’s cancer risk can occur through making healthier choices such as maintaining a healthy weight, limiting alcohol intake, and protecting the skin from UV exposure.
Cerebrovascular Disease
Cerebrovascular disease, or a stroke, is caused when something blocks the blood supply to a part of the brain or a blood vessel in the brain ruptures (CDC, 2023i). Regardless of the cause, parts of the brain become damaged or die, leading to problems with movements, memories, thoughts, emotions, language, or other body functions. Strokes can occur at any age, but some people are at greater risk. Those with a history of a previous stroke or transient ischemic attack (TIA), hypertension, high cholesterol, coronary artery disease, atrial fibrillation, diabetes, obesity, and sickle cell disease are at much higher risk of having a stroke. Some lifestyle choices that increase the risk of stroke include (CDC, 2023j):
- a diet high in saturated fats and cholesterol,
- a lack of enough physical activity,
- too much alcohol consumption, and
- tobacco use.
There are also genetic components to stroke risk and factors related to age, sex, race, and ethnicity. Individuals aged 55 and older are more likely to have a stroke, and strokes are more common in women than men. Those who are non-Hispanic Black or Pacific Islander are more likely to die from a stroke than non-Hispanic White people, Hispanic people, AIAN, and Asians. Black people have a higher risk of having a first stroke and are more likely to die from a stroke than White people (CDC, 2023j).
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is a group of diseases that block airflow and cause other breathing-related problems. COPD includes emphysema and chronic bronchitis. Tobacco smoking is the primary cause of COPD; other causes are related to exposure to air pollutants in the home and workplace, genetic factors, and a history of respiratory infections. The CDC (2021h) reports that women; people aged 65 and older; AIAN and multiracial non-Hispanic people; those who are unemployed, retired, or unable to work; those with less than a high school education; those who are divorced, widowed, or separated; current or former smokers; and those with a history of asthma are more likely to develop COPD.
Alzheimer’s Disease
Alzheimer’s disease is the most common type of dementia. It begins with mild memory loss and then progresses to the inability to hold a conversation or respond to the environment appropriately, causing severe difficulties in performing activities of daily living (CDC, 2020d). Alzheimer’s disease impacts the part of the brain that controls thoughts, memories, and language. Much remains to be learned about this disease. The best-known risk factor for developing Alzheimer’s disease is age. Genetics may also play a role in its development. Findings suggest that a healthy lifestyle could decrease the risk of developing Alzheimer’s disease (CDC, 2020d).
Alzheimer’s Disease—Genes Do Not Equal Destiny
In the Aging and Health Matters podcast episode “Alzheimer’s Disease—Genes Do Not Equal Destiny,” host Montrece Ransom speaks with CDC’s Scott Bowen about research that found a healthy lifestyle can help reduce the risk for Alzheimer’s disease (CDC, 2022o).
Listen to the podcast or read the transcript, and then respond to the following questions.
- What were the new findings from the research?
- What were the four healthy lifestyles that helped to prevent dementias in the research?
Diabetes
Diabetes is a chronic health condition caused by the body either not making enough insulin or not using insulin effectively. When either of these occurs, too much blood sugar remains in the bloodstream (CDC, 2022e). Over time, the increased blood sugar can lead to serious health problems, including heart disease, vision difficulties, and kidney disease. More than one in three adults in the United States have prediabetes, with blood sugar levels higher than normal but not high enough to develop type 2 diabetes, and over 80 percent of adults do not know they have prediabetes (CDC, 2022j). Prediabetes can increase the risk of heart disease and stroke and can be viewed as an opportunity to prevent type 2 diabetes. See Figure 26.3 for more about prediabetes.
The three types of diabetes are type 1 diabetes, type 2 diabetes, and gestational diabetes. Gestational diabetes was discussed briefly earlier in this chapter. In type 1 diabetes, the body does not make enough insulin, perhaps due to an immune reaction. Risk factors for this type of diabetes are family history and age, as it usually develops in children, teens, or young adults. White people in the United States are more likely to develop type 1 diabetes than Black or Hispanic people (CDC, 2022j), and there is no known way to prevent it. In type 2 diabetes, the pancreas makes less insulin than previously, and the body becomes resistant to it. Type 2 diabetes can sometimes be prevented with healthy diet and activity. A variety of factors put a person at risk for type 2 diabetes, including:
- having prediabetes;
- being overweight;
- being age 45 or older;
- having a direct relative with type 2 diabetes;
- being physically active less than three times weekly;
- having gestational diabetes or giving birth to a baby weighing over 9 pounds; and
- being African American, Hispanic, or AIAN (CDC, 2022e).
Also, more than half of women with PCOS develop type 2 diabetes by age 40, likely related to insulin resistance that occurs with PCOS (CDC, 2022w). Diabetes is the primary cause of kidney failure, lower-limb amputations, and adult blindness. The number of adults diagnosed with diabetes has more than doubled over the last 20 years. Of the adult U.S. population, 38 percent have prediabetes (CDC, 2022j).
Chronic Liver Disease
Chronic liver disease is a progressive deterioration of liver function, which includes the production of clotting factors and other proteins, detoxification of harmful metabolism products, and bile excretion. Cirrhosis is the final stage of chronic liver disease. The most common causes of chronic liver disease are alcoholic liver disease, non-alcoholic fatty liver disease, chronic viral hepatitis, and certain genetic and autoimmune causes. Other causes include use of certain drugs (amiodarone, isoniazid, methotrexate, phenytoin, and nitrofurantoin) and the vascular Budd-Chiari syndrome (Sharma & Nagalli, 2022). Of the causes, it is possible to deter chronic liver disease by limiting the use of over-the-counter pain medications and consumption of high-fat foods and alcohol and reducing the risk of developing hepatitis through vaccination, safer sex practices, and good hygiene.
Chronic Kidney Disease
Chronic kidney disease involves the damage of kidneys such that they cannot filter blood to remove wastes, toxins, and excess fluid. This excess fluid and waste remain in the body, leading to heart disease and stroke. The kidneys also help control blood pressure, stimulate the production of red blood cells, keep the bones healthy, and regulate important chemicals such as sodium, potassium, and calcium (CDC, 2022c). Risk factors for chronic kidney disease include diabetes, high blood pressure, heart disease, a family history of chronic kidney disease, and obesity. Following a healthy lifestyle and addressing any of the conditions that are risk factors can help decrease the effects or prevent chronic kidney disease.
Communicable Diseases
Two of the 10 diseases in Table 26.10 are communicable diseases (influenza and COVID-19). Both are respiratory in nature, with similar symptoms, and are easily transmitted (CDC, 2022p). See Pandemics and Infectious Disease Outbreaks for more information.
Comparison of Health Outcomes Between Adults
When comparing health outcomes between adults, many factors must be considered. SDOH, discussed in Social Determinants Affecting Health Outcomes, including economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context, are only a few of these factors. Others include age, gender, race, and lifestyle behaviors.
The following key health outcomes are commonly compared in adults; see The Health of the Population for more information:
- Overall health status: An individual’s self-perceived health status ranges from excellent to poor. In the United States, in 2019, 11.2 percent of people reported fair or poor health status. Trends related to age group and economic stability can be viewed on the CDC Health Status page.
- Chronic disease prevalence: This refers to the proportion of a population with chronic disease at a point in time. Data from the 2018 National Health Interview Survey (NHIS) found that 51.8 percent of the U.S. adult population had been diagnosed with at least one of the 10 chronic conditions previously discussed, and 27.2 percent had more than one of them. Data broken down into categories of sex, race/ethnicity, age, health insurance coverage, and location of residence (urban versus rural) can be viewed at Prevalence of Multiple Chronic Conditions Among U.S. Adults, 2018 (Boersma et al., 2020).
- Mortality rates: These are the number of deaths in a population, typically measured as the number of deaths per 100,000 individuals. The provisional mortality data in the United States in 2022 indicated that overall death rates were highest among males, older adults, and Black persons. In 2022, the highest weekly numbers of overall deaths and COVID-19-associated deaths were in January and December. Overall death and COVID-19-associated death data by age group, sex, and race and ethnicity can be viewed at Provisional Mortality Data — United States, 2022 (Ahmad et al., 2023).
- Quality of life: Health-related quality of life (HRQOL) is an individual’s or a group’s perceived physical and mental health over time. On the individual level, HRQOL involves perceptions of physical and mental health and their correlates, including health risks and conditions, functional status, social support, and socioeconomic status. On the community level, HRQOL includes community-level resources, conditions, policies, and practices that can influence a population’s functional status and perceptions of health (CDC, 2018). The County Health Rankings (University of Wisconsin Population Health Institute, 2023) model of health indicates measures that influence how well and how long people live. In this model, the following measures connect to quality of life:
- Poor or fair health
- Poor physical health days
- Poor mental health days
- LBW
- Frequent physical distress
- Frequent mental distress
- Diabetes prevalence
- HIV prevalence
In 2020, 12 percent of U.S. adults reported that they considered themselves in fair or poor health, that their physical health was not good on 3 of the previous 30 days, and that their mental health was not good on 4.4 of the previous 30 days. The percentage of live births with LBW (under 2,500 grams) was 8 percent. Also, 9 percent of adults were living with a diagnosis of diabetes, and 380 of every 100,000 residents aged 13 and over were living with a diagnosis of HIV (University of Wisconsin Population Health Institute, 2023).
Educational Interventions to Promote Self-Care in Adults
The WHO (2022d, para. 2) defines self-care as “the ability of individuals, families, and communities to promote their own health, prevent disease, maintain health, and to cope with illness and disability with or without the support of a health professional.” The concept of self-care recognizes individuals as active participants in managing their health in various areas, including health promotion, disease prevention and control, self-medication, providing care to dependent persons, and rehabilitation, including palliative care. Self-care is not intended to replace the need for the formal health care system but allows a different option to receive health care.
Some examples of educational interventions that may be used to promote self-care in the adult population include:
- Health education classes: can provide individuals or groups with information on topics such as healthy eating, physical activity, stress management, and disease prevention. Classes can be offered in various settings, such as community centers, workplaces, or health care facilities.
- Self-help materials: brochures, pamphlets, and books can provide individuals with information to maintain good health and prevent illness and can be made available in waiting rooms, libraries, and other public spaces.
- Workshops: can focus on learning practical self-care skills, such yoga or healthy cooking; may be led by health care professionals, community leaders, or trained volunteers.
- Mobile health applications (apps): can provide individuals with personalized health information, reminders, and tracking tools to help them maintain healthy habits. Apps are downloaded on smartphones and are available at any time.
- Social support groups: can provide individuals with the emotional support and encouragement needed to maintain healthy habits; can be led by trained facilitators and can meet in-person or virtually.
The WHO’s Guideline on Self-Care Interventions for Health and Well-Being offers suggestions for many health situations for adults. These guidelines stress the importance of tailoring these interventions to the needs and preferences of the target population to ensure maximum effectiveness (WHO, 2022d). See Planning Community Health Education for more information.
Healthy People 2030 Goals for Adults
Several Healthy People 2030 goals specifically target the health of the adult population. Healthy People 2030 divides these into goals for males and females. The overarching goal is to “improve health and well-being" (ODPHP, n.d.-d, para. 1).
The difference in the wording of the Healthy People 2030 goals for each sex is likely because males die an average of 5 years earlier than females (ODPHP, n.d.-d). According to the NCHS (2022),
- Life expectancy at birth for females in the United States dropped 0.8 years from 79.9 years in 2020 to 79.1 in 2021, while life expectancy for males dropped one full year, from 74.2 years in 2020 to 73.2 in 2021. The report shows the disparity in life expectancy between males and females grew in 2021 from 5.7 years in 2020 to 5.9 years in 2021. From 2000 to 2010, this disparity had narrowed to 4.8 years, but gradually increased from 2010 to 2019 and is now the largest gap since 1996. (para. 4)
Males are also at higher risk for some serious health conditions, such as heart disease, lung cancer, and HIV (ODPHP, n.d.-d). Specific Healthy People 2030 objectives for males are related to prostate cancer (reduce the prostate cancer death rate) and sexually transmitted infections (reduce the syphilis rate in males who have sex with males and reduce gonorrhea rates in male adolescents and young males) (ODPHP, n.d.-d).
Females also have unique health issues, such as menopause, and some health issues that may affect both sexes can pose unique challenges for females (ODPHP, n.d.-i). Females are also at risk for breast cancer and cervical cancer. There are several specific Healthy People 2030 Objectives for females, including:
- Reduce iron deficiency in females aged 12 to 49 years
- Reduce the female breast cancer death rate
- Increase the proportion of females who get screened for breast cancer
- Increase the proportion of females who get screened for cervical cancer
- Increase the proportion of females at increased risk who get genetic counseling for breast and/or ovarian cancer
- Reduce infections cause by Listeria
- Reduce the proportion of adults with osteoporosis
- Reduce pelvic inflammatory disease in female adolescents and young females
- Increase the proportion of sexually active female adolescents and young females who get screened for chlamydia
- Reduce the syphilis rate in females
Other goals target adult health, even though Healthy People 2030 does not specifically group these into such a category. Table 26.11 provides some examples.
| Category | Example of Healthy People 2030 Objective |
|---|---|
| Physical activity | Increase the proportion of adults who meet the guidelines for aerobic physical activity and muscle-strengthening activity from 25.2% in 2020 to 29.7% in 2030. |
| Nutrition and healthy eating | Reduce the proportion of adults with obesity from 41.8% between 2017 and 2020 to 36% in 2030. |
| Tobacco use | Reduce current tobacco use in adults from 19.3% in 2021 to 17.4% in 2030. |
| Drug and alcohol use | Reduce the proportion of people who had alcohol use disorder in the past year from 5.3% in 2019 to 3.9% in 2030. |
| Mental health | Reduce the suicide rate from 14.2 suicides per 100,000 population in 2018 to 12.8 per 100,000 population in 2030. |
| Chronic diseases | Reduce the number of diabetes cases diagnosed yearly from 5.5 new cases of diabetes per 1,000 adults in 2019–2021 to 4.8 per 1,000 adults in 2030. |
These Healthy People 2030 goals and objectives reflect the importance of promoting healthy behaviors, preventing chronic diseases, and improving mental health in adults. This can be achieved by addressing some of the SDOH, mentioned previously in this chapter and in Social Determinants Affecting Health Outcomes. For instance, increasing access to healthy, safe, and affordable food can improve the nutrition and health of adults (Figure 26.4). There are a variety of factors contributing to access of such foods (ODPHP, n.d.-e):
- Availability: The location, number, variety, and quality of grocery stores, food services, and farmers markets affects the availability of healthy foods in the community.
- Cost: The cost of foods affects which items adults purchase. The availability of produce and other healthier items can be limited, and they are often more expensive at convenience stores or smaller markets.
- Transportation: Access to reliable transportation can make it easier to travel for food and gives adults more choice in where they obtain food. Less access to reliable transportation can be a challenge for those living in rural communities.
- Community Programs: Local participation in community food support programs, such as farmers markets that accept payment using Supplemental Nutrition Assistance Program (SNAP) benefits, can encourage healthier food choices.
Health Promotion and Disease Prevention Activities to Improve the Health of Adults
Many health promotion activities for adults focus on addressing the short list of risk behaviors that lead to chronic illness; these include tobacco use, poor nutrition, physical inactivity, and excessive alcohol use. By engaging in health promotion activities, adults can improve their health, reduce their risk of chronic diseases, and create supportive environments that make healthy choices easier and more accessible. Mitigation of 7 of the 10 diseases shown in Table 26.10 can occur by addressing these behaviors. The CDC’s National Center for Chronic Disease Prevention and Health Promotion (2022c) provides detailed approaches to address these behaviors, including:
- helping people who smoke quit,
- increasing access to healthy foods and physical activity,
- preventing excessive alcohol use,
- promoting lifestyle change and disease management,
- promoting community water fluoridation,
- promoting mental health and emotional well-being, and
- promoting better sleep.
Public health policies and programs can also play a critical role in promoting health and improving the overall well-being of adults. Many success stories have resulted from health promotion activities to address the risk behaviors connected to the United States’ common chronic illnesses:
- Healthy Foods in Alabama Corner Stores Help Fight Food Deserts
- Coeur d’Alene Tribe Gets More Native Americans Moving with Pow Wow Sweat
- Tiffany R.’s Story: Tips from Former Smokers®
- Check Your Drinking. Make a Plan to Drink Less
- Beth’s Experience as a Breathe Well, Live Well Educator
- How Right Now
Adulthood comes with many responsibilities and increased productivity. From the ages of 18 through 65 years, significant biological, physiological, social, and psychological changes occur (Mayo Clinic, 2023). During this time, adults develop relationships with significant others, marriages or partnerships, families, and careers while making lifelong decisions. All of this impacts the health of adults.
Nurses are integral to fostering health promotion and disease prevention in U.S. adults. Along with individual, client-centered care, the nurse may need to provide family-centered and workplace health promotion and disease prevention to best address the health of this population. Nurses often conduct health assessments to identify risk factors and develop individualized, family, and population plans. This may include assessing lifestyle factors or screening for chronic diseases. Nurses provide education to individual and adult populations on healthy lifestyle behaviors, disease prevention, and self-care management. Nurses perform preventative measures to detect and prevent diseases, such as administering immunizations, performing screenings, and providing counseling. Nurses coordinate care for adults with complex health needs through referrals to appropriate health care providers, community resources, or social services to assist in meeting their needs. Finally, nurses advocate for the adult population by promoting policies and environments that support health and prevent disease, such as working to address SDOH that contribute to health disparities (Melariri et al., 2022).
Primary Prevention
Primary prevention involves taking measures to prevent health problems or injuries before they happen. A variety of primary prevention strategies can be used in the adult population. Some of these include:
- Immunizations: Immunizations are a highly effective mechanism of preventing infectious diseases such as influenza, pneumonia, COVID-19, and hepatitis B. The HPV vaccine can prevent several different types of cancer (CDC, 2023e). See the CDC’s 2023 Recommended Adult Immunization Schedule for specific recommendations for adults (CDC, 2023a).
- Health education: Education can alter behaviors that could lead to disease or injury and can increase resistance to disease or injury should exposure occur. Some examples of health education for the adult population include nutrition, regular exercise, avoidance of smoking, workplace safety, safe sex practices, and sun safety (Figure 26.5).
- Advocacy: Nurses can advocate for legislation and enforcement to ban or control the use of hazardous products, such as asbestos, or to mandate safe and healthy practices, such as the use of seat belts.
Averting musculoskeletal disorders such as lower back pain, neck and shoulder pain, wrist strain, and tendonitis is one example of primary prevention. These disorders are among the leading causes of work-related disability associated with prescription opioid use that can progress into substance use disorder (Le & Rosen, 2021). Primary prevention can address musculoskeletal disorders and implement proper ergonomics in the workplace. For example, nurses can educate workers to lift with their arm and leg muscles rather than their back. Implementing a work site stretch and flex program can prepare the employee’s body for the shift ahead (ResponsAble Safety Staffing, 2018). Personal protective equipment (PPE) designed to reduce the risk of injury, such as shoulder and knee pads, can prevent injury. These strategies can prevent the progression to a substance use disorder and reduce workers’ compensation, health care, social security, and other disability costs associated with work-related injuries (Le & Rosen, 2021). Caring Across Practice Settings discusses occupational health in more detail.
Secondary Prevention
Secondary prevention is critical for detecting and treating diseases, before they cause significant harm. Screening tests, diagnostic tests, and routine health exams are essential for early detection and treatment of diseases. The 2023 Adult Preventive Health Guidelines: Ages 19 through 64 Years provides specific information (Highmark, 2023a). Examples of secondary prevention strategies for adults include:
- Cancer screening: Screenings for cancer, such as mammograms, colonoscopies, and Pap tests, can detect cancers at its earliest stages, when treatment is most effective.
- Cardiovascular disease screenings: Regular blood pressure and cholesterol screenings can detect early signs of cardiovascular disease, allowing for early intervention and treatment.
- Diabetes screenings: Screening for diabetes with a simple blood test can detect the disease or prediabetes early, allowing for early intervention and treatment to prevent progression and complications.
- Routine health exams: Regular checkups with a health care provider can help identify health problems before they become serious.
- Skin cancer screenings: Routine skin cancer screenings can detect early signs of skin cancer.
- STI screenings: Regular STI screenings can detect early signs of infection, allowing for early treatment, prevention of spread, and prevention of complications
- Osteoporosis screenings: Regular bone density screenings can detect early signs of osteoporosis, allowing for early intervention and treatment to prevent fractures.
The HPV test, which looks for the virus that can cause cell changes on the cervix, and the Pap test, which looks for precancers or cell changes on the cervix that, if untreated, might become cervical cancer, are the two tests that can help either prevent cervical cancer or find it early in adult women. Jasmine’s Story: Preventing Cervical Cancer provides one person’s experience with this screening.
The CDC has also developed an interactive experience, called Talk to Nathan, that provides a conversation with an avatar to help clients determine if they should be screened for prostate cancer. Another interactive experience is provided to health care providers to allow them to practice helping clients make decisions about prostate cancer screening and treatment (CDC, 2022m).
Tertiary Prevention
Tertiary prevention focuses on preventing further complications and improving the quality of life for adults who are living with a chronic disease or condition. Some examples of tertiary prevention strategies for adults include:
- Disease management programs: Disease management or disease self-management programs are designed to help adults with chronic diseases manage their condition and prevent progression or complications. They may include education, lifestyle changes, medication management, and support groups.
- Rehabilitation programs: Rehabilitation programs, such as physical therapy and occupational therapy, can help adults regain strength and function following an illness or injury.
- Chronic pain management: Chronic pain management programs can help adults manage their pain and improve their quality of life. These may include medication management, therapies, and psychological support.
- Palliative care: Palliative care is specialized medical care for those living with a serious illness, such as cancer or heart failure. It is meant to provide symptom care to allow them to focus on their quality of life. Palliative care can be provided along with curative treatment (National Institute on Aging, 2021).
- End-of-life care: End-of-life care is often also known as hospice care. It focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life. Attempts to cure a person’s illness are no longer used (National Institute on Aging, 2021).
- Mental health support: Mental health support may include therapy and support groups to assist adults and their families in coping with emotional and psychological effects of diseases.
The CDC’s National Diabetes Prevention Program was created in 2010 to address the increasing burden of prediabetes and type 2 diabetes on adults in the United States. Partnerships between public and private organizations led to the development of evidence-based, cost-effective interventions to help prevent type 2 diabetes in communities. The Lifestyle Change Program is one result of this effort. It is designed for adults who are overweight, not yet diagnosed with type 1 or type 2 diabetes, and not currently pregnant but either are diagnosed with prediabetes, were previously diagnosed with gestational diabetes, or have high-risk results on the CDC’s prediabetes risk test. The program involves a CDC-approved curriculum, a lifestyle coach, and a support group of people with similar goals and challenges (CDC, 2022u).
Integration of Sociocultural and Linguistically Responsive Interventions for Adults
A “one size fits all” approach to health promotion and disease prevention may not be effective for all clients. Sociocultural and linguistic factors such as language barriers, cultural beliefs, and SDOH can significantly influence an individual’s health outcomes. Therefore, integrating sociocultural and linguistically responsive interventions into health care is crucial for promoting health equity and improving health outcomes for all individuals, including adults. This section explores the importance of integrating sociocultural and linguistically responsive interventions for adults and some examples of how nurses can effectively implement these interventions into practice.
Sociocultural Interventions
By incorporating socioculturally responsive components into the design of health promotion and disease prevention programs, nursing interventions can more effectively engage and promote healthy behaviors among the adult population. Immigrant adults are one specific population that may benefit from such integration. Immigrants face unique cultural barriers to participation in mainstream health promotion programs. These include a lack of access to health care for a variety of reasons, including ineligibility for certain programs, limited support for culturally appropriate health care services, lack of knowledge of the U.S. health care system, distrust of the U.S. health care system, and fears related to deportation with the use of public services (Ali et al., 2021). Other barriers may involve specific customs and unique cultural or religious understandings of health and disease. U.S. immigrants are more likely to be unaware of a chronic disease, such as hypertension, and have lower treatment rates. Ali et al. (2021) determined that while modifiable lifestyle behavioral risk factors must be the common target for hypertension reduction interventions, additional factors should be considered in immigrant communities. These factors include:
- gender roles,
- perceptions about physical activity,
- demanding work schedules,
- neighborhood barriers to healthy living, and
- limited physical and financial accessibility to appropriate spaces for healthy activities.
For example, Oshunluyi et al. (2020) described group-based culturally adapted educational sessions on hypertension for African immigrants that incorporated culturally appropriate storytelling. Ma et al. (2020) described using local libraries, churches, and homes to provide group-based culturally adapted education sessions to Filipino Americans at risk of hypertension. Family members have been shown to have a very strong role in impacting sociocultural and economic factors related to immigrant health and behavior change (Ali et al., 2021). Therefore, family members have been successful as change agents in this population.
Linguistically Responsive Interventions
While sociocultural responsiveness as a whole is imperative in the design of health promotion and disease prevention programs for adults, there is a specific need for linguistic responsive interventions. Kling et al. (2018) described using open, multipurpose rooms inside park recreation centers for group-based multilingual fitness classes. In the classes, five instructors were Hispanic, and four were non-Hispanic Black. Six instructors led the class in English, one led in Spanish, and one led in a mixture of English and Spanish.