Chronic diseases account for seven of the ten leading causes of death in the United States (WHO, 2020). In North Carolina, chronic disease disparities are some of the highest in the country. Specifically in rural areas, an area of interest to our group, there are large health disparities in chronic disease prevalence, morbidity, and mortality (CDC, 2023). These disparities are partly attributable to access: less access to healthcare providers, less access to quality food, housing and transportation, and less access to health prevention programs leading to higher rates of unhealthy behaviors. This is all compounded with the fact that our payment systems have historically not placed a high value on prevention. We also have been slow to collaborate across sectors to improve chronic disease prevention. To reduce chronic disease rates in our county, a multi-pronged and lifespan approach will be needed. However, one approach that is surely needed involves investing in nurse scientists and amplifying nursing as a key player in addressing chronic disease. There are many ways to do this but today we focus on developing the next generation of nurse prevention scientists, and in particular, Primary Prevention Nurse Scientists. We are defining Primary Prevention Nurse Science as a sub-discipline of prevention science that aims to prevent disease BEFORE it begins, an approach that for far too long has taken a back seat to more reactive approaches to addressing chronic disease in our country.
Primary Prevention Nurse Scientists are key to the development of new care models that leverage the unique expertise of nursing and our traditional social justice lens to address deeply rooted inequities in chronic disease in our country. Investment in primary prevention is key to addressing some the most challenging health issues in our country and saving our country billions in health-care costs related to avoidable ER visits and other hospitalizations. Nurse scientists need to be leading the charge of continuing to build the evidence base in this area given the strong underpinning the nursing profession has in protecting and promoting the health of patients, families and communities. Yet compared to other areas of science, there has been very little focus on the development and funding of Primary Prevention Nurse Scientists. For example, we conducted a recent search of NIH’s RePORTER, a catalog of all NIH funded research, to determine the landscape of funding around primary prevention science from the National Institute of Nursing Research (NINR). Using the search term “prevention” we pulled currently funded R01 mechanism and T32 institutional training grants by NINR. We pulled 61 R01 grants. We reviewed titles and abstracts and determined the 13 or 21% of those proposals have a primary prevention focus. We pulled 6 T32 training awards that mentioned the word “prevention” in title or abstract. From further review of abstract, only two T32’s appeared to have some explicit focus on primary prevention, none were specifically focused on primary prevention of disease. We need to increase these numbers. NINR states that 43% of their budget is focused on prevention, we must push to shift more of this budget towards prevention and specifically, primary prevention science. Although we acknowledge limitations to this approach (many nurse researchers’, including myself, are funded to do primary prevention work by other institutes or foundations, so this is far from perfect) we still think this information provides a starting point to track what we hope is an increased focus on primary prevention science among nurse researchers and NINR.
Primary prevention has been a mainstay of nursing for decades and nursing has strong historical underpinnings in health promotion and primary disease prevention. Nurses have and continue to play a critical role in promoting primary prevention in patients and communities. Nursing science now has a critical role to lead in generating innovative primary prevention care models that leverage nursing’s holistic view of treating patients incorporating an understanding of environmental and contextual factors that shape health. These holistic care models are key to disrupting chronic disease rates in our country. Recent changes to strategic priorities for Nursing Research suggests this is a critical time to advance Primary Prevention Nursing Science and capitalize on increased attention and federal funding focused on health promotion and prevention. Now is the time to amplify nursing’s position as a leader in primary prevention nursing science. Our group is committed to this charge, knowing the strength and expertise nurses bring to elevate primary prevention science to improve the health of the communities we serve.
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