Verhaltensbasierte Prävention chronischer Krankheiten – wie kann sie gelingen?

Zusammenfassung

Hintergrund: Tabakrauchen, gesundheitsriskanter Alkoholkonsum, Übergewicht und Bewegungsmangel tragen zu mehr als 50 % von Herzinfarkten bei und bilden die häufigsten vermeidbaren Entstehungsfaktoren von Krebserkrankungen. Herz-Kreislauf- und Krebserkrankungen ließen sich verringern durch Prävention zusätzlich zur medizinischen Versorgung. Ziel dieses Beitrags ist die Elemente darzustellen, die Prävention ausmachen: Teilnehmerraten, Interventionsprogramme und Ergebnisse. Ergebnis-Kriterien umfassen die Intentionen zur Verhaltensänderung, die Verhaltensweisen selber, die gesamte Lebenszeit und die Zeit der Freiheit von chronischer Krankheit und Behinderung.

Ergebnisse: Der Stand internationaler Evidenz zeigt, dass Präventionsleistungen auf nationaler Ebene Umweltänderungen und direkte Interventionen umfassen sollten. Umweltänderungen beinhalten Reduktion der Attraktivität von und Schutz der Menschen vor gesundheitsriskanten Produkten. Direkte Intervention schließt besonders Beratungen ein. Diese Leistungen führen zu Reduktionen inzidenter Herz-Kreislauf- und Krebserkrankungen. Die Evidenz zur Wirksamkeit von Prävention stellen Verlaufsstudien, Modellrechnungen zu Risikofaktoren und Krankheiten sowie Kontrollgruppenstudien bereit. Alle drei Analyse-Ansätze belegen Erfolge der Prävention. Die Zusammenarbeit von Prävention und medizinischer Versorgung trägt zu Synergien bei.

Folgerung: Es besteht ein Handlungsdefizit. Bewährte oder als wirksam belegte Leistungen sollten in die Praxis umgesetzt, die Kooperation zwischen Prävention und medizinischer Versorgung gefördert werden.

Abstract

Background: Tobacco smoking, unhealthy alcohol drinking, overweight, and lack of physical activity add to more than 50 % of myocardial infarction and are the most prevalent avoidable factors related to cancer. Cardiovascular disease and cancer may be curbed by preventive action in addition to medical care. The aim of this contribution is to present the elements that constitute prevention: participation rates, intervention programs, and outcomes. Criteria for outcomes include intention to change behaviors, the behavior change, total lifetime and time of life free of chronic disease and disability.

Results: Evidence reveals that national preventive action should include legal action, environmental change, and direct health behavior change. The measures include reducing the appeal of and increasing the protection against risky products. Such provisions will reduce cardiovascular disease and cancer incidence. Direct behavior change includes counseling individuals in the general population. Evidence is provided by cohort, modeling, and controlled trial data. All three approaches revealed success of prevention. Collaboration of prevention and medical care will add to synergies.

Conclusion: A deficit of action exists. Effective preventive action should be implemented into practice, cooperation between prevention and medical care be supported.

Schlüsselwörter

Prävention - Umweltveränderung - Verhaltensintervention

Keywords

prevention - environmental changes - brief intervention

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