Spectrum of Prevention

The spectrum of prevention is a systematic tool that promotes a range of activities for effective drowning prevention to help people move beyond the perception that prevention is merely education. While an activity may clearly align with 1 or 2 levels on the spectrum, the results of implementing an activity can be maximized by thinking through related actions for the other levels of the spectrum.

For example, adopting a new law or policy may be the result of activities aimed at influencing legislation and policy — but effective implementation of that new law or policy likely involves efforts to change organizational practices, educate providers, promote community education, and strengthen individual knowledge and skills.

The 6 spectrum levels are:

• Influencing policy and legislation
  Developing strategies to change laws and policies to influence outcomes. This encompasses changes to national and state laws or county and municipal ordinances, as well as the adoption of formal policies by boards and commissions.
• Changing organizational practices
  Adopting regulations and evidence-informed practices to shape norms to enhance drowning prevention efforts. For example, this can include a swim school adding water safety education for parents or guardians while their child participates in swim lessons, or companies that rent stand-up paddleboards, kayaks, canoes, or boats adding a life jacket wear requirement.
• Fostering coalitions and networks
  Convening and maintaining groups (organizations or individuals) to address a common goal and increase the likelihood of success in drowning prevention efforts. This can include creating a state-wide water safety alliance developing and implementing a water safety action plan, a community task force addressing a specific local issue, or a coalition of organizations collaborating on a solution to a common challenge (e.g., a coalition of partners from across the country interested in developing a national minimum training standard).
• Educating providers
  Ensuring that providers have the necessary understanding and skills to educate or train others effectively. This encompasses efforts to educate providers who provide training and education (e.g., swim instructors, lifeguard trainers, public safety training officers, physicians, teachers, childcare providers) or transmit information to end users (e.g., pool installers, insurance companies, media).
• Promoting community education
  Reaching groups of people with information and resources to promote water safety. This involves efforts focused on specific groups or the population at large, such as public awareness campaigns.
• Strengthening individual knowledge and skills
  Enhancing an individual’s capability to prevent drowning and incorporate water safety through individual or group educational or training sessions. This includes water safety education, swim lessons, demonstrations on how to properly fit a life jacket, lifeguard certification training, and continuing education on pool safety for health inspectors.

Implementation Level

State, County, and Community level:
To reduce drowning across the United States, local context is key. Professionals at the state, county, or community level can use the recommendations and resources in the National Action Plan to create data- and evidence-informed context-specific water safety action plans that address local needs. 

National level:
The National Action Plan includes 40 national implications — these are actions at a national level that support uptake and implementation of recommendations at the state, county, and community levels. They include actions such as developing national minimum standards, advocacy toolkits with model laws, and national-level guidance. Developing these tools and resources and encouraging their adoption or use will help address existing inequities between and within states, counties, and communities.

Evidence Level

The evidence for the Recommendations was analyzed in two phases: an analysis of evidence found by each of the working groups; and then by an expert panel engaged specifically to determine and communicate a consistent level of evidence as part of the final work product.  

The initial phases of evidence analysis utilized categories and examples (evidence-based; promising; insufficient evidence; ineffective; potentially harmful) taken from Peden M. et al (eds.) ‎(2008) World report on child injury prevention. World Health Organization.  https://apps.who.int/iris/handle/10665/43851 and Quan L., Bennett E.E., Branche C.M. (2008) Interventions to Prevent Drowning. In: Doll L.S., Bonzo S.E., Sleet D.A., Mercy J.A. (eds) Handbook of Injury and Violence Prevention. Springer, Boston, MA. https://doi.org/10.1007/978-0-387-29457-5_5 and in consultation with Linda Quan, MD and Stephen Langendorfer, PhD.

The final classification of each recommendation, based on recommendation by our panel of experts, was simplified to a 3-point scale and falls into one of the following categories:

• High – Reasonable research evidence
• Medium – Limited research evidence
• Low – Little or no research evidence / Expert opinion