A review of five major community-based cardiovascular disease prevention programs. Part II: Intervention strategies, evaluation methods, and results.
Major community-based cardiovascular disease prevention programs have been conducted in North Karelia, Finland; the state of Minnesota; Pawtucket, Rhode Island; and in three communities and more recently in five cities near Stanford, California. The main hypothesis is that community intervention will reduce the prevalence of cardiovascular disease risk factors and consequently reduce cardiovascular disease incidence, morbidity, and mortality. Intervention strategies include community mobilization, social marketing, school-based health education, worksite health promotion, screening and referral of those at high risk, education of health professionals, direct education of adults, and modification of physical environments. Formative evaluation provides short-term feedback to program managers about immediate effects of intervention strategies. Outcome evaluation examines the effects of intervention on longitudinally sampled cohorts and compares cardiovascular risk status and morbidity and mortality in intervention and comparison communities. Results from North Karelia and the Stanford Three Community Study indicate that this model is efficacious and cost-effective. The National Heart, Lung, and Blood Institute biomedical research spectrum envisions research in knowledge transfer and innovation diffusion as the last link in the causal chain whereby research affects the health of the population, but research in this area remains undeveloped compared to other aspects of cardiovascular disease prevention. This is Part II of a two part article; Part I appeared in Volume 4, Number 3.
Shea
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School of Public Health, Columbia University, New York City.
Basch
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D002140:California; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D004059:Diffusion of Innovation; D005387:Finland; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008137:Longitudinal Studies; D008910:Minnesota; D010043:Outcome and Process Assessment, Health Care; D015397:Program Evaluation; D012237:Rhode Island; D012307:Risk Factors