title: A systematic review and meta-analysis of primary prevention programmes to improve cardio-metabolic risk in non-urban communities.
abstract: Although cardiovascular disease (CVD) and type 2 diabetes mellitus (T2DM) prevention programmes have been effective in urban residents, their effectiveness in non-urban settings, where cardio-metabolic risk is typically elevated, is unknown. We systematically reviewed the effectiveness of primary prevention programmes aimed at reducing risk factors for CVD/T2DM, including blood pressure, body mass index (BMI), blood lipid and glucose, diet, lifestyle, and knowledge in adults residing in non-urban areas.
  
  
  
  Twenty-five manuscripts, globally, from 1990 were selected for review (seven included in the meta-analyses) and classified according to: 1) study design (randomised controlled trial [RCT] or pre-/post-intervention); 2) intervention duration (short [<12months] or long term [≥12months]), and; 3) programme type (community-based programmes or non-community-based programmes).
  
  
  
  Multiple strategies within interventions focusing on health behaviour change effectively reduced cardio-metabolic risk in non-urban individuals. Pre-/post-test design studies showed more favourable improvements generally, while RCTs showed greater improvements in physical activity and disease and risk knowledge. Short-term programmes were more effective than long-term programmes and in pre-/post-test designs reduced systolic blood pressure by 4.02mmHg (95% CI -6.25 to -1.79) versus 3.63mmHg (95% CI -7.34 to 0.08) in long-term programmes. Community-based programmes achieved good results for most risk factors except BMI and (glycated haemoglobin) HbA1c.
  
  
  
  The setting for applying cardio-metabolic prevention programmes is important given its likelihood to influence programme efficacy. Further investigation is needed to elucidate the individual determinants of cardio-metabolic risk in non-urban populations and in contrast to urban populations.
authors.affiliation: Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Electronic address: andre.rodrigues@monash.edu.
authors.forename: Andre L
authors.initials: AL
authors.lastname: Rodrigues
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Electronic address: jocasta.ball@acu.edu.au.
authors.forename: Jocasta
authors.initials: J
authors.lastname: Ball
authors.affiliation: Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Electronic address: chantal.ski@acu.edu.au.
authors.forename: Chantal
authors.initials: C
authors.lastname: Ski
authors.affiliation: Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Electronic address: simon.stewart@acu.edu.au.
authors.forename: Simon
authors.initials: S
authors.lastname: Stewart
authors.affiliation: Dept. of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia. Electronic address: melinda.carrington@acu.edu.au.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Carrington
mesh_terms: D002318:Cardiovascular Diseases / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D015444:Exercise; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D011322:Primary Prevention; D012307:Risk Factors; D012424:Rural Population
keywords: Cardiovascular disease; Diabetes; Intervention; Prevention; Rural