Can a sustainable community intervention reduce the health gap? - 10-Year evaluation of a Swedish community intervention program for the prevention of cardiovascular disease

Department of Public Health and Clinical Medicine, Umeå University, Sweden.
Scandinavian journal of public health. Supplement (Impact Factor: 1.44). 02/2001; 56(56):59-68. DOI: 10.1080/140349401316898144
Source: PubMed

ABSTRACT This paper evaluates the 10-year outcomes of a Northern Sweden community intervention program for the prevention of cardiovascular disease (CVD), with special reference to the social patterning of risk development.
Using a quasi-experimental design, trends in risk factors and predicted mortality in an intervention area (Norsjö municipality) are compared with those in a reference area (Northern Sweden region) by repeated independent cross-sectional surveys.
There were significant differences in changes in total cholesterol level and systolic blood pressure between the intervention and reference populations. The predicted coronary heart disease mortality (based on the North Karelia risk equation). after adjustment for age and education, was reduced by 36% in the intervention area and by 1% in the reference area.
We conclude that a long-term community-based CVD prevention program which combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. When evaluated for different social strata, we found no signs of an increasing health gap between socially privileged and less privileged groups. Socially less-privileged groups benefited the most from the present prevention program.

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Available from: Kurt Boman, Aug 25, 2014
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    • "Addressing community dynamics can lead to better absorption and institutionalization of intervention activities and principles by implementing organizations, increased capacity of community members and organizations to mobilize resources, technical assistance, researcher involvement, and public support for existing or developing programs (Jana et al 2004; Schensul, 2009). Programs that extend beyond the individual to peer, family, and community involvement have proven effective in a number of interventions, contributing to the reduction of cardiovascular risk (Weinehall et al., 2001), reduction in childhood obesity (Beech, 2003; Janicke, 2008), greater adolescent psychosocial health (Williams et al., 2003), greater treatment efficacy for co-occuring mental illness and substance abuse disorders (Holder, 2000), and reduction of sexual risk factors among substance-users (Fleming, 2006). "
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    ABSTRACT: This paper responds to the call for culturally-relevant intervention research by introducing a methodology for identifying community norms and resources in order to more effectively implement sustainable interventions strategies. Results of an analysis of community norms, specifically attitudes toward gender equity, are presented from an HIV/STI research and intervention project in a low-income community in Mumbai, India (2008-2012). Community gender norms were explored because of their relevance to sexual risk in settings characterized by high levels of gender inequity. This paper recommends approaches that interventionists and social scientists can take to incorporate cultural insights into formative assessments and project implementation These approaches include how to (1) examine modal beliefs and norms and any patterned variation within the community; (2) identify and assess variation in cultural beliefs and norms among community members (including leaders, social workers, members of civil society and the religious sector); and (3) identify differential needs among sectors of the community and key types of individuals best suited to help formulate and disseminate culturally-relevant intervention messages. Using a multi-method approach that includes the progressive translation of qualitative interviews into a quantitative survey of cultural norms, along with an analysis of community consensus, we outline a means for measuring variation in cultural expectations and beliefs about gender relations in an urban community in Mumbai. Results illustrate how intervention strategies and implementation can benefit from an organic (versus a priori and/or stereotypical) approach to cultural characteristics and analysis of community resources and vulnerabilities.
    Social Science [?] Medicine 05/2011; 72(10):1630-8. DOI:10.1016/j.socscimed.2011.03.029 · 2.89 Impact Factor
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    • "Methods based on individual meetings such as health dialogues instead of group meetings, seem to suit better families from groups that are more vulnerable. In a study where health dialogues similar to the Health Curve were used, patients from lower social groups reported greater benefit from health dialogues compared to patients from groups that were more socially secure (Weinehall et al., 2001). Moreover, when mothers ranked clinical strategies for promoting infant health, those with lower incomes and limited education preferred intervention through individual guidance and support (Gaffney and Altieri, 2001). "
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    ABSTRACT: The Health Curve, used by nurses in community-based health care, is an educational tool for conducting goal-directed dialogues concerning lifestyle and health. The aim of this study was to investigate how child health nurses experienced the Health Curve as a tool for conducting dialogues with parents. Fourteen nurses were interviewed. The data were analysed according to qualitative analysis. The results showed that nurses working in child health care experienced the Health Curve as a useful tool for conducting health dialogues with parents. Through their work with the Health Curve, the nurses gained a greater insight into, and understanding of, the families' health and life situation. The results indicated that working with the Health Curve could increase the opportunity for nurses to provide parents with support early in the process, helping the family to lead a healthy lifestyle.
    Journal of Child Health Care 04/2009; 13(1):75-88. DOI:10.1177/1367493508098382 · 0.88 Impact Factor
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    • "Other studies have evaluated the risk factor reduction in the Norsjö intervention area compared to a reference area up to 1992/94 [29,30]. Our present study confirmed a risk factor load reduction between 1986 and 1996. "
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    ABSTRACT: Public health interventions are directed towards social systems and it is difficult to foresee all consequences. While targeted outcomes may be positively influenced, interventions may at worst be counterproductive. To include self-reported health in an evaluation is one way of addressing possible side-effects. This study is based on a 10 year follow-up of a cardiovascular community intervention programme in northern Sweden. Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes. Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated. Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved.
    BMC Public Health 02/2007; 7(1):190. DOI:10.1186/1471-2458-7-190 · 2.26 Impact Factor
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