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Use of lay opinion leaders to promote diffusion of health innovations in a community programme: Lessons learned from the North Karelia Project

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The innovation-diffusion approach offers a useful framework to community programmes that aim to influence health-related life-styles. This approach emphasizes that the risk-reducing life-styles are the innovations that diffuse with time through the natural networks of the given social system. This article describes the systematic use of lay opinion leaders in the North Karelia project, a comprehensive community-based preventive cardiovascular programme in Finland. Over 800 lay opinion leaders were trained to promote reduction of heart disease risk factors and, after approximately four years, a survey was conducted to assess the long-term feasibility and self-reported effects. The results and the experiences are discussed. It is concluded that the use of lay opinion leaders made a significant contribution to the overall impact of the project.
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Traducción de: Communication of Innovations. A Cross-Cultural Approach
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In 1971 the North Karelian population petitioned the Finnish Government to do something to reduce the extremely high heart disease rates in this largely rural county of 180,000 inhabitants in Eastern Finland. The North Karelia Project was formulated and launched in 1972 in close cooperation with Finnish experts and WHO. The aim of the project was to carry out a comprehensive community-based program for control of CVD and to promote health in the whole of North Karelia. This effort was considered a major national pilot program to evaluate its potential for nationwide and international use. A comprehensive community-based strategy was chosen which would favorably influence these factors by promotion of healthy lifestyles in the whole community. The program has encouraged people in North Karelia to stop smoking, to change their diets, and to have their blood pressure controlled. As far as smoking is concerned, the primary objective has been cessation of smoking. Reduction in the number of cigarettes smoked has been secondary. Change to low-tar cigarettes has not been promoted. In recent years, smoking prevention among children has also been promoted. A broad range of activities has been integrated into the local social organization and the existing service structure of the area. The activities have mainly been carried out by the community itself. The role of the project has mainly been to prepare the guidelines and necessary materials, to provide training and feedback, and to coordinate the activities. The effort to influence smoking has been based on such behavioral principles as increased health information, provision of preventive services, persuasion, teaching of practical change skills, provision of social support, environmental modifications, and community organization. In North Karelia in 1972-1982, reported smoking rates among men fell about 10% during the first year and then remained constant until further reduction after 1978. Among women, changes were smaller, with some increase in the 1978-1980 period.
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The North Karelia Project in Finland illustrates the fundamental goals of health promotion. Specific activities of the project serve as examples of how concepts from the social and behavioral sciences can be applied to achieve estimated reductions in predicted risk of disease. The results in North Karelia are not conclusive, but they are encouraging, and the investigations conducted there is an essential reference for future research in health promotion and disease prevention.