Dissecting the "black box" of community intervention: background and rationale

Pearson, T. A.; Lewis, C.; Wall, S.; Jenkins, P. L.; Nafziger, A.; Weinehall, L.

doi:10.1080/140349401316898081

Cited by 9 publications

(14 citation statements)

References 7 publications

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“…Late-adopter communities frequently fail to engage innovation unless additional efforts are expended to organize the community, to ensure personal health services, and to enact policy and environmental changes. 40 Such efforts did occur in Franklin, likely explaining why it became an early adopter, only later matched by the rest of the state, as the smoking and mortality data demonstrate. Rural Health Associates and its physician group rapidly improved financial access as well as local access to dental, specialty, and primary care, subsequently maintained in large part by the single county hospital.…”

Section: Discussionmentioning

confidence: 99%

Community-Wide Cardiovascular Disease Prevention Programs and Health Outcomes in a Rural County, 1970-2010

Record

Onion

Prior

et al. 2015

JAMA

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IMPORTANCE Few comprehensive cardiovascular risk reduction programs, particularly those in rural, low-income communities, have sustained community-wide interventions for more than 10 years and demonstrated the effect of risk factor improvements on reductions in morbidity and mortality. OBJECTIVE To document health outcomes associated with an integrated, comprehensive cardiovascular risk reduction program in Franklin County, Maine, a low-income rural community. DESIGN, SETTING, AND PARTICIPANTS Forty-year observational study involving residents of Franklin County, Maine, a rural, low-income population of 22 444 in 1970, that used the preceding decade as a baseline and compared Franklin County with other Maine counties and state averages. INTERVENTIONS Community-wide programs targeting hypertension, cholesterol, and smoking, as well as diet and physical activity, sponsored by multiple community organizations, including the local hospital and clinicians. MAIN OUTCOMES AND MEASURES Resident participation; hypertension and hyperlipidemia detection, treatment, and control; smoking quit rates; hospitalization rates from 1994 through 2006, adjusted for median household income; and mortality rates from 1970 through 2010, adjusted for household income and age. RESULTS More than 150 000 individual county resident contacts occurred over 40 years. Over time, as cardiovascular risk factor programs were added, relevant health indicators improved. Hypertension control had an absolute increase of 24.7%(95%CI, 21.6%–27.7%) from 18.3%to 43.0%, from 1975 to 1978; later, elevated cholesterol control had an absolute increase of 28.5% (95%CI, 25.3%-31.6%) from 0.4% to 28.9%, from 1986 to 2010. Smoking quit rates improved from 48.5% to 69.5%, better than state averages (observed − expected [O − E], 11.3%; 95% CI, 5.5%–17.7%; P < .001), 1996–2000; these differences later disappeared when Maine’s overall quit rate increased. Franklin County hospitalizations per capita were less than expected for the measured period, 1994–2006 (O − E, −17 discharges/1000 residents; 95% CI −20.1 to −13.9; P < .001). Franklin was the only Maine county with consistently lower adjusted mortality than predicted over the time periods 1970–1989 and 1990–2010 (O − E, −60.4 deaths/100 000; 95%CI, −97.9 to −22.8; P < .001, and −41.6/100 000; 95% CI, −77.3 to −5.8; P = .005, respectively). CONCLUSIONS AND RELEVANCE Sustained, community-wide programs targeting cardiovascular risk factors and behavior changes to improve a Maine county’s population health were associated with reductions in hospitalization and mortality rates over 40 years, compared with the rest of the state. Further studies are needed to assess the generalizability of such programs to other US county populations, especially rural ones, and to other parts of the world.

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Section: Discussionmentioning

confidence: 99%

Community-Wide Cardiovascular Disease Prevention Programs and Health Outcomes in a Rural County, 1970-2010

Record

Onion

Prior

et al. 2015

JAMA

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“…Such approaches may actually promulgate racial/ethnic, socioeconomic, and geographic disparities by benefiting early-adopter communities while leaving late-adopter communities at higher risk. 83 A recently expanding approach to these types of interventions is to use the principles of community-based participatory research by working with community members to understand the social and cultural context of the target population, to identify appropriate settings for the intervention, and to work with local community members to design and implement the intervention. Interventions that have adhered to the principles of community-based participatory research by using culturally sensitive approaches, conducting interventions in settings such as churches 84 and barbershops, 85 and using local neighborhood residents as health promoters [86][87][88] have been successful in promoting healthy behavior change.…”

Section: Community Settings Targeted For Interventionmentioning

confidence: 99%

“…Surveillance and educational interventions may be sufficient to change behavior in some communities, but other communities may require additional support through community organization, healthcare provision, or environmental change. 83 Organizational partnerships are an important part of any intervention strategy. They can provide local venues for education and health services, foster resource development and broad-based advocacy for policies and legislation, and ultimately result in permanent changes in the local environment.…”

Section: Public Health Interventions For Population-wide Cardiovasculmentioning

confidence: 99%

American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 Update

Pearson¹,

Palaniappan²,

Artinian³

et al. 2013

Circulation

207

120

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“…They aim to create a positive infrastructure for change and a will to initiate action on both community and individual level [1]. However, social systems are vulnerable and it is difficult to foresee all consequences of an intervention.…”

Section: Introductionmentioning

confidence: 99%

“…The observed positive cardiovascular risk factor reduction and the results from the process evaluation have been guiding the intervention strategies in the county and in 1991 the programme was implemented in varying forms in the whole region as the Västerbotten Intervention Programme (VIP). The programme has gained international interest for comparisons of cardiovascular prevention strategies [20] and for its attempt of dissecting the "black box" of community interventions in general [1]. …”

Section: Introductionmentioning

confidence: 99%

To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme

et al. 2007

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BackgroundPublic 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.MethodsBoth 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.ResultsMost 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.ConclusionOur 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.

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Dissecting the "black box" of community intervention: background and rationale

Cited by 9 publications

References 7 publications

Community-Wide Cardiovascular Disease Prevention Programs and Health Outcomes in a Rural County, 1970-2010

Community-Wide Cardiovascular Disease Prevention Programs and Health Outcomes in a Rural County, 1970-2010

American Heart Association Guide for Improving Cardiovascular Health at the Community Level, 2013 Update

To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme

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