Community intervention trials in high-income countries

Community intervention trials in high-income countries. This chapter summarizes results of combined mass media and community organizing methods used and evaluated during the past 40 years to achieve chronic disease prevention through changes in behaviour and risk factors. These studies are examples of experimental epidemiology and community-based participatory research, using cost-effective health promotion methods. The chapter also reviews earlier experiences in public screening, immunization, family planning, HIV/AIDS, and tobacco control, which provided useful theory and methods on which the later trials built. Major advances in theory development and intervention methods occurred in the 1970s from two pioneering community intervention projects on cardiovascular disease prevention from Stanford (USA) and Finland. These projects, followed in the 1980s and beyond in North America, Europe, Australia, and elsewhere, added many major lessons in both theory and practice. These lessons, considered ‘operational imperatives’, are: economic, social normative (or ‘denormalization’), informed electorate, public health, surveillance, comprehensiveness, formative, ecological, and logical sequencing of needs and action. Therefore, these recent decades of applying ‘total community’ health promotion in developed countries achieved considerable change at reasonable cost. Such communities were changed greatly through organizing and education; changes requiring advocacy, activism, partnership building, leadership, and regulations. This results in community transformation, creating ‘community efficacy’, a composite of enhanced self-efficacy of the community’s residents and leaders. Such transformed communities, as models, allow leverage in disseminating methods, including regulatory tactics. Such dissemination can lead to national changes analogous to those of the recent decade’s tobacco control successes.