Effects of the Heartbeat Wales programme over five years on behavioural risks for cardiovascular disease: quasi-experimental comparison of results from Wales and a matched reference area

• Published in: BMJ Vol. 316; no. 7134; pp. 818 - 822
• Main Authors: Tudor-Smith, Chris, Nutbeam, Don, Moore, Laurence, Catford, John
• Format: Journal Article
• Language: English
• Published: London British Medical Journal Publishing Group 14.03.1998; British Medical Association; BMJ Publishing Group Ltd; BMJ Publishing Group LTD; BMJ Publishing Group; British Medical Journal
• Edition: International edition
• Subjects: Adolescent; Adult; Analysis; Behavior; Behavior change; Biological and medical sciences; Body Weight; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - prevention & control; Change agents; Cigarette smoking; Community based instruction; Community health; Community health care; Community Health Services; Community-based programs; Coronary heart disease; Cross-Sectional Studies; Diet; Disease prevention; Disease risk; Efficacy; Exercise; Fried foods; Health Behavior; Health education; Health promotion; Health Promotion - methods; Health risk assessment; Health status; Health Surveys; Heart; Heart diseases; Heart health; Humans; Independent sample; Infrastructure; Intervention; Medical sciences; Middle Aged; Nutrition research; Policy making; Population; Prevention programs; Program Evaluation; Psychoeducational intervention; Public health; Qualitative research; Quasi-experimental methods; Regression Analysis; Research methodology; Risk factors; Risk-Taking; Sample size; Secularism; Smoking; Smoking Cessation; Studies; Study and teaching; Trends; Wales - epidemiology; United Kingdom; Great Britain; Europe; Wales; United Kingdom > UK; United States > US; Human; Prevention; 1985; Statistical analysis; Behavioral analysis; Risk factor; 1990; Cardiovascular disease; Influence; Therapeutic schedule
• ISSN: 0959-8138; 0959-8146; 1468-5833; 1756-1833
• DOI: 10.1136/bmj.316.7134.818

Abstract Objective: To assess the net 5 year effects of intervention of a community based demonstration project, the Heartbeat Wales programme, on modifiable behavioural risks for prevention of cardiovascular disease. Design and setting: Quasi-experimental design comparing results from two independent cross sectional population surveys conducted in 1985 and 1990 in Wales and a matched reference area in north east England. Subjects: Random, stratified samples of people aged 18-64 years (18 538 in 1985 and 13 045 in 1990) in Wales and in north east England (1483 and 4534, respectively). Intervention: A coordinated range of activities for heart health promotion in Wales entailing public education campaigns along with supportive policy and infrastructure change. In the reference area no additional community heart health promotion was planned, though considerable activity did take place, “contaminating” the reference area. Main outcome measures: Fifteen self reported behavioural indicators relating to dietary choice, smoking, frequency of exercise, and weight. Results: Positive changes (for health) in behavioural outcomes were observed among the population in Wales, including a reduction in reported smoking prevalence and improvements in dietary choice. There was no net intervention effect for the programme over and above observed change in the reference area. Conclusions: No definite conclusions can be drawn concerning the efficacy of the programme in terms of behavioural outcomes. With hindsight, the difficulties of evaluating such a complex multifaceted intervention were underestimated. Further debate on the most appropriate methods for assessing the effectiveness of community based health promotion programmes is called for. Key messages Heartbeat Wales was set up in 1985 as a community based programme to demonstrate risk reduction for cardiovascular disease Important changes were observed in modifiable risks for cardiovascular disease in Wales between 1985 and 1990 There was an unexpectedly rapid uptake of heart health promotion activity in the reference area No net intervention effects were found for the programme over and above changes in the reference area Improvements in methods of evaluation for community based health promotion programmes are required