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Community participation and social patterning in cardiovascular disease intervention
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
1993 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This study addresses health policy and public health in the field of cardiovascular disease (CVD) on the local level in Sweden. The overall aim is to contribute to the assessment of structural and social conditions within public health by analysing participation processes and outcome patterns in a local health programme. The northern Swedish MONICA study served as a reference area. The research strategy has been to integrate quantitative and  qualitative methodologies and, thereby, focus on different aspects of the health programme under study.

The mortality rate was excessive in the study area of Norsjö relative to both provincial and national figures over a period of more than 10 years. This finding formed the basis for a tenyear comprehensive and community-based health programme towards the prevention of CVD and diabetes.

Even in this seemingly homogeneous area it was found that socio-economic circumstances were associated with the public health. Almost half of the study population had hypercholesterolaemia (;>6.5 mmol/1), 19% of men and 25% of women were smokers and 30% and 29%, respectively, had high blood pressure. Age had a strong impact on all outcome measures. After adjustments for age and social factors it was found that the relative risk of having hypercholesterolaemia dropped significantly in both sexes during the six years of intervention. The probability of being a smoker was significantly reduced only in highly educated groups. No statistically significant change over time could be found for the risk of suffering high blood pressure. In the reference area of northern Sweden there were no changes over time for any of the selected risk factors. The likelihood of self-assessed good health decreased with increasing risk factor load, with the exception of hypercholesterolaemia , in all social strata.

The authorities, including the health and medical staff, were the main actors on the mediastage. Men in manual occupations were least affected by the media coverage. The actors and the public as well as the media viewed the health programme as orientated towards individual lifestyles. Community participation was mainly defined by the actors based on the medical and health planning approach. Differences in interpretations, social interests, personal conflicts and ideological constraints among the actors at local level were observed. Some critical attitudes towards the organization and management of the health programme were also noted among the citizens. However, a majority of the public wanted the health programme to continue. The present study underlines the importance of considering age, gender and social differences in the planning and evaluation of CVD preventive programmes.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 1993. , 49 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 383
Keyword [en]
cardiovascular disease, diabetes, prevention, social factors, evaluation, social epidemiology
Keyword [sv]
folkhälsovetenskap
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology; Public health
Identifiers
URN: urn:nbn:se:umu:diva-7544ISBN: 91-7174-816-4 (print)OAI: oai:DiVA.org:umu-7544DiVA: diva2:147215
Public defence
1993-11-19, Tandläkarhögskolan, Rosa salen, 9tr., Umeå universitet, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Projects
digitalisering@umu
Available from: 2008-01-10 Created: 2008-01-10 Last updated: 2013-03-05Bibliographically approved
List of papers
1. Local health planning and intervention: the case of a Swedish municipality
Open this publication in new window or tab >>Local health planning and intervention: the case of a Swedish municipality
1988 (English)In: Scandinavian journal of primary health care. Supplement, ISSN 0284-6020, Vol. 1, 57-64 p.Article in journal (Refereed) Published
Abstract [en]

This article attempts to illustrate the process from community diagnosis to community involvement by a case study from the north of Sweden. The case of Norsjö is one of few documented Swedish examples of a preventive program with a broad participation from the community. The results up to now are promising and further illustrate the importance of decentralized health planning and local data.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-64715 (URN)3227203 (PubMedID)
Available from: 2013-02-01 Created: 2013-02-01 Last updated: 2015-04-29Bibliographically approved
2. Towards a framework for outcome assessment of health intervention: Conceptual and methodological considerations
Open this publication in new window or tab >>Towards a framework for outcome assessment of health intervention: Conceptual and methodological considerations
1994 (English)In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 4, no 2, 125-130 p.Article in journal (Refereed) Published
Abstract [en]

We provide a framework for assessing the outcome of community-based intervention programmes for the promotion of cardiovascular health at local level. Particular attention is therefore given to conceptual components connected with community participation in health programmes and to methodological approaches in the evaluation of cardiovascular disease (CVD)-prevention programmes. In a search of the literature covering more than 20 years (1966–1988) in 2 databases (MEDLINE and SOCA), we found that the concepts of ‘community participation’ and ‘community involvement’ have mainly been used during the latter half of the study period. The concepts were often used interchangeably and with no statement as to their precise meanings. The methodological examination of 2 well-known community-based CVO-preventive programmes revealed that most of the scientific papers from these programmes dealt with health behavioural and/or medical effects. The suggested framework presented in this study is designed as a longitudinal process analysis focusing on critical key steps along the path from input to output. The suggested research strategy is problem-orientated, inter-disciplinary and based on a multi-method approach.

Place, publisher, year, edition, pages
Oxford University Press, 1994
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-65776 (URN)10.1093/eurpub/4.2.125 (DOI)
Available from: 2013-02-14 Created: 2013-02-11 Last updated: 2017-12-06Bibliographically approved
3. Mass communication and health promotion: The power of the media and public opinion
Open this publication in new window or tab >>Mass communication and health promotion: The power of the media and public opinion
1994 (English)In: Health Communication, ISSN 1041-0236, E-ISSN 1532-7027, Vol. 6, no 1, 21-36 p.Article in journal (Refereed) Published
Abstract [en]

By means of content analysis, this study evaluated the ways in which a community-based preventive program in Sweden in the field of cardiovascular diseases and diabetes was reported in the news by the Swedish mass media We were also interested in determining whether, and to what extent, 5 years of exposure to the media had affected the health habits of the residents in the intervention area. Thus, the views of the public were obtained via a cross-sectional posttest survey of all adults 16 to 80 years of age. Responses were obtained from 65% of the population. Data were interpreted within a framework of a three-dimensional power approach: control of issue resolution, control of information content, and emphasis and control of ideology. The health program has attracted much attention, and some of the contents have been commented on in depth (e.g., dietary habits, health examinations, and organizational issues). The authorities, including the health and medical staff, were the main actors on the media stage. The media coverage was largely restricted to middle-aged men, whereas women, children, young people, and pensioners were less salient in the news. The mass media were found to emphasize an individual standpoint concerning health habits, and when the "ordinary people" appeared it was as exemplary models in the spirit of the health program. The results indicated sex and social class differences among people recalling the media news. Men in manual occupations were the least affected by the media coverage of the health program.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-65963 (URN)10.1207/s15327027hc0601_2 (DOI)
Available from: 2013-02-14 Created: 2013-02-14 Last updated: 2017-12-06Bibliographically approved
4. Gender and social patterning of health: the Norsjö cardiovascular preventive programme in northern Sweden 1985-1990
Open this publication in new window or tab >>Gender and social patterning of health: the Norsjö cardiovascular preventive programme in northern Sweden 1985-1990
1994 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 12, no 3, 155-161 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To assess the extent to which the impact of social stratification on cardiovascular disease (CVD) risk factors was different among men and women.

DESIGN: Pooled data from six (1985-90) cross-sectional health surveys.

SETTING: The intervention area is an inland municipality, Norsjö, in northern Sweden with a population of 5,300 inhabitants.

MAIN OUTCOME MEASURES: Smoking, high blood pressure, hypercholesterolaemia, and perceived health status.

RESULTS: Almost half of the study population had hypercholesterolaemia (> or = 6.5 mmol/l), 19% of men and 25% of women were smokers, and 30% and 29%, respectively, had hypertension. Age had a strong impact on all outcome measures. Social factors were associated with smoking in women and with hypercholesterolaemia in men. There were no sex differences in perceived good health. The likelihood of self-assessed good health decreased with increasing risk factor load, with the exception of hypercholesterolaemia, in all social strata.

CONCLUSION: The present study implies the importance of considering age, gender, and social differences in intervention and evaluation of CVD preventive programmes. The study also demonstrate that self-defined health contains important information on cardiovascular risk profile.

Place, publisher, year, edition, pages
Informa Plc., 1994
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-64712 (URN)10.3109/02813439409003692 (DOI)7997692 (PubMedID)
Available from: 2013-02-01 Created: 2013-02-01 Last updated: 2017-12-06Bibliographically approved
5. Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme
Open this publication in new window or tab >>Changing social patterns of risk factors for cardiovascular disease in a Swedish community intervention programme
Show others...
1993 (English)In: International Journal of Epidemiology, ISSN 0300-5771, E-ISSN 1464-3685, Vol. 22, no 6, 1026-1037 p.Article in journal (Refereed) Published
Abstract [en]

Since 1985 a small-scale community-based cardiovascular disease (CVD) preventive programme has been in operation in an inland municipality, Norsjö, in Northern Sweden. The aim of this study was to assess the development of the relationship between social position and CVD risk factors in repeated cross-sectional surveys (1985-1990) among all men and women aged 30, 40, 50 and 60 years in the study area, using an age-stratified random sample from the Northern Sweden MONICA Study of 1986 and 1990 as reference population. These multiple cross-sectional surveys comprised a self-administered questionnaire and a health examination. Of the study population 95% (n = 1499) and 80% of those in the reference area (n = 3208) participated. Subjects were classified with regard to demographic, structural and social characteristics in relation to CVD risk factors and self-reported health status. Time trends in classical risk factor occurrence were assessed in terms of age- and sex- adjusted odds ratios using Mantel-Haenszel procedures. When simultaneously adjusting for several potential confounders we used a logistic regression analysis. Initially, more than half of the study population, both males and females, had and elevated (> or = 6.5 mmol/l) serum cholesterol level. After adjustments had been made for age and social factors it was found that the relative risk of hypercholesterolaemia dropped substantially and significantly among both sexes during the 6 years of CVD intervention in the study area. However, the probability of being a smoker was significantly reduced only in highly educated groups. Among other risk factors no single statistically significant change over time could be found. In the reference area there were no changes over time for the selected CVD risk factors. People in the study area had a less favourable perception of their health than those in the reference area. Social differences were found when perceived good health was measured, especially in variables indicating emotional and social support. When sex, age and social factors had been accounted for there was not clear change over the years in perceived good health.

Place, publisher, year, edition, pages
Oxford University Press, 1993
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-64713 (URN)10.1093/ije/22.6.1026 (DOI)8144283 (PubMedID)
Available from: 2013-02-01 Created: 2013-02-01 Last updated: 2017-12-06Bibliographically approved
6. Co-operation, participation and conflicts faced in public health: lessons learned from a long-term prevention programme in Sweden
Open this publication in new window or tab >>Co-operation, participation and conflicts faced in public health: lessons learned from a long-term prevention programme in Sweden
Show others...
1994 (English)In: Health Education Research, ISSN 0268-1153, E-ISSN 1465-3648, Vol. 9, no 3, 317-329 p.Article in journal (Refereed) Published
Abstract [en]

A comprehensive community-based programme for prevention of cardiovascular diseases (CVD) and diabetes was established in 1985 in a small municipality in northern Sweden. A cross-sectional survey to the general public was performed and semi-structured open-ended interviews were taken of actors at different levels. Notes from official records were also included in the study. The aim was to describe and discuss some factors that promote or constrain community participation in health programmes. The results generally confirmed that the right of definition concerning the health programme mainly remained with the health professionals. Community participation was mainly defined by the actors based on the medical and health planning approach and, thereby, as a means to transform health policy plans into reality by transmitting health knowledge and increasing consciousness among the citizens of the need for changing lifestyles. However, participation as a means of identifying problems and demonstrating power relationships and as elements in promoting local democracy was hardly represented among the actors at all. Overall, the CVD health programme was characterized by consensus between the actors. Despite this, debates and arguments about interpretations, social interests, personal conflicts and ideological constraints were observed. However, a majority of the public wanted the CVD preventive programme to continue.

Place, publisher, year, edition, pages
Oxford University Press, 1994
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-3848 (URN)10.1093/her/9.3.317 (DOI)10150452 (PubMedID)
Available from: 2004-04-06 Created: 2004-04-06 Last updated: 2013-03-04Bibliographically approved

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Citation style
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  • ieee
  • modern-language-association-8th-edition
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More languages
Output format
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