Mittelmark M B, Hunt M K, Heath G W, Schmid T L
Department of Public Health Sciences, Bowman Gray School of Medicine, Winston-Salem, NC 27157-1063.
J Public Health Policy. 1993 Winter;14(4):437-62.
Public health departments nation-wide are implementing community-based cardiovascular disease (CVD) prevention programs. Many such programs are turning for guidance to three research and demonstration projects: the Stanford Five City Project, the Pawtucket Heart Health Program, and the Minnesota Heart Health Program. This article summarizes some of the lessons learned in these projects and recommends strategies for the new generation of CVD prevention programs. The core of a successful program is the community organization process. This involves identification and activation of key community leaders, stimulation of citizens and organizations to volunteer time and offer resources to CVD prevention, and the promotion of prevention as a community theme. A wide range of intervention settings are available for health promotion. As is true for the workplace, places of worship are receptive to health promotion programs and have access to large numbers of people. Mass media are effective when used in conjunction with complementary messages delivered through other channels, such as school programs, adult education programs, and self-help programs. Community health professionals play a vital role in providing program endorsement and stimulating the participation of other community leaders. School-based programs promote long-term behavior change and reach beyond the school to actively involve parents. Innovative health promotion contests have widespread appeal and promote participation in other community interventions. In the area of evaluation, health program participation rates are appropriate primary outcome measures in most community-oriented prevention programs. Other program evaluation priorities include community analysis and formative evaluation, providing data to fine-tune interventions and define the needs and preferences of the community. It is premature to comment conclusively on the effectiveness of community-based CVD prevention programs in reducing population risk factor levels. However, it has been demonstrated that a broad range of intervention strategies can favorably modify the health behaviors of specific groups in communities such as employees and school children.
全国的公共卫生部门都在实施以社区为基础的心血管疾病（CVD）预防项目。许多这样的项目都在向三个研究与示范项目寻求指导：斯坦福五城市项目、波塔基特心脏健康项目和明尼苏达心脏健康项目。本文总结了这些项目中吸取的一些经验教训，并为新一代的心血管疾病预防项目推荐了策略。一个成功项目的核心是社区组织过程。这包括识别和激活关键的社区领袖，激励公民和组织自愿投入时间并为心血管疾病预防提供资源，以及将预防作为社区主题进行推广。有多种干预场所可用于健康促进。就像工作场所一样，宗教场所也愿意接受健康促进项目，并且能够接触到大量人群。大众媒体与通过其他渠道（如学校项目、成人教育项目和自助项目）传递的补充信息结合使用时会很有效。社区卫生专业人员在提供项目认可和激励其他社区领袖参与方面发挥着至关重要的作用。以学校为基础的项目促进长期行为改变，并延伸到学校之外，积极让家长参与进来。创新的健康促进竞赛具有广泛吸引力，并促进参与其他社区干预措施。在评估方面，健康项目参与率是大多数以社区为导向的预防项目合适的主要结果指标。其他项目评估重点包括社区分析和形成性评估，提供数据以微调干预措施并确定社区的需求和偏好。就基于社区的心血管疾病预防项目在降低人群风险因素水平方面的有效性得出最终结论还为时过早。然而，已经证明广泛的干预策略可以有利地改变社区中特定群体（如员工和学童）的健康行为。
