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Effectiveness of Community-Based Health Promotion Interventions in Urban Areas: A Systematic Review

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Abstract

Over the past few decades, a community-based approach was seen to be the “gold standard” for health promotion and disease prevention, especially in the field of socially deprived neighborhoods in urban areas. Up to the beginning of the 2000s, earlier reviews provide valuable information on activities in this context. However, in their conclusions they were limited to North America and Europe. Therefore, we conducted a systematic literature review on community-based health promotion and prevention programs worldwide. The Pubmed and PsycINFO databases were screened for relevant articles published between January 2002 and December 2018, revealing 101 potentially eligible publications out of 3646 hits. After a systematic review process including searching the reference lists, 32 papers met the inclusion criteria and were included in the review. Twenty-four (75.0%) articles reported improvements in at least one health behavior, health service access, health literacy, and/or a range of health status outcomes. Large-scale community-based health promotion programs, however, often resulted in limited or missing population-wide changes. Possible reasons are methodological limitations, concurrent context effects, and limitations of the interventions used. Our results confirm that community-based interventions are promising for health promotion and disease prevention but so far their potential is not fully realized. For the future, such interventions should aim at proximal outcomes and invest in community capacity building.

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References

  1. Trojan, A., Süß, W., Lorentz, C., Nickel, S., & Wolf, K. (Eds.). (2013). Quartiersbezogene Gesundheitsförderung. Umsetzung und evaluation eines integrierten lebenweltbezogenen Handlungsansatzes. [Neighborhood-related health promotion]. Weinheim and Basel: Beltz Juventa.

    Google Scholar 

  2. McLeroy, K. R., Norton, B. L., Kegler, M. C., Burdine, J. N., & Sumaya, C. V. (2013). Community-based interventions. American Journal of Public Health,93(4), 529–533.

    Article  Google Scholar 

  3. Raine, K. D., Plotnikoff, R., Schopflocher, D., et al. (2013). Healthy Alberta communities: Impact of a three-year community-based obesity and chronic disease prevention intervention. Preventive Medicine,57(6), 955–962.

    Article  PubMed  Google Scholar 

  4. Merzel, C. M., & D’Afflitti, J. (2003). Reconsidering community-based health promotion: Promise, performance, and potential. American Journal of Public Health,93(4), 557–574.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hills, D. (2004). Evaluation of community-level interventions for health improvement: A review of experience in the UK. London: Tavistock Institute.

    Google Scholar 

  6. WHO. (2013). Closing the health equity gap. Policy options and opportunities for action. New York: WHO.

    Google Scholar 

  7. Loss, J., Eichhorn, C., Gehlert, J., Donhauser, J., Wise, M., & Nagel, E. (2007). Gemeindenahe Gesundheitsförderung—Herausforderung an die evaluation [Community-based health promotion—A challenge for the evaluation]. Das Gesundheitswesen,69(2), 77–87.

    Article  CAS  PubMed  Google Scholar 

  8. Wright, A., McGorry, P. D., Harris, M. G., Jorn, A. F., & Pennell, K. (2006). Development and evaluation of a youth mental health community awareness campaign—The compass strategy. BMC Public Health,6, 215. https://doi.org/10.1186/1471-2458-6-215.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Roussos, S. T., & Fawcett, S. B. (2000). A review of collaborative partnerships as a strategy for improving community health. Annual Review of Public Health,21, 369–402.

    Article  CAS  PubMed  Google Scholar 

  10. Craig, P., Deppe, P., Macintyr, S., et al. (2008). Developing and evaluating complex interventions: The new Medical Research Council guidance. British Medical Journal,337, a1655.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Golden, S. D., & Earp, J. A. L. (2012). Social ecological approaches to individuals and their contexts: Twenty years of health education & behavior health promotion interventions. Health Education & Behavior,39(3), 364–372.

    Article  Google Scholar 

  12. Blankenship, K. M., Friedman, S. R., Dworkin, S., & Mantell, J. E. (2006). Structural interventions: Concepts, challenges and opportunities for research. Journal of Urban Health,83(1), 59–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Baker, E. A., & Brownson, C. A. (1998). Defining characteristics of community-based health promotion programs. Journal of Public Health Management and Practice,4(2), 1–9.

    Article  CAS  PubMed  Google Scholar 

  14. Liberato, S. C., Brimblecombe, J., Richie, J., Ferguson, M., & Coveney, J. (2011). Measuring capacity building in communities: A review of the literature. BMC Public Health,11, 850.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Boutillier, M., Cleverly, S., & Labonte, R. (2000). Community as a setting for health promotion. In B. D. Poland, L. W. Green, & I. Rootman (Eds.), Settings for health promotion: Linking theory to practice (pp. 251–307). Thousand Oaks: Sage.

    Google Scholar 

  16. Stokols, D. (1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion,10(4), 282–298.

    Article  CAS  PubMed  Google Scholar 

  17. Farquhar, J. W., Fortmann, S. P., Flora, J. A., et al. (1990). Effects of communitywide education on cardiovascular disease risk factors: The Stanford Five-City Project. Journal of the American Medical Association,264(3), 359–365.

    Article  CAS  PubMed  Google Scholar 

  18. Carlaw, R., Mittlermark, M. B., Bracht, N., & Luepker, R. (1984). Organisation for a community cardiovascular health program: Experiences from the Minnesota heart health program. Health Education Quarterly,11, 243–252.

    Article  CAS  PubMed  Google Scholar 

  19. Goodman, R. M., Wheeler, F. C., & Lee, P. R. (1995). Evaluation of the heart to heart project: Lessons from a community-based chronic disease prevention project. American Journal of Health Promotion,9, 443–455.

    Article  CAS  PubMed  Google Scholar 

  20. Puska, P., Salonen, J. T., Tuomiletho, J., Nissinen, A., & Koltke, T. E. (1983). Evaluating community-based preventive cardiovascular programs: Problems and experiences from the North Karelia project. Journal of Community Health,9(1), 49–64.

    Article  CAS  PubMed  Google Scholar 

  21. Laverack, G. (2007). Health promoting practice. Building empowered communities. New York: Open University Press.

    Google Scholar 

  22. Leviton, L. C., Snell, E., & McGinnis, M. (2000). Urban issues in health promotion strategies. American Journal of Public Health,90(6), 863–866.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G., & PRISMA Group. (2019). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLOS Medicine,6, e1000097. https://doi.org/10.1371/journal.pmed.

    Article  Google Scholar 

  24. Abbema, E. A. (2004). Effect evaluation of a comprehensive community intervention aimed at reducing socioeconomic health inequalities in the Netherlands. Health Promotion International,19(2), 141–156.

    Article  CAS  PubMed  Google Scholar 

  25. Blair, Y., MacPherson, L., McCall, D., & McMahon, A. (2006). Dental health of 5-year-olds following community-based oral health promotion in Glasgow, UK. International Journal of Paediatric Dentistry,16, 388–398.

    Article  CAS  PubMed  Google Scholar 

  26. Bukman, A. J. (2017). Effectiveness of the MetSLIM lifestyle intervention targeting individuals of low socio-economic status and different ethnic origins with elevated waist-to-height ratio. Public Health Nutrition,20(14), 2617–2628.

    Article  PubMed  Google Scholar 

  27. De Henauw, S., et al. (2016). Effects of a community-oriented obesity prevention programme on indicators of body fatness in preschool and primary school children. Main results from the IDEFICS study. Obesity Reviews,16(Suppl. 2), 16–29.

    Google Scholar 

  28. De Bourdeaudhuij, I., Verbestel, V., De Henauw, S., et al. (2015). Behavioural effects of a community-oriented settingbased intervention for prevention of childhood obesity in eight European countries. Main results from the IDEFICS study. Obesity Reviews,16(Suppl. 2), 30–40.

    Article  PubMed  Google Scholar 

  29. Flowers, P., Hart, G. J., Williamson, L. M., Frankis, J. S., & Ger, D. J. (2002). Does bar-based, peer-led sexual health promotion have a community-level effect amongst gay men in Scotland? International Journal of STD and AIDS,13(2), 102–108.

    Article  CAS  PubMed  Google Scholar 

  30. Gustafsson, S., Wilhelmson, K., Eklund, K., et al. (2012). Health-promoting interventions for persons aged 80 and older are successful in the short term—Results from the randomized and three-armed elderly persons in the risk zone study. Journal of the American Geriatrics Society,60(3), 447–454.

    Article  PubMed  Google Scholar 

  31. Hillier, F. C., Batterhamm, A. M., Nixon, C. A., et al. (2012). A community-based health promotion intervention using brief negotiation techniques and a pledge on dietary intake, physical activity levels and weight outcomes: Lessons learnt from an exploratory trial. Public Health Nutrition,15(8), 1446–1455.

    Article  PubMed  Google Scholar 

  32. Lorentzen, C., Ommundsen, Y., Jenum, A. K., & Holme, I. (2007). The ‘Romsås in Motion’ community intervention: Program exposure and psychosocial mediated relationships to change in stages of change in physical activity. International Journal of Behavioral Nutrition and Physical Activity. https://doi.org/10.1186/1479-5868-4-15.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Luten, K. A., Reijneveld, S. A., Dijkstra, A., & de Winter, A. F. (2016). Reach and effectiveness of an integrated community-based intervention on physical activity and healthy eating of older adults in a socioeconomically disadvantaged community. Health Education Research,31(1), 98–106.

    PubMed  Google Scholar 

  34. Phillips, G., Bottomley, C., Schmidt, E., et al. (2014). Well London phase-1: Results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods. Journal of Epidemiology and Community Health,68(7), 606–614.

    Article  PubMed  Google Scholar 

  35. Schuit, A. J., Wendel-Vos, G. C. W., Verschuren, W. M. M., et al. (2006). Effect of 5-year community intervention Hartslag Limburg on cardiovascular risk factors. American Journal of Preventive Medicine,30(3), 237–242.

    Article  PubMed  Google Scholar 

  36. Ronda, G., Van Assema, P., Ruland, E., et al. (2004). The Dutch heart health community intervention ‘Hartslag Limburg’: Results of an effect study at individual level. Health Promotion International,19(1), 21–31.

    Article  PubMed  Google Scholar 

  37. Alagiyawanna, A. M. A. A. P., Rajapaksa-Hewageegana, N., & Gunawardena, N. (2017). The impact of multiple interventions to reduce household exposure to secondhand tobacco smoke among women: A cluster randomized controlled trial in Kalutara district, Sri Lanka. BMC Public Health,17(1), 810.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Balaji, M., Andrews, T., Andrew, G., & Patel, V. (2011). The acceptability, feasibility, and effectiveness of a population-based intervention to promote youth health: An exploratory study in Goa, India. Journal of Adolescent Health,48(5), 453–460.

    Article  Google Scholar 

  39. Jiang, Y. Y., Yang, Z. X., Ni, R., et al. (2013). Effectiveness analysis on the physical activity and the health benefit of a community population based program. Biomedical and Environmental Sciences,26(6), 468–473.

    PubMed  Google Scholar 

  40. Malekafzali, H., Eftekhari, M. B., Hejazi, F., et al. (2010). The effectiveness of educational intervention in the health promotion in elderly people. Iranian Journal of Public Health,39(2), 18–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  41. Mohammadifard, N., Kelishai, R., Safavi, M., et al. (2009). Effect of a community-based intervention on nutritional behaviour in a developing country setting: The Isfahan Healthy Heart Programme. Public Health Nutrition,12(9), 1422–1430.

    Article  PubMed  Google Scholar 

  42. Pazoki, R., Nabipour, I., Seyednezami, N., & Imami, S. R. (2007). Effects of a community-based healthy heart program on increasing healthy women’s physical activity: A randomized controlled trial guided by community-based participatory research (CBPR). BMC Public Health,7, 216. https://doi.org/10.1186/1471-2458-7-216.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Sarrafzadegan, N., Kelishadi, R., Siavash, M., et al. (2012). How does the impact of a community trial on cardio-metabolic risk factors differ in terms of gender and living area? Findings from the Isfahan healthy heart program. Journal of Research in Medical Sciences,17(3), 732–740.

    PubMed  PubMed Central  Google Scholar 

  44. Tran, V. D., Lee, A. H., Jancey, J., et al. (2017). Physical activity and nutrition behavior outcomes of a cluster-randomized controlled trial for adults with metabolic syndrome in Vietnam. Trials,18(1), 18. https://doi.org/10.1186/s13063-016-1771-9.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Zeng, Q., He, Y., Shi, Z., et al. (2016). A community-based controlled trial of a comprehensive psychological intervention for community residents with diabetes or hypertension. Shanghai Archives of Psychiatry,28(2), 72–85.

    PubMed  PubMed Central  Google Scholar 

  46. Bazzano, A. T., Zeldin, A. S., Diab, I. R., et al. (2009). The healthy lifestyle change program. A pilot of a community-based health promotion intervention for adults with developmental disabilities. American Journal of Preventive Medicine,37, S201–S208.

    Article  PubMed  Google Scholar 

  47. De Heer, H. D., Balcazar, H. G., Wise, S., et al. (2015). Improved cardiovascular risk among Hispanic border participants of the Mi Corazón Mi Comunidad Promotores de Salud Model: The HEART II cohort intervention study 2009–2013. Frontiers in Public Health,3, 149. https://doi.org/10.3389/fpubh.2015.00149.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Hoeft, K. S., Barker, J. C., Shiboski, S., Pantoja-Guzman, E., & Hiatt, R. A. (2016). Effectiveness evaluation of Contra caries oral health education program for improving spanish-speaking parents’ preventive oral health knowledge and behaviors for their young children. Community Dentistry and Oral Epidemiology,44(6), 564–576.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Meng, H., Wamsley, B., Liebel, D., et al. (2009). Urban–rural differences in the effect of a medicare health promotion and disease self-management program on physical function and health care expenditures. The Gerontologist,49(3), 407–417.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lytvyak, E., Olstad, D. L., Schopflocher, D. P., et al. (2016). Impact of a 3-year multi-centre community-based intervention on risk factors for chronic disease and obesity among free-living adults: The Healthy Alberta Communities study. BMC Public Health,16, 344. https://doi.org/10.1185/s12889-016-3021-1.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Raine, K. D., Plotnikoff, R., Nykiforuk, C., et al. (2010). Reflections on community-based population health intervention and evaluation for obesity and chronic disease prevention: The healthy Alberta communities project. International Journal of Public Health,55(6), 679–686.

    Article  PubMed  Google Scholar 

  52. Schulz, A. J., Israel, B. A., Mentz, G. B., et al. (2015). Effectiveness of a walking group intervention to promote physical activity and cardiovascular health in predominantly non-Hispanic black and Hispanic urban neighborhoods: Findings from the walk your heart to health intervention. Health Education & Behavior,42(3), 380–392.

    Article  Google Scholar 

  53. Fox, P. J., Vazquez, L., Tonner, C., et al. (2010). A randomized trial of a multifaceted intervention to reduce falls among community-dwelling adults. Health Education & Behavior,37(6), 831–848.

    Article  Google Scholar 

  54. Bolton, K. A., Kremer, P., Gibbs, L., et al. (2017). The outcomes of health-promoting communities: Being active eating well initiative—A community-based obesity prevention intervention in Victoria. Australia. International Journal of Obesity,41(7), 1080–1090.

    Article  CAS  PubMed  Google Scholar 

  55. Wright, A., McGorry, P. D., Harris, M. G., Jorm, A. F., & Pennell, K. (2006). Development and evaluation of a youth mental health community awareness campaign—The compass strategy. BMC Public Health,6, 215. https://doi.org/10.1186/1471-2458-6-215.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Navarro, J. I., Sugelem, D. M., Ferraro, A. A., Polanco, J. J., & Barros, A. J. D. (2013). The double task of preventing malnutrition and overweight: A quasi-experimental community-based trial. BMC Public Health,13, 212. https://doi.org/10.1186/1471-2458-13-212.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Simões, E. J., Hallal, P. C., Siqueira, F. V., et al. (2017). Effectiveness of a scaled up physical activity intervention in Brazil: A natural experiment. Preventive Medicine,103, 566–572.

    Article  Google Scholar 

  58. Jemmott, J. B., III, Jemmott, L. S., Ngwane, Z., et al. (2014). Theory-based behavioral intervention increases self-reported physical activity in South African men: A cluster-randomized controlled trial. Preventive Medicine,64, 114–120.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Effective Public Health Practice Project. (1998). Quality assessment tool for quantitative studies. Hamilton. Retrieved June 3, 2019 from https://merst.ca/ephpp/.

  60. Derges, J., et al. (2014). ‘Well London’ and the benefits of participation: Results of a qualitative study nested in a cluster randomised trial. British Medical Journal Open,4, e003596. https://doi.org/10.1136/bmjopen-2013-003596.

    Article  Google Scholar 

  61. Nanz, P., & Fritsche, M. (2012). Handbuch Bürgerbeteiligung. Verfahren und Akteure, Chancen und Grenzen [Handbook citizen participation. Procedures and actors, opportunities and limits]. Bonn: Bundeszentrale für politische Bildung.

    Google Scholar 

  62. Milton, B., Attree, P., French, B., et al. (2011). The impact of community engagement on health and social outcomes: A systematic review. Community Development Journal,47(3), 316–334.

    Article  Google Scholar 

  63. Cyril, S., Smith, B. J., Possamai-Inesedy, A., & Renzaho, A. M. (2015). Exploring the role of community engagement in improving the health of disadvantaged populations: A systematic review. Global Health Action,8, 29842. https://doi.org/10.3402/gha.v8.29842.

    Article  PubMed  Google Scholar 

  64. Fienieg, B., Nierkens, V., Tonkens, E., Plochg, T., & Stronks, K. (2012). Why play an active role? A qualitative examination of lay citizens’ main motives for participation in health promotion. Health Promotion International,27(3), 416–426.

    Article  PubMed  Google Scholar 

  65. Bär, G. (2012). Partizipation im Quartier—Gesundheitsförderung mit vielen Adressaten und Dynamiken [Participation in the neighborhood—Health promotion with many addressees and dynamics]. In R. Rosenbrock & S. Hartung (Eds.), Handbuch Partizipation und Gesundheit (pp. 172–182). Bern: Hans Huber.

    Google Scholar 

  66. Fröding, K., Elander, I., & Eriksson, C. (2012). Neighbourhood development and public health initiatives: Who participates? Health Promotion International,27(1), 102–116.

    Article  PubMed  Google Scholar 

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This work was supported by the Free and Hanseatic City of Hamburg, Germany (Grant Number: LFF-FV 50).

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Nickel, S., von dem Knesebeck, O. Effectiveness of Community-Based Health Promotion Interventions in Urban Areas: A Systematic Review. J Community Health 45, 419–434 (2020). https://doi.org/10.1007/s10900-019-00733-7

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