How widespread are the use of frameworks and theories in applied health promotion research in rural and remote places? A review of programs targeted at cardiometabolic risk factors

Abstract

Introduction: In Australia, modifiable cardiometabolic risk factors are in excess in rural and remote communities. High-quality community-level health promotion is paramount for the management of population health risk in such settings, especially in the context of reduced access to healthcare services. Two indicators of quality of health promotion programs are the use of formal frameworks and the adoption of socio-behavioural theories upon which to base intervention strategies. This study examined the extent to which these two quality elements were reported in health promotion programs designed to reduce cardiometabolic disease (CMD) risk in rural and remote settings. Methods: PubMed, ScienceDirect, Cochrane Library and EBSCOHost were searched using search strings linking health promotion programs, the geographic setting and CMD and risk factors. A title/abstract eligibility screen was conducted prior to full-text assessment. Articles had to report on the planning, implementation or evaluation of intervention strategies to be eligible. Articles were ineligible if they reported clinical drug trials or behaviour prescription efficacy trials. Results: Of eligible programs (n=62) from 66 articles, 37% (n=22) reported using a framework and 35% (n=22) reported the use of theories. While 16% (n=10) reported using both, 48% (n=30) reported neither. Conclusions: Fewer than one in five published health promotion programs for CMD risk in rural and remote settings report being both guided by a formal framework and underpinned by theory. This low level of explicit reporting of quality indicators suggests a large scope for improvement in the conduct and reporting of health promotion programs for CMD risk in rural and remote settings.