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

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.