COMMUNITY-ACTION FOR HEALTH PROMOTION - A REVIEW OF METHODS AND OUTCOMES 1990-1995

Objective: Our objective was to explore the effectiveness of community action as a strategy for health promotion, through a critical review of five years of community action evaluation literature. Methods: Comm unity action was defined as a health promotion program that involved t he community in implementation and control of the process of the progr am. Criteria for scientific evaluation of programs were proposed for s ampling and control procedures, reliability and validity of instrument s, analysis techniques, and specification of details of the interventi on. A critical review of the literature, located by an on-line and rel ated reference search, was undertaken for community action aimed at re ducing cancer and cardiovascular disease, between January 1990 and May 1995. Results: None of seven community action studies (17 articles) t hat examined cancer risk factors fulfilled all the criteria for rigoro us scientific evaluation. The most methodologically adequate cancer st udy, the COMMIT intervention, had only a moderate degree of success in reducing community smoking rates. Similarly, none of the six studies (25 articles) on cardiovascular disease fulfilled all the criteria. Th e results for the most methodologically adequate study, the Minnesota Heart Health Program, were disappointing, with strong secular trends p reventing adequate assessment of the intervention effect. Conclusions: The finding that none of the reviewed studies met all evaluation crit eria was due to several factors, including political considerations, f easibility, and the continued evolution of the science of evaluation i n health promotion. Some important questions are posed for researchers by the failure of methodologically superior projects, such as COMMIT, to show major gains in reducing health risk behaviors. Medical Subjec t Headings (MeSH): community action, health promotion, evaluation stud ies (program evaluation).