Different outcomes for different interventions with different focus! A cross-country comparison of community interventions in rural Swedish and US populations

Objectives: There is a need among healthcare providers to acquire more know ledge about small-scale and low budget community intervention programmes. T his paper compares risk factor outcomes in Swedish and US intervention prog rammes for the prevention of cardiovascular disease (CVD). The aim was to e xplore how different intervention programme profiles affect outcome. Methods: Using a quasi-experimental design. trends in risk factors and esti mated CVD risk in two intervention areas (Norsjo, Sweden and Otsego-Schohar ie County. New York state) are compared with those in reference areas (Nort hern Sweden region and Herkimer County, New York state) using serial cross- sectional studies and panel studies. Results: The programmes were able to achieve significant changes in CVD ris k factors that the local communities recognized as major concerns: changing eating habits in the Swedish population and reducing smoking in the US pop ulation. For the Swedish cross-sectional follow-up study cholesterol reduct ion was 12%. compared to 5% in the reference population (p for trend differ ences <0.000). The significantly higher estimated CVD risk (as assessed by risk scores) at baseline in the intervention population was below that of t l e Swedish reference population after 5 years of intervention. The Swedish panel study provided the same results. In the US, both the serial cross-se ctional and panel studies showed a > 10% decline in smoking prevalence in t he intervention population, while it increased slightly in the reference po pulation. When pooling the serial cross-sectional studies the estimated ris k reduction (using the Framingham risk equation) was significantly greater in the intervention populations compared to the reference populations. Conclusions: The overall pattern of risk reduction is consistent and sugges ts that the two different models of rural county intervention can contribut e to significant risk reduction. The Swedish programme had its greatest eff ect on reduction of serum cholesterol levels whereas the US programme had i ts greatest effect on smoking prevention and cessation. These outcomes are consistent with programmatic emphases. Socially less privileged groups in t hese rural areas benefited as much or more from the interventions as those with greater social resources.