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

  • Stefan NickelEmail author
  • Olaf von dem Knesebeck
Review

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.

Keywords

Community-based health promotion Outcome evaluation Neighborhood Urban area 

Notes

Funding

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

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10900_2019_733_MOESM1_ESM.docx (26 kb)
Supplementary material 1 (DOCX 26 kb)
10900_2019_733_MOESM2_ESM.docx (22 kb)
Supplementary material 2 (DOCX 21 kb)

References

  1. 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. 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.Google Scholar
  3. 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.Google Scholar
  4. 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.Google Scholar
  5. 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. 6.
    WHO. (2013). Closing the health equity gap. Policy options and opportunities for action. New York: WHO.Google Scholar
  7. 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.Google Scholar
  8. 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.Google Scholar
  9. 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.Google Scholar
  10. 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.Google Scholar
  11. 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.Google Scholar
  12. 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.Google Scholar
  13. 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.Google Scholar
  14. 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.Google Scholar
  15. 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. 16.
    Stokols, D. (1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion, 10(4), 282–298.Google Scholar
  17. 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.Google Scholar
  18. 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.Google Scholar
  19. 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.Google Scholar
  20. 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.Google Scholar
  21. 21.
    Laverack, G. (2007). Health promoting practice. Building empowered communities. New York: Open University Press.Google Scholar
  22. 22.
    Leviton, L. C., Snell, E., & McGinnis, M. (2000). Urban issues in health promotion strategies. American Journal of Public Health, 90(6), 863–866.Google Scholar
  23. 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.Google Scholar
  24. 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.Google Scholar
  25. 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.Google Scholar
  26. 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.Google Scholar
  27. 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. 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.Google Scholar
  29. 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.Google Scholar
  30. 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.Google Scholar
  31. 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.Google Scholar
  32. 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.Google Scholar
  33. 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.Google Scholar
  34. 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.Google Scholar
  35. 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.Google Scholar
  36. 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.Google Scholar
  37. 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.Google Scholar
  38. 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.Google Scholar
  39. 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.Google Scholar
  40. 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.Google Scholar
  41. 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.Google Scholar
  42. 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.Google Scholar
  43. 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.Google Scholar
  44. 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.Google Scholar
  45. 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.Google Scholar
  46. 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.Google Scholar
  47. 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.Google Scholar
  48. 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.Google Scholar
  49. 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.Google Scholar
  50. 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.Google Scholar
  51. 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.Google Scholar
  52. 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.Google Scholar
  53. 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.Google Scholar
  54. 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.Google Scholar
  55. 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.Google Scholar
  56. 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.Google Scholar
  57. 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.Google Scholar
  58. 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.Google Scholar
  59. 59.
    Effective Public Health Practice Project. (1998). Quality assessment tool for quantitative studies. Hamilton. Retrieved June 3, 2019 from https://merst.ca/ephpp/.
  60. 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.Google Scholar
  61. 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. 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.Google Scholar
  63. 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.Google Scholar
  64. 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.Google Scholar
  65. 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. 66.
    Fröding, K., Elander, I., & Eriksson, C. (2012). Neighbourhood development and public health initiatives: Who participates? Health Promotion International, 27(1), 102–116.Google Scholar

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Authors and Affiliations

  1. 1.Institute of Medical SociologyUniversity Medical Center Hamburg-EppendorfHamburgGermany

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