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

BMJ 1998;316:818-822 ( 14 March )

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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

Chris Tudor-Smith, director of research and development, ^a Don Nutbeam, professor of public health, ^b Laurence Moore, lecturer in health services research, ^c John Catford, professor of health strategies. ^d

^a Health Promotion Wales, Ffynnon-las, Llanishen, Cardiff CF4 5DZ, ^b Department of Public Health and Community Medicine, University of Sydney, NSW 2006, Australia, ^c University of Bristol, Department of Social Medicine, Canynge Hall, Bristol BS8 2PR, ^d Deakin University, Burwood, Victoria 3125, Australia

Correspondence to: Mr Tudor-Smith chris.tudorsmith{at}hpw.wales.nhs.uk

Objective: To assess the net 5 year effects of intervention of a community based demonstration project, the HeartbeatWales programme, on modifiable behavioural risks for preventionof cardiovascular disease.
Design and setting: Quasi-experimental design comparing results from two independent cross sectional population surveysconducted in 1985 and 1990 in Wales and a matched reference areain 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 innorth east England (1483 and 4534, respectively).
Intervention: A coordinated range of activities for heart health promotion in Wales entailing public education campaignsalong with supportive policy and infrastructure change. In thereference area no additional community heart health promotionwas planned, though considerable activity did take place, "contaminating"the reference area.
Main outcome measures: Fifteen self reported behavioural indicators relating to dietary choice, smoking, frequencyof exercise, and weight.
Results: Positive changes (for health) in behavioural outcomes were observed among the population in Wales, includinga reduction in reported smoking prevalence and improvements indietary choice. There was no net intervention effect for the programmeover and above observed change in the reference area.
Conclusions: No definite conclusions can be drawn concerning the efficacy of the programme in terms of behaviouraloutcomes. With hindsight, the difficulties of evaluating sucha complex multifaceted intervention were underestimated. Furtherdebate on the most appropriate methods for assessing the effectivenessof community based health promotion programmes is called for.

Key messages

Heartbeat Wales was set up in 1985 as a community based programme to demonstrate risk reduction for cardiovascular disease
Important changes were observed in modifiable risks for cardiovascular disease in Wales between 1985 and 1990
There was an unexpectedly rapid uptake of heart health promotion activity in the reference area
No net intervention effects were found for the programme over and above changes in the reference area
Improvements in methods of evaluation for community based health promotion programmes are required

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