Effectiveness of a community leaders' programme to promote healthy lifestyles in Tokyo, Japan.

The aim of this study was to evaluate a community-based health promotion programme in terms of changing: (i) attitudes with respect to a healthy lifestyle; (ii) behaviour with respect to access to health-related information; and (iii) attitudes and health literacy regardless of socio-economic status. In this programme, 20 people are selected every 2 years in each municipality from the lay people of the community, and they are designated as members of a 'community leaders' committee' by the Mayor. They, as a group, have opportunities to gain knowledge about and skills in healthy lifestyles, and undertake voluntary activities to serve the community. A programme intervention sample (INT group) was selected from programme participants from 13 municipalities in the greater Tokyo area. A questionnaire survey was carried out with the INT group and a general population group (REF group). The data obtained for female respondents, aged 30-59 years, in the two sample populations (n = 662 and 1361, respectively) were analysed using the chi(2) test, the Kruskal-Wallis test and multivariate log-linear methods. Another questionnaire was given to female programme participants (n = 200) to identify any changes since the start of their participation. The results showed that the people in the INT group were pursuing healthier lifestyles than those in the REF group; current non-smokers who performed physical exercise and who ate meals regularly paid more attention to a healthy lifestyle and were more interested in the relationship between food and health. From the INT and REF groups, 22 and 4% of people, respectively, frequently obtained information from health professionals, and 29.8 and 10.8%, respectively, were satisfied with their access to health-related information. Results of multivariate log-linear analysis showed that significantly more people in the INT group were doing exercise, eating meals regularly, paying attention to nutritional balance and to food additives, were interested in health, and were satisfied with access to health information, after excluding the effects of age and socio-economic factors (p < 0.05). The results also showed positive changes after the implementation of the programme. These findings indicated that the people in the INT group were significantly more likely to pursue a healthier lifestyle and to have greater health literacy than those in the REF group, regardless of socio-economic status. In conclusion, this community participation approach, employing a committee style, was effective in improving health-related behaviour and in promoting health literacy while overcoming socio-economic variation.