Public health impact of community-based nutrition and lifestyle interventions.

Community-based interventions have increasingly received attention since researchers and public health professionals have come to acknowledge the importance of an environment that makes the healthy choice the easy choice. All stakeholders including the target community are involved to achieve changes in legislation, in people's social and physical context, and in individual characteristics that support healthy diets and other lifestyles. Some early large-scale community-based heart health interventions showed promising results. The Stanford Five City Project, for example, showed net improvements in knowledge of coronary heart disease risk factors of approximately 12%. Net declines in smoking prevalence (14%), cholesterol (2%), and systolic (3%) and diastolic (5%) blood pressure were also observed. Most later studies did not replicate these findings and it was therefore suggested that community-based interventions, which require substantial commitment and resources, may be less effective than approaches targeting high-risk groups. We present the rationale and theories for community-based interventions, and then elaborate on the methodological challenges in the design and the outcome and process evaluation of community-based interventions. We provide an overview of some of the evidence on the effectiveness of community-based heart health interventions and conclude with the perspectives for community-based interventions in future research and practice.