回顧社區健康介入計畫：以預防心血管疾病為例

A Review of community-based Intervention Programs: Heart Health Projects as Examples

林宜平(Yi-Ping Lin)

《台灣公共衛生雜誌》 24卷6期 (2005/12) Pp. 461-470

https://doi.org/10.6288/TJPH2005-24-06-01

摘要

本文以預防心血管疾病為例，回顧歐美等國的大型社區健康介入計畫，探討此類計畫缺乏長期成效的可能原因，並討論其研究設計與測量指標，最後則小結社區健康介入計畫未來的研究取向。歐美等國的社區心血管疾病預防計畫，多半由研究機構設計與執行，然而幾個著名的大型社區研究計畫，長期追蹤的結果都發現，介入社區的各項健康指標雖然大有改善，但是對照社區也有同樣的變化，二者在統計上並無顯著差異。本文由這類大型介入計畫的研究設計與其背後的社會變遷，探討計畫缺乏成效的可能原因，並進一步討論美國式量化研究的缺失，比較健康照護體系與社區的異同，及介紹社區層次的健康指標。作者以歐美等國的社區心血管疾病的預防計畫為例，建議未來社區健康介入研究，除致力於個人行為改變外，應同時考慮環境與政策改變；在方法學上質性研究應與量性研究並重；評量工具可由社區指標取代個人指標；而研究計畫的主導者則應由研究者轉移到社區居民。

關鍵字

社區健康 ； 疾病預防 ； 心血管疾病

並列摘要

This article used community heart health projects as examples to review the trend and development of community-based intervention programs in the US and European countries. The author explored the reasons for why there was no significantly effective outcome in many of these large-scale programs, and discussed the study designs and health indictors of such programs. From both review and discussion, the author suggested future research strategies in community-based intervention studies. Since the 1970s, many American and European research institutes have supported large-scale community-based intervention programs aiming at preventing cardiovascular diseases. In many programs, the prevalence of risk factors and cardiovascular disease had been lowered in the intervened communities that were the subject of intervention. The controlled community, however, also showed the same secular changes over in the long-term research period. Statistically speaking, there were no significant differences between the experimental and control groups. The author reviewed some new research designs and new approaches in community-based intervention studies. As a conclusion, the author suggest that future community-based studies should consider environmental and policy changes as well as individual behavior changes; apply both qualitative and quantitative methods, replace individual-level indicators with community-level indicators, and shift the directorship of the program from investigators to community participants.

並列關鍵字

community health ； disease prevention ； cardiovascular disease

參考文獻

Projects using community-level indicators

行政院衛生屬國民健康局：社區健康營造網

Baxter T,Milner P,Wilson K(1997).A cost-effective, community based heart health promotion project in England: Prospective comparative study.BMJ.315,582-5.

Carlton RA,Lasater TM,Assaf AR,Feldman HA,McKinlay S(1995).Pawtucket Heart Health Writing Group. The Pawtucket heart health program: Community changes in cardiovascular risk factors and projected disease risk.Am J Public Health.85,777-85.

Cheadle A,Sterling TD,Schmid TL,Fawcett SB(2000).Promising community-level indicators for evaluating cardiovascular health-promotion programs.Health Educ Res.15,109-16.