Prevention of ischaemic heart disease in primary health care. Experiences from a health promotion programme

Abstract: This thesis is based on the Live for Life health promotion programme, which was started in the County of Skaraborg in 1989. Special reference is given to the results obtained from a health interview, which was offered, to 30- and 35-year old men and women in the county.Aims of the study: The main purpose was to describe and evaluate methods for health promotion work. Special aims were to characterise 30- and 35-year old persons in the county with respect to lifestyle factors and biological risk markers. The association between lifestyle and biological risk factors were studied, as well as the effect of lifestyle changes on biological risk markers. Sub-aims were to determine if there was an effect of the health promotion programme on hard end-points (mortality from ischaemic heart disease) in the community, and to evaluate the dietary instrument used.Study population and methods: All health care centres in the former County of Skaraborg participated in the Live for Life programme, and as one part of the programme 30- and 35-year old persons in the county were invited to a health dialogue using a "Health Curve". A nurse carried out this health interview. Information about dietary habits was obtained by using a specially designed self-instruction questionnaire. Register data were used for studying changes in mortality from ischaemic heart disease as a possible effect of the intervention programme.Results and conclusions: Detailed information has been obtained about lifestyle factors and biological risk markers from the health dialogues. Women reported better dietary habits and lower alcohol consumption than men, while men smoked less, experienced less mental stress and reported less psychological strain. Dietary habits were more favourable at the age of 35 years than at the age of 30, both in men and women. The specially designed dietary questionnaire showed good between-method correlation for fat and fibre with a 3-day food record and there was a significant association with dietary habits measured with the questionnaire and serum cholesterol concentration. The dietary questionnaire proved to be a useful tool as part of the health dialogue. Those who improved their lifestyle (dietary and physical activity habits were studied in this respect) also improved their biological risk markers. In communities offering the health dialogue there was a more favourable development concerning biological risk markers such as body mass index and serum cholesterol concentration compared with communities with a community health strategy only. In one of the communities of Skaraborg (Habo), which participated to full extent in the Live for Live programme, premature mortality from ischaemic heart disease decreased substantially compared with the rest of Sweden. This may be an effect of improvements in both primary and secondary prevention in co-operation between the community and primary health care.