Community participation and sustainability--evidence over 25 years in the Västerbotten Intervention Programme

Margareta Norberg, Yulia Blomstedt, Göran Lönnberg, Lennarth Nyström, Hans Stenlund, Stig Wall, Lars Weinehall, Margareta Norberg, Yulia Blomstedt, Göran Lönnberg, Lennarth Nyström, Hans Stenlund, Stig Wall, Lars Weinehall

Abstract

Background: Selection bias and declining participation rates are of concern in many long-term epidemiological studies. The Västerbotten Intervention Programme (VIP) was launched in 1985 as a response to alarming reports on elevated cardiovascular disease (CVD) mortality in Västerbotten County in Northern Sweden. The VIP invites women and men to a health examination and health counselling during the year of their 40th, 50th, and 60th birthdays.

Objective: To evaluate trends in participation rates and determinants of participation in the VIP from 1990 to 2006.

Design: Registry data on socio-economic status from Statistics Sweden, and mortality and hospitalisation data from the National Board of Health and Welfare, both covering the whole Swedish population, were linked to the VIP and analysed for participants and non-participants.

Results: During 1990-2006, 117,710 individuals were eligible to participate in the VIP, and 40,472 of them were eligible to participate twice. There were 96,560 observations for participants and 61,622 for non-participants. The overall participation rate increased from 56 to 65%. Participants and non-participants had minimal differences in education and age. Initial small differences by sex and degree of urban residence decreased over time. Despite an increasing participation rate in all groups, those with low income or who were single had an approximately 10% lower participation rate than those with high or medium-income or who were married or cohabitating.

Conclusion: Sustainability of the VIP is based on organisational integration into primary health care services and targeting of the entire middle-aged population. This enables the programme to meet population expectations of health promotion and to identify high-risk individuals who are then entered into routine preventive health care services. This has the potential to increase participation rates, to minimise social selection bias, and to reinforce other community-based interventions.

Keywords: community participation; health surveys; intervention; primary health care; selection bias.

Figures

Fig. 1
Fig. 1
Annual number of participants and non-participants in the Västerbotten Intervention Programme (VIP), 1990–2006. The dashed vertical line indicates 1995, the year the VIP was integrated into basic primary health care services.

References

    1. Beaglehole R, Ebrahim S, Reddy S, Voute J, Leeder S. Prevention of chronic diseases: a call to action. Lancet. 2007;370:2152–7.
    1. WHO. Cardiovascular diseases fact sheet N 317. 2011. Available from: [cited 20 June 2012]
    1. Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997;349:1655–9.
    1. The National Board of Health and Wellfare. Statistical databases – causes of death statistics [database on the Internet] 2011. Available from: [cited 20 June 2012]
    1. Wall S, Rosen M, Nystrom L. The Swedish mortality pattern: a basis for health planning? Int J Epidemiol. 1985;14:285–92.
    1. Nystrom L, Rosen M, Wall S. Why are diabetes, stomach cancer and circulatory diseases more common in Northern Sweden? Scand J Prim Health Care. 1986;4:5–12.
    1. Norberg M, Wall S, Boman K, Weinehall L. The Vasterbotten Intervention Programme: background, design and implications. Glob Health Action. 2010;3:4643. doi: 10.3402/gha.v3i0.4643.
    1. Tolonen H, Dobson A, Kulathinal S. Effect on trend estimates of the difference between survey respondents and non-respondents: results from 27 populations in the WHO MONICA Project. Eur J Epidemiol. 2005;20:887–98.
    1. Sogaard AJ, Selmer R, Bjertness E, Thelle D. The Oslo Health Study: the impact of self-selection in a large, population-based survey. Int J Equity Health. 2004;3:3.
    1. Kjoller M, Thoning H. Characteristics of non-response in the Danish Health Interview Surveys, 1987–1994. Eur J Public Health. 2005;15:528–35.
    1. Van Loon AJ, Tijhuis M, Picavet HS, Surtees PG, Ormel J. Survey non-response in the Netherlands: effects on prevalence estimates and associations. Ann Epidemiol. 2003;13:105–10.
    1. Vartiainen E, Laatikainen T, Peltonen M, Juolevi A, Mannisto S, Sundvall J, et al. Thirty-five-year trends in cardiovascular risk factors in Finland. Int J Epidemiol. 2010;39:504–18.
    1. Eriksson M, Holmgren L, Janlert U, Jansson JH, Lundblad D, Stegmayr B, et al. Large improvements in major cardiovascular risk factors in the population of northern Sweden: the MONICA study 1986–2009. J Intern Med. 2011;269:219–31.
    1. Bonita R, Brandstrom A, Malmberg G. Linnaeus: alive and well. Glob Health Action. 2011;4:5760.
    1. Malmberg G, Nilsson LG, Weinehall L. Longitudinal data for interdisciplinary ageing research. Design of the Linnaeus database. Scand J Public Health. 2010;38:761–7.
    1. Morton LM, Cahill J, Hartge P. Reporting participation in epidemiologic studies: a survey of practice. Am J Epidemiol. 2006;163:197–203.
    1. Hotchkiss JW, Davies C, Gray L, Bromley C, Capewell S, Leyland AH. Trends in adult cardiovascular disease risk factors and their socio-economic patterning in the Scottish population 1995–2008: cross-sectional surveys. BMJ Open. 2011;1:e000176.
    1. Tolonen H, Laatikainen T, Helakorpi S, Talala K, Martelin T, Prattala R. Marital status, educational level and household income explain part of the excess mortality of survey non-respondents. Eur J Epidemiol. 2010;25:69–76.
    1. Shahar E, Folsom AR, Jackson R. The effect of nonresponse on prevalence estimates for a referent population: insights from a population-based cohort study. Atherosclerosis Risk in Communities (ARIC) Study Investigators. Ann Epidemiol. 1996;6:498–506.
    1. Veenstra MY, Friesema IH, Zwietering PJ, Garretsen HF, Knottnerus JA, Lemmens PH. Lower prevalence of heart disease but higher mortality risk during follow-up was found among nonrespondents to a cohort study. J Clin Epidemiol. 2006;59:412–20.
    1. Alkerwi A, Sauvageot N, Couffignal S, Albert A, Lair ML, Guillaume M. Comparison of participants and non-participants to the ORISCAV-LUX population-based study on cardiovascular risk factors in Luxembourg. BMC Med Res Methodol. 2010;10:80.
    1. Strandhagen E, Berg C, Lissner L, Nunez L, Rosengren A, Toren K, et al. Selection bias in a population survey with registry linkage: potential effect on socioeconomic gradient in cardiovascular risk. Eur J Epidemiol. 2010;25:163–72.
    1. Weinehall L, Hallgren CG, Westman G, Janlert U, Wall S. Reduction of selection bias in primary prevention of cardiovascular disease through involvement of primary health care. Scand J Prim Health Care. 1998;16:171–6.
    1. Damiani G, Federico B, Basso D, Ronconi A, Bianchi CB, Anzellotti GM, et al. Socioeconomic disparities in the uptake of breast and cervical cancer screening in Italy: a cross sectional study. BMC public health. 2012;12:99.
    1. Colton CW, Manderscheid RW. Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing chronic disease. 2006;3:A42.
    1. Hansen V, Jacobsen BK, Arnesen E. Prevalence of serious psychiatric morbidity in attenders and nonattenders to a health survey of a general population: the Tromso Health Study. Am J Epidemiol. 2001;154:891–4.
    1. Lindahl B, Stenlund H, Norberg M. Increasing glucose concentrations and prevalence of diabetes mellitus in northern Sweden, 1990–2007. Glob Health Action. 2010;3:5222. doi: 10.3402/gha.v3i0.5222.
    1. Ng N, Soderman K, Norberg M, Ohman A. Increasing physical activity, but persisting social gaps among middle-aged people: trends in Northern Sweden from 1990 to 2007. Glob Health Action. 2011;4:6347.
    1. Norberg M, Lundqvist G, Nilsson M, Gilljam H, Weinehall L. Changing patterns of tobacco use in a middle-aged population: the role of snus, gender, age, and education. Glob Health Action. 2011;4:5613. doi: 10.3402/gha.v4i0.5613.
    1. Groeneveld IF, Proper KI, van der Beek AJ, Hildebrandt VH, van Mechelen W. Factors associated with non-participation and drop-out in a lifestyle intervention for workers with an elevated risk of cardiovascular disease. Int J Behav Nutr Phys Act. 2009;6:80.
    1. Davies G, Pyke S, Kinmonth AL. Effect of non-attenders on the potential of a primary care programme to reduce cardiovascular risk in the population. Family Heart Study Group. BMJ. 1994;309:1553–6.
    1. Jackson R, Chambless LE, Yang K, Byrne T, Watson R, Folsom A, et al. Differences between respondents and nonrespondents in a multicenter community-based study vary by gender ethnicity. The Atherosclerosis Risk in Communities (ARIC) study investigators. J Clin Epidemiol. 1996;49:1441–6.
    1. Criqui MH, Barrett-Connor E, Austin M. Differences between respondents and non-respondents in a population-based cardiovascular disease study. Am J Epidemiol. 1978;108:367–72.
    1. Reijneveld SA, Stronks K. The impact of response bias on estimates of health care utilization in a metropolitan area: the use of administrative data. Int J Epidemiol. 1999;28:1134–40.

Source: PubMed

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