Dissecting the ``black box' ' of community intervention: Lessons from community-wide cardiovascular disease prevention programs in the US and Sweden

The overall goal of this paper is to attempt to dissect to be referred to as ` the black box’ of community intervention, using black box ofcommunity intervention for CVD prevenexperiences from two community intervention protion.

Abstract

behavior could be clari® ed. Finally, the outcomes In a comprehensive review of community-based trials expected of each intervention might be more precisely for cardiovascular disease (CVD) prevention, Schooler speci® ed and measured. This dissection then would et al. (1) conclude that ` Our review of community provide a better view of what can or cannot be accompprevention trials, however, revealed inadequate lished with population-based CVD risk reduction information about how program components achieved programs. their eVects’ ’ . This conclusion is so frequently cited as The overall goal of this paper is to attempt to dissect to be referred to as ` the black box’ ’ (2). Typically, the ` the black box’ ’ of community intervention, using black box of community intervention for CVD prevenexperiences from two community intervention protion consists of provision of public health interventions grams ± one in Sweden (the NorsjoE community interto modify several deleterious health behaviors and vention programme) (8) and one in the US (the reduce CVD burden (3). However, what actually goes Otsego± Schoharie healthy heart program) (9). The on in this ` black box’ ’ is often unclear, although the strategies are to describe population segments that may hope is that a positive eVect will result. Measures of bene® t diVerentially from various intervention stratsuccess such as behavior change or health are separated egies and to better elucidate the targets of diVerent by a number of steps and processes, many of which interventions. This then allows development of a are diYcult to measure. Our expectations of a positive working model which may better explain the results result are high (4). When these expectations are not obtained in these two studies. met, there is a tendency to doubt the worthiness of the