Brownson 1996.
| Methods |
Study design: controlled before‐after study (independent samples) Sampling frame: non‐institutionalized adults with telephones Sampling method: at baseline, random‐digit dialing; at follow‐up, RDD in entire intervention area for first 1000 respondents, then RDD in communities with > 20% black population for next 500 Collection method: telephone interviews (n = 1510) Description of the community coalition: The Missouri Southeastern District Health Office hired a full‐time project co‐ordinator to form and oversee 6 county coalitions comprising representatives from the community, municipal government, a citizen advocacy agency, religious organizations, university staff, and local and state health departments. County coalitions had full control over selection and implementation of interventions |
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| Participants |
Communities: 6 rural counties in the southeastern Missouri Bootheel region compared with the rest of rural Missouri Country: USA Ages included in assessment: 18+ Reasons provided for selection of intervention community: The Bootheel region displayed significantly high rates of death from coronary heart and cerebrovascular disease, as well as the largest minority population in Missouri, and high rates of poverty, unemployment, and medical underservice Intervention community (population size): 6 rural counties in the southeastern Missouri Bootheel region (approximately 160,000) Comparison community (population size): the rest of rural Missouri (not reported) |
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| Interventions |
Name of intervention: Bootheel Heart Health Project Theory: Social Learning Theory, Stage Theory of Innovation Aim: to assess whether a community‐based risk reduction project reduces major modifiable risk factors for cardiovascular disease Description of costs and resources: each county coalition given $5,000 to 8,000 per year to implement intervention activities Components of the intervention: Intervention activities included blood pressure and cholesterol screenings, walking groups, exercise and cooking/nutrition classes, parties, pageants, and anti‐smoking campaigns and contests Start date: September 1990 Duration: 4 years |
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| Outcomes |
Outcomes and measures:
Time points: baseline (1990) and follow‐up (1994) |
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| Notes | Fifth outcome reported in study (cholesterol checked in past 2 years) not included in review because comparison community data collected 1 year earlier. Comparison between “coalition present” and “coalition absent” communities within the Bootheel 6‐county region not included in this review Outcomes measured at the population level by telephone surveys Source of funding: government |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | High risk | Intervention was not randomly assigned |
| Allocation concealment (selection bias) | High risk | No allocation concealment |
| Baseline outcome measurement similar | High risk | Baseline rates of physical activity significantly different even after adjustment for demographic factors by analysis of covariance (43.1% in intervention group vs 29.0% in control group) |
| Baseline characteristics similar | High risk | Allocation by region; intervention and comparison populations are not comparable |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | Blinding not reported |
| Incomplete outcome data (attrition bias) All outcomes | High risk | Sampling strategy was changed between baseline and follow‐up in the intervention group. Response rate declined over time in the intervention group and was not stated for the control group. Proportion of study sample without telephone not stated for control population |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | No blinding |
| Protection against contamination | Unclear risk | No statement regarding contamination |
| Selective reporting (reporting bias) | Unclear risk | Only 5 risk factors reported out of 87+ BRFSS questions |