美国斯坦福5城市慢性病社区干预项目的经验和教训

Analysis of Experiences and Lessons from the Community-based Intervention Program for Chronic Diseases in 5 Stanford Cities in the United States

1970年代以来,欧美发达国家实施了许多慢性病社区干预项目。在梳理美国斯坦福5城市项目的研究设计、干预措施、主要成效和经验教训后,发现斯坦福5城市项目在进行慢性病的社区干预时,如果不能把握长期趋势的影响,不考虑社区本身的复杂性,那么有限的社区干预很难得到令人满意的效果,且某些微弱的效果无法用量化方法识别出来。因此,在社区干预研究中,不仅要事先估计风险因素的变化趋势,深入理解社区变化的发生机制,还要设法获得干预效果,并注重定性评估方法的使用。

Many community-based programs have been enacted to prevent chronic diseases in Europe and USA since the 1970s.This article aims to explore the Stanford Five-City Project in the USA,including the research design,education methods,intervention effects and relevant lessons.The Stanford Five-City Project shows that it's hard to have satisfactory effects for the limited community-based intervention if we can't assess the impacts of secular trend and understand the complexities of real community.What makes the situation worse is that some modest effects cannot be detected by the quantitative methods.Therefore,in the community intervention studies,we should not only assess the trend of risk factors,understand the mechanisms of community change,and improve the effects of intervention activities,but also pay more attention to the use of qualitative evaluation methods.