A process evaluation of a two-year community cardiovascular risk reduction program: what was done and who knew about it?

The County Health Improvement Program (CHIP) used a community organization approach to place cardiovascular risk reduction programs in the media, worksites, health sector and community organizations of Lycoming County, Pennsylvania, a mixed urban—rural area with a population of 118 000. During a two-year period, mass media campaigns, primarily involving radio and newspaper, were the most extensive intervention; they were used to promote CHIP activities and emphasize skills for smoking cessation, hypertension medication compliance and weight control. Other activities included risk reduction programs at six worksites, 100 lectures to community organizations, two annual community-wide blood pressure screening and monitoring campaigns, and distribution of pamphlets and quit-smoking kits to doctors and dentists. Community-level awareness of CHIP increased significantly over the two-year period, from 58% at one year to 76% at two. This increase was observed for both sexes, all ages, urban and rural residents and persons with different levels of education. However, in both survey years the risk factors and mass education tactics most heavily emphasized prior to the surveys were the most salient. Measuring implementation and awareness can help program planners form realistic expectations of the amount of community level impact that can be expected within a given time frame for programs of varying scope and intensity.