March S, Torres E, Ramos M, Ripoll J, García A, Bulilete O, et al. Adult community health-promoting interventions in primary health care: A systematic review. Preventive Medicine [Internet]. 2015 Jul [cited 2015 Oct 20];76:S94–104. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0091743515000183
OBJECTIVE: To examine evidence on the effectiveness of health-promoting community interventions carried out in primary health care.
METHODS: Systematic review of originals and systematic reviews of health-promoting community interventions with the participation of primary health care. A working definition of community activities was used in the inclusion criteria. Databases searched up to 2013: PUBMED, EMBASE, CINHAL, Web of SCIENCE, IBECS, IME, and PSICODOC. No restrictions on year of publication or design. Articles were reviewed by separate researchers to identify risks of bias.
RESULTS: Fifty-one articles published between 1966 and 2013 were included: 11 systematic reviews and 40 originals that described 39 community interventions. There is evidence on the effectiveness of community interventions in reducing cardiovascular risk factors, encouraging physical exercise, preventing falls and improving self-care among chronic patients compared with usual individual care. The effectiveness of some interventions increases when the community is involved in their development. Most assessments show positive results despite design limitations.
CONCLUSIONS: The community approach may be more effective than the individual in usual preventive interventions in primary care. There is a lack of evidence on many community interventions in primary care and further research is needed.
El objetivo de esta revisión es describir la evidencia disponible sobre la efectividad de intervenciones comunitarias de salud (promotoras de salud) en población adulta donde han participado equipos de Atención Primaria. Los criterios de selección en la revisión han sido los siguientes:
– Addressed to the general population or those over 40 years old.
– Focused on health promotion, that is, they attempt to provide people with the means necessary to improve and exercise more effective control over their health and illness processes.
– Participation of PHC professionals in intervention design, development, or recruitment/referral of patients and their assessment.
– Active community participation in the design, development and/or evaluation of the intervention, or acting as motivators/promoters. For this article we understand by community groups showing common characteristics, needs or interests.
– If participation is not active, they are included only if they formed part of an intersectoral action (collaboration between the health sector and others such as education, social services, and NGOs) or group health education that explicitly states that participatory methodologies are used
La descripción de las intervenciones comunitarias se agrupan en diferentes temas: prevención de caídas, reducción del riesgo cardiovascular, promoción de la salud mental, auto-cuidado y control de las enfermedades crónicas, control de la diabetes, participación en programas de cribado, uso apropiado de los servicios sanitarios, actividad física en población anciana.
Muy interesante, como siempre, leerse la discusión del artículo para entender algunas cuestiones: aunque se trate una revisión focalizada en promoción de la salud en algunos casos lo más publicado sigue siendo desde la prevención de la enfermedad, dificultades metodológicas para clasificar evidencias de intervenciones complejas de salud comunitaria, muchas intervenciones comunitarias no publicadas, etcétera.
Nuestros queridos autores y autoras concluyen:
There is evidence of the effectiveness of health education interventions, imparted by professionals using participatory methodologies or by trained peers, in improving self-care in people with chronic illnesses. Likewise on the effectiveness of community-based programmes which involve the use of distinct community resources to reduce CVR factors. Offering group physical exercise activities (walks, sports-centre workshops) is very effective for the elderly and cost-effective for the general population.
Results appear to indicate that some interventions work better in a group/community environment than in the individual and that greater involvement of patients and the community in interventions improves their effectiveness. Bearing in mind that group/community interventions are compatible and complementary with individual ones, it can be concluded that it is important to continue conducting research into their effectiveness, especially in particular areas where there are no assessments that contribute to the available evidence