Health Promotion International, Vol. 14, No. 4, 317-327,
December 1999
© Oxford University Press 1999
Evaluation of a community-based health promotion program supporting public policy initiatives for a healthy diet
1 Centre for Health Program Evaluation and 2 Centre for Program Evaluation, The University of Melbourne, Australia
Address for correspondence: David Dunt, Centre for Health Program Evaluation, PO Box 477, West Heidelberg, Victoria 3081, Australia
The ‘Towards a Healthy Diet’ phase of the Shepparton Healthy Heart Project was evaluated. The principal goal of this phase was to promote public policy initiatives that promoted healthy diet, supported by changes in community opinion and interest in healthy diet. Changing individual behaviour was a secondary goal only. These public policy initiatives were directed at eating places, schools and the health services. The eating places initiative promoted healthy practices in food preparation and presentation as well as customer healthy food choice behaviours. These initiatives were accompanied by media-based health education and community events. The evaluation employed a two-community, quasi-experimental study design which assessed process, formative and impact (but not outcome) dimensions relevant to the program's objectives. Community opinion as well as dietary behaviour and cognition about healthy diet were assessed using a panel mail questionnaire survey of 1137 residents in the two communities. Community awareness and response to Towards a Healthy Diet were assessed at its completion in a separate cross-sectional mail questionnaire survey of 703 residents of Shepparton. Supermarket sales figures supplemented assessment of behaviour. Fifty-one eating places were assessed using interviews of a panel of proprietors/managers as well as on-site inspections. Initiatives aimed at schools were assessed by on-site interviews, those at general practitioners by a panel mail questionnaire survey. Towards a Healthy Diet achieved its goals only in part. A higher proportion of Shepparton residents reported recent increases in the number of eating places offering healthy food and local residents eating healthy food. There was a significantly greater increase in the number of fruit dishes offered in Shepparton eating places as well as customer requests for fruit. Changes in individual behaviours only differed in the two communities for frequency of eating take-away food, where there was a significant decrease in Shepparton. Canteen policies were more frequently implemented in Shepparton schools. This study provides support for community-based approaches to healthy diet-based public policy initiatives supported by social marketing in the future. Further rigorously evaluated demonstration projects are necessary to replicate and extend these results. This is true for other alternative approaches to community-based programs so far implemented for promoting healthy diet.
Key words: determinants of health; environmental health; health education
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