The Swedish model of health dialogues, a combined individual- and community-based primary preventive program for cardiovascular disease, is associated with reduced mortality: a systematic review.

Abstract

Behavioural risk factors are key determinants of premature death. The Swedish model of health dialogues, which has been developed since 1985, aims to promote healthy behaviours, for prevention of cardiovascular disease, by inviting everyone in specific age groups to primary care for health dialogues combined with community-oriented activities. The health dialogue was performed by trained nurses, based on individual results from questionnaires on health behaviors and results of physiological measures, using visual pedagogic tools and motivational interviewing techniques. The community intervention part of the program aimed to encourage and enhance healthy behaviors, e.g. by collaboration with civil society, e.g. local sports organizations and/or grocery stores. In this first systematic review of the model, seven studies were identified fulfilling the inclusion criteria, having control/reference groups, defined outcome health measures (mortality, risk factors, lifestyle behaviours) and follow-ups of at least one year. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) was used to assess the quality of evidence. The effect on mortality, on risk factors and lifestyle behaviours was evaluated. The model showed effects with reduced premature all-cause mortality and cardiovascular mortality with a moderate level of evidence. Specifically, intention to treat analyses showed a 9.4% and 29% reduction in all-cause mortality in two studies, and 5% reduction of cardiovascular mortality in one large study. Furthermore, levels of blood pressure, cholesterol, fasting blood glucose, waist and BMI were reduced (moderate/low level of evidence) and dietary habits were improved (moderate level of evidence). Health benefits of the model were greater when health dialogues were combined with community-oriented activities. The results of this first systematic review of the Swedish model of health dialogues showed significant effects of the Swedish model of health dialogue, on cardiovascular and all-cause mortality. The method is a multifactorial intervention that includes both individual and community/societal intervention, where the respective contributions of both parts of the intervention cannot be delineated.