Adult community health-promoting interventions in primary health care: A systematic review

• We review health-promotion interventions carried out in primary care.
• We identify community interventions which show evidence of effectiveness.
• A lack of evidence in some areas is detected.
• We describe difficulties in research and publishing about community interventions.

ObjectiveTo examine evidence on the effectiveness of health-promoting community interventions carried out in primary health care.MethodsSystematic 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.ResultsFifty-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.ConclusionsThe 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.