Evaluation Framework

Section III: Heart Disease and Stroke Prevention Program Description

Goals of CDC's Heart Disease and Stroke Prevention Program

• Increase the capacity of states to promote CVH and prevent and control CVD.
   
• Conduct surveillance of CVD, CVD–related risk factors, and policy and environmental sectors that support CVH.
   
• Develop, implement, and improve program interventions to promote CVH and prevent and control CVD.
   
• Identify intervention "models that work" in promoting CVH and preventing and controlling CVD.
   
• Eliminate disparities in CVH between general and priority populations.

The Heart Disease and Stoke Prevention Program goals involve changing environmental and policy systems that affect people's cardiovascular health as well as increasing education, training, assessment, and communication to prevent and control CVD. To meet these goals, programs attempt to influence those in a position to make policy changes to improve the cardiovascular health of individuals (e.g., health care providers, school principals, business managers). To be effective, an intervention plan should use educational, policy, and environmental strategies.

Environmental change interventions are used to change both the physical and social environment to influence people's attitudes and health behaviors. One way to produce environmental change is through policy changes that can be divided into changes in legislative/regulatory policies and changes in organizational policies. Legislative/regulatory policies are formal policies that have been written into laws and affect the general public. Organizational policies are those that specific organizations, such as schools, businesses, or health care providers, create to define appropriate behavior within the confines of their organization. These policies may not affect the general public, but they do affect those who frequent the locations where the policies are in place (Schmid et al., 1995).

To accomplish their goals, state heart disease and stroke prevention programs should engage in capacity building, surveillance, and program interventions. Capacity building and program interventions both contribute directly to targeted policy changes, while surveillance activities are used to help to target areas where policy changes should occur. These three components are complementary, and each is necessary if a state heart disease and stroke prevention program is to be effective. Each of these components is discussed in greater depth below, and a glossary of terms related to the heart disease and stroke prevention program is included in Appendix A.

Capacity building. Capacity building refers to efforts by state health departments to build the assets, resources, and commitments necessary to improve their residents' cardiovascular health by supporting population–based interventions that emphasize policy and environmental changes at the system level.

The following eight activities are intended to help states build the capacity of their health department:

1. Develop and coordinate partnerships. States should develop new partnerships and enhance existing partnerships with (1) traditional partners within and outside the state health department, (2) nontraditional organizations (e.g., transportation, urban planning, parks and recreation, health care organizations), and (3) organizations that address a CVD risk factor or serve priority populations. By involving these organizations to promote cardiovascular health, states will help increase coordination among partners and avoid duplicating cardiovascular disease prevention efforts.
    
2. Develop the scientific capacity to define the cardiovascular disease burden and to evaluate programs. By enhancing their capacity in epidemiology, behavioral science, statistics, surveillance, and data analysis, states can better analyze existing data such as vital statistics, hospital discharge data, and Behavioral Risk Factor Surveillance System (BRFSS) data. These data sources are used to track trends and identify patterns or disparities in the CVD burden by geography, gender, race, ethnicity, and socioeconomic status.
    
3. Develop an inventory of policies and environmental sectors that promote CVH. States should assess existing policies and environments that support positive CVH behaviors at the state level, as well as in communities, schools, worksites, and health care facilities.
    
4. Develop or update a state CVH plan. States should work with partners to develop a comprehensive state plan with population–based objectives and strategies to promote CVH and reduce the prevalence of CVD and related risk factors.
    
5. Provide training and technical assistance. States should provide training to help state and local health department staff, partners, and other organizations better promote CVH.
    
6. Develop population-based strategies. States should identify population–based strategies to promote CVH as well as promote the prevention and control of CVD and related risk factors.
    
7. Develop culturally competent strategies for addressing priority populations. States should identify intervention strategies specific to priority populations.
    
8. Develop a CVH infrastructure within the state health department. States should develop program and managerial infrastructure to support CVH activities by hiring program, evaluation, and epidemiologic staff and identifying additional resources.

Surveillance. CVD epidemiologic data are compiled from data in existing surveillance systems such as state BRFSS surveys and mortality and morbidity reports. These surveillance systems track changes in rates of CVD and related risk factors. States should use surveillance information to increase their scientific or epidemiologic capacity to define the CVD burden, (see item 2 of capacity building). States should also use surveillance data when setting priorities for program planning, developing a state CVH plan, identifying priorities for policy and environmental interventions, improving evaluation capacity, and identifying priority populations.

Program Interventions. Program interventions should focus on policy and environmental strategies as well as on educating people about CVH. Interventions are implemented at both the state level and in communities, schools, worksites, and health care facilities.

Date last reviewed: 05/12/2006
Content source: Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion