An Individually Tailored Behaviour Change Programme for Cardiovascular Prevention: Effectiveness and Cost- Effectiveness

Abstract

Cardiovascular disease (CVD) is the main cause of death and disability in Europe and 10% of the total health care costs in the European Union is due to CVD. This thesis provides original research on a cardiovascular prevention programme focused on medical risk factors and risk behaviours such as an unhealthy diet, low levels of physical activity, and smoking in a highly educated sample. The behavioural interventions, namely a website and oneon-one coaching were part of an individually tailored behaviour change programme. The effectiveness of this programme was evaluated compared to a medical intervention only condition with total CVD risk assessment, communication, and follow-up. After 36 months improvements in most of the medical risk factors such as blood pressure and cholesterol were found in both study conditions. The effects of the programme on behaviour were evaluated at 6, 12, and 24 months and improvements in fat intake and physical activity were found in both conditions. The studies of this thesis corroborated the knowledge on intervention exposure. The dose-response analyses showed that a higher intervention dose led to better results in behaviour and determinants of behaviour. The study on exposure to the website showed that the surfing depth was low in general but an effect of use of tailored physical activity advice on physical activity was found. The participants of this study self-selected the intervention dose and delivery modes of the intervention. For physical activity and dietary behaviours, different delivery modes were effective. The Internet and e-mail were better for physical activity while face-to-face contacts were better for dietary behaviours. Nevertheless, there were no significant differences between both study conditions, suggesting that a medical screening with follow-up is sufficient to change important CVD risk factors in the highly educated. The behaviour change programme was effective in influencing key risk factors but screening was as effective in this population. However, we should consider that partial effects might be attributable to spontaneous changes of risk factors in the community due to community interventions and health policy initiatives (e.g., smoking, diet). Nevertheless, based on these results the organisation of screening events with follow-up in the primary care setting is a good action in CVD prevention in the highly educated.