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Cited by 713Community Health and DevelopmentPublic Health Policies and EducationHealth Promotion and Cardiovascular Prevention

Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential

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Merzel, Cheryl, D’Afflitti, Joanna·2003·American Journal of Public Health
DOI 10.2105/ajph.93.4.557PMC PMC1447790
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Abstract

Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.

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  • Community-based interventions have shown significant potential in fostering sustainable behaviour change and garnering local support, especially in health promotions.

    “Community-based interventions have shown significant potential in fostering sustainable behaviour change and garnering local support, especially in health promotions,44 45 making them invaluable assets in combating AMR at the grassroots level.”

    From Public-targeted interventions addressing antimicrobial resistance and antibiotic use in Sub-Saharan Africa: a scoping review (2025) · cites this paper as [44]

    The Methods section says community-based health promotion can foster local ownership and support behavioural change, and that drawing on community resources may enhance sustainability. It also cautions that sustainable communitywide health impact is unrealistic for time- and resource-limited interventions. The claim overstates the evidence for sustainable behaviour change as a demonstrated outcome. (LLM, conf=0.84)

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Cited by

Sorted by citations

Authors
Merzel, C., & D’Afflitti, J.
Affiliations
Columbia University (US)
ORCID
Merzel, Cheryl
Venue
American Journal of Public Health
Publisher
American Public Health Association
Published
2003-04
Volume
93
Issue
4
Pages
557-574
ISSN
  • 0090-0036 (ISSN-L)
  • 1541-0048
DOI
10.2105/ajph.93.4.557
PMC
PMC1447790
OpenAlex
W2138463569
Cited by
713
References
9
Citations by year
2026: 9 · 2025: 19 · 2024: 24 · 2023: 30 · 2022: 26 · 2021: 33 · 2020: 27 · 2019: 37 · 2018: 44 · 2017: 35 · 2016: 28 · 2015: 36 · 2014: 46 · 2013: 36 · 2012: 26
FWCI
59.86
Type
journal article
Language
en
Open access
Locations
  • American Journal of Public Health (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › General Health Professions › Community Health and Development
  • Health Sciences › Health Professions › General Health Professions › Public Health Policies and Education
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
Keywords
community health promotion, disease prevention programs, program effectiveness, HIV prevention programs, secular trends, effect size, formative research, social norms, program evaluation
MeSH terms
Health Promotion, Health Status, Humans, Preventive Health Services, Social Change, Social Values, United States, Program Evaluation, Public Health Practice, Models, Organizational, Community Health Planning, Evidence-Based Medicine, Social Marketing

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