Change in health risk perception following community intervention in Central Havana, Cuba

It is increasingly recognized that individual values, beliefs and behavior operate within a social context. There is growing consensus that local perceptions and indigenous knowledge should be important elements in the evaluation of programs aimed at improving health. Thus, an assessment of changes in health risk perception was included in the evaluation of a multi-component intervention project undertaken between 1996 and 1999 aimed at improving the health and well-being of residents in the inner city community of Cayo Hueso, in Centro Habana, Cuba. The community intervention involved a tremendous mobilization of government and non-governmental organizations, to promote social and cultural activities and address deficiencies in housing, water supply, waste disposal and street illumination. Prior to the interventions, 365 adults were surveyed regarding their perceived health risks regarding 41 health determinants, scored on four-point Likert scales ranging from 'without risk' to 'very risky'. A factor analysis of these data classified perception of risk into five areas: social environment, threats to personal health, lifestyle choices, environmental sanitation and housing conditions. The objective of the current analysis was to determine if there were changes in the level of perceived risk to health over the 5 years pre- versus post-intervention in Cayo Hueso, and if so, whether these changes were significantly different from changes seen during the same 5-year period in Colón, another community in Centro Habana not receiving focused interventions. During the first quarter of 2001, 1703 individuals living in 654 households in Cayo Hueso and Colón were interviewed in their homes using an enhanced version of the 1996 risk perception instrument. Ordinal logistic regression models, adjusted for age, gender and years of education, were fit to assess change in health risk perception between 1996 and 2001. Significant declines in perceived health risk were found in both Cayo Hueso and Colón within all five domains, with significantly greater declines in many areas in Cayo Hueso compared with Colón, particularly with respect to housing-related health risks, indeed the main target of the intervention. Risk perception surveys are useful characterizations of widely held views in a target population. Our findings of decreased perceived health risk following public health, physical and social interventions to improve health suggests that this line of inquiry merits consideration in planning evaluations of multi-sectoral community-based health promotion interventions.