Out of context? Translating evidence from the North Karelia project over place and time

Within the literature on community-based heart health promotion and chronic disease prevention, the North Karelia project is often viewed as a model program for achieving community-wide reductions in risk factors and mortality associated with cardiovascular disease. In the present study, we examine the tendency to attempt replication of elements of the North Karelia project, without due consideration of the unique population and setting being targeted. We analysed a sample of 64 articles reporting on community-based interventions targeting chronic disease, published between 1990 and 2002. Of these 64 articles, 43 (67%) made explicit reference to North Karelia or one of the other early projects (Stanford, Minnesota, Pawtucket). Of these 43 articles, 8 (19%) explicitly acknowledged the unique features of the population/setting in question, and articulated a need to adapt to these unique features, while 10 (23%) provided no acknowledgment of unique population/setting features. The remaining 25 (58%) were 'in between', and examples from each group are discussed. We conclude that for many contemporary community-based interventions, concern with replicating the North Karelia project is accompanied by inadequate consideration or reporting of the details of the unique context (including people, place and time), and this may undermine the success of community-based health promotion.