• Rosanne Crouch, Anne Wilson, and Jonathan Newbury.
• Spencer Gulf Rural Health School, Port Pirie, South Australia, Australia. rosanne.crouch@adelaide.edu.au
• Int J Evid Based Healthc. 2011 Sep 1;9(3):236-45.

BackgroundCardiovascular disease is the leading cause of death and disability for women in Australia. Women living in rural areas are at greater risk of heart disease, because of limited access and availability of healthcare in rural areas. Lifestyle is a major determinant to the risk of heart disease. Risk factors such as smoking, hypertension, diet, physical activity and alcohol intake can be controlled or modified by lifestyle changes. As heart disease develops over many years, women need to be following healthy lifestyle practices and reduce their chance of a first or recurrent heart attack.AimTo determine the effectiveness of primary health education or intervention programs for cardiac risk reduction in healthy women living in rural areas.Inclusion CriteriaTypes of participants. Women aged 16-65 years, living in rural areas, who participated in primary healthcare education programs. Types of interventions. Primary health education or intervention programs aimed at improving rural women's knowledge of their risk of heart disease, for example group work, videos, telephone, workshops, educational material and counselling. Types of outcomes. Primary outcomes included: • Knowledge level of heart disease risk factors. • Lifestyle modification, for example dietary improvements such as reduced daily salt intake, increased intake of fruit and vegetables and decreased intake of fat, increased frequency of exercise, decreased levels of smoking, alcohol intake within national guidelines. • Health assessment measures, for example blood pressure, body weight, cholesterol levels. Types of studies. Any randomised controlled trials, other experimental studies, as well as cohort, case-control and cross-sectional studies were considered for inclusion. Search strategy. A search for published and unpublished studies in the English language was undertaken.Methodological QualityEach study was appraised independently by two reviewers using the standard Joanna Briggs Institute instruments.Data Collection And AnalysisInformation was extracted from studies meeting quality criteria using the standard Joanna Briggs Institute tools. Although similar outcomes are explored in many of the studies, the variable outcome measures precluded the use of meta-analysis. Data are therefore summarised in tables or by using narrative analysis.ResultsNine trials were included in the review. Three trials compared the effects of interventions on physical activity, one on smoking and five on multiple risk factors. Studies following interventions targeting physical activity reported that women's physical activity can be increased and that these increases can be sustained at 12 months. While there were decreases in blood pressure at 6 months, studies with a 5-year follow up found no decreases for both systolic and diastolic blood pressure. Overall results of studies into dietary modification programs also did not sustain an effect over a longer period of time.ConclusionThe results of this review suggest that in rural areas, lifestyle interventions delivered by primary care providers in primary care settings to patients at low risk appeared to be of marginal benefit. Resources and time in primary care might be better spent on patients at higher risk of cardiovascular disease, such as those with diabetes or existing heart disease.© 2011 The Authors. International Journal of Evidence-Based Healthcare © 2011 The Joanna Briggs Institute.

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