North Karelia Project on Smoking

The intervention was based on the application of behavioural and social theories in a community setting, including Bandura's social learning theory, the classical communication-persuasion model, and the belief-attitude-intentional model.

Based on these theories, the health education activities of the project consisted of increased health information, persuasive messages, provision of social support, and certain environmental modifications. The project activities were implemented mainly through existing community structures, and emphasised community participation. For instance, local authorities and civic organisations were asked to promote no-smoking areas in their facilities. Local physicians and nurses were asked to inquire about smoking and to give advice to their patients about cessation. Specific smoking cessation courses were organised. Printed information on smoking was included in patient cards and files. During the initial 5-year period, 39 seminars were arranged for the training of local health personnel in various education skills.

At the same time, both mass and interpersonal communication via various community leaders was used to influence smoking behaviour in the community. The major theoretical background here was innovation-diffusion theory, which treats smoking cessation and non-smoking as a new innovation that spreads through the community. People are classified into the categories of innovators, early adopters, early majority, late majority, and laggards; the innovators and early adopters are understood to have the greatest social influence in the community. Based on the classical idea of the two-step flow of new ideas and attitudes through opinion leaders, the project worked in close co-operation with different kinds of official and unofficial leaders in the community. A network of lay leaders was established and trained to support the community activities.

During the first 5 years of the programme, local newspapers published about 250 articles on smoking. The local radio station broadcast the project's specific non-smoking messages. During the same period, 45,000 anti-smoking leaflets were distributed in addition to other anti-smoking materials, including 150,000 copies of signs and stickers with the message, "Do not smoke here - we are in the North Karelia Project."

During the second 5-year period, 1977-1982, most of the activities continued in the local area. At the same time the project, as a national pilot programme, launched nation-wide activities. Thereafter, the use of the reference area in the evaluation was limited. Comprehensive smoking cessation programmes were broadcast on national television in 1978, 1979, 1980, and 1982. These were supported in North Karelia by extensive field activities, a primary feature of which was the training of lay leaders to provide social reinforcement in imitating television models who stopped smoking.

Smoking.

By using a comprehensive community-based media strategy, a favourable influence was expected to reach the whole community with the promotion of healthy lifestyles. These efforts were based on the behavioural principles of increased health information, provision of preventative services, persuasion, teaching practical change skills, providing social support, environmental modifications, and community organisation as vectors for change.