To be seen, confirmed and involved - a ten year follow-up of perceived health and cardiovascular risk factors in a Swedish community intervention programme

Both quantitative and qualitative approaches were used to address the interaction between changes in self-rated health and risk factor load. Qualitative interviews contributed to an analysis of how the outcome was influenced by health related norms and attitudes.Most people maintained a low risk factor load and a positive perception of health. However, more people improved than deteriorated their situation regarding both perceived health and risk factor load. "Ideal types" of attitude sets towards the programme, generated from the interviews, helped to interpret an observed polarisation for men and the lower educated.Our observation of a socially and gender differentiated intervention effect suggests a need to test new intervention strategies. Future community interventions may benefit from targeting more directly those who in combination with high risk factor load perceive their health as bad and to make all participants feel seen, confirmed and involved.Public health interventions are directed towards social systems trying to influence people's attitudes and actual behaviours. They aim to create a positive infrastructure for change and a will to initiate action on both community and individual level [1]. However, social systems are vulnerable and it is difficult to foresee all consequences of an intervention. While targeted outcomes may be positively influenced, intervention strategies may also have unintended consequences and at worst be counterproductive for example by increasing the risk of stigmatisation, labelling or discrimination [2]. The effects can also differ unfairly by age, gender and educational level. To include self-reported outcome measures of health is one way of addressing these possible side-effects.Through a few simple questions self-rated health indicate how respondents perceive their health in general and/or in comparison with other people of their own age. Self-rated health is known to be a multi-dimensional concept including not only physic