Preplanned Studies: Evaluation of China Healthy Lifestyle for All Interventions Based on RE-AIM Framework — China, 2007–2020

Overall, 7 of the top 10 fatal diseases in the world are chronic noncommunicable diseases (NCDs) (1). Approximately 89% of deaths in China were attributed to NCDs in 2018 (2). In order to mitigate the effects of NCDs in China, it is necessary to establish a system for comprehensive NCDs control, carry out comprehensive health education and promotion, and advocate the adoption of a healthy lifestyle by the public (3). Therefore, multiple national departments launched the China Healthy Lifestyle for All (CHLA) campaign to promote and disseminate information on a healthy lifestyle, promote technical measures and support tools, and carry out various national activities in 2007. To evaluate the implementation and intervention of CHLA, we applied the RE-AIM model (4). Overall, the CHLA has shown an upward growth trend and actions taken under the CHLA in multiple domains have shown great progress. To further promote the CHLA, measures were tailored to local conditions.

This study contains a literature review, systematic review, and meta-analysis and applied the RE-AIM model to evaluate the process and results of the CHLA project. The relevant literature was retrieved from both Chinese and English databases as well as other publicly available platforms, including the VIP Chinese Journal Service Platform, the China National Knowledge Infrastructure (CNKI), and the United States National Library of Medicine (PubMed) with the key words of CHLA and its related activities. A mixed research approach combining qualitative and quantitative methods was used to collect and analyze the data. Annual progress data for CHLA comes from the work information management system of CHLA, which includes CHLA activities’ data from 31 provincial-level administrative divisions (PLADs) and Xinjiang Production and Construction Corps (XPCC) in the mainland of China. The evaluation dimensions are described in Table 1.

In the “Reach” dimension, the coverage and mass participation in the CHLA actions were shown in Table 2. In our study, up to December 31, 2015, a total of 2,507 counties (districts) across the country had launched the CHLA, a launch rate of 80.90%. Up to December 31, 2020, a total of 2,817 counties (districts) across the country had launched the CHLA action, a launch rate of 95.20%. The rates in the eastern, central, and western regions were 97.36%, 97.73%, and 91.36%, respectively. The launch rate of each region has increased in the two phases with the fastest expansion in the western region. In general, the launch rate of the western region, as compared with the eastern and central regions, was still at a low level.

In the “Efficacy” dimension, the CHLA action had achieved a remarkable intervention effect. In 2012, the National Action Office carried out a nationwide assessment of the CHLA, which mainly assessed its five aspects, including “awareness of the CHLA action,” “awareness of healthy lifestyles,” “awareness of health knowledge,” “use of health support tools,” and “changes in lifestyle and behavior.” It has been documented that specific knowledge on a healthy lifestyle, such as the recommended level of physical activity, recommended intake of oil and salt, and parameters for a healthy Body Mass Index were higher in the action groups than in the non-action groups, and higher in urban than rural populations (5). In addition, the proportion of conscious control of oil and salt intake in urban and rural action groups was higher than that in non-action groups (5). In this study, according to the inclusion and exclusion criteria, 42 pieces of literature (47 studies) were included in the meta-analysis. The results showed that the CHLA was effective. See Table 3 for the results on lifestyle and behavior changes in the CHLA action group and the control group. In addition, it was notable that the CHLA was well accepted across the country. For example, in 2014, Shanghai carried out an evaluation of the effect of the yearly distribution of health gift packages to the city’s residents as part of the CHLA action, showing 82.1% satisfaction.

In the “Adoption” dimension, many departments were involved in the action. The first phase of the CHLA was jointly initiated by three departments and the second phase was jointly managed by five ministries and commissions. In light of local conditions and the advantages of multi-department collaboration, a working mechanism for the CHLA has been gradually formed under the leadership of the government and with the participation of various departments. For example, the Chongqing Municipal Education Commission, market regulatory departments, sports departments, municipal governments, propaganda unions, and other relevant departments actively issued policy documents conducive to the control of risk factors related to chronic NCDs.

In the “Implementation” dimension, the corresponding results were shown in Table 4. Increasing trends were seen in the number of trainees, on-site activities, health lectures, and so on since the launch of the CHLA actions in the eastern, central, and western regions. In the first phase of CHLA implementation, the eastern region made progress in all areas, while the western region lagged behind. In the second phase, progress was made in all regions.

In the “Maintenance” dimension, central and local governments took many measures to ensure the sustainability of the CHLA actions. For example, Shandong Province brought salt reduction interventions under the provincial basic public health service projects and grassroot medical and health service institutions carried out salt reduction interventions and follow-up for residents in areas under their jurisdiction. In addition, since the launch of the CHLA, many technical programs have been released, such as the Overall Program of Action on Healthy Lifestyles for All (2007–2015), the Implementation Program for Healthy Lifestyle Instructors, the Action Program on Healthy Lifestyles for All (2014–2025), and so on. These actions have also been incorporated into policy documents such as the Performance Evaluation Standard for Disease Prevention and Control (2012), the Outline of the “Healthy China 2030” Plan, and China’s Mid-and Long-term Plan for the Prevention and Treatment of Chronic Diseases (2017–2025) and so on.