| The purpose of this study was to investigate the effectiveness and efficiency of Education for cholesterol reduction compared to other routinely used alternative interventions (Drug Only, Education plus Drug, and No Intervention) and to explore the relationship of specific education design strategies with effectiveness. The study provided an empirical test of education concepts and theories applied to an important public health problem and identified efficiencies and inefficiencies in treatment alternatives for reducing cholesterol among adults at risk for coronary heart disease.;A quasi-experimental, nonequivalent group design was used. The sample consisted of 219 adults who received health care in out-patient clinics employing dietitians in three geographically dispersed states in 1987. Data on the type and amount of intervention and presence of education design strategies were abstracted from medical records. Effectiveness was determined using a series of statistical procedures to identify and adjust for selectivity bias including subgroup analyses. Costs were estimated using market prices.;Clinically meaningful and statistically significant cholesterol decline was found for all groups except the No Intervention group. These findings established the effectiveness of education and drug alternatives,however the degree of change was significantly different between Education and the Drug Only and Education plus Drug alternatives (;Within the education alternative, effectiveness was enhanced by specific objectives and well chosen, individualized materials, and attenuated by education provided by someone other than a dietitian, existing cardiovascular disease, and rural location. Higher numbers of education episodes added to cost and were not associated with greater effectiveness.;Specific inefficiencies are identified and recommendations made regarding the need for future study of education design strategies. |
