Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods

Phillips, Gemma and Bottomley, Christian and Schmidt, Elena and Tobi, Patrick and Lais, Shahana and Yu, Ge and Lynch, Rebecca and Lock, Karen and Draper, Alizon and Moore, Derek and Clow, Angela and Petticrew, Mark and Hayes, Richard and Renton, Adrian (2014) Well London Phase-1: results among adults of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods. Journal of Epidemiology and Community Health, 68 (7). pp. 606-614. ISSN 0141-7681

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Abstract

Background: We report the main results, among adults, of a cluster-randomised-trial of Well London, a community engagement programme promoting healthy eating, physical activity and mental well-being in deprived neighbourhoods. The hypothesis was that benefits would be neighbourhood-wide, and not restricted to intervention participants.The trial was part of a multi-component process/outcome evaluation which included non-experimental components (self-reported behaviour change amongst participants, case studies and evaluations of individual projects) which suggested health, well-being and social benefits to participants.
Methods: Twenty matched pairs of neighbourhoods in London were randomised to intervention/control condition. Primary outcomes (five portions fruit/vegetables/day; 5x30 min of moderate intensity physical activity/week, abnormal General Health Questionnaire (GHQ)-12 score and Warwick–Edinburgh Mental Well-being Scale (WEMWBS) score) were measured by post-intervention questionnaire survey, among 3986 adults in a random sample of households across neighbourhoods.
Results: There was no evidence of impact on primary outcomes: healthy eating (relative risk [RR] 1.04, 95% CI 0.93 to 1.17); physical activity (RR:1.01, 95% CI 0.88 to 1.16); abnormal GHQ12 (RR:1.15, 95% CI 0.84 to 1.61); WEMWBS (mean difference [MD]: −1.52, 95% CI −3.93 to 0.88). There was evidence of impact on some secondary outcomes: reducing unhealthy eating-score (MD: −0.14, 95% CI −0.02 to 0.27) and increased perception that people in the neighbourhood pulled together (RR: 1.92, 95% CI 1.12 to 3.29).
Conclusions: The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours, well-being and social outcomes. Low participation rates and population churn likely compromised any impact of the intervention. Imprecise estimation of outcomes and sampling bias may also have influenced findings. There is a need for greater investment in refining such programmes before implementation; new methods to understand, longitudinally different pathways residents take through such interventions and their outcomes, and new theories of change that apply to each pathway.

Item Type: Article
Research Areas: A. > School of Science and Technology > Natural Sciences
Item ID: 24140
Notes on copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/
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Depositing User: Patrick Tobi
Date Deposited: 16 Apr 2018 10:45
Last Modified: 30 Nov 2018 06:06
URI: http://eprints.mdx.ac.uk/id/eprint/24140

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