Article Text

Download PDFPDF

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
  1. Gemma Phillips1,
  2. Christian Bottomley2,
  3. Elena Schmidt1,
  4. Patrick Tobi1,
  5. Shahana Lais1,
  6. Ge Yu1,
  7. Rebecca Lynch3,
  8. Karen Lock4,
  9. Alizon Draper5,
  10. Derek Moore6,
  11. Angela Clow3,
  12. Mark Petticrew4,
  13. Richard Hayes2,
  14. Adrian Renton1
  1. 1Institute for Health and Human Development, University of East London, London,UK
  2. 2Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  3. 3Department of Psychology, University of Westminster, London, UK
  4. 4London School of Hygiene and Tropical Medicine, London, UK
  5. 5Department of Human and Health Sciences, University of Westminster, London, UK
  6. 6Institute for Research on Child Development, University of East London, London, UK
  1. Correspondece to Professor Adrian Renton, Institute for Health and Human Development, University of East London, Suite 250, University House, The Green, Water Lane, London E15 4LZ, UK; a.renton{at}uel.ac.uk

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 multicomponent 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; 5×30 m 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 postintervention 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.

  • RANDOMISED TRIALS
  • DEPRIVATION
  • DIET
  • EXERCISE
  • HEALTH PROMOTION

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/

Statistics from Altmetric.com

Supplementary materials

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.