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.
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.
Institute for Health and Human Development, University of East London, London,UK.
Gemma
G
Phillips
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Christian
C
Bottomley
Institute for Health and Human Development, University of East London, London,UK.
Elena
E
Schmidt
Institute for Health and Human Development, University of East London, London,UK.
Patrick
P
Tobi
Institute for Health and Human Development, University of East London, London,UK.
Shahana
S
Lais
Institute for Health and Human Development, University of East London, London,UK.
Ge
G
Yu
Department of Psychology, University of Westminster, London, UK.
Rebecca
R
Lynch
London School of Hygiene and Tropical Medicine, London, UK.
Karen
K
Lock
Department of Human and Health Sciences, University of Westminster, London, UK.
Alizon
A
Draper
Institute for Research on Child Development, University of East London, London, UK.
Derek
D
Moore
Department of Psychology, University of Westminster, London, UK.
Angela
A
Clow
London School of Hygiene and Tropical Medicine, London, UK.
Mark
M
Petticrew
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
Richard
R
Hayes
Institute for Health and Human Development, University of East London, London,UK.
Adrian
A
Renton
D000328:Adult; D019058:Community Networks; D016001:Confidence Intervals; D005260:Female; D006293:Health Promotion / Q000458:organization & administration*; D006801:Humans; D008131:London; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015397:Program Evaluation; D040242:Risk Reduction Behavior; D011795:Surveys and Questionnaires; D014505:Urban Population
DEPRIVATION; DIET; EXERCISE; HEALTH PROMOTION; RANDOMISED TRIALS