Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial.

Journal article


Wall, M, Hayes, R, Moore, D, Petticrew, M, Clow, A, Schmidt, E, Draper, A, Lock, K, Lynch, R and Renton, A (2009). Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial. BMC Public Health. 9 (1), p. 207.
AuthorsWall, M, Hayes, R, Moore, D, Petticrew, M, Clow, A, Schmidt, E, Draper, A, Lock, K, Lynch, R and Renton, A
Abstract

BACKGROUND: In London and the rest of the UK, diseases associated with poor diet, inadequate physical activity and mental illness account for a large proportion of area based health inequality. There is a lack of evidence on interventions promoting healthier behaviours especially in marginalised populations, at a structural or ecological level and utilising a community development approach.The Well London project financed by the Big Lottery 'Wellbeing' Fund and implemented by a consortium of London based agencies led by the Greater London Authority and the London Health Commission is implementing a set of complex interventions across 20 deprived areas of London. The interventions focus on healthy eating, healthy physical activity and mental health and wellbeing and are designed and executed with community participation complementing existing facilities and services. METHODS/DESIGN: The programme will be evaluated through a cluster randomised controlled trial. Forty areas across London were chosen based on deprivation scores. Areas were characterised by high proportion of Black and Minority Ethnic residents, worklessness, ill-health and poor physical environments. Twenty areas were randomly assigned to the intervention arm of Well London project and twenty 'matched' areas assigned as controls. Measures of physical activity, diet and mental health are collected at start and end of the project and compared to assess impact.The quantitative element will be complemented by a longitudinal qualitative study elucidating pathways of influence between intervention activities and health outcomes. A related element of the study investigates the health-related aspects of the structural and ecological characteristics of the project areas. The project 'process' will also be evaluated. DISCUSSION: The size of the project and the fact that the interventions are 'complex' in the sense that firstly, there are a number of interacting components with a wide range of groups and organisational levels targeted by the intervention, and secondly, a degree of flexibility or tailoring of the intervention, makes this trial potentially very useful in providing evidence of the types of activities that can be used to address chronic health problems in communities suffering from multiple deprivation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN68175121.

KeywordsHumans; Health Surveys; Health Status Indicators; Cluster Analysis; Data Interpretation, Statistical; Longitudinal Studies; Attitude to Health; Socioeconomic Factors; Adolescent; Adult; Ethnic Groups; Health Promotion; Community Health Services; Health Services Research; London; Adolescent; Adult; Attitude to Health; Cluster Analysis; Community Health Services; Data Interpretation, Statistical; Ethnic Groups; Health Promotion; Health Services Research; Health Status Indicators; Health Surveys; Humans; London; Longitudinal Studies; Socioeconomic Factors; 1117 Public Health And Health Services; Public Health
Year2009
JournalBMC Public Health
Journal citation9 (1), p. 207
PublisherLondon South Bank University
ISSN1471-2458
Digital Object Identifier (DOI)doi:10.1186/1471-2458-9-207
Publication dates
Print28 Jun 2009
Publication process dates
Deposited26 Feb 2018
Accepted28 Jun 2009
Accepted author manuscript
License
CC BY 4.0
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https://openresearch.lsbu.ac.uk/item/87q4z

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