Abstract

BackgroundObesity, overweight and unemployment are interlinked, with debilitating effects on mortality, health, wellbeing and quality of life. Existing interventions to reduce overweight, obesity and unemployment have addressed these challenges independent of each other with limited success. The Adding to Social capital and individual Potential In disadvantaged REgions (ASPIRE) project will develop an innovative model using a combination of skills training and health and wellbeing interventions to improve health, wellbeing, quality of life and reduce overweight, obesity and unemployment in England and France. The aim of this paper is to outline the protocol for evaluating the ASPIRE project to examine the effectiveness of the intervention and clarify the mechanisms and contextual factors which interact to achieve outcomes.MethodsA mixed-method realist evaluation using a single-group before-and-after design will be used. The evaluation will consist of development of an initial programme theory, theory validation and refinement using quantitative and qualitative data to understand the causal mechanisms, contexts of implementation and their interactions that result in outcomes observed in ASPIRE. Primary outcomes that will be assessed are change in body weight and body mass index, reemployment and a rise on the ASPIRE participation ladder. The ASPIRE participation ladders consists of a series of 5 steps to engage participants in the project. The first step on the ladder is joining an ASPIRE hub with paid employment as the final step on the ladder. Secondary outcomes will be physical activity, diet quality, self-efficacy and health-related quality of life. Both quantitative and qualitative approaches are appropriate in this study because the use of validated questionnaires and objective measures will demonstrate how much the intervention addressed outcomes related to weight loss and reemployment and the qualitative data (photovoice) will provide insights into the contexts and experiences that are unique to participants in the project.DiscussionThe results from this evaluation will provide an understanding of how a model of health-related interventions which improve health, wellbeing and maintenance of a healthy lifestyle could reduce overweight, obesity and unemployment. The findings will enable the adaptation of this model for effective implementation in different contexts and circumstances.Trial registrationISRCTN registry: Study ID: ISRCTN17609001, 24th February 2021 (Retrospectively registered).

Highlights

  • Obesity, overweight and unemployment are interlinked, with debilitating effects on mortality, health, wellbeing and quality of life

  • Amenyah et al BMC Public Health (2021) 21:582 (Continued from previous page). The results from this evaluation will provide an understanding of how a model of health-related interventions which improve health, wellbeing and maintenance of a healthy lifestyle could reduce overweight, obesity and unemployment

  • This paper is the first to use a mixed-methods realist evaluation to investigate the effectiveness of a novel health-related model targeted at individuals who are unemployed or living with obesity or overweight

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Summary

Introduction

Overweight and unemployment are interlinked, with debilitating effects on mortality, health, wellbeing and quality of life. The Adding to Social capital and individual Potential In disadvantaged REgions (ASPIRE) project will develop an innovative model using a combination of skills training and health and wellbeing interventions to improve health, wellbeing, quality of life and reduce overweight, obesity and unemployment in England and France. Apart from being a health risk factor, obesity is strongly associated with unemployment, social disadvantages and reduced socioeconomic productivity [10] and poor individuals in Europe are 10–20% more likely to be obese compared to individuals in high income brackets [11,12,13]. Consistent with global trends, obesity across the France Channel English (FCE) area (south and east coasts of England and the north coast of France) is a significant concern In this region, high levels of obesity have been shown to coincide with high rates of unemployment. Higher consumption of fruit and vegetables was associated with higher income, and vice versa: 36% of all adults in the highest income quintile had consumed five or more portions of fruit and vegetables on the previous day compared with

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