Abstract
BackgroundThe Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London. The effectiveness of Well London is being evaluated in a pair-matched cluster randomized trial (CRT). The baseline survey data are reported here.MethodsThe CRT involved 20 matched pairs of intervention and control communities (defined as UK census lower super output areas (LSOAs); ranked in the 11% most deprived LSOAs in London by the English Indices of Multiple Deprivation) across 20 London boroughs. The primary trial outcomes, sociodemographic information, and environmental neighbourhood characteristics were assessed in three quantitative components within the Well London CRT at baseline: a cross-sectional, interviewer-administered adult household survey; a self-completed, school-based adolescent questionnaire; a fieldworker completed neighborhood environmental audit. Baseline data collection occurred in 2008. Physical activity, healthy eating, and mental wellbeing were assessed using standardized, validated questionnaire tools. Multiple imputation was used to account for missing data in the outcomes and other variables in the adult and adolescent surveys.ResultsThere were 4,107 adults and 1,214 adolescent respondents in the baseline surveys. The intervention and control areas were broadly comparable with respect to the primary outcomes and key sociodemographic characteristics. The environmental characteristics of the intervention and control neighborhoods were broadly similar. There was greater between-cluster variation in the primary outcomes in the adult population compared to the adolescent population. Levels of healthy eating, smoking, and self-reported anxiety/depression were similar in the Well London adult population and the national Health Survey for England. Levels of physical activity were higher in the Well London adult population but this is likely to be due to the different measurement tools used in the two surveys.ConclusionsRandomization of social interventions such as Well London is acceptable and feasible and in this study the intervention and control arms are well-balanced with respect to the primary outcomes and key sociodemographic characteristics. The matched design has improved the statistical efficiency of the study amongst adults but less so amongst adolescents. Follow-up data collection will be completed 2012.Trial registrationCurrent Controlled Trials ISRCTN68175121
Highlights
The Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London
Public health policies have repeatedly emphasized the need for preventive interventions that focus on increasing healthy eating and physical activity to reduce chronic disease incidence [9,10]
The United Kingdom (UK) Foresight report on mental capital and wellbeing reported the annual costs of mental ill-health and reduced mental wellbeing in England to be approximately £77 billion, with more than half this cost being due to lost economic productivity [1]
Summary
The Well London program used community engagement, complemented by changes to the physical and social neighborhood environment, to improve physical activity levels, healthy eating, and mental wellbeing in the most deprived communities in London. Public health policies have repeatedly emphasized the need for preventive interventions that focus on increasing healthy eating and physical activity to reduce chronic disease incidence [9,10]. The complex interaction of individual, social, and environmental determinants of health behaviors is well-recognized [3,11,12,13,14,15,16,17,18,19,20,21], but few public health interventions that combine modification of the social and built environment with individual-level health promotion activities have been evaluated in the UK context [22]. Interventions that can address wellbeing in a holistic manner, seeking to improve mental health and wellbeing in addition to health behaviors, may have greater success in increasing physical activity and healthy eating
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