Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial
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Date
2009-06-28
DOI
Open Access Location
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Publisher
BioMed Central
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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
Description
Keywords
Public health, Intervention, Deprivation, Health inequality, Community
Citation
Wall, M., Hayes, R., Moore, D., Petticrew, M., Clow, A., Schmidt, E., et al. (2009). Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial. Bmc Public Health, 9(207). doi: 10.1186/1471-2458-9-207