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 communityengagement
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 nonexperimental
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.