Since 2007, IHHD has played a major role in the development, delivery and evaluation of Well Communities (formerly called Well London). This has been one of the most ambitious and radical attempts in the UK to develop a community development model that enhances the health and wellbeing of disadvantaged communities whilst delivering system change. It has been developed over two phases through work with 33 London neighbourhoods across 20 boroughs and is now in phase 3.Well Communities provides a framework for communities and local organisations to work together to improve health and wellbeing, build resilience and reduce inequalities. The framework is designed to be embedded as a mainstream approach – a ‘different way of working’ rather than a fixed term intervention.
The framework comprises four main suites of activities in Well Communities:
"This has been one of the most ambitious and radical attempts in the UK to develop a community development model"
- A comprehensive Community Engagement, needs Assessment and Design process (delivered through the CEAD project) that enables interventions to be developed around the needs and priorities identified by local residents.
- Core “Heart of the Community” projects that release capacity and build knowledge, skills and confidence. These comprise a team of local volunteers, young health leaders, DIY Happiness community mental wellbeing champions, and a range of individual and group training opportunities.
- Action on specific local needs and issues is taken forward through a portfolio of themed activities and projects determined by the needs and issues identified by each community through the CEAD process. These can include, cultural and arts activity, and projects to improve healthy eating, physical activity, mental health, and local environments.
- On-going community and service provider engagement in the development of the local programme and to influence local services to ensure they are more responsive to community perceived needs and priorities – stimulating system change from the bottom up.
Phase 1 (2007 to 2011) was supported by £9.46m from the Big Lottery Fund and delivered in 20 of the most deprived neighbourhoods across London by a multi-sectoral Well London Alliance. This partnership was hosted and coordinated by the Greater London Authority, the regional government for London.
Phase 2 (2012-2015) took place in 11 areas and focussed on testing replicability on a ‘natural neighbourhood’ basis. In two areas, the approach was scaled up to larger neighbourhoods. The approach was also piloted in the new settings of a housing association and primary care general practice. The programme was funded by two further grants from Big Lottery totalling £2.3M. The interventions were refined in line with the evidence and learning from phase 1. Key changes included moving the programme to a locally commissioned model, and having a dedicated part-time coordinator in each area.
The programme is now called Well Communities with a new logo and branding so that it can be rolled out beyond London. Phase 3 (2015 - ) will see the framework approach scaled up and embedded as part of mainstream services in some London boroughs and piloted in rural, semi urban and other urban areas in and beyond London. We also want to link the programme into primary and secondary care and look at how it can support people with long term conditions and multiple morbidities. Nationally, there is considerable interest in this asset based community development and co-production approach.
A unique feature in the development of the framework has been the parallel programme of comprehensive implementation support, to ensure the fidelity of, and learning about the model, together with robust research and evaluation of its effectiveness and cost effectiveness. The University of East London-led research has involved collaboration with a number of other research institutions including the London School of Hygiene and Tropical Medicine, Westminster University, and the Centre for Health Service Economics and Organisation at Oxford University. The phase 1 evaluation attracted significant additional research funding from the Wellcome Trust.
In 2011, the Well London programme won Health Promotion and Community Wellbeing award from the Royal Society for Public Health. The award recognised the programme’s achievements and innovative approach to promoting community health and wellbeing. Its approach was also endorsed by Professor Sir Michael Marmot, Director of UCL’s Institute of Health Equity.
More recently, Well London has been recognised as a ‘pioneer’ by the What Works Centre for Wellbeing as a model for community engagement approaches in health and wellbeing.
And Well London has been rated second out of 41 'best practice examples' across Europe by CHRODIS. The EU Joint Action on Chronic diseases (JA-CHRODIS) - in which NHS England is a partner - is a European collaboration that brings together over 70 associated and collaborating partners who work together to identify, validate, exchange and disseminate good practice on chronic diseases across EU Member States and to facilitate its uptake across local, regional and national borders. Sharing of good practice and looking into its potential transferability to other regions is a key aspect of the JA-CHRODIS work, and the Well Communities (formerly known as Well London) team from the Institute for Health & Human Development at the University of East London (UEL) welcomed 17 visitors from 11 countries across Europe to showcase their work in this area, across the life cycle. According to Joint Action criteria, the London-based project has been rated high in six areas:
- comprehensiveness of the intervention,
- equity of the approach,
- participation and empowerment,
- governance and project management,
- potential for scalability and transferability.
"The scale and complexity of the Well London programme mark it out as a nationally and internationally significant initiative applying a community development approach in neglected urban areas. It is generating learning and evidence not only to support its integration locally but also to inform wider policy and practice in a field of growing importance."
Aims and Objectives
There are two main aims
- To provide an effective framework for communities and local organisations to work together to improve health and wellbeing, build resilience and reduce inequalities.
- To develop the evidence base for a community development approach to health and wellbeing that will influence policy and practice to secure real enhancements to wellbeing and reductions in health inequalities in the most disadvantaged communities.
- To develop a locally focussed, integrated, community-led approach that improves community health and well-being and is effective and sustainable in even the most deprived neighbourhoods.
- To engage and empower people to build and strengthen the foundations of good health and well-being in their communities by:
- Significantly increasing community participation in health and well-being enhancing activities
- Building individual and community confidence, cohesion, sense of control and self esteem
- Stimulating development of formal and informal community and social support networks
- Integrating with and adding value to what is already going on locally
- Identifying, designing and taking action on community-identified health related needs and issues
- Building capacity of the community and local organisations to deliver activities and making strategic links locally and regionally so the improvement in health and well-being is sustainable for the longer term
Outcomes and Impact
The overall findings indicate that the programme generates a high level of interest and participation and that participants experience a wide range of benefits. In both Phases 1 and 2 levels of participation and the targets agreed with Big Lottery for healthy eating, physical activity, mental wellbeing, social connectedness and volunteering were exceeded.
In phase 2 the degree of change in these participants translated into a net significantly positive change in the whole group on some measures of physical activity (total MET minutes of doing physical activities per week), healthy eating (total quantity of fruit and vegetable in yesterday’s diet) and mental wellbeing (hope scale score).
- Physical activity: 82% of participants did more physical activity at follow-up (based on total MET minutes per week) compared to their baseline. The difference was significant. 54% did less sitting (a measure of sedentary behaviour).
- Healthy eating: 54% were eating more healthily of whom 19% met the government ‘5 fruits or vegetables a day’ target. Fifty one percent were eating less unhealthily.
- Mental wellbeing: 54% reported improved mental wellbeing on the Warwick Edinburgh Mental Wellbeing Scale (WEMWBS). The proportion was higher when based on the other MWB measures, i.e. the Adult Hope scale and General Health Questionnaire 12 item (GHQ 12) scale. With the Adult Hope scale (and its two subscales – Pathway and Agency), the level of change was statistically significant.
- Social connectedness: The mean positive change across all the scale items was 31%.
- Volunteering: 60% participants reported doing more volunteering at follow-up compared to baseline.
Other positive outcomes and impacts illustrated through interviews, case studies and in the qualitative evidence included
- Numbers accessing training and qualifications
- People progressing to paid employment
- Increased community networks and connections
- Increased capacity of local community & voluntary organisations
- Improved relationships and integrated working between local statutory and community & voluntary organisations
- Transformed community spaces
- Additional resources levered into deprived neighbourhoods
Well Communities builds the capacity of local voluntary and community organisations so they can better meet the needs of local people. Organisations are encouraged to work in new or more integrated ways and play a key role in delivering Well Communities. This includes coordinating local programmes, and recruiting and managing volunteers and young apprentices.
The programme takes place at the grass-roots of the community and uses community development and co-production to ensure that new activities build on existing assets, and that local communities are involved in decision making at each stage of development and delivery. It develops the skills, knowledge and networks that enable programme benefits to be sustained beyond the funding period. A variety of opportunities are provided for people to develop their ideas into projects or help their local community.
Reports and Publications
A selected list of publications and reports mostly generated from Well Communities phases 1 and 2
- Findlay G, Tobi P (2017). Well Communities. Perspectives in Public Health; 137(1):17-20. http://journals.sagepub.com/doi/pdf/10.1177/1757913916680329
- Wittenberg R, Findlay G, Tobi P (2017). Costs of the Well London programme. PSSRU Unit Costs of Health and Social Care 2016; 12-16. Personal Social Services Research Unit, University of Kent. http://www.pssru.ac.uk/project-pages/unit-costs/2016/index.php
- Frostick, C., Watts, P., Netuveli, G., Renton, A., Moore, D. (2016). Well London Phase-1: Results among adolescents of a cluster-randomised trial of a community engagement approach to improving health behaviours and mental well-being in deprived inner-city neighbourhoods. Journal of Community Practice
- Tobi P, Findlay G, Renton A. (2016) Wellcome Trust End of Grant Report. A randomised cluster controlled trial of community level interventions to address social and structural determinants of physical activity, diet and mental wellbeing (Grant number 083679/Z/07/Z). IHHD, London.
- Frostick, C., Phillips, G., Renton, A., Moore D. The Educational and Employment Aspirations of Adolescents from Areas of High Deprivation in London. J Youth Adolescence (2016) 45: 1126. doi:10.1007/s10964-015-0347-4
- Tobi P, Tong J, Farr R, Dan-Ogosi I, Mbema C, Netuveli G, Findlay G. (2015) Well London Phase 2 evaluation: participant outcomes. Institute for Health and Human Development, London.
- Watts P., Buck D., Netuveli G., Renton A. (2015) Clustering of lifestyle risk behaviours among residents of forty deprived neighbourhoods in London: lessons for targeting public health interventions. Journal of Public Health, Vol. 38, No. 2, pp. 308–315. doi:10.1093/pubmed/fdv028. PDF
- Derges J, Clow A, Lynch R, Jain S, Phillips G, Petticrew M, Renton A, Draper A. (2014) ‘Well London’ and the benefits of participation: results of a qualitative study nested in a cluster randomised trial. BMJ Open 2014;4:e003596. doi:10.1136/bmjopen-2013-003596 http://bmjopen.bmj.com/content/4/4/e003596.full.pdf+html
- Phillips G, Bottomley C, Schmidt E, Tobi P, Lais S, Yu G, Lynch R, Lock K, Draper A, Moore D, Clow A, Petticrew M, Hayes R, Renton A. (2014) 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. J Epid Comm Health 2014. DOI: 10.1136/jech-2013-202505. http://jech.bmj.com/content/early/2014/01/30/jech-2013-202505.full.pdf+html
- Phillips G, Bottomley C, Schmidt E, Tobi P, Lais S, Yu G, Lynch R, Lock K, Draper A, Moore D, Clow A, Petticrew M, Hayes R, Renton A. (2014) Measures of exposure to the Well London Phase-1 intervention and their association with health, wellbeing and social outcomes. J Epid Comm Health 2014. DOI: 10.1136/jech-2013-202507. http://jech.bmj.com/content/early/2014/02/10/jech-2013-202507.full.pdf+html
- Bertotti M, Watts P, Netuveli G, Yu G, Schmidt E, Tobi P, Lais S, Renton A. (2013) Types of Social Capital and Mental Disorder in Deprived Urban Areas: A Multilevel Study of 40 Disadvantaged London Neighbourhoods. PLoS ONE 2013 8(12): e80127. http://www.plosone.org/article/info:doi/10.1371/journal.pone.0080127
- Watts P, Phillips G, Petticrew M, Hayes R, Bottomley C, Yu G, Schmidt E, Tobi P, Moore D, Frostick C, Lock Karen, Renton A. (2013) Physical Activity in Deprived Communities in London: Examining Individual and Neighbourhood-Level Factors. PLoS ONE 2013 8(7): e69472 http://www.plosone.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pone.0069472&representation=PDF
- Bertotti M, Adams-Eaton F, Sheridan K and Renton A. (2012) Key barriers to community cohesion: views from residents of 20 London deprived neighbourhoods. GeoJournal 77(2): 223-234 http://link.springer.com/article/10.1007/s10708-009-9326-1
- Phillips G, Hayes R, Bottomley C, Petticrew M, Watts P, Lock K, Clow A, Draper A, Moore D, Schmidt E, Tobi P, Lais S, Yu G, Barrow-Guevara G, Renton A. (2012) OP06 Well London: Results of a Cluster-Randomised Trial of a Community Development Approach to Improving Health Behaviours and Mental Wellbeing in Deprived Inner-City Neighbourhoods. J Epidemiol Community Health 2012;66:A3 doi:10.1136/jech-2012-201753.006
- Phillips G, Petticrew M, Draper A, Derges J, South J, Adams-Eaton F, Sheridan K, Renton A (2012) What is complexity and what do you do with it? Reflections on use of controlled trials to assess complex public health interventions. On behalf of the Well London Trial Investigators Group. The Lancet, Volume 380, Special Issue, S65, 23 November 2012. DOI: http://dx.doi.org/10.1016/S0140-6736(13)60421-3
- Phillips G, Renton A, Moore DG, Bottomley C, Schmidt E, Lais S, Yu G, Wall M, Tobi P, Frostick C, Clow A, Lock K, Petticrew M, Hayes R. (2012) The Well London Programme - a Cluster Randomised Trial of Community Engagement for Improving Health Behaviours and Mental Wellbeing: Baseline Survey Results. Trials13:105 http://www.ncbi.nlm.nih.gov/pubmed/22769971
- Renton A, Phillips G, Daykin N, Taylor K, Petticrew M (2012) Think of your art-eries: arts participation, behavioural cardiovascular risk factors and mental well-being in deprived communities in London. Public Health (RSPH) 126(Suppl 1):S57-64. http://www.ncbi.nlm.nih.gov/pubmed/22766259
- Sheridan, K (2012) Well London Appreciative Inquiry and Community Café Reports for 9 LSOAs. The results from the Community Engagement Process for Well London Phase 2, BIG Lottery Funded Programme. IHHD, London
- Sheridan, K, Adams-Eaton, F, Trimble, A., Renton, A., Bertotti, M (2011) Community Engagement using World Café: The Well London Experience Groupwork and Wellbeing, 20(3): 32-50
- Yu, G, Schmidt E, Watts P, Bertotti M (2011) A multilevel analysis of the effect of bonding social capital on leisure time physical activity: evidence from 40 disadvantaged areas in London, Health and Place 17(5): 1023-1029 http://www.sciencedirect.com/science/article/pii/S1353829211001183
- Wall M, Hayes R, Moore D, Petticrew M, Clow A, Schmidt E, Draper A, Lock K, Lynch R, Renton AM (2009) Evaluation of community level interventions to address social and structural determinants of health: a cluster randomised controlled trial. BMC Public Health 9: 207. http://www.biomedcentral.com/content/pdf/1471-2458-9-207.pdf
- Sheridan, K., Adams-Eaton, F., Bertotti, M. (2008) Well London Appreciative Inquiry and Community Café Reports for 20 LSOAs. The results from the Community Engagement Process for Well London, BIG Lottery Funded Programme. IHHD, London
Documentary evidence of the effectiveness of the approach and its very positive impact, to date, in Phase 2 is captured in a short film that can be viewed on Vimeo.
This short animation also describes the approach.
How Well London is helping deprived communities to better health (on Well London) The Guardian May 2012
Professor Gail Findlay, Director of Health Improvement
Project Team: Alison Pearce (on secondment), Kevin Sheridan, Patrick Tobi, Jin Tong, Ruby Farr
Funders: Big Lottery Fund, Wellcome Trust, Various NHS Trusts, CCGs, and Local Authorities
Evaluation Reports: Links to all the evaluation reports for phases 1 and 2 of Well London can presently be found at http://www.welllondon.org.uk/1145/research-evaluation.html
For more information, contact: Gail Findlay FFPH, Director of Health Improvement, email@example.com