Well London is a multi-component community engagement programme designed to improve the health of Londoners living in socio-economically deprived areas. To evaluate outcomes of the Well London interventions, a cluster randomized controlled trial (CRCT) was conducted that included a qualitative component. The aim was to explore in depth the nature of the project benefits to residents and processes by which these were achieved.
The longitudinal qualitative study was nested within the CRCT. Purposive sampling was used to select three intervention areas and 61 individuals within these areas. Interviews were conducted at inception and following completion of the Well London interventions. Transcripts of the interviews were coded and analysed using Nvivo.
Positive benefits relating to the formal outcomes of the CRCT were reported, but only among those who participated in project activities. The extent of benefits reported was influenced by factors relating to the physical and social characteristics of each area. The highest levels of change occurred in the presence of: a) social cohesion, pre-existing but also as facilitated by Well London activities; b) personal and collective agency; c) involvement and support of external organisations. Where the physical and social environment remained unchanged, there was less participation and fewer benefits reported.
These findings show interaction between participation, well-being and agency, social interactions and cohesion, and that this modulated if and what benefits respondents reported. Pathways to change were thus complex and variable, but both personal well-being and local social cohesion emerged as important mediators of change.