Preliminary evaluation of a novel community-based programme to promote Intentional Health

Leeanne Nicholls1, Niky Dix2 and Ian Frampton1

  1. College of Life and Environmental Sciences, University of Exeter, UK
  2. Exhale Foundation CIO, Cornwall, UK.

Introduction

Improving people’s health and wellbeing can have a significant impact on their quality of life. There is a growing need for self-management support and health promotion. Obesity is the outcome of a complex set of factors arising across many areas of our lives. Therefore there is a needed ‘whole system approach’, with multiple actions across all parts of the system. The UK National Institute for Health and Care Excellence (NICE) has produced guidance on the use of community engagement for delivering health preventive interventions.

Interventions to change health related behaviours are usually complex, comprising many, often interacting components (Craig et al., 2008). Importantly, intention to change has been identified as a major predictor and mediator of outcome of positive health interventions. Sheldon and Kasser (1998) have shown that well-being increases are most likely when a person chooses and attains self-concordant goals, that is, goals that “fit” the person. Performing intentional activities as a group or with the support of others is likely to promote greater and more sustained happiness change than “bowling alone” (Putnam, 2000).

The aim of the present study is therefore a preliminary evaluation of the Intentional Health (IH) Programme and its impact on improving participants’ health and wellbeing.

Method

Participants

Forty participants in pilot IH programmes were invited to give informed consent for their routinely collected data to be included in the evaluation.

Intervention

IH is an integrated toolkit to facilitate learning and preventative health and wellbeing in a supportive and non-judgmental way. Its ten-session programme is supported by a comprehensive member’s handbook, short video animations, small group discussion and activities. It includes elements of nutrition, diet, exercise and specific topics such as creating healthy habits, getting enough rest, looking at boundaries, communication and dealing with conflict, acknowledging that healthy choices impact a whole complex individual and helping that person to feel valued in themselves before there would be any lasting change. It places value on a combination of physical, mental and emotional aspects.

Measures

Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWEBS).

Big Lottery Core Outcome Questionnaires

Physical Health Parameters – Resting heart rate, Body Mass Index (BMI), weight (kg)

Results

Participation in the IH Programme is associated with a statistically significant increase in Mental Wellbeing, as measured by the SWEMWEBS, see Figure 1. Before participating, group mean scores on this measure were in the Below Average range (between the bottom 61% and 80% of responses nationally); after participation, group mean scores had risen to the Average range (between the 41% and 60% of responses nationally).

Fig 1 - Pre and Post data chart

Figure 1

Figure 1: Group mean scores on the SWEMWEBS, pre and post intervention (n =33).

For the Big Lottery Outcome Questionnaires, statistically significant improvements were observed in the following domains:

  • Healthy eating – intentionality and confidence
  • Personal wellbeing – resilience & optimism
  • Personal wellbeing – competence and autonomy
  • Mental wellbeing – stress

There were no significant changes in the following domains:

  • Physical activity – intentionality, self efficacy and autonomy
  • Social wellbeing
  • Physical Health Parameters (pulse rate, BMI, weight)

Discussion

Preliminary evaluation of the IH Programme suggests that participation is associated with statistically significant increases in subjective wellbeing. This improvement is clinically meaningful at the group level, with average scores moving from the Below Average to Average range. This overall change is reflected in some domains of the Big Lottery Outcome Questionnaire, including Healthy Eating, Personal and Mental Wellbeing. However, there were no significant changes in Physical Activity, Social Wellbeing or Physical Health Parameters.

Intentionality was identified in relation to Healthy Eating, but not in relation to Physical Activity. This suggests that the construct may be domain specific, rather than reflecting a fundamental underlying motivator for change. Further studies with future cohorts of IH will help to clarify how sharing scores with participants influences individual and group outcomes for this promising intervention.

7th July 2016