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Table 2 Findings on inequalities in intervention effect by SES

From: Do multiple community-based interventions on health promotion tackle health inequalities?

Author, Year

Study Design and Country

Risk of Biasa

Intervention Type

Outcome Type

Findings

Abbema et al., 2004 [16]

Quasi-experimental, Netherlands (n of a deprived area: 323; control area I: 322; control area II: 342)

2

1) Social marketing (articles in local newspaper on speeding and safe playing)

2) Individual or group education (e.g. physical exercises, traffic lessons in schools)

3) Networking/partnership (e.g. discussion meetings, professional networking)

4) Environmental change (e.g. dog walking sites, fitting out children’s playground)

5) Regulatory interventions (speed control)

6) Sense of community (multicultural meetings, neighborhood parties)

Perceived health; health-related problems (stress, lack of area safety, parenting problems)

Few reduced inequalities, but even more negative effects (area level)

Bolton et al., 2017 [33]

Quasi-experimental, Australia (n of five areas of socio-economic disadvantage: 2408 children and adolescents, 501 adults; control group: 3163 children and adolescents, 318 adults)

1

1) Social marketing (e.g. newsletters,newspaper articles, project web pages, booklets)

3) Networking/partnership (e.g. partnership agreements, steering committees, school co-ordinator models)

4) Environmental change (e.g. healthy eating in schools, physical activity opportunities)

Anthropometry; health-related behaviors; quality of life

Few reduced inequalities (area level)

Buscail et al., 2016 [17]

Pre-post-test (no control group), France (n of adults in a low-income neighborhood: 199 and 217)

2

1) Social marketing (flyers and informative brochures on physical activity)

3) Networking/partnership (questioning residents on barriers)

4) Environmental change (offering and access to physical activity at community centers; pedestrian orientation paths)

Physical activity behavior (WHO guidelines)

Reduced inequalities (area level)

Cummins et al., 2005 [18]

Quasi-experimental, UK (n of men and women in a deprived community: 493 aged 16+; comparison group: 310)

3

1) Social marketing (advertisement)

4) Environmental change (provision of a new food supermarket)

Fruit and vegetable consumption; self-reported health; psychological health

No difference (area level)

Egan et al., 2016 [19]

Pre-post-test (no control group), UK (n of 14 differentially disadvantaged neighborhoods: 1006)

2

2) Individual or group education (anti-social behavior services/initiatives)

3) Networking/partnership (stakeholders’ consultation including residents)

4) Environmental change (complex housing improvements, demolition and new build)

Self-reported mental and physical health

Reduced inequalities by subgroups (lower income and higher investment groups respectively)

Gans et al., 2018 [29]

Cluster randomized controlled trial, USA (n in 8 intervention sites with low income: 837; 7 control sites: 760)

1

1) Social marketing (motivational campaigns, cooking demonstrations/taste-testing events)

2) Individual or group education (multi-component nutrition education)

4) Environmental change (discount prices, mobile fresh F&V markets)

F&V intake

Reduced inequalities (area level)

Gautam et al., 2014 [34]

Quasi-experimental, New Zealand (n in low-income area: 345; control area: 631)

3

1) Social marketing (biannual information campaign to retailers, wallet card, DVD)

5) Regulatory interventions (controlled purchase operations)

6) Sense of community (social artwork)

Parental and retail supply of tobacco to minors

No difference (area level)

Goodman et al., 2013 [20]

Secondary analysis of census data, UK (n of commuters in 18 intervention cities: 1,266,337; control group: 969,605)

2

2) Individual or group education (e.g. cycle training in schools and colleges)

4) Environmental change (e.g. cycle lanes, cycle parking stands at workplaces)

Cycling/walking to work

Reduced inequalities at area level, but smaller in the most of the deprived areas

Higgerson et al., 2018 [21]

Secondary analysis of two datasets, UK (n of a deprived area: 6160; control area: >  1,5 million for the rest of country)

2

1) Social marketing (considerable promotional activities to raise awareness)

2) Individual or group education (full time equivalent health trainers)

3) Networking/partnership (Healthy Communities Partnership)

4) Environmental change (free access to leisure facilities)

Gym and swim attendances; overall physical activity

Slightly reduced inequalities (area level), greater in the most disadvantaged subgroup

Jongeneel-Grimen et al., 2016 [22]

Quasi-experimental, Netherlands (n of the 40 most deprived districts: 1445; control area: 44,795 for the rest of country)

1

2) Individual or group education (e.g. broad-based primary school activities)

3) Networking/partnership (e.g. action plan tailored to specific local problems)

4) Environmental change (e.g. housing quality, public parks and gardens)

5) Regulatory interventions (e.g. debt assistance and tax reductions, traffic safety)

6) Sense of community (social neighborhood environment)

Mental health

No difference (area level)

Kelaher et al., 2010 [35]

Quasi-experimental, Australia (n of 5 deprived sites: 1479; control sites: 717)

2

2) Individual or group education (e.g. improved employment, learning)

3) Networking/partnership (e.g. action plan with local agencies and residents, Place Manager)

4) Environmental change (e.g. housing, physical environment, increased access to service)

6) Sense of community (increased community pride)

Self-reported health and life satisfaction

No difference at area level, but effective among people being involved in the intervention

Luten et al., 2016 [25]

Quasi-experimental, Netherlands (n of a disadvantaged community: 430 older adults; control group: 213)

2

1) Social marketing (e.g. posters, radio spots, advertorials and press reports, website)

2) Individual or group education (e.g. lifestyle meeting, physical activities for free)

3) Networking/partnership (e.g. promotion by professionals and peers)

4) Environmental change (e.g. healthy eating market, fruit for free)

Physical activity; healthy eating

No differences except for transport-related physical activity

Mohan et al., 2017 [23]

Secondary analysis of data from two panel surveys, UK (n of 36 deprived areas: 596; 3 control areas: 2726)

1

2) Individual or group education (e.g. employability and educational courses)

3) Networking/partnership (e.g. 3-years-action plan by local stakeholders and residents)

4) Environmental change (e.g. housing quality, land developed for green space)

5) Regulatory interventions (e.g. traffic calming schemes, security measures)

6) Sense of community (social neighborhood environment)

Self-rated mental and physical health; life satisfaction; smoking and exercise

No difference or only small trend towards a reduction in inequalities (area level)

O’Loughlin et al., 1999 [30]

Pre-post-test (no control group), Canada (n of a low-income, innercity neighborhood: 819)

3

1) Social marketing (e.g. nutrition campaign, menu-labeling in local restaurants, contests)

2) Individual or group education (e.g. smoking-cessation and nutrition workshops, screening for CVD risk)

Self-reports of smoking, high-fat food consumption, level of physical activity

No difference or only small increase in frequency of cholesterol checkups (area level)

Onion et al., 2019 [31]

Secondary analysis of data from 1971 to 2015, USA (n of one deprived rural area: ~ 22,400; other counties: ~ 994,500)

2

1) Social marketing (e.g. heart healthy menu campaign, brochures on fitness opportunities)

2) Individual or group education (e.g. education and coaching in schools and worksites)

3) Networking/partnership (e.g. lay and professional leadership, health coach collaboration)

4) Environmental change (e.g. new health and fitness center, access to school facilities)

5) Regulatory interventions (e.g. smoke-free recreation areas)

Smoking and mortality rates

Reduced inequalities (area level), but reverted after interventions’ withdrawal

Phillips et al., 2014 [24]

Cluster randomized, UK (n of 20 deprived neighborhoods: 2061 adults; 20 control neighborhoods: 2046)

1

2) Individual or group education (e.g. physical activity sessions, healthy cooking classes)

3) Networking/partnership (e.g. partnerships with local and city-wide organizations)

4) Environmental change (e.g. community gardens and redevelopment of greenspaces, availability of healthy food)

6) Sense of community (intercultural and intergenerational approaches)

Fruit and vegetable consumption; physical activity; mental well-being; social outcomes

No difference (area level)

Raine et al. 2010 [32]

Quasi-experimental, Canada (n of four socioeconomically diverse areas: 4761; control areas: 9775)

1

2) Individual or group education (e.g. leisure activities to encourage people to be active)

3) Networking/partnership (e.g. regular tele-conferences, team meetings)

4) Environmental change (e.g. walking and cycling trails, community gardens)

5) Regulatory interventions (e.g. food security initiatives)

6) Sense of community (promote social inclusion)

Self-perceived health; healthy diet; physical activity, anthropometric; social cohesion

No difference in health outcomes (area level)

Rivera et al., 2004 [38]

Randomized controlled trial, Mexico (n of 347 low-income communities: 578; crossover intervention group: 419)

1

2) Individual or group education (e.g. sessions on nutrition and health education)

4) Environmental change (e.g. food supplements, cash transfers for families associated with medical visits and school attendance)

Height increment and anemia rates in children

Reduced inequalities (area level)

Schulz et al., 2015 [36]

Cluster randomized, USA (n of a low-to-moderate income area: 695 Non-Hispanic Black and Hispanic residents; control group: not reported)

2

2) Individual or group education (training and support lay health promoters, walking group)

3) Networking/partnership (long-standing collaboration among community groups, health service providers, and researchers)

4) Environmental change (e.g. improvements to parks and greenways, safety environment)

Physical activity; CVD risk factors

Reduced inequalities (area level), no difference by SES

Stafford et al., 2014 [25]

Secondary analysis of nation-wide data, UK (n of 39 deprived areas: ~ 17,000; 3 control areas: ~ 3000)

1

2) Individual or group education (e.g. sport or exercise projects, drug/alcohol abuse, food projects, family learning)

3) Networking/partnership (e.g. community commitment, engaging partner agencies in six domains)

4) Environmental change (e.g. housing quality, green/open spaces, access to employment and health services)

5) Regulatory interventions (e.g. Police increase numbers & activity, street lightning, wardens)

6) Sense of community (e.g. sense of community projects)

Self-rated mental and physical health; smoking behavior; social determinants of health

Reduced inequalities in self-rated health and smoking (area level)

Verkleij et al., 2011 [26]

Quasi-experimental, Netherlands (n of intervention region with 50% low-income areas: 3000; reference region: 895)

1

1) Social marketing (e.g. stop-smoking campaign on local television/radio/newspaper, pamphlet distribution)

2) Individual or group education (e.g. computer-tailored nutrition education, supermarket tours)

3) Networking/partnership (e.g. local health committees, public-private collaboration)

4) Environmental change (e.g. food labeling, creating walking and bicycling clubs)

5) Regulatory interventions (e.g. smoke-free areas)

Quality of life (QoL)

No difference at area level, but decrease of mental QoL in subjects with moderate/high SES

White et al., 2016 [27]

Quasi-experimental, UK (n of 35 most deprived areas: 4197; 75 control areas: 6695)

3

2) Individual or group education (e.g. providing teaching assistants, computer skills training)

3) Networking/partnership (e.g. community multiagency partnership boards)

4) Environmental change (e.g. housing maintenance and redeveloping wasteland, installing street lightning, sports equipment)

6) Sense of community (e.g. building community facilities)

Mental health

Reduced inequalities in mental health (area level)

Zapata Moya, Navarro Yáñes, 2017 [28]

Quasi-experimental, Spain (residents of 59 deprived areas: 245,337; 59 control areas: 218,462)

1

4) Environmental change (e.g. re-built houses and buildings, public space, promoting access to health services)

6) Sense of community (e.g. community life facilities)

Preventable and less-preventable mortality

Reduced inequalities in preventable mortality, but not in less-preventable mortality

  1. a 1 = strong, 2 = moderate, 3 = weak study quality (global rating according to EPHPP [39])