The Oxford Health Alliance The Oxford Health Alliance Community Interventions for Health: Methodology Confronting the Epidemic of Chronic Disease

The Oxford Health Alliance Community Interventions for Health (CIH) CIH is the largest and most comprehensive multinational collaborative study for community interventions ever undertaken The long-term goal of the CIH study is to create sustainable interventions that prevent and control the leading chronic diseases by addressing the three main risk factors CIH aims to develop, evaluate and showcase sustainable interventions in addressing tobacco use, unhealthy diet and physical inactivity in communities

The Oxford Health Alliance Study design CIH took place in 3 communities in Hangzhou City in China, Kerala in India and Mexico City Non-randomised, controlled study using population approach Two panel, cross-sectional study with assessment at baseline and after months of intervention Intervention and comparison sites selected with similar population size, socio-demographic profile and with geographical separation

The Oxford Health Alliance Methods Each country identified an intervention and control area with similar socio-economic status Baseline data about tobacco use, diet and physical activity were collected from a sub-sample in each area using lifestyle questionnaires Biometric data were collected from a stratified sub-sample Environmental scans were conducted to assess the effect of the local environment on health Interventions were delivered in four main settings: schools, workplaces, neighbourhoods and health centres Interventions lasted 2 years, and follow-up data were collected post-intervention

The Oxford Health Alliance Organisation of CIH CIH management board International National Local China IndiaMexicoUK NeighborhoodsHealth Centers Workplaces Schools NeighborhoodsHealth Centers Workplaces Schools NeighborhoodsHealth Centers Workplaces Schools NeighborhoodsHealth Centers Workplaces Schools

The Oxford Health Alliance Process system for CIH Knowledge, attitudes and behaviors for healthy eating, physical activity and tobacco use Inputs for change Locus of change Assessment of change Health education Social marketing Community mobilization Structural change Strategies for change IndividualFamilyCommunitySociety Questionnaires Environmental scan Policy reviews

The Oxford Health Alliance Evaluation Surveys of adult community sample, workplaces and schools Biometric data Process evaluation Environmental scan

The Oxford Health Alliance Evaluation: Survey type Adult community Adult workplace Health care workers School survey (ages 12-16)

The Oxford Health Alliance Evaluation: Survey process Translation and back-translation Cultural adaptation Piloting and feedback based on samples of 200 Adult community sample - randomized selection of households and then KISH method within households to select participant Adult community surveys administered by trained paraprofessionals/professionals All other surveys were self-administered on-site at schools and workplaces

The Oxford Health Alliance Evaluation: research study sample Survey sample per country site NeighbourhoodSchool children Workplaces (including industry, health centres, and schools) Health care providers (doctors and nurses) TOTAL Intervention site1,0002,0002,700 (1,000, 1000, 700) 4006,100 Control site1,0002,0002,700 (1,000, 1000, 700) 4006,100 SAMPLE AGGREGATE 2,0004,0005, ,200

The Oxford Health Alliance Biometric measurements Collected from all participants: Height Weight Waist circumference Hip circumference Heart rate Skin-fold thickness Blood pressure Collected from a sub- sample: Fasting glucose Random glucose Total cholesterol HDL LDL Triglycerides

The Oxford Health Alliance Process evaluation Process evaluation examines the internal workings of the program and includes questions such as: What is delivered in reality? Where are the gaps between design and delivery? Examining factors such as: Who: the program recipients and staff What: activities, behaviours materials When: frequency and length of intervention Where: community context and physical setting How: strategies for operating the intervention

The Oxford Health Alliance Process measures used in CIH Structural Interventions  The number and types of structural change implemented in environment and policies Health Education  The number of and level of attendance at health education programs across workplaces, schools and neighborhoods  The number of and level of attendance at health professional training for adopting standardization of risk factor assessment and advice Community Coalition Building  Strength of community coalition  Community readiness to change  Key stakeholder engagement including number of collaborative meetings and calls, involvement of specific types of partners, and tasks needed to achieve buy-in, ensure follow-through and maintain partnership for successful data collection and intervention delivery Media  The types, distribution coverage, and placement of social marketing media

The Oxford Health Alliance Environmental scanning 400m (0.25m) Information Streets Stores and kiosks Cigarette vending Street vending Restaurants and food services Parks and gardens Recreational facilities School

The Oxford Health Alliance Community Health Environment Scan (CHESS) using GIS Wong et al, Glob Health Action 2011;7:

The Oxford Health Alliance GIS mapping – an example Mapping of supermarkets in a town in the UK

Evaluation Analyses - Summary 1.Comparing intervention vs control communities 2. Pre and post assessment of individual behaviour change: – Surveys for prevalence of risk factors – Site-specific surveys allowing integration of relevant issues in each site – Physical and biological measurement 3. Community changes in environment and policy – Document review – Environmental scans – Key informant interviews – GIS mapping and environmental scans