The province of Groningen (Netherlands) is facing large health disparities and a rapidly aging population. The province’s relatively large subpopulation with a low socio-economic status (SES) often has an unhealthy lifestyle. This causes chronic health problems, often with onset from the age of 40 on. In addition to a higher rate of personal health problems, social participation and informal care exchange are lower in low SES neighborhoods. To improve positive health in middle-aged and older low SES individuals, community-based interventions are needed that will not only affect individual inhabitants but the entire livability of these neighborhoods.
The proposed project focuses explicitly on three core aspects of positive health, namely physical vitality, resilience, and social vitality. The community-based “Community Wise” intervention, which will be developed and tested in this project, addresses all three aspects. Community Wise is partly based on the existing evidence-based DELFGOUD and GRIP&GLEAM (G&G) interventions. The proposed project will be carried out in several areas including low SES neighborhoods in the city of Groningen, low SES villages belonging to the municipality of Delfzijl in the North East, and the low SES area of the Peat colonies which covers 13 municipalities in the South East of the province of Groningen. In these areas Community Wise meets the needs of inhabitants, professionals and municipalities.
The aim of the proposed study is to determine the effect and the impact of the Community Wise intervention. To do so, we will compare a group receiving the Community Wise intervention to a waiting list control group on the primary outcome of positive health. The latter consists of physical vitality (fitness and muscle strength), resilience and social vitality (loneliness and social cohesion). Secondary outcomes to be evaluated are body mass index, nutrition, daily functioning, connectedness, well-being, and intervention ownership. The primary target group consists of low SES people 40 years of age and older, having low levels of resilience, low physical activity, and/or low social vitality. The secondary target group consists of participating neighborhood inhabitants who do have healthy levels of resilience or physical and/or social vitality.
The study design is a pretest–posttest experimental controlled intervention. Two streets or communities in the target neighborhoods will be approached simultaneously, respecting natural borders (usually certain streets). After the baseline assessment, one community will be randomly assigned to the intervention group the other to the waiting list control group. Post-intervention assessments will take place directly after intervention delivery has been completed and again after 6 and 12 months. We aim to include 200 participants at baseline in order to yield 154 completers.
Based on the DELFGOUD recruitment method, a proactive integrated approach will be used in which inhabitants as well as formal and informal networks participate. Community Wise will be a jointly developed network intervention with three parts: 1) “Get going” [Aan de slag], based on DELFGOUD and focusing on physical vitality; 2) “At the Wheel” [Aan het stuur], based on the G&G interventions and focusing on resilience; and 3) The “Street project” will be an entirely bottom-up intervention component designed to stimulate social vitality. The aim of the Street project is to stimulate participants to investigate the positive health preferences of inhabitants and together plan how to realize prioritized community positive health preferences. Ownership skills will be taught throughout Community Wise. This will enable participants to facilitate the maintenance of activities, keep participants involved, and incorporate new participants. In this way the community will take over ownership of the project and become independent of the project initiators, which is the ultimate goal.
Summary in Dutch
De provincie Groningen kenmerkt zich door grote gezondheidsachterstanden en een vergrijzende populatie. De relatief grote groep met een lage sociaal-economische status (SES) heeft vaak een ongezonde leefstijl, waardoor al vanaf 40-jarige leeftijd chronische aandoeningen optreden. Bovendien zijn er veel buurten met weinig sociale participatie en mantelzorg. Om de positieve gezondheid in deze buurten te bevorderen wordt de integrale buurtaanpak “Community Wise” ontwikkeld en getest. Community Wise is een buurtnetwerk-interventie voor 40+ers in zgn. krachtwijken. De interventie is deels gebaseerd op de bestaande effectieve DELFGOUD en GRIP&GLANS interventies. Community Wise is gericht op drie centrale componenten van positieve gezondheid, namelijk fysieke vitaliteit, veerkracht en sociale vitaliteit, en heeft als basis de behoeften van bewoners, professionals en gemeenten. Community Wise wordt uitgevoerd in krachtwijken in de stad Groningen, rondom Delfzijl, en in de Veenkoloniën.