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OBJECTIVES: The UK government's response to the obesity epidemic calls for action in communities to improve people's health behaviour. This study evaluated the effects of a community intervention on dietary quality and levels of physical activity of women from disadvantaged backgrounds. DESIGN: Non-randomised controlled evaluation of a complex public health intervention. PARTICIPANTS: 527 women attending Sure Start Children's Centres (SSCC) in Southampton (intervention) and 495 women attending SSCCs in Gosport and Havant (control). INTERVENTION: Training SSCC staff in behaviour change skills that would empower women to change their health behaviours. OUTCOMES: Main outcomes dietary quality and physical activity. Intermediate outcomes self-efficacy and sense of control. RESULTS: 1-year post-training, intervention staff used skills to support behaviour change significantly more than control staff. There were statistically significant reductions of 0.1 SD in the dietary quality of all women between baseline and follow-up and reductions in self-efficacy and sense of control. The decline in self-efficacy and control was significantly smaller in women in the intervention group than in women in the control group (adjusted differences in self-efficacy and control, respectively, 0.26 (95% CI 0.001 to 0.50) and 0.35 (0.05 to 0.65)). A lower decline in control was associated with higher levels of exposure in women in the intervention group. There was a statistically significant improvement in physical activity in the intervention group, with 22.9% of women reporting the highest level of physical activity compared with 12.4% at baseline, and a smaller improvement in the control group. The difference in change in physical activity level between the groups was not statistically significant (adjusted difference 1.02 (0.74 to 1.41)). CONCLUSIONS: While the intervention did not improve women's diets and physical activity levels, it had a protective effect on intermediate factors-control and self-efficacy-suggesting that a more prolonged exposure to the intervention might improve health behaviour. Further evaluation in a more controlled setting is justified.

Original publication




Journal article


Bmj open

Publication Date





behavour change, complex public health intervention, diet, physical activity, self efficacy, sense of control, Adult, Controlled Before-After Studies, Diet, Female, Health Behavior, Health Promotion, Humans, Motor Activity, Public Health, Self Efficacy, Self-Control