A systematic review of the effectiveness of whole‐of‐community interventions by socioeconomic position

Abstract

Whole-of-community (WOC) interventions have led to modest reductions in population weight gain. Whether they exhibit differential effectiveness by socioeconomic position (SEP) remains unknown. We aimed to summarize evidence of differential effectiveness of WOC interventions by SEP. Electronic databases and grey literature were searched to identify studies that evaluated the effectiveness of a WOC intervention on behavioural change measures, energy balance behaviours and/or anthropometric outcomes according to any measure of SEP. Interventions were assessed for the following characteristics: structural changes to the environment, number of settings the intervention acted in, presence of community engagement and whether equity was considered in its design. Ten studies were included. Nine reported a greater or equal effect among low SEP groups compared with high SEP groups. These studies commonly featured interventions that incorporated structural changes to the environment, acted across more than three settings and/or employed community engagement. Conclusions did not change when excluding low-quality studies (n = 4). WOC interventions represent an effective and equitable approach for the reduction of population weight. Structural components, a larger number of settings and community engagement were common in equitable WOC interventions and should be considered in the design of future WOC interventions.

Efficacy of population‐wide diabetes and obesity prevention programs: An overview of systematic reviews on proximal, intermediate, and distal outcomes and a meta‐analysis of impact on BMI

“…Nine reviews evaluated evidence regarding multicomponent community‐based or “whole of community” interventions . These interventions combined multiple elements to encourage healthy diet and increased physical activity across the entire population living within a geographically defined area, such as a city, village, or region.…”

“…Of the nine reviews, three evaluated outcomes solely in terms of increases in physical activity, one in terms of increasing walking, and the remaining five weight‐related measures. One review incorporated a meta‐analysis but noted a high degree of heterogeneity between studies, two undertook quantitative synthesis, and the remainder were narrative syntheses. Reviews incorporated 83 primary studies, many with multiple publications, including 34 with pre‐post design and comparison group, 24 cluster RCTs, eight repeat cross‐sectional studies, and the remainder employing a variety of study designs.…”

“…Of the four good‐quality reviews that reported effect on physical activity, the three most recent reviews did not find a positive effect in most included studies and one review, which included papers up to the year 2000, found a median net increase in the percentage of people being active of 4.2% (range, −2.9% to 9.4%). Five good‐quality reviews, which reported impact on BMI or weight, found positive findings in most included studies. Two good‐quality reviews reported no change in the prevalence of overweight/obesity, but included only a small number of studies.…”

“…Of the seven reviews that assessed quality of included studies, four used Cochrane Risk of Bias tools, one the EPHPP tool, one Community Guide Criteria, and one bespoke assessment derived by the authors . The reviews that used Cochrane risk of bias tools reported between 42% and 58% of included studies to be at high risk of bias due to failure to randomize allocation of communities, high rates of attrition, and poor quality of outcome measures.…”

Can policy ameliorate socioeconomic inequities in obesity and obesity‐related behaviours? A systematic review of the impact of universal policies on adults and children

“…Further systematic reviews are now available concerning the impact of a variety of interventions on inequities in obesity and related behaviours. Two of these reviews, which assessed 11 and 10 studies, respectively, concluded that obesity prevention and whole‐of‐community interventions that were equally or more effective among lower SEP groups often involved environmental change. By contrast, among 20 high‐quality studies in adults and 23 studies in children , interventions at individual, community and societal levels either reduced inequities in obesity or had no impact, with little evidence of widening.…”