Making the urban environment around schools healthier, developing an initial programme theory: an early realist process evaluation of the London superzones pilot

Abstract

BACKGROUND: More than four out of five people in England live in an urban area so the urban environment is an important determinant of health and an important contributor to health inequalities. This is especially true for children, for whom the impacts of their local environment may have lifelong effects. To improve the health effects of the urban environment the London Devolution Partnership piloted multi-agency partnerships focusing on 400m 'superzones' around schools in deprived communities. The intention is for local partners to work together to make the environment within the superzone healthier. METHODS: A realist process evaluation of 13 pilot sites. We used data from programme documents, a rapid literature search, and interviews with lead officers for the 13 local authorities that took part in the programme. Qualitative analysis was used to identify combinations of context, mechanisms, and outcomes (CMOs) that affected the creation of a local partnership and plan. RESULTS: All but one of the 13 pilot sites established a superzone and multi-agency action plan. We identified 12 CMOs that affect the process of creating a school superzone. We present a logic model that describes how these CMOs combine to make up an initial programme theory of superzones. Key aspects of this programme theory include the importance of local partners' priorities, leadership and support from across the local authority, and the flexibility of the model itself. CONCLUSION: The superzones model is an emerging framework for local place-based partnership working to improve the urban environment. However, the success of the model is likely to depend on local context. The evidence presented here could guide the further roll out of the model, and support those local authorities that want to create superzones.