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Community health and wellbeing A baseline health and wellbeing study of the Edward Woods Estate, Hammersmith & Fulham, West London

October 2013 Produced for the Tri-‐Borough Public Health Service, London Borough of Hammersmith & Fulham Prepared by Collaborate

Penny Stothard [email protected]

Collaborate

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Contents

1. Summary of key findings .............................................................................................. 3

2. Introduction and methodology .................................................................................... 6

3. Findings ..................................................................................................................... 11

3.1 Perceptions of health ............................................................................................... 11

3.1.1 Self reported levels of health ............................................................................ 11

3.1.2 What does 'being healthy' mean to residents? ................................................. 12

3.1.3 Health priorities ................................................................................................ 14

3.2 Healthy behaviours ................................................................................................... 15

3.2.1 Fruit and vegetable consumption ..................................................................... 15

3.2.2 Healthy eating .................................................................................................. 18

3.2.3 Physical activity ................................................................................................ 19

3.2.4 Smoking ............................................................................................................ 25

3.2.5 Alcohol consumption ........................................................................................ 27

3.2.6 The impact of smoking and alcohol consumption ............................................ 28

3.3 Accessing primary care services ............................................................................... 30

3.3.1 Choosing a service ................................................................................................. 30

3.3.2 Satisfaction with local services .............................................................................. 31

3.4 Emotional wellbeing ................................................................................................. 33

3.4.1 Satisfaction with life ......................................................................................... 33

3.4.2 Feeling of anxiety .............................................................................................. 35

3.4.3 Mental wellbeing .............................................................................................. 37

4. Recommendations and considerations for future surveys .......................................... 39

5. Appendices ................................................................................................................ 46

Appendix A: Responding profile of residents .................................................................. 46

Appendix B: Questionnaire instruments ......................................................................... 47

Appendix C: Key external data sources cited in this report ............................................. 54

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1. Summary of key findings A survey was carried out in Summer 2013 with 172 adult residents living on the Edward Woods Estate, located in the London Borough of Hammersmith and Fulham. The interviews were conducted face-‐to-‐face by local Community Champion volunteers with the support of one professional market researcher. The main findings and implications are discussed below according to the main themes of the report.

What does 'being healthy' mean to you?

• Overall, 61% of residents consider their health to be either good or ‘very good’– 39% and 22% respectively. Around 1 in 7 admitted that their health is 'bad' or 'very bad'. Levels of self-‐reported health appear to be just slightly lower than the national average. Older residents and males are less likely to say that their health is good.

• 'Being healthy' is most commonly associated with regular exercise or being generally

fit/active and eating a balanced diet (both receiving endorsement from just over half of residents). Avoiding a reliance on alcohol or tobacco was given a low priority despite the well -‐known dangers of smoking and alcohol misuse.

• Not doing enough exercise is the most significant health concern for residents, followed by

healthy eating (14%). Amongst those not currently in good health, we see that diabetes and lung/heart conditions are the greatest concerns.

Healthy behaviours: diet

• The average number of portions consumed on a typical weekday is 3.5 portions; therefore two-‐thirds of residents are not meeting the Government's five-‐a-‐day target. This is slightly above national estimates and is therefore not a particular area of concern; however one in ten residents are consuming just 0 to 1 portions of fruit/vegetables in a typical day, which needs some attention.

• Men are eating less fruit and vegetables and need to be encouraged to eat more. Overall,

43% of residents claim that they would like to eat more healthily than they do at the moment. The primary barriers are connected to personal finances: well over half of those who say they want to eat more healthily, suggest that cheaper fresh food would help them. This suggests that any positive messages that are conveyed to residents around healthy eating must convey that this is possible in an economical way – ‘good healthy food on a budget’. This could possibly be delivered as part of a community cooking class programme.

• Around one quarter who want to eat more healthily also said that positive advice from a

doctor/nurse or friends/family would encourage them. This highlights the power of 'word of mouth' and that a multi-‐faceted approach targeting Health Care Professionals and community peers is required and endorses the role of the local Community Champions.

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Healthy behaviours: physical activity

• Physical activity levels are in line with national averages although just under one-‐fifth of Edward Woods’ respondents do not undertake any physical activity (of at least 30 minutes).

• Older residents, men and BME groups are less likely to meet the target for physical exercise.

• There is a strong appetite for doing more physical activity. Around half of residents indicate that they would like to do more physical activity than they currently are. Current barriers include lack of motivation and finances -‐ one fifth saying they do not have enough money. A multi-‐dimensional programme therefore needs to be designed, which highlights where and how people can get involved in (low-‐cost) physical activity opportunities.

• Half of residents did not endorse any of the possible sports/activities on the list shown to them (particularly men), underlining the challenging nature of finding physical activity pursuits that will engage a wide range of the local population. The most popular stated exercise/physical activities are connected to a gym/indoor environment, driven mainly by females and those who are under 44 years. The majority would be prepared to pay £2 or less for a 1-‐hour exercise class. One in ten said that they would not be prepared to pay anything for such a resource.

Healthy behaviours: smoking and alcohol

• One-‐quarter indicated that they are a current smoker, which is broadly in line with the national average. The average number of cigarettes smoked per current smoker per day is 10, which is the same as the average reported for the whole population in the Health Survey for England. Smoking rates are higher amongst men and those from a white background.

• Just over one quarter confirm that they currently drink alcohol, perhaps slightly lower than the national average. Just 7 out of 44 residents expressed a desire to reduce the amount of alcohol that they typically drink.

• Around 1 in 7 residents smoke and drink (12%), behavior which carries the largest health

risk.

Accessing primary care services

• The overwhelming majority (82%) of residents interviewed indicated that they would go to their GP if they were feeling ill. Other channels of advice have very low consideration levels (e.g. NHS Direct, community pharmacies). Awareness of these alternative methods could be promoted.

• Satisfaction levels with local GPs are high, although most of this is at the 'fairly satisfied' level. Dental surgery satisfaction levels (87%) are around the same level as the GP and hospital (91%). One third of residents say that they are 'very satisfied' with their dentist.

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This level of performance is again much more positive than the equivalent figures across the country.

• Amongst the small number who are unhappy with their GP, a wide range of reasons emerge

-‐ waiting times and staff manner/language are found to be key.

Emotional wellbeing

• Overall, 77% rate their overall life satisfaction as medium or high, which is identical to the equivalent national figure. Although fieldwork did take part during pleasant weather and the feel-‐good buzz of the Royal Family birth, this is still a positive result.

• Residents who define their personal health as either 'very good' or 'good' are more likely to

be satisfied with their life compared with those who are in fair to bad health. This reinforces the importance of emotional wellbeing in the community.

• 70% of residents have low anxiety, a more positive result than the equivalent national figure. Amongst those who are experiencing anxiety, the main reasons appear to be related to personal finances e.g. childcare costs, paying my rent, benefit changes. Practical measures to address these concerns would therefore be a sensible and welcomed addition to local services.

• We experimented with a tool that academics have created, which is designed to measure mental wellbeing (WEMWBS). The overall results are higher than average, particularly amongst women, the BME population and those in good health living on the estate.

• On average, residents were least likely to agree with the statement 'I've been feeling relaxed' and, in particular, the statement 'I've had energy to spare'. This would suggest that the promotion of energising physical/mental activities in the community would be beneficial.

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2. Introduction and methodology

Background The broad objective of this study was to better understand health attitudes and behaviours amongst adults living on the Edward Woods Estate in Hammersmith and Fulham, West London. The study was conceived and delivered as a unique, multi-‐partner approach, as illustrated below. Figure A: Summary of study delivery agents

Key to the project methodology was the Edward Woods’ Community Champions project, part of the Tri-‐Borough Community Champions Programme1. The programme is delivered by the Behaviour Change team, part of the Tri-‐Borough Public Health Service for Hammersmith & Fulham, Kensington & Chelsea and Westminster. The programme is based on the team’s belief that the professionals do not have all of the answers. Instead, they take an asset-‐based and community engagement approach, which aims to engage with and empower residents and communities to articulate local problems and come up with their own solutions. The community champions are a group of volunteers trained as health ambassadors and community researchers. The Edward Woods’ Community Champions project was run by the White City Residents’ Association for the duration of this survey. The Public Health Behaviour Change team commissioned social research and marketing agency, Collaborate, to design the consultation, support the project manager, analyse the results and comment on the implications based on our wide experience of working with community engagement projects. A market research fieldwork agency, Research by Design, was also commissioned to provide community researcher training for the community champions.

1 See www.communitychampionsuk.org for more information on the programme

Community Champions

Public Health Service

Social resarch and markekng

agency

Market research fieldwork agency

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The Edward Woods Estate is a relatively small area situated in the north-‐east corner of the Hammersmith and Fulham borough. It is sandwiched between the A3220 Trunk Road and the border of the Royal Borough of Kensington and Chelsea. The estate is characterised by residents who are socially excluded and it currently exhibits poor health outcomes compared with the surrounding area: Table A: Current health conditions of Edward Woods estate compared to wider area (Source: Census 2011)

Development of the study Collaborate designed and developed the survey during June and early July 2013. It contains many pre-‐validated questions that have been shown to work reliably in national household surveys and that we have used with other local Community Champion Hubs. An initial project briefing was held on 5 June 2013, led by Collaborate, to introduce the project, its approach and discuss the role of the Community Champions with the volunteers and project team. This also provided the first opportunity to introduce the draft questionnaire and discuss this with the champions. The Community Champion volunteers and project team subsequently had the opportunity to amend the questionnaire to bring a local relevance to the survey. A workshop with champions on 13 June 2013, led by Research by Design, included interactive social research training, a briefing on the general health survey and an opportunity to trial the questionnaire in a 'safe environment'. Based on the feedback received at the workshop, the questionnaire was then finalised and printed. The questionnaire is reproduced in Appendix B. The majority of the questions were designed to be administered face-‐to-‐face using a paper questionnaire. Showcard prompts were also produced to make the interaction between fieldworker and resident as easy as possible. More sensitive questions connected to emotional and mental wellbeing, were administered using the Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS) pro-‐forma2 to ensure confidentiality and to avoid embarrassment. Materials were provided electronically by Collaborate. The Community Champions Project team took responsibility to provide each Community Researcher with a comprehensive research pack including printed health surveys, WEMWBS surveys, showcards including map of the local area, authorisation letter, quota sheet, clip board, bag, pens, ID badge, t-‐shirt and blank envelopes for the surveys.

Fieldwork A total of 172 questionnaires were completed with residents, using a face-‐to-‐face methodology from 17 June – 2 August 2013. The Edward Woods Estate Community Champions were pivotal to the research phase by conducting 51 of the surveys. An experienced market research interviewer

2 This is a self completion exercise. See Appendix C for more information.

Edward Woods Hammersmith & Fulham

London

Day to day activity is limited (16-‐26 yrs) 10% 5% 5% Self-‐reported health (bad/very bad) 9% 4% 5%

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helped deliver a further 102 surveys and programme staff conducted 19 surveys. The champions were given training on Market Research Society quality standards as part of their wider training in preparation for this project (as described above). Six community champions carried out interviews depending on their time availability. As part of their general remit, champions were also encouraged to provide sign-‐posting to relevant community services at the end of the survey. The surveys were completed in a variety of settings including:

• 122 at respondents' homes • 16 on street • 14 at a community event (e.g. Coffee morning, Wellness event, Zumba class) • 7 in a community setting.

An authorisation letter was also produced containing more information about the purpose of the consultation and contact details for residents who required more information. The White City Residents’ Association managed the champions and fieldwork phase and also undertook the data entry of the completed surveys. A fieldwork debrief session, led by Collaborate, was held on 13 August; this has also informed some of the reflections and recommendations included in Section 4. The Community Champions chose Westfield shopping vouchers as an incentive to encourage residents to complete the survey (values of £40, £60 and £100). The Community Champion project team administered the prize draw to select the winners.

Sample size Social research surveys are generally conducted in order to discover how a certain population behave or think. If surveys are carried out properly then it is not necessary to talk to every member of the population as we can make inferences from those that are included in the 'sample'. The full profile of the achieved sample is produced in Appendix A. Standard fieldwork controls, known as 'quotas', were put in place to encourage all fieldworkers to conduct surveys with a mix of different members of the community (e.g. conducting half of surveys with men, and half with women). Table A below summarises the diversity captured in the achieved sample, according to key demographic and household characteristic questions. The ‘known population’ derived from National Census 2011 can now be used to benchmark the data, which can be seen to be highly representative, particularly in relation to gender and ethnicity. A broad mix of residents was interviewed therefore meaning that it is not necessary to calibrate the results (a process sometimes referred to as ‘weighting’).

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Table B: Achieved sample compared with target quotas

A total of 54% of questionnaires were completed by adults who live by themselves. This corresponds with Census 2011 figures which indicate that 53% of all households in the output area are occupied by a single person (12% aged 65 and over). This is much higher than the average proportion of single person households across Hammersmith and Fulham which is 38%. Correspondingly, there are a high proportion of childless households in the Edward Woods sample (78% reported having no children aged under 8 and 63% with no children aged 18 years). 25% of single adult households reported having a child present in the household. All 172 completed questionnaires were electronically captured by the White City Residents’ Association. As part of a quality assurance procedure, Collaborate checked the questionnaires for missing answers and mis-‐entered data.

Analysis and reporting No survey can produce perfect results as they are subject to many practical and statistical influences. A sample size of 172 means that the results are reasonably reliable. There are 1,300 adults currently living on the Edward Woods estate, so this sample has a margin of error of around +/-‐ 7% points. This means that if 50% of respondents to our survey said they were satisfied with a health service, if the survey were conducted again the value could lie anywhere between 43% and 57%. The reader therefore needs to be cautious about making general conclusions from the data. This is particularly the case when examining sub-‐groups (e.g. certain ethnic groups) or ‘filtered’ questions, which were only asked of certain respondents depending on their answer to a previous question. The purpose of this study is to generate insights into the local community, which can broadly guide policy development. Any 'differences' between percentages that are observed are unlikely to be statistically valid. Observed differences in the report narrative have not been tested for statistical significance.

Number achieved

Percentage Actual percentage1 (Census 2011)

Male 70 41% 50% Female 101 59% 50% 18-‐29 years 29 17% 24% 30-‐44 years 45 26% 33% 45-‐64 years 42 24% 29% 65 years and over 56 33% 14% White British/Irish/European/Other 67 39% 39% Black/Black British 63 37% 38% Asian/Asian British 8 5% 8% Mixed/Dual Heritage 11 6% 8% Other ethnicity 21 12% 7%

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Each survey question in this report is presented as a proportion of the 'valid base' only. This means that any missing values (i.e. if a resident chose not to answer a particular question) have been suppressed from the analysis so the base size differs slightly from question to question. The full comprehensive data tables are available in a separate document. Occasionally, percentages in a chart will not sum to 100%. This is normal in social research reporting and is because, in the interests of clarity, percentages are shown 'rounded' i.e. no decimal places are indicated. Where the report refers to the sum of two percentages (e.g. the number of residents who said they were either very or fairly satisfied with a public service) this will have been calculated accurately from the original, unrounded data.

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3. Findings The results of the survey are presented throughout this section by theme. Where possible, results from the Edward Woods Estate have been compared with national data sets (see Appendix C for references).

3.1 Perceptions of health

3.1.1 Self reported levels of health

Firstly, the survey asked Edward Woods’ Estate residents about how they perceive their own health in general. Self-‐reported health is an important indicator of the general health of the population. The Health Survey for England includes this question because it is a valid measure for predicting future health outcomes and can be used to project use of health services and provide information useful for policy development. However, it has been noted that different people answer this question in different ways so careful interpretation is very important. Overall, 61% of Edward Woods’ Estate residents think that their health is either ‘very good’ or ‘good’ (Fig. 1). Just one-‐fifth consider their health to be 'very good'. Around 1 in 7 respondents admitted that their health is 'bad' or 'very bad' (13%).

Figure 1: Perceptions of own health in general (Q1) Valid base: 171

Questions on self-‐assessed general health have been widely used in specialised health surveys, general population surveys and the National Census; the Health Survey for England has asked a similar question for many years. Between 1993 and 2011, the national population reporting either 'very good' or 'good' general health has fluctuated between 74%-‐78% amongst men and 73%-‐76% amongst women. The prevalence of people saying that their general health is either 'very bad' or 'bad' has ranged from 4% to 8% across both sexes over the same period. In this context, we can

Very good, 22%

Good, 39%

Fair, 26%

Bad, 10%

Very bad, 3%%

Edward Woods (n=171)

Very good/Good: 61%

Very good/Good: 76%

National data (n=8,596)

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therefore say that levels of self-‐reported health are lower on the Edward Woods’ Estate compared with the national average. This is even more concerning given that previous studies have shown that respondents can provide 'socially desirable' answers to questions of this nature3. Therefore, the real number of people who consider themselves to have poor health may actually be higher. A 2012 study conducted on the nearby White City estate4 near Shepherd’s Bush in Hammersmith and Fulham also highlighted some possible cultural/religious issues around a similar question -‐ specifically, an unwillingness to appear ungrateful about health or aspects of life. The table below allows us to understand how different types of people on the estate answered the question about self-‐assessed health (Table 1). Some of the sub-‐groups are fairly small so we have to be careful about the interpretation of the results (see Section 2). Older residents are far less likely to say that their health is either very good or good. For instance, 81% of 18-‐44 year olds said their health was 'Very good/Good' (Total good), compared with just 45% of those aged 45 years and over. Men are also slightly less likely to say that they are in good health compared with women.

Table 1: Variations around self-‐reported health in general (Q1) Sub groups based on those with more than 50 residents

3.1.2 What does 'being healthy' mean to residents? Residents were asked what their personal definition of 'being healthy is'; this was a spontaneous, open-‐ended question and respondents could mention several elements, which were captured by the interviewer (Fig. 2). The two most common associations are regular exercise or being generally fit/active and eating a balanced diet (both receiving endorsement from just over half of residents). Getting enough sleep and having a positive attitude are also mentioned by four in ten residents. The avoidance of harmful substances or avoiding certain behaviours was mentioned far less. Just one-‐fifth of residents associate not smoking, not eating junk food, or not drinking alcohol as a main factor in being healthy (19%, 20% and 16% respectively). Smoking prevalence and alcohol consumption are discussed in Section 3.2.

3 Derek L. Phillips and Kevin J. Clancy (1972) Some Effects of Social Desirability in Survey Studies, American Journal of Sociology, Vol. 77, No. 5

4 Stothard, Penny (2012) Understanding Child Oral Health on White City, NHS North West London, June 2012

Very good Total good Base: Male 16% 54% 69 Female 27% 65% 101 18-‐44 years 38% 81% 74 45 and over 10% 45% 97 White 18% 61% 67 Non white 25% 62% 102 No children present in h/hold 14% 47% 106 1 or more children present 36% 86% 62

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These associations have implications for the design of materials and interventions if we want to communicate with residents about broad health issues. Figure 2: Self definition of 'being healthy' (Q3) Valid base: 172

The ranking of health definitions do not differ significantly according to whether residents consider their health to be good or poor (Fig. 3). Figure 3: Variations in self-‐definition of 'being healthy' (Q3)

10%

11%

12%

15%

16%

20%

19%

22%

31%

34%

37%

40%

40%

52%

53%

Other

Limikng/reducing prescripkon drugs

Taking vitamin supplements

Not taking illegal/non prescribed drugs

Not drinking alcohol (excessively)

Not smoking

Not eakng junk food

Avoiding illness/injuries

Geqng five fruit/veg a day

Having enough energy

Weight (not too fat / not too thin)

Having a posikve aqtude/healthy mind

Geqng enough sleep

Eakng a balanced diet

Regular exercise / being fit and ackve

• Regular exercise (56%) • Eakng a balanced diet (54%) • Posikve aqtude (45%) • Get enough sleep (41%) • Weight (41%)

Those who consider health as very good/good (n=104)

• Regular exercise (51%) • Eakng a balanced diet (48%) • Posikve aqtude (31%) • Get enough sleep (39%) • Have enough energy (30%)

Those who consider health as very bad/bad/fair (n=67)

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3.1.3 Health priorities

Residents were shown a list of possible health-‐related issues and asked to select the ones that are a concern to them or their family. Figure 4 below shows the results of this exercise for all residents and for those who had earlier indicated that they do not consider themselves to be in good health (see Section 3.1). Not doing enough exercise is the most significant issue for all residents (16%) followed by healthy eating (14%). When we examine the results of just those who are not in good health, we see that diabetes and lung/heart conditions are the largest concerns (19% respectively). Figure 4: Health issues and concerns, for all residents and those who report not currently being in good health (Q2)

The other main medical conditions mentioned are: arthritis (n=7), blood pressure (n=5) and back problems (n=4).

51%

6%

10%

4%

13%

12%

19%

19%

7%

9%

18%

29%

4%

5%

6%

9%

9%

9%

10%

10%

14%

16%

Other

Drinking too much alcohol

Cancer

Looking ater your teeth

Stress/mental health

Smoking

Lung or heart condikons

Diabetes

Losing weight

Healthy eakng

Not doing enough exercise

All (n=148)

Those not in good health (n=67)

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3.2 Healthy behaviours

3.2.1 Fruit and vegetable consumption The World Health Organisation (WHO) and the UK Committee on Medical Aspects of Food and Nutrition (COMA) recommend eating at least five portions (400g) of fruit and vegetables a day. This is a key feature of the Government's strategy for reducing early deaths from coronary heart disease, strokes and cancer, as well as reducing health inequalities amongst the general population. This recommendation forms the basis of the 'five-‐a-‐day' programme, which is now an extremely well-‐recognised public health promotion doctrine. Edward Woods’ Estate residents were asked about their personal fruit and vegetable consumption. The average (mean) number of portions consumed on a typical weekday is 3.5 portions. Fig. 5 shows the full results for this question and highlights that two-‐thirds of residents are not meeting the Government's five-‐a-‐day target. This is slightly above national estimates (see below) and is therefore not a particular cause of concern; however one in ten residents are consuming just 0 to 1 portions of fruit/vegetables in a typical day, which needs some attention.

Figure 5: Fruit and vegetable consumption (Q4) Valid base: 169

The Health Survey for England indicates that 27% of the adult population meets the five-‐a-‐day guideline and that the average fruit and vegetables consumed per day is 3.2 portions. It should be pointed out however that the Health Survey for England takes a more 'scientific' approach to the measurement of dietary intake, in contrast to the looser, self-‐defined question asked in our study.

2%

8%

19%

21%

18%

21%

7%

2%

None One Two Three Four Five Six Seven or more

Number of portions on a typical weekday

Does not meet target: 69%Does meet target: 31%

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The National Diet and Nutrition Survey (NDNS), which uses an even more detailed approach with a diary, estimated that adults consume 4.1 portions per day -‐ and reported a total of 31% consume five or more portions of fruit and vegetables a day. NDNS estimates are considered as slightly better than the Health Survey for England figures, at least in part because NDNS is better able to capture the contribution from composite dishes containing fruit and vegetables. More detailed analysis highlights that men living on the Mozart Estate are less likely to be consuming their five-‐a-‐day target (23% compared with women 36%). This finding is also backed up by the Health Survey for England, which found that women continue to be more likely than men to consume five or more portions of fruit and vegetables a day. Table 2: Variations around fruit and vegetable consumption (Q7)

Although there is little difference in fruit and vegetable consumption across the age groupings, the results do suggest that BME (Non White) residents and those living with one or more children are more likely to meet their 5-‐a-‐day target. The Health Survey for England also found that consumption varied with age among both sexes, but was actually lowest amongst those aged 16-‐24 (15% of men and 20% of women this age ate five or more portions) and highest amongst the older age groups (30% of men and 36% of women in 55-‐64 age group). Further analysis allows us to examine the relationship between fruit and vegetable consumption and levels of self-‐assessed health (Fig. 6). The results show that those residents those who report that their own health is good are more likely to meet the five-‐a-‐day target (36%) compared with those who are not in good current health (23%). This latter group is far more likely to say that they consume 3-‐4 portions a day (46%).

Meets 5 a day recommendation

Base:

Male 23% 70 Female 36% 98 18-‐44 years 29% 72 45 and over 32% 97 White 22% 67 Non white 36% 100 No children present in h/hold 24% 107 1 or more children present 42% 60

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Figure 6: Relationship between fruit/vegetable consumption (Q4) and self reported health (Q1)

28% 32%

35%

46%

36%

23%

0%

10%

20%

30%

40%

50%

Very good/good health (n=104) Fair/bad/very bad current health (n=67)

2 or less porkons a day

3-‐4 porkons a day

5 or more porkons a day

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3.2.2 Healthy eating In terms of context, national surveys have previously asked people about the factors that most influence their choice of a food product (Fig. 7). Although the quality of food is most paramount (79% select quality or freshness of food as the primary factor), eating food that is considered 'healthy' comes second, chosen by 64% of the adult population.

Figure 7: What are the most important influences on your choice of foods (British Social Attitudes Survey 2008 n=2245) Mentions above 20% only

Overall, 43% of Edwards Woods residents claim that they would like to eat more healthily than they do at the moment. These residents were then asked what would help them achieve this (Fig. 7 overleaf). The primary factors are connected to finances: well over one half of those who say they want to eat more healthily, suggest that cheaper fresh food would help them (59%) and over one-‐third say it would help if they had more money (38%). This suggests that any positive messages that are conveyed to residents around healthy eating must convey that this is possible in an economical way -‐ "good cooking on a budget". This could possibly be delivered as part of a community cooking class programme -‐ which received support from one-‐third of residents. Around one quarter of residents who want to eat more healthily also said that positive advice from a doctor/nurse or friends/family (27% and 25% respectively) would encourage them (Fig. 8). This highlights the power of 'word of mouth' and that a multi-‐faceted approach targeting Health Care Professionals and community peers is required and endorses the role of the Community Champions.

26%

27%

27%

30%

33%

33%

34%

45%

60%

63%

64%

79%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Convenience in preparakon

Availability in the shops I can usually get to

Impact on the community where food comes from

Habit or roukne

What my family / spouse / children will eat

To try something new or different.

Animal welfare / free range

Foods I know how to cook / prepare

Price of food / value for money / special offers.

Taste of food

Eakng food that is healthy or low fat

Quality or freshness of food

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Figure 8: Interest in eating more healthily (Q5) and enablers to make this happen (Q6) Mentions above 9% only

3.2.3 Physical activity Physical activity has become an increasingly important public health issue as the government attempts to reduce levels of obesity amongst the population. Lack of activity is associated with many chronic conditions, including heart disease, diabetes, osteoporosis, certain cancers, as well as obesity. Government guidelines for physical activity have been available for several decades. Current guidance is for at least 30 minutes of physical activity on five or more days a week. This exercise should be of at least moderate intensity. Physical activity can be taken in shorter bouts allowing for the accumulation of activity throughout the day. Targets can be achieved through structured exercise or sports, general lifestyle activity -‐ or a combination of both. The Government advises that all adults should also aim to improve muscle strength on at least two days a week and minimise sedentary activities.

Yes, would like to eat more heathily,

43%No, would not like

to, 55%

Don't know, 2%

15%

19%

19%

25%

27%

32%

38%

59%

Better shops/supermarkets nearby

Better labelling of foods

More time to cook

Advice from family member or friends

Advice from doctor/nurse

Local cooking classes

If I had more money

If fresh food was cheaper

What would help you? (Base: 73)

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Two main definitions are important when measuring and monitoring physical activity levels:

The results show that, on this basis, over half of Edward Woods’ Estate residents (53%) meet the recommended target of 30 minutes of physical activity for 5 or more days a week. Just under one-‐fifth of Edward Woods’ residents do not undertake any physical activity for at least 30 minutes (17%).

Figure 9a: Participation in moderate intensity (Q7a) physical activity

At least five times a week for 30 mins,

53%1-‐4 times a week for

minimum 30 minutes, 30%

No moderate intensity activity ,

17%

Moderate intensity activity:

• Can be achieved through brisk walking, cycling, gardening and housework, as well as some sports and exercise

• Target: 150 minutes per week • On average, Edward Woods residents reported that they undertake

moderate activity on 4.2 days a week (equating to at least 2.1 hours in total)

Vigorous intensity activity:

• Activity that makes you breathe much harder than normal • Examples include running, football, cycling, or going to the gym • Target: 75 minutes per week • On average, Edward Woods residents reported that they undertake

vigorous activity on 1.0 days a week (at least 30 minutes)

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Although the results for moderate activity appear positive, it should also be pointed out that levels of vigorous intensity activity and sports are much lower; just 6% of adults undertake vigorous activity five times a week, and just over one quarter undertake it less frequently. Two thirds therefore do no vigorous activity in a typical week and this target needs to be better communicated. Figure 9b: Participation in vigorous intensity (Q7b) physical activity Valid base: 162

Overall, however, physical activity levels appear to be on a par with the national average (Fig. 9c). A new report from the Health Survey for England published in July 2013 suggests that it is reasonable to add moderate and vigorous physical activity across a whole week as long as bouts are at least 10 minutes in duration. On the basis that Edward Woods’ residents recorded moderate and vigorous activity separately, 61% of our respondents are meeting the recommended target level on the estate. Figure 9c: Summary of physical activity levels and comparison to national figures

Edward Woods 5 days of moderate

intensity 53%

At least 150 minutes of either moderate or intensive ackvity 61%

Na_onal Moderate ackvity for 30 mins, five days a week

34%

Na_onal Meets weekly guidelines (moderate or vigorous level) for 150 mins

61%

22 | P a g e

Older residents (49%), men (49%) and BME groups (46%) are less likely to meet the target for physical activity than others. Table 3: Variations in those meeting physical activity targets (Q7a-‐b)

Around half of residents indicate that they would like to do more physical activity than they currently are (49%, as shown in Fig. 10). These residents are more likely to be those who are currently under achieving the national recommendation of 5 times a week for 30 minutes (Fig. 11 overleaf). A variety of barriers to participation are cited by residents, including lack of motivation (24%). Finances also feature strongly -‐ one fifth saying they do not have enough money. A multi-‐dimensional programme therefore needs to be designed, which highlights where and how people can get involved in (low cost) physical activity opportunities. Figure 10: Interest in doing more physical activity (Q8) and participation barriers (Q9) Base: 170 Mentions above 16% only

Yes, would like to do more

exercise/physical activity, 49%

No, would not like to, 50%

Don't know, 1%

17%

17%

18%

19%

22%

24%

24%

25%

I have no-‐one to exericse with

Caring responsibilites

I don't have enough leisure time

My work commitments

I don't have enough money

Poor health or physical limitations

No facilities in local area

Struggle to motivate myself

What stops you? (Base: 83)

5 days of moderate intensity activity

Meets total minutes per week (vigorous and

moderate)

Base:

Male 49% 55% 67 Female 55% 65% 98 18-‐44 years 59% 66% 70 45 and over 49% 58% 96 White 65% 71% 66 Non white (BME) 46% 56% 99 No children present in h/hold 51% 58% 104 1 or more children present 57% 68% 60

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Figure 11: Interest in doing more exercise (Q8) and current moderate intensity activity levels (Q7a)

Residents were asked what sort of exercise or physical activity interests them the most from a list of pre-‐determined choices (Fig. 12). Half of residents said that none of the activities on the list interested them, underlining the challenging nature of finding physical activity pursuits that will engage a wide range of the local population.

The most popular stated exercise/physical activities are connected to a gym/indoor environment. Fitness classes (22%) and affordable gym access (11%) were most mentioned. Facilities which support these activities, are therefore likely to be received well.

Figure 12: Main sorts of exercise or physical activities that interest Edward Woods’ residents (Q10) Base 159 -‐ items of 3% or more

Of those doing 5 days of ackvity for 30 minutes

Of those doing zero days of ackvity a week Of those doing

1-‐4 days of ackvity for 30 minutes

Fitness classes in the community 22%

Affordable gym access 11%

Yoga / pilates 4%

Dance classes 3%

Community walks 3%

None of the above 50%

79%

64%

30%

Say they want to do more

physical activity

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The results in Table 4 below illustrate that where there is appetite for certain activities, most notably fitness classes, this is being driven mainly by females and those who are under 44 years. Men, in particular, were more likely to say that there was nothing on the list that was of interest to them (58%). Table 4: Variations in interest levels for selected types of physical exercise (Q10)

Just under half of respondents completed a follow-‐up question, which asked how much they would be prepared to pay to attend a 1-‐hour exercise class (Fig. 13). Of these, the majority, 72%, feel that it should cost £2 or less. Indeed, one in ten said that they would not be prepared to pay anything for such a resource. Figure 13: Willingness to pay for a 1 hour exercise class (Q10a) Base 83 (those who are interested or who answered the question)

The table overleaf illustrates that spending preferences are reasonably similar across demographic groups, although some base sizes are quite limited to be conclusive.

8%

36% 36%

18%

Should be free Less than £1 £1 -‐ £1.99 £2 -‐ £4.99

Fitness classes Affordable gym access

Yoga/pilates Base:

Male 15% 12% 0% 65 Female 27% 10% 7% 93 18-‐44 years 32% 16% 3% 69 45 and over 14% 7% 4% 90 White 18% 6% 5% 62 Non white 24% 14% 3% 95 No children present in h/hold 18% 5% 4% 96 1 or more children present 28% 18% 3% 60

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Table 5: Variations in amount prepared to pay for 1 hour class (Q10a) (based on those who are interested or who answered the question)

3.2.4 Smoking Smoking is the single greatest cause of preventable illness and premature death in the UK. Tobacco consumption is recognised as the UK’s biggest cause of preventable illness and early death, with an estimated 102,000 people dying in 2009 from smoking-‐related diseases including cancers5. Overall, three quarters of Edward Woods’ Estate respondents stated that no one in their household smokes cigarettes or chews tobacco or shisha (Fig. 14). Therefore, 26% indicated that they are a current smoker, which is broadly in line with the national average (21%). The average (median) number of cigarettes smoked per current smoker per day is 10, which is the same as the average reported for the whole population in the Health Survey for England (median: 10). Of the 26% of residents who smoke on Edward Woods, many are low frequency smokers, which is classified as under 10 cigarettes per day (44%) but one-‐fifth are smoking 20 cigarettes or more on a daily basis.

5 Peto, R., et al., Mortality from smoking in developed countries 1950-‐2005 (or later). March 2012.

Less than £1 £1 -‐ £1.99 £2 -‐ £4.99 Base: Male 31% 28% 19% 32 Female 32% 34% 15% 62 18-‐44 years 34% 28% 18% 50 45 and over 30% 36% 14% 44 White 21% 24% 21% 33 Non white 37% 37% 13% 60 No children present in h/hold 25% 31% 17% 48 1 or more children present 42% 30% 14% 43

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Figure 14: Whether resident currently smokes cigarettes or shisha, or chews tobacco (Q11) and frequency (Q12) Valid base: 171

As Table 6 illustrates, on the Edward Woods’ estate, smoking is more prevalent amongst men (41%) and those of a White ethnic background (36%). Table 6: Variations around cigarette/shisha smoking and chewing (Q11)

Currently smokes, 26%

Does not smoke, 74%

Under 5 cigarettes,

14%

5 to 9 cigarettes,

30%10 to 19 cigarettes,

35%

20 or more

cigarettes, 21%

Frequency of smoking, per day (n=43)

Zero residents stated that they chew pan or betel

3 residents stated that they smoke shisha (weekly)

Current smoker Base: Male 41% 70 Female 16% 100 18-‐44 years 22% 74 45 and over 30% 97 White 36% 67 Non white 21% 102 No children present in h/hold 33% 107 1 or more children present 16% 60

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3.2.5 Alcohol consumption Drinking alcohol is generally recognised as an established part of British culture and most adults drink alcohol, at least occasionally. However alcohol has been identified as a causal factor in more than 60 medical conditions, including mouth, throat, stomach, liver and breast cancers; hypertensive disease (high blood pressure), cirrhosis and depression6. Consumption frequency, availability and the pricing of alcohol continue to be significant public policy areas of interest. Just over one quarter of Edward Woods’ residents confirm that they currently drink alcohol (Fig. 15). Direct national comparisons are difficult but appear to suggest that consumption levels on the estate are lower than average. According to the Health Survey for England (2011) 87% of British men and 81% of women had drunk alcohol at least occasionally in the last year. 18% of men drank alcohol on five or more days in the previous week, compared with 10% of women. A large proportion of British adults claimed not to have had a drink in the last week (31% of men, 46% of women). 13% of men and 19% of women were non-‐drinkers. Just 7 out of 44 residents expressed a desire to reduce the amount of alcohol that they typically drink. There was insufficient time in the Edward Woods interview to ask about frequency or how many units are consumed therefore we cannot comment on residents' drinking behaviour in relation to current NHS guidelines i.e. to what extent people are moderate or more excessive in their alcohol consumption in relation the guidelines.

Figure 15: Whether resident currently drinks alcohol (Q13) and propensity to reduce alcohol consumption (Q14)

6 Department of Health. 1995 Sensible drinking: the report of an inter-‐departmental working group. Rehm J, Room R, Graham K et al. The relationship of average volume of consumption and patterns of drinking to burden of disease: an overview. Addiction 2003;98:1209-‐1228.

Yes, drink alcohol nowadays, 27%

No, do not drink, 73%

Edward Woods (n=169)

Yes, 7

No, 37

Would like to reduce amount (n=44)

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3.2.6 The impact of smoking and alcohol consumption A small but significant proportion of Edward Woods’ Estate residents report that they currently smoke and drink alcohol. Overall, around 1 in 7 residents smoke and drink (12%) whilst around the same number are reliant on just one of these substances. This is validated by academic studies in the US7, which show that dependence on alcohol and tobacco are correlated; indeed people who are dependent on alcohol are three times more likely than others to be smokers and, conversely, those who are dependent on tobacco are four times more likely to depend on alcohol. Work funded by NHS Health Scotland shows that the combined effects of smoking and consuming alcohol have a higher impact on cause-‐specific mortality8. Figure 16: Crossover between reporting of smoking (Q11) and drinking alcohol (Q13) amongst all respondents Valid base: 169

We examined earlier in Section 3.1.3, the extent to which residents have particular health concerns; not doing enough exercise and healthy eating are the most significant issues for all residents (16% and 14% respectively). Examining these results according to whether the resident is dependent on tobacco or alcohol reveals a different pattern (Fig. 17).

Perhaps unsurprisingly, smoking is a much greater concern amongst current smokers (24%) whilst the same cannot be said amongst drinkers (just 11% who currently drink alcohol state that drinking too much is a health concern of theirs). This is broadly in line with the finding in Fig. 15 that 7 out of 44 residents express a desire to reduce the amount of alcohol that they typically drink.

7 Grant, B.F.; Hasin, D.S.; Chou, S.P.; et al. Nicotine dependence and psychiatric disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61:1107–1115, 2004 8 Hart, CL et al. 2010. The combined effect of smoking tobacco and drinking alcohol on cause-‐specific mortality: a 30 year cohort study, BMC Public Health 2010, 10:789

14% 14%

Smoke cigarettes or shisha Drinks alcohol

12%

Both

29 | P a g e

Lung or heart conditions are more of a concern to both smokers and drinkers (18% and 16% respectively) than amongst the general population (9% as shown in Fig. 4).

Figure 17: Health issues and concerns (Q2) according to those who report smoking and drinking alcohol (both n=45)

9%

7%

7%

11%

11%

11%

11%

11%

16%

22%

11%

2%

4%

4%

7%

9%

11%

13%

16%

18%

22%

24%

Cancer

Substance missue

Looking ater teeth

Drinking too much alcohol

Losing weight

Stress/mental health

Diabetes

Healthy eakng

Lung or heart condikons

Not doing enough exercise

Smoking

Smokers

Drinkers

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3.3 Accessing primary care services

3.3.1 Choosing a service Most contact with the NHS is through primary care, which includes GP practices, dental practices community pharmacies and high street optometrists. Accessing primary care is key for early symptom reporting and also the delivery of preventative health measures (e.g. blood pressure checks, reminders for cervical smear tests, or to offer smoking cessation interventions). Tools such as the Healthy Foundations segmentation9 have been created to develop a better understanding of people's health behaviours and motivations, including their likelihood of attending the GP. The vast majority (82%) of Edward Woods’ Estate residents indicate that they would go to their GP if they were feeling ill (thinking about a situation where they were generally unwell to the point that they were struggling to cope with pain or discomfort). This is a pleasing finding given that, against the backdrop of ever-‐limited resources, members of the public are encouraged to use health care responsibly; a situation which some commentators have suggested can provoke an unwanted reticence in consulting a GP about symptoms.10

Figure 18: Where would you go if you were feeling ill? (Q15) Valid base: 162

The other results shown in Fig. 18 clearly indicate that other channels of advice are very low in terms of consideration e.g. only 3% chose NHS Direct, now known as the NHS 111 service, as a source and 3% chose a Walk-‐in centre. Awareness of these alternative methods could be promoted. A recent London-‐based campaign, which could be considered for the area includes ‘Not always A&E’11 and the national campaign ‘Choose Well’.12 9 Department of Health (2011) The Healthy Foundations Lifestage Segmentation 10 Tod AM. Craven J. (2006) Diagnostic delay in lung cancer: Barriers and facilitators in delay. 11 Not always A&E (2012), initiated by NHS ONEL http://www.notalwaysaande.co.uk 12 Choose Well (2010) http://www.nhsdirect.nhs.uk/About/WhatIsNHSDirect/ChooseWell

3%

3%

6%

82%

Walk-‐in or Urgent Care Centre

NHS Direct (phone)

Hospital/A&E

GP surgery

Other responses:

NHS Choices website 2%Pharmacy/chemist 2%Friends / family 2%

No responses:

Books / journalsOther websites

31 | P a g e

3.3.2 Satisfaction with local services Satisfaction levels with local GPs are high. Over one-‐third of residents are 'very satisfied' (35%) and a further 53% are fairly satisfied (total satisfaction 88%). Just 5% of residents are dissatisfied with their GP. This level of satisfaction appears to be well above the national figure and certainly higher than the average for Inner London surgeries in general (Fig. 20 overleaf). It is also contrary to local anecdotal feedback received although the reader should note that the majority of satisfaction is at the 'fairly satisfied' level indicating that residents are not completely satisfied with the service they are receiving. Dental surgery satisfaction levels (87%) are around the same level as the GP and hospital (91%). One third of residents say that they are 'very satisfied' with their dentist. This level of performance is again much more positive than the equivalent figures across the country (dentist 54%, hospital 65%) and, moreover, amongst Inner London services in general.

Figure 19: Satisfaction with local health services (Q16) Valid base: those who are registered/have used each service, GP (167), hospital (141), dentist (134)

1% 1% 4% 5% 1% 2%

7% 6%

7%

53% 65% 66%

35% 26% 21%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

GP Denkst Hospital

Very saksfied

Fairly saksfied

Neither

Fairly dissaksfied

Very dissaksfied

32 | P a g e

Figure 20: Summary of satisfaction levels and comparison with national figures (Q16) National and regional results collected from the Place Survey 2008/09 (see Appendix D)

Sample size limitations do not allow us to explore the experiences of different patient types within the Edward Woods community. However, an Ipsos-‐MORI report, using data from the Place Survey (2008/09) highlights the factors, which are useful in confirming differences in the perceptions of health services13. For example, an older age profile (aged 65+) appears to be closely and strongly related with satisfaction with GPs. The authors commented that this is a common finding, not just in relation to health services, with older people more likely to rate most public services highly. Residents expressed a wide range of reasons, both systemic and non-‐systemic, as to why they are not satisfied with their GP. Fig. 21 lists the main reasons according to whether the resident had said they were dissatisfied with the service overall at Q16. Sample sizes are limited but waiting times and staff manner/language emerge as issues. Interestingly, no residents expressed dissatisfaction with the building environment itself.

Figure 21: Reasons for being unhappy with your GP (Q17)

13 Duffy, B and Lee Chan, D. 'People Perceptions and Place' August 2009 (Ipsos MORI)

GP (family doctor) 88% local saksfackon

Nakonal: 77% Inner London: 67%

Hospital 91% local saksfackon


Den_st 87% local saksfackon


GP service -‐ those who are actively dissatisfied (n=8)

• Poor quality of health

professionals (n=3) • The way the staff talk to me

(n=1) • Waiting times too long (n=1) • Poor attitude of staff/too

impersonal (n=2) • Don't always see same doctor

(n=1)

GP service -‐ other patients who expressed a view (n=22)

• Poor quality of health professionals

(n=4) • Distance (n=3) • Poor transport links (n=2) • Inconvenient opening times (n=2) • Waiting times too long (n=8) • The way the staff talk to me (n=8) • Difficulty making an appointment (n=1) • Don't always see same doctor (n=1)

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3.4 Emotional wellbeing

3.4.1 Satisfaction with life Mental health is an important health topic and one on which the NHS spends a significant amount of money. For people to live healthy lives, their mental health is as important as their physical health. There is increasing policy interest in wellbeing at both a national and local level. The Government is committed to introducing measures which go beyond traditional economic metrics when gauging how our society is progressing. However, national wellbeing is a complex factor to measure; the economy, quality of life, the state of the environment, sustainability, equality as well as individual citizens' wellbeing all contribute. The ONS highlights some examples of how policy interest in wellbeing has been increasing:

• Subjective wellbeing data being made available at a detailed level to allow comparisons to be made between different councils and neighbourhoods

• Tracking the wellbeing of job seekers as it has already been found that low wellbeing can be an obstacle to finding work

• Measuring the impact that adult learning has on life satisfaction, which should lead to better decisions when allocating budgets for Community Learning

• An evaluation of the National Citizen Service showed that wellbeing improved amongst young people who participated in the project

Since 2011, ONS has included four key emotional wellbeing questions on their household surveys (summarised in Fig. 21 below). The latest national results, released in July 2013, show that over three-‐quarters of adults rate their overall life satisfaction as medium-‐high and four-‐fifths felt that the things they do in their life are worthwhile. Although ideally we would have asked all four elements on our survey, we only had space for overall, life satisfaction and feeling of anxiety.

Figure 21: Individual wellbeing measures 2012/13-‐national scores from Annual Population Survey14

14 For 'Life satisfaction', 'Worthwhile' and 'Happy yesterday', medium/high is 7 to 10 on a 11 point scale, where 0 is not at all and 10 is completely. For 'Anxious yesterday', medium/low is 0 to 3 on the same scale.

Overall, how saksfied are you with your life nowdays?

77% Nakonal 77% Edward Woods

Overall, to what extent do you feel that the things you do in your life are worthwhile?

81% Nakonal

Overall, how happy did you feel yesterday?

72% Nakonal

Overall, how anxious did you feel yesterday?

61% Nakonal 70% Edward Woods

Low anxiety

34 | P a g e

Overall, 77% of Edward Woods’ residents rate their overall life satisfaction as medium or high (classified as a score of between 7-‐10). This is identical to the equivalent national figure (77%). The average Edward Woods’ resident rated their satisfaction with life overall as 7.6 out of 10 (again in line with national findings). Fig. 22 illustrates the variation in wellbeing scores that were collected from residents. In terms of context, the reader should be aware that this survey was conducted during a warm summer with national sporting success and also around the time of the birth of HRH Prince George of Cambridge, an event, which created a country-‐wide 'feel good factor'. There was a minor correlation in this survey between feelings of wellbeing and self-‐reported levels of personal health (which we discussed in Section 3.1.1). Residents who define their personal health as either 'Very good' or 'Good' are slightly more likely to be satisfied with their life (average: 7.9 out of 10) compared with those who are in fair-‐ bad health (average: 7.2). Figure 22: Satisfaction with overall life nowadays (Q18) Valid base: 169

Life satisfaction differs according to age. Although slightly more residents who are 45 years and over state that they are satisfied (79% compared with 74% amongst younger age groups) there are actually fewer in this older age bracket who are extremely satisfied with their life (27% provide a score of 9 or 10). This is more in line with national analysis15. Table 7 also shows overleaf that men are less likely to say that they are extremely satisfied with their overall life.

15 Analysis by the ONS has previously shown that satisfaction with life by age actually peaks for the younger age groups and the elderly and dips in middle aged groups (ie. a U-‐shaped curve distribution)

.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

0 1 2 3 4 5 6 7 8 9 10

Those in very good/good health

Average: 7.9

Those in fair/poor healthAverage: 7.2

Least satisfied

Completely satisfied

Cumulative pe

rcen

tage

All respondentsAverage: 7.6

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Table 7: Variations in life satisfaction (Q18)

There is a clearer relationship between life satisfaction and self-‐reported health status -‐ 82% of those who earlier indicated they were in good health said they were satisfied with their life. Indeed, one-‐fifth (20%) of those in good health gave their life the top score of 10 out of 10 (not shown). This is double the proportion of those not in good health (9% of those ranked their life as 10 out of 10).

3.4.2 Feeling of anxiety Overall, 70% of Edward Woods’ residents have low anxiety, which is defined as providing a score of 0-‐3 on a scale of 0-‐10. This is a more positive result than the equivalent national figure (61%). Fig. 23 below illustrates that there was no correlation in this sample between feeling anxious and the perception of residents' own health. Figure 23: How anxious did you feel yesterday (Q19) Valid base: 168

50

55

60

65

70

75

80

85

90

95

100

0 1 2 3 4 5 6 7 8 9 10

Those in very good/good health

Average: 2.4

Those in fair/poor healthAverage: 2.3

Not anxious Very anxious

Cumulative pe

rcen

tage

All respondentsAverage: 2.3

Satisfied with life (7-‐10 score)

Very satisfied with life (9-‐10 score)

Base:

Male 76% 24% 70 Female 78% 38% 99 18-‐44 years 74% 40% 73 45 and over 79% 27% 97 White 76% 30% 67 Non white 77% 33% 101 No children present in h/hold 79% 32% 107 1 or more children present 77% 35% 61

36 | P a g e

The main reasons for feeling anxious appear to be related to personal finances. Fig. 24 presents the main reasons selected by residents who had indicated that they had been feeling some anxiety. The most chosen option (n=17) was childcare costs, followed by paying my rent (n=12) and benefit changes (n=12). Practical measures to address these concerns would therefore be a sensible and welcomed addition to local services. Figure 24: Reasons for being concerned lately (Q21) Base: (Those who answered 5 or higher to Q19) n=41

2

4

6

6

8

8

8

9

12

12

17

General stress

Being on my own/isolakon

Mental health issues

Raising my children

Finding work

Condikon of housing

Job security

Other financial worries

Changes to benefits

Paying my rent

Childcare costs

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3.4.3 Mental wellbeing Mental wellbeing consists of positive psychological functioning, satisfaction with life, happiness, fulfilment, enjoyment and resilience in the face of hardship16. University academics have developed a robust, practical way of assessing the wellbeing of people with a scale of questions that reflect current concepts of mental wellbeing. The Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS) contains a series of questions, which cover both subjective well-‐being and psychological functioning17. Due to the sensitive/personal nature of some of the questions, residents were offered the opportunity of filling in the WEBWBS questions on a self-‐completion sheet, which was not seen by the interviewer. We received n=112 WEMWBS sheets suitable for analysis. The results are presented below in Fig. 25. Figure 25: Warwick-‐Edinburgh Mental Well-‐being Scale results (Q20) Valid base: 112

The overall average score for the test was 54.9, which is higher than the results published so far by the academics involved in developing WEBWBS (overall mean of 50.7). Other Local Authority studies

16 Huppert FA, Baylis N. Well-‐being: towards an integration of psychology, neurobiology and social science. Philosophical Transactions of the Royal Society B: Biological Sciences. 2004;359(1449):1447, p1331. 17 The Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS) comprises 14 questions, each with an identical answer scale ranging from ‘none of the time’ to ‘all of the time. The scale is scored by summing responses to each item answered. The minimum scale score is 14 and the maximum is 70.

0.18

0.12

0.16

0.32

0.11

0.03

0.14

0.08

-‐0.12

-‐0.36

-‐0.10

-‐0.31

-‐0.05

-‐0.20 I’ve been feeling optimistic about the future

I’ve been feeling useful

I’ve been feeling relaxed

I’ve been feeling interested in other people

I’ve had energy to spare

I’ve beendealing with problems well

I’ve been feeling good about myself

I’ve been feeling confident

I’ve been thinking clearly

I’ve been feeling close to other people

I’ve been able to make up my own mind about things

I’ve been feeling loved

I’ve been interested in new things

I’ve been feeling cheerful

Mean sum score: 54.9National population: 50.7

Item scored lower than average

Item scored higher than average

38 | P a g e

have identified a slightly higher average score (for example, Coventry City Council: a score of 54.1 in 2012). Our results suggest that mental wellbeing within the Edward Woods’ community is actually therefore above average. Fig. 25 also illustrates how the different elements of the WEMWBS tool were answered. On average, residents were least likely to agree with the statement 'I've been feeling relaxed' and, in particular, the statement 'I've had energy to spare'. This would suggest that the promotion of energising physical/mental activities in the community would be beneficial. In contrast, the most endorsement can be seen for the statements 'I've been able to make up my own mind about things' and 'I've been feeling cheerful'. Table 8 shows how wellbeing differs amongst different types of residents. Mental wellbeing, according to their WEMWBS score, is higher amongst women, the non-‐white population and, in particular, those who are currently in good health. Table 8: Variations in wellbeing scores (Q20)

Average WEMWBS score

Base:

Male 53.3 45 Female 55.9 66 18-‐44 years 56.1 52 45 and over 53.8 60 White 53.4 40 Non white 55.6 71 No children present in h/hold 54.5 65 1 or more children present 55.6 46 Currently in good health (self report) 56.7 75 Not in good health (self report) 51.0 37

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4. Recommendations and considerations for future surveys

Recommendations

The recommendations from this survey have been grouped under four broad strands of work based on the priorities that have emerged from this survey: • Healthy eating • Physical activities • Programme of support targeting men • Other There are obvious overlaps across these broad themes and each is intrinsically linked. The study has also highlighted the following priority groups in particular need of targeted intervention to support them in achieving a healthy and emotionally-‐balanced lifestyle. These groups may present particular challenges for engagement: • People aged 45 years + • Men • BME groups Priorities for action Healthy eating

Two-‐thirds of residents are not meeting the Government's five-‐a-‐day target. This is slightly above national estimates. This should not be a cause for alarm, however there still remains a large proportion of residents who are not eating enough fruit and vegetables and one in ten residents who are consuming just 0 to 1 portions in a typical day. Men are eating less fruit and vegetables. The study reveals that 43% of residents would like to eat more healthily than they currently do – this is encouraging in terms of people’s desire to change their eating habits, however the barriers to achieving this are:

• Cost – well over half of those who say they want to eat more healthily, suggest that cheaper fresh food would help them.

• Knowledge – 32% of residents stated that local cooking classes would help them eat more healthily, with around one quarter saying advice from their GP or nurse, a family member or friend would also help them change their current eating habits.

During the review meeting, the Community Champions concurred with the above findings, agreeing that cost i.e. finding quality fresh food at a good price is difficult locally; and that people do not know how to change their habits or integrate fruit and vegetables more easily into their daily diet.

Access to fresh fruit and vegetables does not appear to be an issue locally. There is a number of shopping opportunities for residents to buy fresh produce. The estate has its own greengrocers

40 | P a g e

selling fresh produce. Anecdotally, there is a perception that the produce is well priced but the quality can be variable. There may be the opportunity to explore working collaboratively with the store management to discuss how access to good quality fresh fruit and vegetables may be achieved.

Other nearby retail outlets include Morrisons, Waitrose and Shepherd’s Bush Market. According to local Community Champions, the former and latter appear to be well-‐priced with good-‐quality produce.

The Obesity team based within the Tri-‐borough Public Health Team may be interested in undertaking more extensive, exploratory work to grasp a better understanding of residents’ shopping, eating and dietary habits. This may include hosting in-‐depth focus groups with residents, particularly from the target audiences indicated above (men, 45 years + and BME groups) to discuss the topic in more detail. Such a piece of targeted research may present the opportunity to co-‐design appropriate activities or information campaigns with end users and provide scope to link with any existing programmes.

Simple dietary tips and advice on how to achieve the recommended five-‐a-‐day, on a budget, would appear to be well-‐received across the estate – ‘eating on a budget’ would need to be at the heart of any campaign. Knowledge and breaking current habits are barriers, which could be addressed with an effective estate-‐based information campaign delivered in partnership with the Obesity team and the Community Champions. Appropriate training for the Community Champions would be required around diet, achieving 5-‐a-‐day, cooking skills, information on eating fresh, frozen, tinned and dried fruits and vegetables etc.

Equipping the Community Champions with the information and skills to be able to share with residents may be an effective, low-‐cost activity to support with this priority. One suggestion at the review meeting was that the champions could deliver a campaign, which includes handing out sample bags of the recommended five-‐a-‐day to demonstrate to residents how simple it can be to achieve. Recipe cards or simple instructions on how to prepare foods could also be included in the bags.

Cook and Eat classes A number of existing activities are taking place on Edward Woods’ estate including cooking classes and ‘Kids in the Kitchen’ sessions. It would be advisable to investigate these classes more – frequency, popularity, attendance etc so as to integrate any feedback into the design of any future classes or activities as a result of this survey. Anecdotally we gather there is scope to improve the attendance at these classes and promoting them better to men, people over 45 years and BME groups could be explored. This may necessitate reviewing the classes to ensure they are well suited to such groups. Better targeted and stronger promotional material may also be needed to support achieving greater awareness of the classes. The Community Champions could have a clear role in promoting the sessions and encouraging class registration. There may also be scope to design a number of sessions targeted solely for men. The Edward Woods’ Community Centre has very good facilities including two kitchens to host cooking classes. The centre staff has also built relations with a number of chefs who live on the estate. This may present excellent opportunities to build on any existing work and to co-‐design a localised programme, working with local chefs.

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Cook and Eat18 classes, cooking demonstrations and healthy recipe cards are tested interventions nationally. Promotion campaigns such as the Love Food Hate Waste19 and publishing healthy, budget-‐proof recipes in future editions of Edward Woods’ NEWS may also form part of a wider programme of interventions to address healthy eating on the estate. Lessons learned from the national Cook and Eat evaluation20 suggest working with a cook and a nutritionist, designing recipes according to target audience and including sessions where children are involved produce better results. Running classes in local schools also generates greater interest. These recommendations could be considered when re-‐commissioning future cooking classes on the estate. The Mozart Community Champions’ Hub, in the neighbouring borough of Westminster, is currently piloting a Summer outdoor cook and eat session – ‘Cook, Eat and Play!’. This pilot involves hosting a family cooking class, followed by an outdoor picnic in a local park and concluding with family games and races to burn off calories and get families being active together. It would be interesting to monitor the pilot phase and consider the findings for similar activities on the Edward Woods’ estate.

Healthy Schools Partnership

With the establishment of the local Healthy Schools Partnership21 across Hammersmith & Fulham, Kensington & Chelsea and Westminster, schools are now being encouraged and supported to develop and deepen their focus on health and wellbeing. This aims to support the attainment, achievement and happiness of both pupils and staff and the wider school communities.

The Healthy Schools Partnership is commissioned by the Tri-‐borough Public Health Service and is an alliance of Local Authority and health services together with a range of other agencies that work with schools. Schools that choose to participate can aim for bronze, silver or gold level. Any intervention around the promotion of healthy eating must include messages around eating on a budget – these may range from tips on reducing waste, how to plan meals for the week and details of local economical food markets. Fruit and veg stores On the nearby White City estate a Pop up fruit and veg22 store is managed by a Community Nutritionist based at Phoenix School Farm and Learning Zone. This may provide opportunities for shared learning and collaborative working. The Pop up fruit and veg store is located on the estate and operates every Wednesday morning. However the store also ‘roams’ the neighbourhood and locates at the gates of local schools on a weekly basis. This initiative works closely with the schools and students and gets students involved in operating the store and selling the produce. Not only does this involvement engage students in the promotion of healthy eating and the key messages of eating ‘five a day’ it also helps students develop and apply arithmetic and customer service skills. The Community Nutritionist also delivers other partnership projects to engage families including Saturday family cooking sessions and Healthy Lifestyle Lessons across local schools.

18 http://www.welllondon.org.uk/367/poplar-‐cook-‐and-‐eat-‐course.html 19 http://england.lovefoodhatewaste.com 20 http://www.welllondon.org.uk/367/poplar-‐cook-‐and-‐eat-‐course.html#evaluation 21 www.westminster.gov.uk/services/educationandlearning/healthy-‐schools/ 22 http://hcga.org.uk/gardens/phoenix-‐school-‐farm/

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The Community Champions project may be able to support with the development or roll out of similar schemes on Edward Woods. National Curriculum cooking lessons There may also be the potential to work collaboratively with local schools building on the Government announcement (as part of the new National Curriculum) for cookery lessons to become a compulsory part of the school curriculum23. From 2014 there are new requirements for both primary and secondary schools to offer cooking classes and to teach the principles of healthy eating. This may also provide impetus in getting families cooking and eating together. It may be beneficial for the Edward Woods’ Community Champions Project Manager to meet with representatives of local schools to discuss how the team and Community Centre may be able to support the delivery of this new requirement.

Physical activity

Physical activity levels are in line with national averages although just under one-‐fifth of Edward Woods’ residents do not undertake any physical activity (of at least 30 minutes). The priority audiences for promoting physical activity are the same as for Healthy eating – 45 years +, men and BME groups. There appears to be a strong appetite for doing more physical activity – around one half of residents indicate they would like to do more than they currently are doing.

The barriers to doing more physical activity that emerge from this study are lack of motivation and finances. Poor health or physical limitations were also cited as barriers. However the challenging nature of hosting appropriate and affordable activities is highlighted by half of survey respondents not endorsing any of the possible sports/activities on the list shown to them, which included:

• Fitness classes in the community • Affordable gym access • Gardening • Dance classes • Team sports e.g. basketball, football • Yoga/ Pilates • Women-‐only fitness • Community walks • Swimming

Unfortunately the free text field where respondents could provide an alternative response was poorly completed so further consultation would be required on respondent-‐based recommendations for consideration.

It appears that of the survey group ‘women under 44 years old’ may be relatively happy with some of the existing provision of activities as this group favours indoor-‐based activities including fitness classes and the gym. A schedule of fitness classes is currently offered at the Edward Woods’ Community Centre including badminton, Zumba and yoga. Anecdotally we gather these classes could be better attended and it may be that there are other barriers for local women to attend these

23 http://www.education.gov.uk/schoolfoodplan/news/a00221479/school-‐food-‐plan-‐cook-‐curric

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classes including lack of awareness, timing and cost. This programme of classes was discussed during the review meeting with the Community Champions where it was suggested that running affordable crèche facilities alongside the activities may enable more mothers with young children to attend the classes. It was also suggested that women-‐only, men-‐only and older people-‐only classes be considered.

There also appears to be scope to expand the current schedule and it may be worthwhile gaining feedback and additional insight into desires for additional exercise classes from both class participants and non-‐participants. This may provide preferences for the types of classes which interest residents. There may then be scope to pilot the most popular classes.

These classes would need to be well publicised in advance via a variety of methods and attendance and feedback monitored to be able to inform any future planning of local activities. As an example the following classes are currently on offer at The Beethoven Centre on the Mozart Estate, Westminster and form part of a programme of affordable physical activity classes that cost £2 a session for adults and £1.50 for under 12s. They aim to improve the health and wellbeing of local residents and include Kung Fu, Creative Dance, Multi-‐Sports, Capoeira, Yoga, Women’s Step, Zumba, Army Boot Camp Fitness and Legs, bums and tums. There may be the potential to discuss running a mini-‐programme from the Edward Woods’ Community Centre or offering taster sessions over a weekend to gauge interest in such activities.

It may also be worthwhile entering into discussions with local leisure centres to explore affordable membership for Edward Woods’ residents.

Motivation was also cited as a barrier to more people participating in physical activity. With this in mind, there may be scope to explore setting up an Edward Woods’ Estate Exercise Buddying Scheme. This could be a simple scheme, which pairs residents with like-‐minded residents to motivate one another to attend classes, visit the gym etc. There may be scope to explore integrating such a service within the local Health Trainer Service. The buddying system could become part of the service-‐offer following the initial appointments with a professional trainer.

Poor health or physical limitations was cited by 24% of respondents as a barrier to doing more physical activity. Targeted promotion of the borough’s free Health Trainer Service to people in poor health and with physical limitations may be able to remove this barrier and the perception that to be able to take part in physical activity you need to be in good health or perfectly mobile. The Health Trainer Service would be able to provide specialist advice and support, or refer to the appropriate services, to support less able residents with the aspiration to be physically fitter.

There is no exercise referral scheme in Hammersmith and Fulham so communicating the findings from this survey to local GPs and highlighting the local appetite for greater physical activity may prompt more GPs to promote exercise and refer to the Health Trainer Service. Edward Woods residents who are registered with a Kensington and Chelsea-‐based GP would be eligible for referral to the exercise referral scheme in Kensington and Chelsea. It may also be a good opportunity to remind GPs of the scheme and check their understanding of the referral process and how it operates in practice.

Better promotion of both the Health Trainer Service and GP referral service should be considered. Educating the Community Champions’ team in both of these services and exploring how the champions may be able to support with signposting or registering clients could also be addressed to ease the registration process for residents and help to bring the services closer to the Edward Woods’ community.

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Emotional health

Overall 77% of respondents rated their overall life satisfaction as medium or high, which is identical to the equivalent national figure so should not be too much of a concern. However, amongst those experiencing anxiety, the main reasons appear to be related to personal finances including childcare costs, paying my rent, benefit changes etc. Responses to other questions throughout the survey such as barriers to doing more physical activity or eating more healthily were commonly answered with responses linked to finances.

This insight suggests that there may be a number of residents struggling to manage their household budgets. Financial workshops delivered in partnership with the local Citizen’s Advice Bureau have recently been hosted on the estate. It would be useful to review the attendance and participant feedback to assess whether any further similar activities may be needed to meet local demand and need. It may also be worthwhile working with the CAB to write an editorial piece for the next edition of the newsletter Edward Woods’ NEWS to be published late 2013.

The Community Champions recently received training as part of the partnership with the local CAB office. There may be scope for the champions to develop further a wider programme of community outreach and signposting across the estate to continue to address this area and support the needs of the local community.

Programme of support targeting men

Men are a notoriously difficult group to engage with around health and wellbeing and are often a challenge for many health and wellbeing professionals.

What this study suggests is that there are a number of health issues which local men are struggling with – healthy diet, physical activity, emotional wellbeing; but there is also the desire amongst local men to want to change their current habits. This desire to change is crucial as it suggests that our target audience is willing to engage in appropriate activities, which they believe will be worthwhile and which would support them in making changes to their daily lifestyle.

This could be the focal point of an additional piece of work, which looks to engage with local men to design and develop a local programme specifically targeting men. Undertaking a robust social marketing approach to developing such a programme would be strongly recommended, which would put local male residents in the driving seat. This would enable them to come up with their own solutions as to what services or activities are needed, where and when, and how such interventions should be branded and promoted. Without such a strong customer orientation and local buy-‐in from residents at the heart of such an approach, its success would be limited.

Other

Smoking Despite smoking levels being broadly in line with the national average (one-‐quarter) and therefore not presenting a particularly high priority for intervention, it should be noted that smoking is the single greatest cause of preventable illness and premature death in the UK, with an estimated

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102,000 people dying in 2009 from smoking-‐related diseases including cancers24. With this in mind, interventions to encourage residents to stop smoking should be considered for delivery on the estate, and in particular targeted at men and those from a white background, where local prevalence is higher. Partnership work with ‘Kick it25’ – the local NHS-‐funded stop smoking service in Hammersmith and Fulham – should continue with increased campaigning and promotional activity on Edward Woods Estate. With the appropriate training and support, the local community champions could assist the Kick it team to increase their profile amongst residents, deliver stop smoking messages and signpost smokers to local support. Other community champions’ hubs have identified champions with a particular interest in helping people to stop smoking and trained them to become local stop smoking advisors; a potential consideration for Edward Woods.

National stop smoking campaigns such as the annual Stoptober26 campaign, which provides free support to encourage smokers to quit smoking for 28 days during October, and national No Smoking Day27, which launches a new annual stop smoking campaign on 12 March, are just two examples of campaigns to target the estate.

Local health services

The overwhelming majority (82%) of residents indicate that they would go to their GP if they were feeling ill (thinking about a situation where they were unwell to the point that they could not cope). The survey highlighted that other channels of advice have very low consideration levels including consulting NHS Direct – now 111 – or community pharmacies.

Awareness of these alternative methods should be promoted. This could be a combination of outreach work via the Community Champions utilising other tested campaigns such as the Not Always A&E or Choose Well to communicate with residents which service is better tailored for certain ailments.

On-‐going messages communicating the wider range of available health services could also be communicated with residents via the Edward Woods’ Community Champions’ newsletter – NEWS and via the Community Champions’ website28.

It may also be interesting to share the findings of this study with the Hammersmith & Fulham Clinical Commissioning Group. Satisfaction levels with local GPs are high, although most of this is at the ‘fairly satisfied’ level. Amongst the small number who are unhappy with their GP, a wide range of reasons emerge – waiting times and staff manner/language are found to be key.

Future surveys

In order to assess whether these interventions have made the desired impact it is recommended that the consultation is repeated in 1-‐2 years. It is also wise to conduct regular consultations to check whether the needs of the population have altered in the intervening time period and to evaluate the success of interventions of the wider Community Champions’ programme.

24 Peto, R., et al., Mortality from smoking in developed countries 1950-‐2005 (or later). March 2012. 25 https://www.kick-‐it.org.uk 26 https://stoptober.smokefree.nhs.uk / https://www.kick-‐it.org.uk/index.php/stoptober-‐2/ 27 http://www.nosmokingday.org.uk 28 http://communitychampionsuk.org

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5. Appendices Appendix A: Responding profile of residents

Number Percentage Male 70 41% Female 101 59% 18-‐29 years 29 17% 30-‐44 years 45 26% 45-‐64 years 42 24% 65 years and over 56 33% White British/Irish/European/Other 67 39% Black/Black British 63 37% Asian/Asian British 8 5% Mixed/Dual Heritage 11 6% Other ethnicity 21 12% 1 adult in household 91 54% 2 adults in household 53 31% 3 adults in household 17 10% 4 or more adults in household 8 5% No children aged under 8 in household 132 78% 1 child aged under 8 in household 17 10% 2 children aged under 8 in household 15 9% 3 or more children aged under 8 in h/hold 5 3% No children present in household (0-‐18yrs) 107 63% 1 child present in household (0-‐18yrs) 18 11% 2 children present in household (0-‐18yrs) 28 17% 3 children present in household (0-‐18yrs) 10 6% 4 or more children present in household (0-‐18yrs)

6 4%

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Appendix B: Questionnaire instruments Edward Woods Estate -‐ Health Attitudes Survey

Hello, my name is ____________and I am helping Hammersmith and Fulham council to understand how residents feel about local health and wellbeing services. It is being administered jointly by a team of local volunteers called Community Champions and an independent market research company Collaborate. Your answers are confidential and will not be shared with anyone outside the research team. By completing this survey you will automatically be entered into a prize draw for the chance to win either a £100, £50 or £25 voucher to spend at Westfields shopping centre. I just need to check a few things with you first please. SCREENING/QUOTAS

QA. This survey is for people and families who live in the Edward Woods neighbourhood. Do you currently live in the Edward Woods estate? SHOWCARD A Yes o1 No o2 CLOSE QB. Could I ask which age bracket you fall into? SHOWCARD B. SINGLE CODE 18-‐29 years o1 30-‐44 years o2 45-‐64 years o3 65 years and over o4

QC. How would you describe your ethnicity? SINGLE CODE White British/Irish/European/Other o1 Mixed/Dual Heritage o4

Black/Black British o2 Other o5

Asian/Asian British o3

QD. Please specify in your own words:

QE. CODE: Gender of respondent

Male o1 Female o2

Thank you. Let’s proceed with the survey.

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GENERAL PERCEPTION OF YOUR HEALTH Q1. How would you rate your current health in general? READ OUT. SINGLE CODE

Very good o1 Bad o4 Good o2 Very bad o5 Fair o3

Q2. Do you have any concerns about any of the following health and wellbeing issues listed here? Read out the number(s) if you find it easier. SHOWCARD C. MULTICODE . PROBE ANYTHING ELSE

Not doing enough exercise o1 Substance misuse o7 Health eating o2 Stress / mental health o8 Losing weight o3 Cancer o9 Looking after your teeth o4 Diabetes o10 Smoking o5 Lung or heart conditions o11 Drinking too much alcohol o6 Other medical conditions (please specify

below): o12

LIFESTYLE (DIET) Q3. Can you tell me what being ‘healthy’ means to you? DO NOT PROMPT. MULTICODE. PROBE TO NOTHING ELSE

Having enough energy o1 Not drinking alcohol (excessively) o9 Getting enough sleep o2 Taking vitamin supplements o10 Eating a balanced diet o3 Not eating junk food o11 Getting five fruit/veg a day o4 Not smoking o12 Having a positive attitude/healthy mind o5 Limiting/reducing prescription drugs o13 Weight (not too fat/not too thin) o6 Not taking illegal/non prescribed drugs o14 Regular exercise/being fit and active o7 Other (specify below…) o15 Avoiding illness/injuries o8

Q4. Approximately, how many portions of fruit and vegetables do you eat on a typical weekday? USE SHOWCARD D IF NECESSARY per day Q5. Would you like to eat more healthily than you do at the moment? SINGLE CODE

Yes o1 ASK Q6 No o2 SKIP TO Q7a (Don’t know) o3 SKIP TO Q7a

Q6. What would help you eat more healthily? SHOWCARD E. MULTICODE. PROBE TO NOTHING ELSE

Advice from doctor/nurse o1 NHS leaflets o8 Advice from family member or friends o2 Local cooking classes o9 If I had more money o3 More information (publications/internet) o10 If fresh food was cheaper o4 More time to cook o11 Better shops/supermarkets nearby o5 Other (please specify): o12 Clearer advice from Government o6 Better labelling of foods o7 Nothing o13

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LIFESTYLE (PHYSICAL ACTIVITY) I am now going to ask you about physical activity you have done in the last 7 days. Please answer the questions even if you do not consider yourself very active. INTERVIEWER: Activity can be in bouts of 10 minute periods. Q7a. During the last 7 days, on how many days did you do 30 minutes of moderate physical activity, which makes you breath somewhat harder than normal, such as brisk walking, housework or gardening?

Days

Q7b During the last 7 days, on how many days did you do 30 minutes of vigorous physical activity? This makes you breathe much harder than normal such as cycling, swimming or going to the gym or an exercise class?

Days

Q8. Would you like to do more exercise or physical activity than you do at the moment? SINGLE CODE Yes o1 ASK Q9 No o2 SKIP TO Q10 (Don’t know) o3 SKIP TO Q10

Q9. What stops you from doing any more physical activity, exercise or sport than you do now? SHOWCARD F. MULTICODE. PROBE TO NOTHING ELSE

No facilities in local area o1 I have no-‐one to exercise with o8

Don’t like facilities in local area o2 I don’t have enough money o9

My work commitments o3 I haven’t got right clothes/equipment o10

Religious/cultural commitments o4 Poor health or physical limitations o11

I don’t have enough leisure time o5 I have injuries which prevent me o12

Caring for children or older people o6 I sometimes struggle to motivate myself o13 Lack of childcare facilities or crèche o7 Other (please specify): o14

Q10. What sort of exercise or physical activity interests you the most? SHOWCARD G. SINGLE CODE .

Fitness classes in the community o1 Women-‐only fitness o7 Affordable gym access o2 Community walks o8 Gardening o3 Swimming o9 Dance classes o4 None of the above o10 Team sports eg basketball, football o5 Other (please specify below): o11 Yoga/pilates o6

Q10a. What is the most you would be prepared to pay to attend a 1-‐hour’s exercise class? SINGLE CODE Less than £1 o1 £1 -‐ £1.99 o2 £2 -‐ £4.99 o3 £5 -‐ £9.99 o4

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£10 or more o5 Not interested in exercise classes o6 (Not prepared to pay) o7 SMOKING & DRINKING Q11. Do you smoke cigarettes or shisha or chew tobacco at all nowadays? SINGLE CODE

Yes o1 ASK Q12 No o2 SKIP TO Q13

Q12. Approximately, how often do you…? ASK FOR EACH OF THOSE THAT APPLY

A. Smoke cigarettes: per day

B. Chew tobacco (e.g. pan/betel): per day

C. Smoke shisha: per week

Q13. Do you drink alcohol nowadays? SINGLE CODE

Yes o1 ASK Q14 No o2 SKIP TO Q15

Q14. Would you like to reduce the amount of alcohol you typically drink? SINGLE CODE

Yes o1 No o2

USING LOCAL HEALTH SERVICES Q15. Which service do you tend to use first in a non-‐emergency health situation? USE IF NECCESSARY: think about time when you have been generally unwell but struggling to deal with the pain or discomfort? SINGLE NHS Choices website o1 Pharmacy/chemist o6 NHS Direct (phone) o2 Books/journals o7 GP surgery o3 Ask family/friends o8 Walk-‐in or Urgent Care Centre o4 Website (please specify) o9 Hospital A&E o5 Other (please specify) o10 Q16. Please indicate how satisfied or dissatisfied you are with the following local health services? SHOWCARD H. SINGLE CODE EACH COLUMN.

A. Your GP B. Your local hospital C. Your dentist

Very satisfied o1 o1 o1 Fairly satisfied o2 o2 o2 Neither satisfied/dissatisfied o3 o3 o3 Fairly dissatisfied o4 o4 o4 Very dissatisfied o5 o5 o5 (Don’t know) o6 o6 o6

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ASK IF RESIDENT IS DISSATISFIED WITH A PARTICULAR SERVICE AT Q16: Q17. And could you tell me why you are unhappy with the .... service. REPEAT IF NECESSARY. SHOWCARD I. MULTICODE.

A. Your GP B. Your local

hospital C. Your dentist

Poor quality of health professionals o1 o1 o1 Distance (too far) o2 o2 o2 Poor transport links o3 o3 o3 Inconvenient opening times o4 o4 o4 Waiting times too long o5 o5 o5 The way staff talk to me o6 o6 o6 The environment/building o7 o7 o7 Other (please specify below:) o8 o8 o8 (Don’t know) o9 o9 o9

INDIVIDUAL WELL-‐BEING Q18. Overall, how satisfied are you with your life nowadays? Please answer on a scale of 0-‐10 where 0 is ‘not at all’ and 10 is ‘completely’.

Q19. Overall, how anxious did you feel yesterday? Please answer on the same scale as before 0-‐10. Q20. We are nearly at the end of the survey now. Before we finish can you complete this document? It has a series of statements about personal feelings. Could you please read each statement and write your own answers on it and then place it directly into this envelope? Your answers will be completely confidential and anonymous. PASS WEMWBS SHEET TO RESPONDENT.

Completed (remember to link) o1 REMEMBER TO ENTER CODE Declined to complete o2 Could not complete (e.g. written English) o3

ASK IF RESIDENT ANSWERS 5 OR ABOVE AT Q19: Q21. Which of the following, if any, have you been concerned about lately. SHOWCARD J. MULTICODE. PROBE TO NOTHING ELSE.

Job security o1 Being on my own / isolation o8 Condition of housing o2 Mental health issues o9 Paying my rent o3 Childcare costs o10 Finding work o4 General stress o10 Changes to Benefits o5 None of the above o11 Other financial worries o6 Other (please specify below): o12 Raising my children o7

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DEMOGRAPHICS Can I just ask you some final questions so that we can check that we have interviewed a range of different households? Q22. Total number of adults currently living in your household Q23. Total number of children (aged under 18 yrs) currently living in your household…

(a) Aged less than 8 years

(b) Aged between 8 and 18 Q24. Are you happy to be revisited by myself or another member of the research team to discuss any of your answers or to be invited to take part in more research?

Yes o1 No o2

Q25. Can I please take some details so that we can contact you? This is optional and your personal responses will be kept confidentially. Your name will automatically be entered into a prize draw for the chance to win either a £100, £50 or £25 voucher to spend at Westfields shopping centre. The details you give us will be used to contact you about the result of the prize draw and let you know about any future Community Champions activities subject to your permission.

Full name Address, including postcode

Telephone number

Email address

I have now finished completing the survey – thank you very much for your time. Q26. INTERVIEWER: RECORD LOCATION OF INTERVIEW At respondent’s home o1 On street o2 Community event o3 Please specify… Community setting o4 Please specify …..

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The Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS)

Below are some statements about feelings and thoughts.

Please tick the box that best describes your experience of each over the last 2 weeks

STATEMENTS None of the time

Rarely Some of the time

Often All of the time

I’ve been feeling optimistic about the future 1 2 3 4 5

I’ve been feeling useful 1 2 3 4 5

I’ve been feeling relaxed 1 2 3 4 5

I’ve been feeling interested in other people 1 2 3 4 5

I’ve had energy to spare 1 2 3 4 5

I’ve been dealing with problems well 1 2 3 4 5

I’ve been thinking clearly 1 2 3 4 5

I’ve been feeling good about myself 1 2 3 4 5

I’ve been feeling close to other people 1 2 3 4 5

I’ve been feeling confident 1 2 3 4 5

I’ve been able to make up my own mind about things 1 2 3 4 5

I’ve been feeling loved 1 2 3 4 5

I’ve been interested in new things 1 2 3 4 5

I’ve been feeling cheerful 1 2 3 4 5

© NHS Health Scotland, University of Warwick and University of Edinburgh, 2006, all rights reserved

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Appendix C: Key external data sources cited in this report

Health Survey for England The Health Survey for England (HSE) is a series of annual surveys designed to measure health and health-‐related behaviours in adults and children living in private households in England. The survey was commissioned originally by the Department of Health and, from April 2005 by The NHS Information Centre for health and social care.

The Health Survey for England has been designed and carried out since 1994 by the Joint Health Surveys Unit of the National Centre for Social Research (NatCen) and the Department of Epidemiology and Public Health at the University College London (UCL) Medical School.

The HSE is used as the primary source to measure progress towards achieving physical activity guidelines.

The full 2012 results will not be available until later in 2013. Initial results for physical activity levels were released in July 2013 and show a new way of examining physical activity levels. See http://www.hscic.gov.uk/catalogue/PUB11218

The Citizenship Survey The Citizenship Survey (formerly known as the Home Office Citizenship Survey, or HOCS) has been commissioned every two years since 2001. Approximately 10,000 adults in England and Wales (plus an additional boost sample of 5,000 adults from minority ethnic groups) are asked questions covering a wide range of issues, including race equality, faith, feelings about their community, volunteering and participation.

From 2007, the survey has moved to a continuous design, allowing the provision of headline findings on a quarterly basis, until the Collation Government cancelled the survey on 31 March 2011. The new Community Life Survey commissioned by the Cabinet Office to provide Official Statistics on issues that are key to encouraging social action and empowering communities, including volunteering, charitable giving, community engagement and well-‐being provides many comparable key measures to the Citizenship Survey so that trends can be tracked over time.

British Social Attitudes Survey The British Social Attitudes (BSA) survey has been running annually since 1983. Every year it asks over 3,000 people what it's like to live in Britain and how they think Britain is run. The survey tracks people's changing social, political and moral attitudes and informs the development of public policy.

New questions are added each year to reflect current issues, but all questions are designed with a view to repeating them periodically to chart changes over time. So far over 85,000 people have taken part. The survey is run by the National Centre of Social Research.

National Diet and Nutrition Survey The National Diet and Nutrition Survey (NDNS) is an infrequent programme of surveys designed to assess the diet, nutrient intake and nutritional status of the general population aged 1.5 years and over living in private households in the UK. The NDNS is jointly funded by the Department of Health (DH) in England and the UK Food Standards Agency (FSA) and carried out by a consortium of three organisations.

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Place Survey The Place Survey was developed by the government’s Department for Communities and Local Government (DCLG) to find out what local people think about certain key services run by local councils and their partners. important to bear in mind that while some of the questions in the Place Survey questionnaire were included in the BVPI 2006/07 and 2003/04 questionnaires (which allows us to compare the findings), The survey took place between the beginning of October 2008 and mid-‐January 2009 and was mainly conducted by postal questionnaire.

WEMWBS Researchers at Warwick and Edinburgh Universities validated a scale previously identified as promising for assessing population mental wellbeing; the shortened version has 14 elements and is known as The Warwick-‐Edinburgh Mental Well-‐being Scale (WEMWBS). The Warwick-‐Edinburgh Mental Well-‐being Scale was funded by the Scottish Executive National Programme for improving mental health and well-‐being, commissioned by NHS Health Scotland, developed by the University of Warwick and the University of Edinburgh, and is jointly owned by NHS Health Scotland, the University of Warwick and the University of Edinburgh. WEMWBS is now included in the core module of the annual Scottish Health Survey and is also being widely used throughout the UK and beyond.

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