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Community health and wellbeing A baseline health and wellbeing study of the World's End and Cremorne Estates, Kensington and Chelsea, West London
August 2014 Produced for the Tri-‐Borough Public Health Service, The Royal Borough of Kensington and Chelsea Prepared by Collaborate
Penny Stothard [email protected]
Collaborate
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Contents
1. Summary of key findings .............................................................................................. 3
2. Introduction and methodology .................................................................................... 7
3. Findings ....................................................................................................................... 2
3.1 Perceptions of health ............................................................................................... 12
3.1.1 Self reported levels of health ............................................................................ 12
3.1.2 What does 'being healthy' mean to residents? ................................................. 13
3.1.3 Health priorities ................................................................................................ 15
3.2 Healthy behaviours ................................................................................................... 16
3.2.1 Fruit and vegetable consumption ..................................................................... 16
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 ................................................................................................. 34
3.4.1 Satisfaction with life ......................................................................................... 34
3.4.2 Feeling of anxiety .............................................................................................. 36
3.4.3 Mental wellbeing .............................................................................................. 38
4. Recommendations and considerations for future surveys .......................................... 40
5. Appendices ................................................................................................................ 48
Appendix A: Responding profile of residents .................................................................. 48
Appendix B: Questionnaire instruments ......................................................................... 49
Appendix C: Key external data sources cited in this report ............................................. 58
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1. Summary of key findings A survey was carried out from February -‐ April 2014 with 143 adult residents living on the World's End and Cremorne Estates, located in the Chelsea Riverside ward in the south of Kensington and Chelsea. The interviews were conducted face-‐to-‐face by a unique combination of local volunteers and a 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, 60% of respondents think that their health is either ‘very good’ or ‘good’. One-‐fifth consider their health to be 'very good'. Around 1 in 7 respondents admitted that their health is 'bad' or 'very bad' (13%). Levels of self-‐reported health are lower than the national average. Older residents are less likely to say that their health is good.
• 'Being healthy' is most commonly associated with regular exercise and being fit and active
(and this is backed up by high levels of reported physical activity which we see later). Eating a balanced diet is a secondary factor but still received a strong level of endorsement. Residents are therefore most likely to respond positively to these public health messages than those that promote the avoidance of harmful substances.
• Stress is the most significant health concern for residents, particularly for those who do not
rate themselves as being in good health. This needs further examination; as we see later, levels of emotional wellbeing are low on the estates. Not doing enough exercise and losing weight are the next most significant concerns for residents.
Healthy behaviours: diet
• The average number of portions consumed on a typical weekday is 3.7 portions; therefore two-‐thirds of residents are not meeting the Government's five-‐a-‐day target. This is around the same as national averages and therefore not a particular cause of alarm; however one in ten residents are consuming just 0 to 1 portions of fruit/vegetables in a typical day, which is worthy of attention with general promotion work.
• Overall, 62% 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 cooking on a budget". This could possibly be delivered as part of a community cooking class programme.
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• It is also interesting to note that one third of those who want to eat more healthily, state that they would like better shops/supermarket close by. This suggests that there may also be a supply side issue locally, not just financial issues.
Healthy behaviours: physical activity
• Physical activity levels appear to be well above the national average amongst respondents although 1 in 10 of World's End and Cremorne residents still do not undertake any physical activity (of at least 30 minutes). The high levels of reported physical activity are being driven mainly by female residents and, surprisingly, those aged over 45 years.
• Despite high levels of physical activity already, 71% of residents indicate that they would like to do more physical activity than they do currently. The largest barriers stated are work commitments and personal motivation. Personal finances are also a large factor. Awareness raising of local cost effective options that can be 'squeezed in' around other time commitments need to be implemented locally.
• Swimming and gym access would be popular additions to local amenities. Swimming would be more popular amongst families with children present, females and BME groups (23%). The appetite for affordable gym access is being driven mainly by men and those who are under 44 years.
• Spending preferences for an exercise class show that the majority of respondents are prepared to pay more than £1 for an exercise class -‐ nearly one third would pay between £2 -‐ £4.99.
Healthy behaviours: smoking and alcohol
• One quarter indicated that they are a current smoker, which is slightly higher than the
national average. The rate is highest amongst men and those with no children living in the household. Many of the residents who smoke on World's End and Cremorne are low frequency smokers.
• Although the sample size on the Cremorne estate is fairly limited, it is interesting to note that rates of smoking are much higher on the World's End estate compared with Cremorne. This may be linked to different demographic profiles in these two areas.
• Just under half of residents confirm that they currently drink alcohol, which is higher than the national average and is a potential source of concern depending on their levels of consumption (which was not asked). Just 11% of drinkers expressed a desire to reduce the amount of alcohol that they typically drink.
• Around 1 in 6 residents smoke and drink (18%), the behaviour that carries the largest health
risk. Since smoking is cited as a more significant health concern amongst smokers on the estates, promoting smoking cessation would probably be more effective than targeting alcohol consumption in the short term. Smokers also appear to be particularly mindful of their own stress levels.
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Accessing primary care services
• The vast majority of residents interviewed indicate that they would go to their GP if they were feeling ill. Consideration and usage of alternative primary care solutions is very low and awareness of these alternative methods should be promoted.
• Satisfaction levels with local GPs are high, with 36% of residents saying they are 'very satisfied'. This level of satisfaction appears to be well above the national figure and certainly higher than the average for Inner London surgeries in general. Total satisfaction levels with the local hospital and dental surgery are higher than the GP.
• Amongst the small number (1 in 10) who are unhappy with their GP, a wide range of reasons
emerge but waiting times and the perceived quality of health care professionals emerge as the main issues. Interestingly, no residents expressed dissatisfaction with the building environment itself.
Emotional wellbeing
• Overall, 65% of respondents rate their overall life satisfaction as medium or high which is someway lower than the equivalent national figure (77%). Younger residents, those with no children, and white groups are the least satisfied with their life overall.
• 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-‐bad health. This reinforces the importance of emotional wellbeing in the community.
• Just one third of respondents have low anxiety (33%), which is a very concerning result compared with the equivalent national figure (61%). Anxiety is particularly an issue for those who do not consider themselves to be in good health. Amongst those who are experiencing anxiety, the main reasons appear to be related to 'general stress', followed by finding work and other financial worries. Practical measures to address these concerns should be a priority and a welcome addition to local services.
• Residents living on the World's End Estate appear to less satisfied with their life compared with those on the Cremorne Estate. Although the number of Cremorne Estate respondents was relatively small it does suggest that positive actions need to be focussed on the World's End Estate first. Levels of anxiety however are high across both estates.
• We experimented with a tool that academics have created which is designed to measure mental wellbeing (WEMWBS)1. The overall results are below the national average. There are no noticeable differences in wellbeing scores amongst different types of residents.
1 Warwick-‐Edinburgh Mental Wellbeing Scale (WEMWBS) proforma. See Appendix C.
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• 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 World's End and Cremorne Estates. 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 World's End and Cremorne Community Champions project, part of the Tri-‐Borough Community Champions Programme2. The programme is commissioned and supported 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 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 locally-‐based volunteers trained as health ambassadors and community researchers. The World's End and Cremorne Community Champions project is hosted and delivered by Chelsea Theatre.3 The Public Health Behaviour Change team commissioned social research and marketing agency, Collaborate, to design the consultation, support the project manager, train champions, analyse the results and comment on the implications based on our wide experience of working with community engagement projects.
2 See www.communitychampionsuk.org for more information on the programme 3 See www.chelseatheatre.org.uk
Community champions
Chelsea Theatre
Social research and markemng
agency
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The World's End and Cremorne Estates are situated in the very south of the Royal Borough of Kensington and Chelsea between the King’s Road and the river Thames. The estates are characterised by residents who are socially excluded and currently exhibit very high self-‐reported limiting long-‐term illness compared with the surrounding area: Table A: Current health conditions of World's End and Cremorne Estates compared with wider area (Source: Census 2011)
Development of the study Collaborate designed and developed the survey during February 2014. It contains many pre-‐validated questions that have been shown to work reliably in national household surveys and that we have used at other local Community Champion hubs. An initial project briefing was held on 10 February, by Collaborate, to introduce the project, its approach and discuss the role of the Community Champions with the project team at Chelsea Theatre. Training workshops with the Community Champions’ team took place on 12 and 19 February, led by Collaborate, and included interactive social research training, a briefing on the general health survey and an opportunity to trial the questionnaire in a ‘safe environment’. This also provided the first opportunity to introduce the draft questionnaire and discuss this with the champions. The Community Champion volunteers and the project team subsequently had the opportunity to amend the questionnaire to bring a local relevance and agree the survey at the latter workshop. Based on the feedback received at the workshop, the questionnaire was then finalised and printed. The questionnaire is reproduced at 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 Wellbeing Scale (WEMWBS) proforma4 to ensure confidentiality and 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, t-‐shirt and blank envelopes for the surveys.
Fieldwork A total of 143 useable questionnaires were completed with residents, using a face-‐to-‐face methodology, during February -‐ April 2014. The World's End and Cremorne community champions were pivotal to the research phase by conducting 59 of the surveys. An experienced market research interviewer helped deliver a further 84 surveys. The champions were given training on
4 This is a self completion exercise. See Appendix C for more information.
World's End and Cremorne
Kensington and Chelsea
London
Day to day activity is limited a lot (16-‐64 yrs) 10% 4% 5% Self reported health (bad/very bad) 11% 5% 5%
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Market Research Society quality standards as part of their wider training in preparation for this project (as described above). Seven community champions carried out interviews depending on their amount of available time (ranging from 2 surveys to 22 surveys). 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:
• 41 in respondents' homes • 53 on street • 10 at a community event (e.g. Art of Wellness festival) • 29 at a community setting • 10 unclassified
The World's End Estate and Cremorne Estate are distinct areas with different demographic profiles (e.g. official figures show that Cremorne Estate has a higher elderly population). Respondents were eligible for interview if they were resident in one of these estates and aged 16+ years (this was slightly lower than other hubs, which have focussed on adults aged 18 years and over). World's End has a larger resident population (around 72% of combined area) and this was reflected in the achieved numbers:
• 103 on World's End estate (72% of interviews) • 40 on Cremorne estate (28% of interviews)
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 Chelsea Theatre managed the champions and fieldwork phase and also undertook the data entry of the completed surveys. The Community Champions chose an iPad mini as an incentive to encourage residents to complete the survey. The Community Champion project team administered the prize draw.
Feedback on approach and survey A study feedback session with Community Champions, Chelsea Theatre staff and a number of community workers took place at the theatre on Tuesday 15 July 2014. Of the 10 champions present, six had been engaged in the study from the beginning attending both the initial project briefing and training workshops. Four ‘new’ champions, six Chelsea Theatre staff and five community workers attended the feedback, which generated interesting debate on previous, existing and planned local activities and enabled the seeds for potential partnerships to be planted. The mixed attendance, however, did mean more detailed discussion and feedback on the project and its approach were limited so as not to disengage fellow participants. The feedback was generally positive, with the ‘original’ champions commenting that it had been an interesting project and a great experience to have received training, undertaken the survey and now listen to the findings, which they themselves had generated. The team believed their role as an interviewer had helped to raise the profile of the Community Champions’ programme amongst residents and as a corollary the champions are now better known
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across the community. This in turn has made it easier for champions to promote other relevant activities and engage further with individuals across the estates on a one-‐to-‐one basis. One champion, who had been particularly active on the survey is currently working with the local Health Trainer team to undertake a ‘whole population’ survey of the World’s End and Cremorne Estates. This door-‐to-‐door survey seeks to engage with every household on the estates and captures contact details, thoughts on local services and asks three questions taken from the Baseline Health Survey. This champion commented that she would never have been able to have undertaken such a survey if she had not have received the research training. She also commented that her experience of the Baseline Health Survey had empowered her and she now felt able and more confident to carry out a door-‐to-‐door survey. Interestingly, this one community champion avoided door-‐to-‐door surveying for the Health Survey as she felt “nervous and scared”, however as she reflected on this now she found this amusing. One suggestion from her was to encourage door-‐to-‐door interviewing more when working with future hubs on the Baseline Health Survey, however she believed that a shorter ‘snapshot’ survey would be more manageable for champions new to research and interviewing.
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 our data, which we can see is highly representative, particularly in relation to ethnicity. We note that younger residents and males were slightly under-‐represented. Overall however a broad mix of residents were interviewed therefore meaning that it is not necessary to calibrate the results (this process is sometimes referred to as ‘weighting’). Table B: Achieved sample compared with target quotas
Number achieved
Percentage Actual percentage1 (Census 2011)
Male 51 36% 45% Female 92 64% 55% 16-‐29 years 20 14% 23% 30-‐44 years 43 30% 26% 45-‐64 years 43 30% 32% 65 years and over 37 26% 20% White British/Irish/European/Other 75 53% 53% Black/Black British 24 17% 10% Asian/Asian British 15 11% 16%
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All 143 completed questionnaires were electronically captured by Community Champions. 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 143 means that the results are reasonably reliable. There are 2,206 adults currently living on the World's End and Cremorne Estates, our sample has a margin of error of around +/-‐ 8% points. This means that if 50% of respondents to our survey said they were satisfied with a health service, for example, if the survey were conducted again the value could lie anywhere between 42% and 58%. 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 (except where the text makes this explicit). Observed differences in the report narrative have not been tested for statistical significance. 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.
Mixed/Dual Heritage 7 5% 8% Other ethnicity 20 14% 13%
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3. Findings The results of the survey are presented throughout this section by theme. Where possible, results from the World's End and Cremorne Estates 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 World's End and Cremorne Estates’ 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, 60% of World's End and Cremorne Estates respondents think that their health is either ‘very good’ or ‘good’ (Fig. 1). 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: 143
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 and shows a very stable picture. Between 1993 and 2012, 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 therefore say that levels of self-‐reported health are significantly lower on the World's End and Cremorne Estates compared with the national average (this difference has been tested statistically).
Very good, 17%
Good, 43%
Fair, 27%
Bad, 8%
Very bad, 6%
World’s End and Cremorne (n=143)
Very good/Good: 60%
Very good/Good: 76%
National data (n=8,341)
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This is even more concerning given that previous studies have shown that respondents can provide 'socially desirable' answers to questions of this nature5. Therefore, the real number of people who consider themselves to have poor health may actually be higher. A recent study conducted on the White City estate6 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 things. The table below allows us to understand how different types of residents 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 less likely to say that their health is either very good or good. For instance, 67% of 18-‐44 year olds said their health was 'Very good/Good' (Total Good), compared with just 55% of those aged 45 years and over.
Table 1: Variations around self-‐reported health in general (Q1)
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 most common association is regular exercise or being generally fit/active (56%) followed by eating a balanced diet (45%). Having a positive attitude or outlook is also mentioned by around one quarter of residents (28%). The avoidance of harmful substances or avoiding certain behaviours was mentioned far less. Just 1 in 10 residents associate not smoking, not eating junk food, or not drinking alcohol as a main factor in being healthy (8%, 10% and 10% respectively). Smoking prevalence and alcohol consumption are discussed further in Section 3.2. These associations have implications for the design of local materials and interventions. Local residents are most likely to respond positively to public health messages promoting a fit and active lifestyle and eating a balanced diet rather than those that promote the avoidance of harmful substances.
5 Derek L. Phillips and Kevin J. Clancy (1972) Some Effects of Social Desirability in Survey Studies, American Journal of Sociology, Vol. 77, No. 5
6 Stothard, Penny (2012) Understanding Child Oral Health on White City, NHS North West London, June 2012
Very good Total good Base: Male 22% 63% 51 Female 15% 59% 92 16-‐44 years 21% 67% 63 45 and over 15% 55% 80 White 17% 63% 75 BME 17% 58% 66 No children present in h/hold 20% 56% 90 1 or more children present 13% 68% 53
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Figure 2: Self-‐definition of 'being healthy' (Q3) Total base: 143
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)
22%
2%
5%
6%
8%
8%
8%
10%
10%
14%
15%
15%
28%
45%
56%
Other
Taking vitamin supplements
Limiting/reducing prescription drugs
Not taking illegal/non prescribed drugs
Weight (not too fat/not too thin)
Getting five fruit/veg a day
Not smoking
Not eating junk food
Not drinking alcohol (excessively)
Getting enough sleep
Avoiding illness/injuries
Having enough energy
Having a positive attitude/healthy mind
Eating a balanced diet
Regular exercise / being fit and active
• Regular exercise (55%) • Eamng a balanced diet (47%) • Posimve astude (29%) • Having enough energy (17%)
Those who consider health as very good/good (n=86)
• Regular exercise (58%) • Eamng a balanced diet (44%) • Posimve astude (26%) • Avoiding illness (16%)
Those who consider health as very bad/bad/fair (n=57)
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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. 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). The options presented to residents for this question is slightly different to that used at previous Community Champions hubs as feedback suggested that earlier versions were too long/complex for residents to answer; mental health and stress were also shown as separate items for the first time. Stress is considered the most significant health issue for all residents (31%). This is particularly the case amongst those who are not in good health (44% of those). Not doing enough exercise and losing weight are the next largest concerns for all residents, selected by 25% and 20% of residents respectively. Amongst those who are not in good health, lung/heart conditions and mental health are also important concerns. 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: blood pressure (n=5) and arthritis (n=2).
16%
0%
4%
7%
9%
12%
12%
18%
21%
18%
16%
19%
28%
44%
12%
0%
1%
3%
7%
8%
8%
10%
14%
15%
15%
20%
25%
31%
Other
Post-‐natal depression
Substance misuse
Drinking too much alcohol
Diabetes
Cancer
Smoking
Mental health
Lung or heart condimons
Health eamng
Looking auer your teeth
Losing weight
Not doing enough exercise
Stress
All (n=143)
Those not in good health (n=57)
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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. World's End and Cremorne Estates residents were asked about their personal fruit and vegetable consumption. The average (mean) number of portions consumed on a typical weekday is 3.7 portions. Fig. 5 shows the full results for this question and highlights that around two-‐thirds of residents are not meeting the Government's five-‐a-‐day target. This is around the same as national estimates (see below) and is therefore not a particular cause of alarm; 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: 141
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 rather looser, self-‐defined question asked in our study.
2%
8%
19%
28%
11%
17%
4%
10%
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. Table 2: Variations around fruit and vegetable consumption (Q4)
There is little difference in fruit and vegetable consumption according to the gender or age of World's End and Cremorne residents (Table 2). There is a small suggestion that White residents (39% meet the 5 a day target) may be more successful at including fruit and vegetables in their diet compared with BME groups (25%) although this difference is not statistically conclusive. The importance of fruit and vegetable consumption therefore needs to be promoted to all groups. 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 who claim to consume five or more portions a day are more likely to report that their own health is good (70%) compared with those who do not eat the recommended number of portions (57%). Figure 6: Relationship between fruit/vegetable consumption (Q4) and self reported health (Q1)
70%
57%
30%
43%
5 or more fruit/veg pormons (n=44) 1-‐4 pormons fruit/veg (n=94)
Very good/good health
Fair/bad/very bad current health
Percentage who meet the 5-‐a-‐day target
Ave. number of portions a day
Base:
Male 33% 3.6 48 Female 31% 3.8 90 16-‐44 years 30% 3.5 61 45 and over 34% 3.9 77 White 39% 3.9 72 BME 25% 3.5 64 No children present in h/hold 33% 3.8 85 1 or more children present 30% 3.6 53
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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, 62% of World's End and Cremorne respondents 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. 8 overleaf). The primary factors are connected to finances: well over half of those who say they want to eat more healthily, suggest that cheaper fresh food would help them (55%) and over one-‐third say it would help if they had more money (36%). 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".
It is also interesting to note that one third of residents of those who want to eat more healthily, state that they would like better shops/supermarket close by. This suggests that there may also be a supply side issue locally, not just financial issues.
26%
27%
27%
30%
33%
33%
34%
45%
60%
63%
64%
79%
Convenience in preparamon
Availability in the shops I can usually get to
Impact on the community where food comes from fair trade / suppormng local farms and industries.
Habit or roumne
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
Eamng 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 7% 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,
62%
No, would not like to, 35%
Don't know, 3%
15%
18%
20%
24%
34%
36%
55%
Local cooking classes
Better labelling of foods
Advice from doctor/nurse
More time to cook
Better shops/supermarkets nearby
If I had more money
If fresh food was cheaper
What would help you? (Base: 88)
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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 World's End and Cremorne Estates residents (59%) meet the recommended target of 30 minutes of moderate-‐intensity physical activity for 5 or more days a week. Around one in ten World's End and Cremorne residents do not undertake any physical activity for at least 30 minutes (9%).
Figure 9a: Participation in moderate intensity (Q7a) physical activity Valid base: 137
Levels of vigorous intensity activity and sports are lower; just 7% of adults undertake vigorous activity five times a week, and around one third undertake it less frequently (1-‐4 times a day). 58%
At least five times a week for 30 mins,
59%
1-‐4 times a week for minimum 30 minutes, 31%
No moderate intensity activity ,
9%
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, World's End and Cremorne residents reported that they
undertake moderate activity on 4.7 days a week
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, World's End and Cremorne residents reported that they
undertake vigorous activity on 1.2 days a week
21 | P a g e
therefore do no vigorous activity in a typical week and the benefits of this form of exercise need to be better communicated. Figure 9b: Participation in vigorous intensity (Q7b) physical activity Valid base: 134
Overall, however, physical activity levels appear to actually exceed 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 World's End and Cremorne residents recorded moderate and vigorous activity separately, 67% of our respondents are meeting the recommended target level on the estates Figure 9c: Summary of physical activity levels and comparison to national figures
At least five times a week for 30 mins ,
7%
1-‐4 times a week for minimum 30 minutes, 35%No vigorous activity
for 30 minutes, 58%
World's End / Cremorne
5 days of moderate intensity: 59%
At least 150 minutes of either moderate or
vigorous acmvity: 67%
Na_onal Moderate acmvity for 30 mins, five days a week:
34%
Na_onal Meets weekly guidelines
(moderate or vigorous level) for 150 mins:
61%
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The high levels of reported physical activity are being driven mainly by female residents (65%) and those aged over 45 years (63%) who are more likely to meet the target for physical activity than others. The age finding is particularly interesting as this is in contrast to the national figures which indicate that physical activity decreases with age, particularly after the age of 55 years. The difference disappears however when we take vigorous intensity activity into account too. Table 3: Variations in those undertaking moderate intensity physical activity (Q7a)
Despite high levels of physical activity already, 71% of respondents indicate that they would like to do more physical activity than they do currently (Fig. 10). These residents are more likely to be those who are currently under-‐achieving the national recommendation levels (Fig. 11). Work commitments and personal motivation emerge as the largest barriers (25% of those who would like to do more). Personal finances also rate highly (24%). Awareness-‐raising of local cost-‐effective exercise options, preferably that can be 'squeezed in' around other commitments need to be implemented along with an effective 'call to action' to create motivation. Figure 10: Interest in doing more physical activity (Q8) and participation barriers (Q9) Base: 143
Yes, would like to do more
exercise/physical activity, 71%
No, would not like to, 28%
Don't know, 1%
12%
15%
15%
19%
21%
23%
24%
25%
25%
I have injuries that prevent me
I have no-‐one to exercise with
Caring for children or older people
No facilities in local area
I don't have enough leisure time
Poor health or physical limitations
I don't have enough money
Struggle to motivate myself
My work commitments
What stops you? (Base: 100)
At least 30 minutes, five times a week
Meets total minutes per week (vigorous and moderate)
Base:
Male 49% 59% 49 Female 65% 72% 88 16-‐44 years 55% 66% 62 45 and over 63% 68% 75 White 61% 72% 70 BME 57% 62% 65 No children present in h/hold 62% 67% 84 1 or more children present 55% 68% 53
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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). The most popular activity from the prompted list was swimming (20%) followed by those connected to a gym/indoor environment, such as affordable gym access (13%) and dance classes (10%). Just 6% of residents rejected any of the activities on the list, reflecting the high interest in undertaking sport and exercise in this community.
Figure 12: Main sorts of exercise or physical activities that interest World's End and Cremorne residents (Q10) Base 142 -‐ items of 8% or more
Of those doing 5 days of acmvity for 30 minutes
Of those doing zero days of acmvity a week Of those doing
1-‐4 days of acmvity for 30 minutes
Swimming 20%
Affordable gym access 13%
Dance classes 10%
Women only fitness 10%
Fitness classes in the community 9%
Team sports e.g. basketball, football 8%
Gardening 8%
None of the above 6%
85%
88%
60%
Say they want to do more
physical activity
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Swimming and gym access would attract different types of residents. The results in Table 4 below illustrate that appetite for affordable gym access is being driven mainly by men (18%), and those who are under 44 years (21 %). Swimming appears to be more popular amongst families with children present (25% selected this), females (22%) and BME groups (23%). Table 4: Variations in interest levels for selected types of physical exercise (Q10)
A follow-‐up question asked residents how much they would be prepared to pay to attend a 1-‐hour exercise class (Fig. 13). The results suggest that the majority of residents are prepared to pay more than £1 for an exercise class (72% of those who are prepared to pay something). Nearly one third would pay between £2 -‐ £4.99. Just 15% stated that they would not be interested in this resource (mainly males, white respondents and those aged 45 years and over). Figure 13: Willingness to pay for a 1-‐hour exercise class (Q10a) Base 136 (those who answered this question)
15%13%
29%
32%
12%
Not interested in exercise classes
Less than £1 £1 -‐ £1.99 £2 -‐ £4.99 £5 or more
Swimming Affordable gym access
Base:
Male 16% 18% 50 Female 22% 11% 92 16-‐44 years 17% 21% 63 45 and over 21% 8% 79 White 17% 13% 74 BME 23% 11% 66 No children present in h/hold 17% 12% 89 1 or more children present 25% 15% 53
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The table below illustrates that spending preferences are varied across demographic groups. White residents and females appear to have a higher tolerance for payment, with 41% and 34% respectively saying they would pay £2 -‐ £4.99 for a class. Families living with 1 or more children also have a higher propensity (46%) to pay slightly more (£2 -‐ £4.99) than those with no children (23%). Table 5: Variations in amount prepared to pay for 1-‐hour class (Q10a) (based on those who answered this 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 cancers7. Overall, three-‐quarters of World's End and Cremorne Estates’ respondents stated they do not smoke cigarettes or chew tobacco or shisha (Fig. 14 overleaf). Therefore, 25% indicated that they are a current smoker, which is just slightly higher than the national average (20%). 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. Of the residents who smoke on World's End and Cremorne, many are low frequency smokers, which is classified as under 10 cigarettes per day (10 out of 32 residents) but around one-‐fifth are smoking 20 cigarettes or more on a daily basis (6 out of 32 residents).
7 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 12% 22% 27% 49 Female 13% 32% 34% 87 16-‐44 years 15% 29% 37% 62 45 and over 11% 28% 27% 74 White 4% 23% 41% 69 BME 20% 34% 23% 65 No children present in h/hold 8% 28% 23% 86 1 or more children present 20% 30% 46% 50
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Figure 14: Whether resident currently smokes cigarettes or shisha, or chews tobacco (Q11) and frequency (Q12) Valid base: 142
Although the sample size on the Cremorne Estate is fairly limited, it is interesting to note that rates of smoking in the sample are much higher on the World's End Estate (29%) compared with Cremorne (15%). This may be linked to different demographic profiles in these two areas. Smoking is more prevalent on the World's End and Cremorne Estates amongst men (32%) and those with no children present in the household (28%). This gender finding is more pronounced than the national picture (namely, 22% of all men report smoking, compared with 18% of women). Table 6: Variations around cigarette/shisha smoking and chewing (Q11)
Currently smokes, 25%
Does not smoke, 75%
Under 5 cigarettes,
3 5 to 9 cigarettes,
7
10 to 19 cigarettes,
16
20 or more
cigarettes, 6
Frequency of smoking, per day (n=32) absolute numbers
3 residents stated that they chew pan or betel
6 residents stated that they smoke shisha (weekly)
Current smoker Base: Male 32% 50 Female 22% 92 16-‐44 years 25% 63 45 and over 25% 79 White 26% 74 BME 24% 66 No children present in h/hold 28% 89 1 or more children present 21% 53
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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 depression8. Consumption frequency, availability and the pricing of alcohol continue to be significant public policy areas of interest. Just under half of World's End and Cremorne Estate residents confirm that they currently drink alcohol (Fig. 15). Direct national comparisons are difficult but appear to suggest that consumption levels on the estates are fairly high. 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. There was insufficient time in the World's End and Cremorne 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. However just 7 people (representing 11%) expressed a desire to reduce the amount of alcohol that they typically drink.
Figure 15: Whether resident currently drinks alcohol (Q13) and propensity to reduce alcohol consumption (Q14) Valid base: 140
8 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, 46%No, do not drink,
54%
Yes, 11%
No, 89%
Would like to reduce amount (n=64)
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3.2.6 The impact of smoking and alcohol consumption A small but significant proportion of World's End and Cremorne Estates’ respondents report that they currently smoke and drink alcohol. Overall, around 1 in 6 residents smoke and drink (18%). 1 in 3 residents only drink alcohol and 46% of residents consume neither. This is validated by academic studies in the US,9 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 mortality10. Figure 16: Cross over between reporting of smoking (Q11) and drinking alcohol (Q13) amongst all respondents Valid base: 140
We examined earlier in Section 3.1.3, the extent to which residents have particular health concerns; stress, not doing enough exercise and losing weight are the most significant issue for all residents. Examining these results according to whether the resident is dependent on tobacco or alcohol reveals a different pattern (Fig. 17).
Stress is particularly an issue cited by smokers (42% state this is a concern for them). Smoking itself is a large health concern amongst smokers (31%) compared with those who drink alcohol (12%) and the general World's End and Cremorne population (8% -‐ not shown). There is no such equivalent pattern amongst drinkers, which reflects the finding in Fig. 15 that a small number of drinkers
9 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 10 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
7% 29%
Smokes cigarettes or shisha Drinks alcohol
Both
18%
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express a desire to reduce the amount of alcohol that they typically drink. This could be because residents who reported that they drink alcohol are only doing so infrequently and do not therefore perceive this to be a health risk. Additional insights into alcohol consumption would be needed to understand this more fully.
Figure 17: Health issues and concerns (Q2) according to those who report smoking (n=36) or drinking alcohol (n=65)
3%
5%
12%
15%
11%
15%
14%
8%
20%
22%
12%
35%
3%
6%
6%
8%
8%
8%
11%
14%
17%
28%
31%
42%
Substance missue
Diabetes
Losing weight
Lung or heart condimons
Mental health
Cancer
Healthy eamng
Drinking too much alcohol
Looking auer teeth
Not doing enough exercise
Smoking
Stress
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 segmentation11 have been developed to better understand people's health behaviours and motivations, including their likelihood of attending the GP. The majority of World's End and Cremorne Estates residents (70%) 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). In some senses, 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.12
Figure 18: Where would you go if you were feeling ill/non emergency health situation? (Q15) Valid base: 142
Consideration and usage of alternative primary care solutions is very low. Only 1% of residents would use a Walk-‐In Centre. The other results shown in Fig. 18 clearly indicate that other channels of advice are very low in terms of consideration e.g. only 2% chose NHS Direct, now known as the NHS 111 service, as a source and 6% would chose a pharmacist. Awareness of these alternative
11 Department of Health (2011) The Healthy Foundations Lifestage Segmentation 12 Tod AM. Craven J. (2006) Diagnostic delay in lung cancer: Barriers and facilitators in delay.
2%
6%
9%
70%
NHS Direct (phone)
Pharmacy
Hospital/A&E
GP surgery
Other responses:
Friends / family 3%NHS Choices website 1%
Walk-‐in or Urgent Care Centre 1%Self medication 1%Books/journals 0%
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methods should be promoted. A London-‐based campaign, which could be considered for the area include ‘Not always A&E’13 and the national campaign ‘Choose Well’.14
3.3.2 Satisfaction with local services Satisfaction levels with local GPs are high. Nearly half of residents are 'very satisfied' (46%) and a further 36% are fairly satisfied (total satisfaction 82%). 1 in 10 residents are however dissatisfied with their GP (11%). This level of satisfaction appears to be well above the national figure and higher than the average for Inner London surgeries in general (Fig. 20 overleaf). Total satisfaction levels with the local hospital and dental surgery are similar (85% and 83% respectively). These levels of performance are 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 (136), hospital (124), dentist (120)
13 Not always A&E (2012), initiated by NHS ONEL http://www.notalwaysaande.co.uk 14 Choose Well (2010) http://www.nhsdirect.nhs.uk/About/WhatIsNHSDirect/ChooseWell
5% 7% 5% 6% 6%
2%
7% 5% 7%
36% 26% 36%
46% 57% 49%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
GP Denmst Hospital
Very samsfied
Fairly samsfied
Neither
Fairly dissamsfied
Very dissamsfied
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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)
Attitudes towards GP services differs across the population. Extreme satisfaction with GP services is higher amongst those aged 45 years and over on the estates (Table 7). This is a common feature also highlighted by Ipsos-‐MORI who used Place Survey data from across the country to highlight the factors which are useful in confirming differences in the perceptions of health services15. White groups are also slightly less likely to say they are satisfied with their GP (76%). Our findings also show that those who consider themselves to be in very good/good health are more likely (89%) to be satisfied with their GP service than those who are not in good health (fair/bad/very bad) (73%). This could be because those who are in better health have less reason to visit the GP practice. Table 7: Variations in satisfaction with the local GP service (Q16A)
15 Duffy, B and Lee Chan, D. 'People Perceptions and Place' August 2009 (Ipsos MORI)
GP (family doctor) 82% local samsfacmon
Namonal: 77% Inner London: 67%
Hospital 85% local samsfacmon
Namonal: 65% Inner London: 57%
Den_st 84% local samsfacmon
Namonal: 54% Inner London: 40%
Very satisfied Total satisfied Base: Male 43% 85% 47 Female 48% 81% 89 16-‐44 years 41% 83% 59 45 and over 51% 82% 77 White 44% 76% 71 BME 48% 89% 63 No children present in h/hold 51% 83% 86 1 or more children present 38% 82% 50 Currently in good health (self report) 55% 89% 80 Not in good health (self report) 34% 73% 56
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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 regardless of the rating they had given the service at Q16. Sample sizes are limited but waiting times and the perceived quality of health care professionals emerge as the main issues. Interestingly, no residents expressed dissatisfaction with the building environment itself.
Figure 21: Reasons for being unhappy with your GP (Q17)
As we saw in Fig 19. on the World's End and Cremorne Estates, 13% are dissatisfied with their local dentist. Again, we see a range of issues mentioned as reasons for this (Fig. 22) but with more of an emphasis on the quality of the service/advice received from the dental practitioners.
Figure 22: Reasons for being unhappy with your dentist (Q17)
GP service -‐ all patients who expressed a view (n=17)
• Waiting times too long (n=8) • Poor quality of health professionals (n=5) • Don't always see same doctor (n=3) • Distance (n=1) • Time takes to get an appointment (n=1) • Short amount of time with doctor (n=1) • The way the staff talk to me (n=1)
Dentist service -‐ all patients who expressed a view (n=18)
• Poor quality of health professionals (n=8) • The way the staff talk to me (n=4) • Expense (n=2) • Waiting times too long (n=1) • Inconvenient opening times (n=1) • Short amount of time with doctor (n=1) • Difficulty to make an appointment (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 community 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. 23 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 23: Individual wellbeing measures 2012/13-‐national scores from Annual Population Survey16
16 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 samsfied are you with your life nowdays?
77% Namonal 64% World's End &
Cremorne
Overall, to what extent do you feel that the things you do in your life
are worthwhile?
81% Namonal
Overall, how happy did you feel yesterday?
72% Namonal
Overall, how anxious did you feel yesterday?
61% Namonal 33% World's End & Cremorne
Low anxiety
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Overall, 65% of World's End and Cremorne residents rate their overall life satisfaction as medium or high (classified as a score of between 7-‐10). This is lower than the equivalent national figure (77%). The average World's End and Cremorne resident rated their satisfaction with life overall as 7.2 out of 10 (slightly lower than national average which is 7.5 for adults aged over 16). Fig. 24 illustrates the variation in wellbeing scores that were collected from residents. We can also observe a minor relationship between this measure of wellbeing and self-‐reported levels of personal health from earlier in the survey (see Section 3.1.1). Residents who define their personal health as either 'Very good' or 'Good' are more likely to be satisfied with their life (average: 7.7 out of 10) compared with those who are in fair-‐ bad health (average: 6.4). Figure 24: Satisfaction with overall life nowadays (Q18) Valid base: 143
Residents aged over 45 years of age report having a higher life satisfaction, reflecting the face that age differences are common at national level17. However, those with at least one child present in the household also report having higher levels of life satisfaction (76%) compared with those with no children (58%). White residents are less satisfied with their life overall than BME groups. Residents living on the World's End Estate appear to be less satisfied with their life (61%) compared with those on the Cremorne Estate (73%). Although we cannot be sure of this difference because the number of Cremorne Estate respondents was relatively small (n=40) it does suggest that positive actions need to be focussed on the World's End Estate first.
17 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)
0.0
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 fair/poor healthAverage: 6.4
Least satisfied
Completely satisfied
Cumulative pe
rcen
tage
All respondentsAverage: 7.2
Those in very good/good health
Average: 7.7
36 | P a g e
Table 8: Variations in life satisfaction (Q18) – proportion of medium/high level and mean scores
3.4.2 Feeling of anxiety Overall, just 33% of World's End and Cremorne residents have low anxiety, which is defined as providing a score of 0-‐3 on a scale of 0-‐10. This is a very poor result compared with the equivalent national figure (61%). Fig. 25 below illustrates that there appears to be a correlation between feeling anxious and the perception of residents' own health; those who consider themselves to be in good health are less likely to say that they felt anxious. Figure 25: How anxious did you feel yesterday (Q19) Valid base: 142
There is little variation in anxiety levels according to demographic sub-‐groups (Table 9). Although the proportion of white residents saying they have low anxiety levels is smaller than amongst BME groups, the average mean score is around the same. Unlike life satisfaction, there are also no
0.0
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 fair/poor healthAverage: 5.5
Not anxious
Very anxious
Cumulative pe
rcen
tage
All respondentsAverage: 4.9
Those in very good/good health
Average: 4.5
Satisfied with life Mean score Base: Male 61% 7.2 51 Female 66% 7.1 92 16-‐44 years 70% 7.3 63 45 and over 60% 7.0 80 White 61% 6.9 75 BME 68% 7.6 66 No children present in h/hold 58% 7.1 90 1 or more children present 76% 7.3 53
37 | P a g e
differences between World's End Estate and Cremorne Estate residents (both 33%). Therefore a universal campaign aimed at addressing anxiety levels needs to be considered. Table 9: Variations in life satisfaction (Q18) – proportion of medium/high level and mean scores
Fig. 26 presents the main reasons selected by residents who had indicated that they had been feeling some anxiety. The most frequent option by far was 'general stress' (41%) followed by finding work (24%) and other financial worries (23%). Figure 26: Reasons for being concerned lately (Q20) Base: (Those who answered 5 or higher to Q19) n=82
13%
2%
4%
10%
12%
16%
16%
18%
20%
23%
24%
41%
Other
Childcare costs
None of the above
Being on my own/isolamon
Mental health issues
Paying my rent
Condimon of housing
Changes to benefits
Job security
Other financial worries
Finding work
General stress
Low anxiety Mean score Base: Male 30% 4.8 50 Female 35% 5.0 92 16-‐44 years 31% 5.2 62 45 and over 35% 4.7 80 White 31% 5.0 75 BME 37% 4.8 65 No children present in h/hold 35% 4.8 90 1 or more children present 30% 5.1 53
38 | P a g e
3.4.3 Mental wellbeing Mental wellbeing consists of positive psychological functioning, satisfaction with life, happiness, fulfilment, enjoyment and resilience in the face of hardship18. 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 functioning19. Due to the sensitive/personal nature of some of the questions, residents were offered the opportunity of filling in the WEMWBS questions on a self-‐completion sheet, which was not seen by the interviewer. We received 115 WEMWBS sheets suitable for analysis. The results are presented below in Fig. 27. Figure 27: Warwick-‐Edinburgh Mental Well-‐being Scale results (Q21) Valid base: 115
18 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. 19 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.
0.02
0.00
0.26
0.40
0.06
0.10
0.01
0.09
-‐0.07
-‐0.71
0.14
-‐0.41
0.17
0.07I’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: 50.0National population: 52.3
Item scored lower than average
Item scored higher than average
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The overall average score for the test amongst World's End and Cremorne residents was 50.0. The Health Survey for England has started including this test on its national survey and the average across the country is higher (52.3) suggesting that the sense of wellbeing is slightly lower on the estates.
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 loved'. Table 10 shows that there are no noticeable differences in wellbeing scores amongst different types of residents. However, there is a suggestion that wellbeing is lower amongst World's End Estate residents, compared with those on Cremorne Estate (although the number of surveys completed here was relatively small). Table 10: Variations in wellbeing scores (Q21) Caution around low base sizes should be taken
Average WEMWBS score
Base:
Male 49.8 39 Female 50.1 76 16-‐44 years 49.7 53 45 and over 50.2 62 White 49.8 58 BME 50.1 57 World's End estate 49.5 78 Cremorne estate 50.9 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 study:
• Emotional health • Smoking • Healthy eating • Physical activities • Other There are obvious overlaps across these broad themes and each is intrinsically linked. Priorities for action Emotional health
Overall 65% of respondents rated their overall life satisfaction as medium or high, which is someway lower than the equivalent national figure (77%). Younger residents, those with no children, and white groups are the least satisfied with their life overall.
Anxiety is particularly an issue for those who do not consider themselves to be in good health. This reinforces the link between health and emotional wellbeing. Amongst those experiencing anxiety, the main reasons appear to be related to ‘general stress’, followed by finding work and other financial worries.
These findings suggest it would be worthwhile working closely with the Behaviour Change team within the Tri-‐borough Public Health Service to explore ways to promote mental wellbeing across the community. Happiness DIY workshops20 or other approaches to mental and emotional wellbeing, could be explored by the World’s End and Cremorne Community Champions’ team for their community. Any approach adopted should aim to provide practical advice and information to participants to help reduce both the physical and psychological impact of stress, increase resilience, and build durable personal resources.
Chelsea Theatre is already working closely with West London Action for Children (WLAC)21, which offers a range of counseling and therapy services for children in need and their families in Kensington and Chelsea and neighbouring boroughs. Working in partnership with Chelsea Theatre, WLAC facilitates groups for both parents and children and includes sessions such as Breathing Space, a mindfulness-‐based stress reduction group for parents; and Parent Play, a 10 session-‐long training course for parents of young children who wish to learn play therapy skills so as to support their children’s development and strengthen the parent-‐child relationship.
20 www.welllondon.org.uk/35/diy-‐happiness.html 21 www.wlac.org.uk
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The unique relationship between the World’s End and Cremorne Community Champions and the Chelsea Theatre also places the team in a strong position to be able to explore the use of the performing arts to support emotional wellbeing. An example of this is ‘Sing to Live’, which brings together people of all ages in a community choir. This is helping to boost confidence amongst members and share enjoyment with others from the community.
A number of Community Champions feel passionate that their involvement in the Community Champions’ programme to date has helped to reduce their own isolation, boost their own confidence and offer them tangible training and volunteer experience. Continuous promotion of the Community Champions’ project on the World’s End and Cremorne Estates is needed to communicate the benefits of becoming a champion. Promotion across the estates through their champion outreach programme, within the Chelsea Theatre and in publications, together with personal testimonies from existing Community Champions would help to widen access to the programme for more residents.
The findings suggest that there may be a number of residents struggling to manage their household budgets.
The Your Credit Union22 operates on the World’s End Estate and facilitates a regular pop-‐up session every Friday between noon and 3pm at the TMO’s Offices. It would be worthwhile for the Community Champion team to enter discussions with Credit Union staff to explore promoting the Credit Union to the champions so that they are more aware as to the role credit unions play and how they can support residents in both saving and accessing affordable finance. Once the Community Champions understand more about the Credit Union they could then help to promote the service to residents as part of their wider outreach work and signpost interested residents to the weekly pop-‐up session.
Consideration should be given to include an article on the Credit Union in a future edition of Community Champions’ NEWS so as to support the Credit Union in promoting the service more widely to local people, as well as promotion on the Community Champions and Chelsea Theatre websites and within the theatre building itself.
Financial workshops delivered in partnership with the local Citizen’s Advice Bureau, the Neighbourhood Advice Centre based on World’s End or local Credit Union could be considered. An editorial piece, written in collaboration with the CAB or other local advice organisation, in the next edition of the newsletter World's End and Cremorne NEWS, may also be a consideration to help provide information and promote services to residents.
There may be scope for the World's End and Cremorne champions to receive training from the CAB or similar providers to develop a programme of community outreach and signposting across the estates to address this area and support the needs of the local community e.g. training from Lloyds Money Mentors Training scheme to enable Champions to deliver money advice sessions.
Money for Life23 is Lloyds Banking Group’s award-‐winning personal money management programme targeted at young people and adults. As part of this programme, Money Mentors is a two-‐day course that gives college staff and community workers the knowledge and mentoring skills required to offer one-‐to-‐one money management support. Money for Life Challenge is a national competition that provides £500 grants for teams of 16 to 24 year olds to run a project to improve money management skills in their communities. This may be something for any younger Community
22 www.yourcu.co.uk 23 See www.moneyforlifeprogramme.org.uk
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Champions to consider or a way for Champions to engage with younger residents. The most inspiring and impactful projects progress to the National Finals.
The World's End and Cremorne Community Champions host regular weekly coffee mornings that aim to address problems associated with isolation. Health professionals are also invited to discuss health issues with residents. Broadening the invitation to other professionals including those that could support residents psychologically and financially might be worth consideration. A representative from the Credit Union could also be invited to attend the coffee morning to promote the scheme to attendees.
Events or activities associated with Mental Health Awareness Week and Mental Health Awareness Day e.g. pamper sessions have empowered participants to help address issues of stress and anxiety through massage techniques and essential oils.
Finding work is also a cause of anxiety for residents. Chelsea Theatre is currently addressing this by hosting careers’ advice sessions and IT and CV writing courses on their premises. To ensure greater awareness and sustained attendance, the Community Champions could look to add this course to their signposting activities and again look to promote this in future publications and general communications.
Smoking Just over one quarter of respondents indicated that they are a current smoker, which is slightly higher than the national average. The rate is highest amongst men and those with no children living in the household. Despite them being low frequency smokers, it should be noted that smoking is the single greatest cause of preventable illness and premature death in the UK, with an estimated 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 delivered on the estates, and in particular targeted at the White community, where local prevalence is higher. Partnership work with the Kensington and Chelsea Stop Smoking Service25, should be established with a view to increasing campaign and promotional activity on the World's End and Cremorne Estates where possible. With the appropriate training and support, the local community champions could assist the Stop Smoking team to increase their profile amongst residents to deliver stop smoking messages and signpost smokers to local support. Activity should target men on the World’s End Estate in the first instance as insight suggests smoking is more prevalent amongst this group. 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 World's End and Cremorne.
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 in March 2015, are just two examples of campaigns to target the World's End and Cremorne Estates.
The Community Champion team has already joined forces with the Kick it Stop Smoking Service to deliver a joint Stop Smoking campaign this August. The plans are in the early stages and may include
24 Peto, R., et al., Mortality from smoking in developed countries 1950-‐2005 (or later). March 2012. 25 See 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
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a campaign bus coming to the estate. It would be important to consider some of the findings from this study, particularly those which reveal that residents will be more likely to respondent to positive messages around being activity and eating healthily as this is what they equate to being healthy rather than stopping smoking. A further consideration should be that the rate of smoking is highest amongst men with no children living in the household.
Joining forces with the Health Trainer programme that supports being more active and eating more healthily could compliment the campaign well and enable the campaign message to be more upbeat and attractive to residents. Once residents are engaged, or signed up, the messages around stopping smoking could then be addressed.
In the design and delivery of any campaign or behaviour change activity, it will be important to bear in mind that local residents commonly associate ‘being healthy’ with regular exercise and being fit and active. This would suggest that residents will be more likely to respond to more positive public health messages than those that promote the avoidance of harmful substances. A phased approach which first engages residents through a positive healthy activity and then addresses smoking or drinking once they are engaged may prove to be more successful than direct smoking cessation messages.
Healthy eating
Two-‐thirds of residents are not meeting the Government's five-‐a-‐day target. This is around the same as national estimates and therefore not a particular cause for concern, however there still remains one in ten residents who are consuming just 0 to 1 portions of fruit and vegetables in a typical day. The importance of fruit and vegetable consumption needs to be promoted to all groups. The study reveals that 62% 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 primary barrier to achieving this is cost. Well over half of those who say they want to eat more healthily, suggest that cheaper fresh food would help them. Access to fresh fruit and vegetables does appear to be an issue locally. One third of those who want to eat more healthily, state that they would like better shops/supermarket close by. This suggests that there may also be a supply side issue locally, not just financial issues. The feedback session generated an interesting discussion on healthy eating and ideas for addressing this priority. Slimming clubs were discussed; ‘Weight Watchers’ or a similar group is not available locally and a number of participants believed residents would welcome such a scheme or approach. One of the Health Trainers at the session was a little wary of some of the commercial ‘clubs’ available on the market as they can favour or promote products to support weight loss. However, the Health Trainer team welcomed exploring the format of a weight loss-‐style club or group if this were popular with residents. This could be designed and delivered in collaboration with the Health Trainer team, Community Champions and other partners, which would then enable a course to be more bespoke, perhaps making it more family friendly and also addressing some of the wider issues mentioned above around access to affordable, healthy 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 such as BME groups to discuss the topic in more detail. Such a
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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 estates – ‘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 estates-‐based information campaign delivered in partnership with the Obesity team, Health Trainers and the Community Champions. Appropriate training for the Community Champions would be required around diet, achieving 5-‐a-‐day, cooking skills and information on eating fresh, frozen, tinned and dried fruits and vegetables etc.
A new pilot training package, designed collaboratively between Public Health and CLCH, will start to address increasing knowledge around some of these areas. The training will see the Nutrition and Oral Health teams coming together to work with World’s End and Cremorne champions around four themes: drinking water, as opposed to sugary drinks, oral hygiene/tooth brushing; fruit and vegetables; and label reading/portion control. Champions will be equipped with key messages and approaches to addressing these same issues with local residents.
One Community Champion hub hosted a Food and Body Programme to encourage healthy eating and cooking on a budget. Delivery of this course has empowered the Community Champions to develop the knowledge and ability to share relevant information and skills. It may be beneficial to share ideas and experiences across other hubs to explore activities and experiences for World’s End and Cremorne Estates.
Fruit and veg stores A pop-‐up fruit and veg store may address a number of issues highlighted by this study in terms of making fruit and vegetables both more affordable and more accessible to residents of the estates. As the study highlighted, one third of residents of those who want to eat more healthily state that they would like better shops/supermarket close by. Chelsea Theatre hosts a weekly pop-‐up fruit and veg market. Working to integrate the store into any classes or courses that discuss healthy eating and diet should help increase awareness of the store, guarantee more shoppers and help to promote the message that affordable, fresh, good quality produce is available locally to residents. In the neighbouring borough of Hammersmith and Fulham, the White City estate has a Pop up fruit and veg store managed by its Community Nutritionist based at Phoenix School Farm and Learning Zone. There may be opportunities for shared learning and collaborative working between initiatives in other hubs. Pop up fruit and veg stores have been successfully running for a number of years. The Community Nutritionist on White City also delivers other partnership projects to engage families including Saturday family cooking sessions and Healthy Lifestyle Lessons across local schools.
In addition to the fruit and veg store, the team may wish to consider creating an allotment plot (land permitting) to grow fresh produce for the community centre. Again, shared learnings with the Phoenix School Farm may be beneficial as fresh produce is grown and sold via the Pop up store at a community allotment by local residents and students of the school. Numerous schemes run from the farm including farm volunteering sessions, guided tours, workshops and events.
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Cook and Eat classes
Champions suggest that the Cook and Taste sessions, which are currently delivered by the Public Health team and CLCH, are ‘okay but limited in their offering and style.’ ‘Too clinical’ was also a comment on the course suggesting that a more relaxed teaching style that was creative and fun would be more appealing to local residents. The champions present at the debrief session who had attended the Cook and Taste course welcomed working in partnership with Public Health and CLCH to look at ways of building on the existing course format.
The Health Trainer team would also like to work closely with the course deliverers to consider the wider context of how to achieve a healthy diet. Shopping trips or visits to local markets where residents can engage in purchasing healthy produce at affordable prices, then returning back to the centre and being involved in preparing, cooking and eating the food exposes the participants to the full experience of healthy eating. Many still see cost and accessibility to healthy produce as a barrier. Extending the course content so as to go beyond food awareness and preparation, as well as addressing the delivery style so that the course is less of a formal, teacher-‐pupil style and more ‘TV cooking show’ format could see feedback and participation improve.
The national Cook and Eat28 classes encourage healthy eating and cooking on a budget and are tested national interventions. Lessons learned from the national Cook and Eat evaluation 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 if the format and content of the Cook and Taste classes were re-‐designed with the Community Champions and other partners. Sharing ideas with other hubs where similar programmes have been delivered could also be useful. Promotion campaigns such as Love Food Hate Waste and publishing healthy, budget-‐proof recipes in editions of World's End and Cremorne NEWS may also form part of a wider programme of interventions to address healthy eating on the estates. 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 curriculum29. From this year, 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 World's End and Cremorne 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 appear to be well above the national average although 1 in 10 of World's End and Cremorne residents do not undertake any physical activity (of at least 30 minutes). Despite
28 http://www.welllondon.org.uk/367/poplar-‐cook-‐and-‐eat-‐course.html 29 www.schoolfoodplan.com
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these high levels of activity, 71% of residents indicate that they would like to do more than they do currently. The largest barriers stated are work commitments and personal motivation. Personal finances are also a large factor. Awareness raising of local cost effective options that can be ‘squeezed in’ around other commitments need to be implemented. Evening jogging or running clubs may be of interest or promoting the activities, which take place within the Chelsea Theatre, such as dance classes.
Other community champions’ teams across the programme have started to address local concerns of lack of affordable and accessible exercise facilities by setting up a number of physical activity sessions within the local vicinity. These include a walking project, aqua aerobic classes and Sunday morning swimming, yoga, chair-‐based exercise, gym/weights and ‘Legs, bums and tums’ and Zumba dance sessions. Another hub has designed a health and wellbeing programme, which includes Kung Fu, Creative Dance, Multi-‐Sports, Capoeira, Women’s Step and Army Boot Camp Fitness.
Chelsea Theatre is already delivering a number of classes and groups including Family Yoga, African Dance and Pilates. These are inter-‐generational groups, which the champions welcome and believe helps to break down stigma or barriers for people who may not usually like to attend sessions.
Swimming and gym access appear to be the most popular desired facilities of those questioned. With this in mind, it would be pertinent to approach the Chelsea Sports Centre, just off the Kings Road, to explore affordable membership for World's End and Cremorne residents. Apparently a reduced tariff is available to residents who attend the Health Trainer programme or are referred by their GP though the GP referral scheme. The centre offers gym, exercise classes, swimming and teaching pools, football pitches and treatment room. A current refurbishment programme is underway and scheduled for completion by July 2014. Swimming is found to be popular amongst female interviewees, BME groups and families with children. It would be worthwhile bearing in mind that nearly one-‐third of respondents stated they would be prepared to pay between £2 and £4.99 for an activity session.
The champions commented at the feedback session that women-‐only swimming was sought after by residents and this should be explored. The Health Trainer team cited their difficulty to date of trying to source a local swimming venue that has the availability and appropriate layout to enable the pool to be closed or screened off for women and Muslim women-‐only swimming sessions. One local champion suggested approaching Park Walk Primary School, which has a teacher pool. They may be amenable to exploring the Health Trainer programme utilising the pool at specific times and days. Likewise, Chelsea and Westminster Hospital has a swimming pool to support physiotherapy of their patients. Again, the team could approach the hospital to explore access to the pool.
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 a World's End and Cremorne Estates 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 one-‐to-‐one sessions.
Communicating the findings from this survey to local GPs and highlighting the local appetite for greater physical activity may prompt more GPs to promote the Exercise Referral Scheme to those eligible.
Better promotion of both the Health Trainer and GP Referral Services 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
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ease the registration process for residents and help to bring the services closer to the World's End and Cremorne community.
Other
Local health services
The vast majority 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, particularly during periods of high usage such as the winter months. 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 World's End and Cremorne Community Champions’ newsletter – NEWS and via the Community Champions’ website30.
It may also be interesting to share the findings of this study with the West London Clinical Commissioning Group. Satisfaction levels with local GPs are high, with one-‐third of residents saying they are ‘very satisfied’. This is well above the national figure and certainly higher than the average for Inner London surgeries in general.
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.
30 http://communitychampionsuk.org
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5. Appendices Appendix A: Responding profile of residents
Number Percentage Male 51 36% Female 92 64% 16-‐29 years 20 14% 30-‐44 years 43 30% 45-‐64 years 43 30% 65 years and over 37 26% White British/Irish/European/Other 75 53% Black/Black British 24 17% Asian/Asian British 15 11% Mixed/Dual Heritage 7 5% Other ethnicity 20 14% 1 adult in household 54 38% 2 adults in household 58 41% 3 adults in household 24 17% 4 or more adults in household 7 5% No children aged under 8 in household 116 81% 1 child aged under 8 in household 15 10% 2 children aged under 8 in household 10 7% 3 or more children aged under 8 in h/hold 2 1% No children present in household (8-‐18yrs) 103 72% 1 child present in household (8-‐18yrs) 32 14% 2 children present in household (8-‐18yrs) 24 8% 3 children present in household (8-‐18yrs) 18 4% 4 or more children present in household (8-‐18yrs)
6 2%
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Appendix B: Questionnaire instruments World’s End and Cremorne Estates -‐ Health Attitudes Survey
Hello, my name is ____________and I am a community champion and I volunteer to help promote living healthily to local people like yourself. I’m not selling anything. I’d just like to talk to you about your health and how you feel about local health and wellbeing services. This is to help us shape and improve what happens locally on the estates for residents. Your answers are confidential and will not be shared with anyone outside of the research team. If you give a few minutes of your time, your name will automatically be entered into a prize draw for the chance to win an iPad mini! 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 World’s End and Cremorne Estates. Do you currently live in the World’s End or Cremorne? SHOWCARD A.
Yes o1 PLEASE RECORD NEIGHBOURHOOD AREA World’s End o1
No o2 CLOSE Cremorne o2
QB. Could I ask which age bracket you fall into? SHOWCARD B. SINGLE CODE
16-‐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 DEMOGRAPHICS QF. Could you tell me the total number of adults currently living in your household.
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QG. And the 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 Thank you. Let’s proceed with the survey. 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 Mental health o8
Healthy eating o2 Stress o9 Losing weight o3 Post-‐natal depression o10 Looking after your teeth o4 Cancer o11 Smoking o5 Diabetes o12 Drinking too much alcohol o6 Lung or heart conditions o13
Substance misuse o7 Other medical conditions (please specify below):
o14
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
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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 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
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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
£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 these days? 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
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B. Chew tobacco (e.g. pan/betel): per day
C. Smoke shisha: per week
Q13. Do you drink alcohol? 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) or 111 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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IF RESIDENT IS DISSATISFIED WITH A PARTICULAR SERVICE, ASK Q17: 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 life? Please answer on a scale of 0-‐10 where 0 is ‘not at all’ and 10 is ‘completely’.
Q19. Overall, how anxious have you felt lately? Please answer on the same scale as before 0-‐10. IF RESIDENT ANSWERS 5 -‐ 10 AT Q19, ASK Q20: Q20. 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 o11
Changes to Benefits o5 None of the above o12
Other financial worries o6 Other (please specify below): o13
Raising my children o7
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Q21. 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 Q22. 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 Q23. 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 an iPad mini. 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. Please write in CAPITAL LETTERS.
Name
Address, including postcode
Telephone number
Email address
I have now finished completing the survey – thank you very much for your time. Q24. INTERVIEWER: RECORD LOCATION OF INTERVIEW
At respondent’s home o1
On street o2
Community event o3 Please specify…
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Community setting o4 Please specify …..
INTERVIEWER DECLARATION: This respondent was contacted and then interviewed face-‐to-‐face according to the accompanying instructions and to the standards of the Market Research Society Code of Conduct.
Name:………………………………………………………. Signature:………………………………………… Date: ……………………………………. Duration of interview:…………………………….minutes
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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 were published on December 18th 2013 and are referenced in this report to provide national context.
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.
