***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Well London is a multicomponent community engagement and coproduction programme design ed to improve the health of Londoners living in socioeconomically deprived neighbourhoods . To evaluate outcomes of the Well London interventions , a cluster r and omised trial ( CRT ) was conducted that included a longitudinal qualitative component , which is reported here . The aim is to explore in depth the nature of the benefits to residents and the processes by which these were achieved . Methods The 1-year longitudinal qualitative study was nested within the CRT . Purposive sampling was used to select three intervention neighbourhoods in London and 61 individuals within these neighbourhoods . The interventions comprised activities focused on : healthy eating , physical exercise and mental health and well-being . Interviews were conducted at the inception and following completion of the Well London interventions to establish both if and how they had participated . Transcripts of the interviews were coded and analysed using Nvivo . Results Positive benefits relating to the formal outcomes of the CRT were reported , but only among those who participated in project activities . The extent of benefits experienced was influenced by factors relating to the physical and social characteristics of each neighbourhood . The highest levels of change occurred in the presence of : ( 1 ) social cohesion , not only pre-existing but also as facilitated by Well London activities ; ( 2 ) personal and collective agency ; ( 3 ) involvement and support of external organisations . Where the physical and social environment remained unchanged , there was less participation and fewer benefits . Conclusions These findings show interaction between participation , well-being and agency , social interactions and cohesion and that this modulated any benefits described . Pathways to change were thus complex and variable , but personal well-being and local social cohesion emerged as important mediators of change Background We report the main results , among adults , of a cluster-r and omised-trial of Well London , a community-engagement programme  promoting healthy eating , physical activity and mental well-being in deprived neighbourhoods . The hypothesis was that benefits would be neighbourhood-wide , and not restricted to intervention participants . The trial was part of a multicomponent process/ outcome evaluation which included non-experimental components ( self-reported behaviour change amongst participants , case studies and evaluations of individual projects ) which suggested health , well-being and social benefits to participants . Methods Twenty matched pairs of neighbourhoods in London were r and omised to intervention/control condition . Primary outcomes ( five portions fruit/vegetables/day ; 5 × 30 m of moderate intensity physical activity/week , abnormal General Health Question naire (GHQ)-12 score and Warwick – Edinburgh Mental Well-being Scale ( WEMWBS ) score ) were measured by postintervention question naire survey , among 3986 adults in a r and om sample of households across neighbourhoods . Results There was no evidence of impact on primary outcomes : healthy eating ( relative risk [ RR ] 1.04 , 95 % CI 0.93 to 1.17 ) ; physical activity ( RR:1.01 , 95 % CI 0.88 to 1.16 ) ; abnormal GHQ12 ( RR:1.15 , 95 % CI 0.84 to 1.61 ) ; WEMWBS ( mean difference [ MD ] : −1.52 , 95 % CI −3.93 to 0.88 ) . There was evidence of impact on some secondary outcomes : reducing unhealthy eating-score ( MD : −0.14 , 95 % CI −0.02 to 0.27 ) and increased perception that people in the neighbourhood pulled together ( RR : 1.92 , 95 % CI 1.12 to 3.29 ) . Conclusions The trial findings do not provide evidence supporting the conclusion of non-experimental components of the evaluation that intervention improved health behaviours , well-being and social outcomes . Low participation rates and population churn likely compromised any impact of the intervention . Imprecise estimation of outcomes and sampling bias may also have influenced findings . There is a need for greater investment in refining such programmes before implementation ; new methods to underst and , longitudinally different pathways residents take through such interventions and their outcomes , and new theories of change that apply to each pathway Purpose . To present an evaluation of a 5-year , community-based , chronic disease prevention project managed by a state health department to determine whether the department could replicate similar previous projects that had received more funding and other re sources . Design . The evaluation used a matched comparison design and a review of archive and interview data . Setting . Florence , South Carolina ( population : 56,240 ) . Subjects . A r and om sample of 1642 persons in Florence ( and 1551 in the comparison ) who responded to a risk factor question naire and underwent a physical assessment ; 70 . 7 % of baseline subjects participated in the postintervention . Forty key persons were interviewed concerning project effectiveness . Interventions by Project . Walk-a-thons , a speakers ' bureau , media messages , restaurant food labeling , and cooking seminars .  More than 31,000 participants were involved in 585 activities . Measures . Question naires focused on hypertension , obesity , high cholesterol , smoking , and exercise . Physical assessment s determined lipid , lipoprotein , apolipoprotein , and blood pressure levels . Analysis of covariance was used for baseline and postintervention comparisons . Content analysis was used on archive and interview data . Results . The project had a slightly favorable intervention effect on cholesterol and smoking , but failed to have an effect on other risk factors for cardiovascular disease . The project influenced community awareness , enlisted influential community members , and fostered linkages among local health services . Conclusions . Health departments can be instrumental in community risk reduction programming ; however , they may not replicate projects having greater re sources Background Second-h and smoke ( SHS ) in households remains a serious public health problem in Sri Lanka , partly due to a lack of voluntary prohibitions of tobacco smoking inside houses . Women are especially at risk of being exposed . Effective community based interventions to reduce the SHS in households targeting women is scarce . The objective of this study was to examine the impact of a multi-component intervention on household SHS exposure among Sri Lankan women . Methods Thirty clusters of 25 women ( aged 18–65 ) from 750 households were r and omized into the intervention and control groups . Women in the intervention group were exposed to activities which focused on improving knowledge on the health effects of SHS , attitudes towards SHS exposure , right to a smoke-free living and women empowerment against smoking . The duration of the intervention was six months . The comparison group received no intervention . The primary outcome of interest was self-reported SHS exposure in the household within 7 days prior to data collection . The secondary outcomes were exposure in the past 30 days , knowledge of the health risks of exposure , attitudes towards exposure , right to smoke-free living , women empowerment against smoking , and smoking inside the homes . Results Final assessment was in 329 ( 89.6 % ) in the intervention group and 309 ( 85.8 % ) in the comparison group . Following the intervention , significantly lower proportion of women in the intervention group as compared to the control group reported SHS exposure in their households within 7-days ( 9.2 % vs. 15.3 % , p = 0.02 ) and 30-days ( 13.6 % vs. 21.6 % , p = 0.008 ) prior to the post survey . As compared to the control group , significantly higher median scores were observed in the intervention group on the knowledge of the health risks of exposure to SHS ( p < 0.001 ) , attitudes on exposure to SHS ( p = 0.004 ) , right to smoke free living ( p = 0.001 ) and women empowerment ( p < 0.001 ) . Conclusion Multi-component intervention activities were effective in reducing household exposure to SHS among women . Trial registration Sri Lanka Clinical Trials Registry SLCTR/2014/033 OBJECTIVE The objective of this paper is to evaluate the behavioural effects , as reported by the parents of the participating boys and girls , of the IDEFICS ( Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS ) intervention . METHODS The effectiveness of the IDEFICS intervention was evaluated through a cluster-controlled trial in eight European countries ( control and intervention communities in each country ) including more than 16,000 children . The 2- to 9.9-year-old children in the intervention group were exposed to a culturally adapted intervention that aim ed to prevent childhood obesity through the community , schools/kindergartens and family . Parents completed question naires to measure  water , soft drink and fruit juice intake ; fruit and vegetable intake ; daily TV viewing and other sedentary behaviours ; daily physical activity levels and strengthening of the parent-child relationships at baseline and follow-up ( 2 years later ) . Mixed models with an additional r and om effect for country were used to account for the clustered study design , and results were stratified by sex . RESULTS The pan-European analysis revealed no significant time by condition interaction effects , neither for boys nor girls , i.e. the analysis revealed no intervention effects on the behaviours of the IDEFICS children as reported by their parents ( F = 0.0 to 3.3 , all p > 0.05 ) . Also very few significance s were found in the country-specific analyses . Positive intervention effects were only found for sport club participation in Swedish boys , for screen time in weekends for Spanish boys and for TV viewing in Belgian girls . CONCLUSION Although no expected intervention effects as reported by the parents on diet , physical activity and sedentary behaviours could be shown for the overall IDEFICS cohort , a few favourable intervention effects were found on specific behaviours in some individual countries . More in-depth analyses of the process evaluation data are needed to obtain more insight into the relationship between the level of exposure to the intervention and its effect OBJECTIVE The present study was conducted to determine the impact of a community-based intervention on the nutritional behaviour of a representative sample of Iranian adults . DESIGN The Isfahan Healthy Heart Programme ( IHHP ) , a six-year , action-oriented , integrated community-based study aim ed at health promotion through the reduction of CVD risk factors , targeted the whole population living in two intervention cities , and compared outcomes with the population of a non-intervention city considered as reference . Dietary interventions were performed as educational , environmental and /or legislative strategies . A global dietary index ( GDI ) was calculated representing the general dietary behaviour . In addition , two consumption indices were calculated for specific food groups , i.e. meat products and major sources of fat . Univariate AVOVA was conducted to evaluate the impact of the intervention on dietary behaviours . SETTING Isfahan and Najaf-Abad ( intervention cities ) and Arak ( reference city ) , central Iran . SUBJECTS The baseline survey was conducted among 12514 r and omly selected adults aged > or = 19 years in both intervention and reference areas . The survey was repeated annually among about 5000 persons ( 2002 - 2005 ) in the intervention and reference communities . RESULTS According to significant year x group interactions in mean fat consumption index ( FCI ) and meat consumption index ( MCI ) in the total population , a significant improvement in FCI and MCI was found in the intervention areas v. the reference area ( P < 0.001 ) . In addition , the GDI improved significantly in the intervention areas v. the reference area ( P < 0.001 ) . CONCLUSIONS The IHHP interventions were effective in improving dietary behaviours at the population level . The highest effectiveness was documented in the change in the type of fat consumed . Such simple and integrated interventions can be adopted in other developing countries with limited financial re sources OBJECTIVE To determine whether a health-promotion intervention increases South African men 's adherence to physical-activity guidelines . METHOD We utilized a cluster-r and omized controlled trial design . Eligible clusters , residential neighborhoods near East London , South Africa , were matched in pairs . Within r and omly selected pairs , neighborhoods were r and omized to theory-based , culturally congruent health-promotion intervention encouraging physical activity or attention-matched HIV/STI risk-reduction control intervention .  Men residing in the neighborhoods and reporting coitus in the previous 3 months were eligible . Primary outcome was self-reported individual-level adherence to physical-activity guidelines averaged over 6-month and 12-month post-intervention assessment s. Data were collected in 2007 - 2010 . Data collectors , but not facilitators or participants , were blind to group assignment . RESULTS Primary outcome intention-to-treat analysis included 22 of 22 clusters and 537 of 572 men in the health-promotion intervention  and 22 of 22 clusters and 569 of 609 men in the attention-control intervention .  Model-estimated probability of meeting physical-activity guidelines was 51.0 % in the health-promotion intervention and 44.7 % in attention-matched control ( OR=1.34 ; 95 % CI , 1.09 - 1.63 ) , adjusting for baseline prevalence and clustering from 44 neighborhoods . CONCLUSION A theory-based culturally congruent intervention increased South African men 's self-reported physical activity , a key contributor to deaths from non-communicable diseases in South Africa . TRIAL REGISTRATION Clinical Trials.gov Identifier : NCT01490359 Citizen participation in neighbourhood development is one way to promote public health and contribute to the well-being of individuals . However , some people participate while others do not . This study examines the individual characteristics of people who during the past 2 years have participated in a neighbourhood development process  compared with potential and non- participants . Socio-demographic factors , perceptions and behaviour were analysed in a cross-sectional study . A question naire was answered by 1160 r and omly chosen citizens over the age of 18 who lived in three Swedish cities . The most important single 
    Output:
    
Large-scale community-based health promotion programs , however , often result ed in limited or missing population -wide changes .
Our results confirm that community-based interventions are promising for health promotion and disease prevention but so far their potential is not fully realized .