Can Place-Based Modifications Make a Difference to Local Health Inequalities in Urban Essex: An Evaluation Protocol

Stemming from a complex picture of compositional, contextual and wider determinants, health inequalities are presented at the level in which people reside (i.e., their place). Examples of this exist within Essex, England, where despite seeming affluence, pockets of high multiple deprivation exist. Programmes delivered across the system representing each place may provide a solution to these complex challenges. For this reason, Epping Forest District Council commissioned the evaluation of a programme representing two place-based projects within their district (i.e., Limes Farm and Oakwood Hill). This paper provides the evaluation protocol for this programme. Broadly, the evaluation seeks to investigate the design, implementation, mechanisms and effectiveness of both projects. Our evaluation is underpinned by the Medical Research Council (MRC) guidelines for the design, evaluation and implementation for complex interventions, and takes inspiration from a realist approach. We aim to understand where each project works, who does the projects work for, what impact do the projects have, and how and why does the projects work. This will be achieved through a mixed-methods approach which utilises a cohort study, ripple-effects mapping, focus groups, and secondary data analysis. Quantitative data will be analysed using descriptive, general linear and multi-level models, while qualitative data will be understood using visualisation (ripple-effects maps) and reflexive thematic analysis. Data will be triangulated to create programme theory configurations, which explain the outcomes which stemming from the programme, and how these are shaped by mechanisms within a given context. We anticipate our novel and robust approach to contribute to policy surrounding the adoption and implementation of place-based approaches.