The Specific Objectives (S.O.) have been established as follows:
S.O. 1: To estimate the impact of specific interventions modifying the urban built environment on diabetes and cardiovascular diseases and to identify and measure the association between the characteristics of the urban environment and NCD risk behaviours
Firstly, the project aims to estimate the impact of different types of interventions modifying the urban built environment – e.g. creation of green areas, provision of exercise facilities, improvement of walkability of streets-, as well as their functional characteristics, on the spatio-temporal incidence of NCDs. It also aims to identify and measure the association of the prevalence of NCD risk behaviours with the physical-social and functional characteristics of the urban environment – e.g. population density, connectivity and walkability of the street layout, accessibility and availability of facilities- by clustering neighbourhoods into different categories according to benchmark criteria. This first stage of the project is set in a natural experimentation framework, as it is based on a retrospective observational analysis of the impact of different urban interventions on territorial units for which the experimental assignment is exogenous. This objective is aligned with the work proposed for WP2.
S.O.2: To analyse in depth the behavioural causal links driving the association between NCDs and urban built environment through the exploration of different casuistries related to the relationship of the neighbours with their urban environment & S.O.3. To understand the enablers and barriers for vulnerable populations to engage with the urban physical environment
The following stage of the project will build on the findings obtained in the previous one and will focus specifically on exploring what ecological and individual variables facilitate a causal association between the urban environment and NCD risk behaviours. Thus, the interim results of the project will be discussed in the framework of a mixed participatory approach based on GIS-supported Qualitative Research.
The participatory sessions will be articulated through the collection and presentation of project results in an interactive web application, and will aim to find plausible causal links explaining the identified associations between urban environment and health oriented behaviour, based on available theory and evidence on place-driven behaviour.
This objective is aligned with the work proposed for WP3 and will address together with S.O.1 (WP2) one of the main expected outcomes of the topic: to provide public health managers and authorities access to improved insights and evidence on the NCDs caused or impacted by city environments and which factors influence the implementation of preventive actions that address risk behaviours in concerned city populations
S.O.4. To implement interventions focused on empowering citizens, especially among those vulnerable or socially disadvantaged, to improve their relationship with the urban environment in such a way that behaviours decreasing the risk of NCDs are adopted & S.O.5. To promote the use of the urban environment by citizens through behavioural change interventions.
A specific pilot implementation strategy will be deployed to foster behavioural changes towards healthier lifestyles addressing the NCDs risk factors, especially those related to diabetes and cardiovascular diseases, in urban settings. A longitudinal cohort of 900 people in 3 countries (regions, municipalities) (Spain, Croatia and The Netherlands) will be involved in a pre- vs. post-intervention study design. HORUS will work to involve in the pilot studies the following vulnerable target groups: low-income communities, migrants and ethnic minorities. The pilot interventions on behavioural change will be supported by the use of ICTs to promote healthy choices around lifestyles through an urban social network app. The development of WP4 will fulfil these specific objectives which will also address the following expected outcome of the topic: Adopting an implementation science approach to Associated with document studying interventions in different city contexts, researchers, clinicians and authorities have an improved understanding how specific interventions can be better adapted to different city environments and how the interventions could be scaled within and across cities taking into account specific social, political, economic and cultural contexts’.
S.O.6. To provide evidence on the effectiveness of interventions empowering citizens, especially those vulnerable or socially disadvantaged, to engage with the urban environment by adopting behaviours that decrease the risk of NCDs & S.O.7. To provide evidence on city planning criteria to prevent the adoption of NCD risk behaviours by the population.
The evaluation will include an effectiveness analysis of the pilots interventions guided by realist evaluation, as well as graphical analysis of the continuous series gathered from the Wakamola social network activity in the pilots. All data collected will be broken down by gender and age. The final results of the project will be collaboratively discussed and validated by different local stakeholders, in order to prepare policy recommendations providing criteria for the effective design and planning of interventions aimed at achieving positive public health effects. As a cross-cutting feature, the project will incorporate citizen science elements in all stages of implementation. These two specific objectives will be achieved through the completion of WP5 on evaluation and WP6 on dissemination, exploitation and policy recommendations. Its successful achievement will respond to the following topic outcomes:
Health care practitioners and providers in high-income countries (HICs) serving vulnerable populations have access to and use specific guidelines to implement health interventions that decrease risk factors of noncommunicable diseases (NCDs) associated with city environments; Adopting an implementation science approach to studying interventions in different city contexts, researchers, clinicians and authorities have an improved understanding how specific interventions can be better adapted to different city environments and how the interventions could be scaled within and across cities taking into account specific social, political, economic and cultural contexts and Communities, local stakeholders and authorities are fully engaged in implementing and taking up individual and/or structural level interventions and thus contribute to deliver better health.