Developed countries are experiencing high levels of mental and physical illness associated with long term health conditions, unhealthy lifestyles and an ageing population. These are interconnected issues: for example cardiovascular disease, diabetes, obesity, and drug and alcohol use are linked with common mental health problems such as anxiety and depression and, in some cases, severe mental health conditions [1]. Furthermore these issues disproportionately affect lower socio-economic groups, and significantly contribute to the widening gap in health inequalities [2].

Formal health care services have both limited capacity and ability to address the challenges of an ageing population and multiple chronic morbidities [3]. In this context attention is increasingly turning outside the formal health care sector to the role of wider civil society and, in particular, community and voluntary sector agencies in the promotion of health and well-being [4,5,6,7]. Agencies that work in community centre settings may be well placed to respond to this agenda. While their specific characteristics vary, in the context of this paper, community centres are multi-purpose organisations dedicated to the provision of services in their neighbourhood or highly local catchment area [8]. Run by community management committees, voluntary agencies or, on occasions, local government authorities, they deliver a wide range of group and individually focused activities. In recent years in the UK, many community centre-based organisations have explicitly linked their aims to the promotion of health and wellbeing through the delivery of, for example exercise, cooking, social, arts and creative activities [9]. Some primary health care providers have reciprocated with the “social prescribing” of these activities to their patients [10]. Advocates [5,11] suggest that community based organisations are well placed to offer informal and user-led activities that fit with local interests and provide additional benefits, such as a basis for developing social support networks and civic action.

However there has been limited research on the impact of such community engagement activities on health related behaviours [12,13]. A positive association between participation in community based activities and health is documented at national (e.g., [14]) and local levels (e.g., [15,16]). There is evidence of the health effects of highly structured and specified interventions in community settings that are delivered as an adjunct to healthcare services. Limits to resources often mean that these interventions need to be targeted at high risk groups and have eligibility criteria that restrict access. At a larger policy scale considerable research has been undertaken to examine the impact of area-based neighbourhood renewal and civil society programmes [17,18]. Such initiatives have built upon evidence of the links between social capital and health and are concerned with population-wide impacts—or with the impact on population segments such as socio-economically disadvantaged groups. Much of the research on health care services and area-based programmes include community-centre activities as a partial or peripheral concern. In contrast, this paper seeks to position community centre initiatives as a central focus of enquiry through the examination of a mix of community based group activities for adults [12,19].

Drawing upon a programme in the South West of England UK, the main objective of this paper is to investigate the associations between participation in community centre-based activities and the health and wellbeing of adults. It then seeks to analyse associations between specific aspects of the programme and identified outcomes. The final objective is to consider the implications of the results for the development of community centre health and wellbeing initiatives.

The South West Well-being (SWWB) programme ran from 2008–2011 and was developed and delivered by a consortium of fifteen community-based voluntary sector organisations from across the South West of England, UK. It was funded by the Big Lottery, local government and local healthcare commissioning bodies, all of whom had a role in appraising the rationale, design and quality of the programme. It also received in-kind support through volunteers. The stated aim of the programme was to “support the healthy living and well-being of individuals and communities by providing locally accessible, people-focused and holistic approaches to tackle health inequalities particularly for those people most in need” [20]. Central characteristics of the programme were:

A focus on individuals’ experiencing low level mental ill health, long term health conditions, low levels of physical activity and/or diet related ill-health. These criteria were combined with low income and/or social isolation.

One consortium organization held overall governance and commissioning accountability for the programme. Lead practitioners and agency managers met every three months to monitor and review programme delivery. In order to adopt common standards of delivery and share best practice, practitioners from all project sites attended three training sessions and translated programme-wide guidance into detailed curricula and schedules for each activity. All groups were led by practitioners with basic community development and health promotion training and were often supported by volunteers. Some group sessions were supplemented with a structured course in individual counselling or personal health goal setting. The types of activities delivered under the programme were classified into three themes—mental wellbeing, physical activity and healthy eating—according to their primary focus. The promotion of social wellbeing was often an underlying, if not central, objective for many activities. Mental wellbeing groups focused on art and craft activities and friendship-building activities. Examples included a “group textile project” to create a knitted representation of a community picnic; and a “moving-on group” that offered practitioner and peer-led advice for people who had a history of poor mental health and social isolation. Physical activity groups included a focus on gentle exercise, dance and aerobic training. Examples included a “chair exercise group” for people with mobility difficulties; and an introductory “belly dancing class”. Health eating groups focused on dietary health. Examples included a “grow and cook group” where an instructor taught recipes based upon produce from a community garden; and a “weight management group” where participants with a history of over-weight problems offered peer support alongside dietary advice from a health promotion practitioner.

Typically the group activities were scheduled as ten week blocks of two hour sessions. Within a shared framework, implementation of the programme was highly tailored to the circumstances of each community centre. Some agencies delivered the programme through multi-purpose community centres that offered health, social care, child care, housing, education, debt advice and other services. Other agencies worked through the premises of partner agencies and community groups. While the specific contexts were diverse, the activities shared a focus on higher social deprivation neighbourhoods or areas—such as rural settings—that lacked other community-based services.

A range of adult age groups participated in the South West Well-being (SWWB) project activities although there was a predominance of females and people out of employment. There was a positive set of associations between participation in community centre-based activities and the aspects of health and well-being measures that respondents reported on. The separate measures for health and psycho-social wellbeing were closely associated with one another, and there was some evidence that the impacts were associated with the focus and format of the inputs and the referral routes.

The results of the study suggest that community centre activities offer benefits that are supportive of health and well-being. A number of features of the activities may help to account for these positive changes. Centres delivering the project activities had close referral and recommendation relationships with healthcare and other partner agencies, although informal routes also played an important role in accessing the services. As Rankin et al. [11] found, the programme activities were developed to connect with locally defined interests and sought to embed activities in participants’ everyday lives. Framing activities in terms of fun, leisure, creativity and socialising—as opposed to illness prevention and the amelioration poor health—is likely to have contributed to the appeal and accessibility of the activities. There are close associations between health-related lifestyle behaviours, such as poor diet and low physical activity, which lends support to a holistic service model. It indicates that work in one area can deliver wider benefits for participants. This case is reinforced for participants where unhealthy lifestyles are compounded with low income, social isolation and other forms of social exclusion [26]. Although the results support, overall, the idea that health-related lifestyle behaviors are closely connected, some findings point to complexity in this regard. Notably the self reported reduction in fruit and vegetable intake countered the pattern of results. Sub-analysis showed that this was not the case for individuals who participated in activities with a specific focus on healthy eating. For the sample as a whole, the result may reflect baseline social approval bias of the measure. This can either be seen as a drawback in the programme design or that it reduces the strength of association between dietary and other health-related behaviours.

There are a range of implications of this study for agencies, practitioners, commissioners and researchers. Commissioners and partner agencies—particularly in the formal healthcare sector—can look to the wider health promoting role of community centres [6,27]. Generic health promoting services in a community context may act as a supplement or alternative to mainstream healthcare provision, especially where alternative approaches are absent. The multiple routes for enrolment on to community centre-based activities are likely to address unmet health needs, while the development of new and potentially supportive social networks provide local assets for health.

The study clearly demonstrates that National Health Service (NHS) and other agencies were able to connect individuals with health and social needs to project activities as part of a targeted referral or recommendation process. However, it was also evident that the services attracted adults with no professionally assessed health needs. Further research is needed to understand the benefits, drawbacks and cost-effectiveness of programmes that adopt this type of open-access approach given an argument that services may fail to reach target groups with high health needs. This raises the question of the extent to which such community centre activities are likely to narrow or widen inequalities in health outcomes and health care access. It is important to note that this study reports only the experiences of adults who enroll on to SWWB activity groups. During the study period, this was about one third of service users. Further research is needed to understand the characteristics and perspectives of individuals who have more limited contact with community centres, not least because it remains hard to interpret the significance of such contact.

The high profile of well-being in local policy making means that it will be important for members of commissioning groups to have a broad understanding of what contributes to, and impacts on, improved well-being and to extend consideration beyond more narrow conceptions of health. Activities such as those delivered through the community centres in this study have a part to play in helping shift an agenda towards the promotion of wellbeing and positive health.

The study has a number of limitations which have a bearing on the interpretation of the findings. Due to limited research funds, the study design did not employ a comparison group, which would have offered a clearer basis for determining the intervention effects. The study was only able to test associations between factors—although the further analyses examined the relationships between project inputs and their anticipated impacts. The follow-up period only captured change on completion of participation in the project activities; we were not able to undertake further data collection to explore longer term behavioural changes. Although the study focused on new entrants, a longer period of data collection might also have informed an understanding of the effects of ongoing and sporadic participation. We explored differences in format, focus and referral patterns, however the project activities were heterogeneous which meant that it was hard to identify further characteristics of the interventions that might account for the results. This is an issue arising from the research context: diverse, emergent and informal structures are defining and inherent characteristics of many community centre activities.

This study found that group-based activities in community centres are associated with improvements in the health and wellbeing of adults who experience poor health and other forms of social disadvantage. Although other relevant work exists on the behavioural effects of primary healthcare interventions and comprehensive area-based initiatives in community settings, previous research has not made community centre schemes the focus for enquiry. The South West Well-being programme illustrates an initiative that sought to deliver a community focus on promoting capacity for personal and social well-being, as opposed to the management of ill health and disease. This reflects a reorientation towards promoting healthy behaviours and well-being, and pro-active investment to avoid future ill health costs.

From a wider public health perspective, the study indicates a need for a more strategic approach to the delivery in community centre services. Although local gains can be made in the short- to medium-term, it is likely that greater benefits can come from comprehensive and coordinated commissioning of community-based wellbeing services [9]. There is also scope for greater transfer of knowledge and innovation in service delivery between community projects that have much share from their locally developed expertise.