BMC Public Health 2009, 9:207 http://www.biomedcentral.com/1471-2458/9/207 The third section exploring physical and non-family social environment uses questions previously administered in the RELACHs study [41] CHIP-AE and the international WHO surveys of young peoples' health (HBSC -See Currie [45]). The questions focus on social relations with peers and family, experiences of bullying, attitudes to school- work, perceptions of threat, thoughts about future pros- pects and perceptions of the local built environment. The fourth section requires adolescents to recall what they had to eat over the previous 24 hour period for breakfast, lunch, dinner and for snacks. The section is based on sim- ilar studies of food and drink in children[57]. A compre- hensive list of possible foods is provided to cue the responses. We ask questions about the context of eating and about general eating and drinking behaviours. We also ask children for their height and weight. In the fifth section adolescents are asked to recall when they have taken part in creative activities and report on where these took place – at school, home, at a local event or arts centre. Children are also asked to recall the last time they purchased art and attended art related events. These questions are drawn from a survey carried out by the Arts Council for England [30]. The final section will include questions from the RELACHs study[41], the HBSC surveys and from other fre- quently used health questionnaires. The section will ask in detail about smoking, alcohol and drug use (based on RELACHs measures see Clark[41]) but the main focus is on measuring chronic and stress-related illness. Qualitative longitudinal study in 10 intervention areas The aim of the qualitative study is to elucidate and inves- tigate the causal pathways through which Well London project activities impact on individuals. In particular, it focuses on the effectiveness of the project activities in empowering and enabling people to set goals and to achieve change in relation to the overall project objectives of increasing MH, HE and HPA. As part of this, it also aims to explore the relationships and connections between people and their environment, both physical and social. The Well London interventions are complex in the MRC sense that the 'active ingredients' are difficult to identify [58]. Springett [59] suggests that such interventions pro- duce a range of outcomes, both intentional and uninten- tional and the relationship between input and outcome is not clear-cut. Furthermore, the nature of interventions at a community level may evolve as interactions and dynam- ics in community engagement change during the project. Local environments are themselves 'complex' [60] and certain outcomes may result from mechanisms working in a specific context [61]. Therefore an evaluation should consider not only "what works for whom", but also "in what circumstances". These aspects of evaluating the Well London interventions will not be captured by the CRCT [62] and for this reason a qualitative study of individuals exposed to the Well London interventions has considera- ble potential to add depth to our understanding of their impact. Following recommendations by the MRC and others for the evaluation of complex interventions, preliminary con- ceptual modelling based on empowerment theory [63] will be used to predict how various project components may empower both individuals and communities at dif- ferent levels and in different domains, and how this will lead in turn to enhanced MH, HPA and healthier food consumption patterns. The objectives of the qualitative study are to: a) identify the processes whereby project activities impact on individ- uals; b) map how the different project components affect individuals and enable and empower people to overcome barriers to improving health behaviours; c) identify fac- tors in the social and physical environment which are per- ceived to act as barriers or supports to adopting healthier lifestyles; d) identify which aspects of the complex inter- ventions are 'active ingredients' and which are not per- ceived to be relevant and/or effective; e) examine whether some participants are more or less responsive to the inter- ventions and why this is the case; and f) investigate how these influences occur or change over time. The qualitative study will examine the interaction between changes at the individual level, such as changes in confidence, self-esteem, self-efficacy, trust, stress, sense of control, mental health, life satisfaction and wellbeing, and changes in individuals' behaviour, such as their engagement in community events or involvement in social networks, their patterns of healthy eating and phys- ical activity. These changes will be related to the wider social and physical milieu within which individuals are situated. Participants' experiences and perceptions of the project activities, including the manner in which they are delivered through consultation, perceived active ingredi- ents and barriers will be examined through semi-struc- tured interviews. The qualitative study will interview individuals in ten of the intervention areas. The interviewees will be purpo- sively selected from those participating in project activities relating to the three key goals of Well London namely HE, HPA and MH. The assumptions behind these themed projects will be mapped as suggested by 'theory of change' approaches [59]. Four to six adults in each area will be interviewed and at baseline will include matched individ- uals not participating in project activities to provide Page 7 of 11 (page number not for citation purposes)