Evaluation of the Healthy Air for Healthy Lungs Programme

Le résumé fourni par la source

The Healthy Air for Healthy Lungs Programme was a two-year, DEFRA-funded initiative delivered across the St Helens and Warrington districts (Northwest of England). The programme aimed to improve respiratory health and wellbeing by reducing exposure to poor indoor air quality (IAQ) in homes where children experienced frequent respiratory symptoms. The target group included families with children aged two to ten who had recurrent use of reliever inhalers and underlying respiratory conditions. The programme sought to raise awareness of the risks of air pollution through in-home monitoring, tailored education, and practical behavioural support. The programme was delivered in participants’ homes, where air quality monitors were installed to track indoor pollutants. Trained wellbeing staff visited households to explain the data, offer tailored advice, and support behaviour changes to reduce air pollution. Over a twelve-month period, participants received follow-ups every three months to review progress and reinforce learning. The model was later expanded to include community outreach and the provision of air purifiers or vouchers to sustain engagement. Recruitment began through general practitioner (GP) referrals but shifted to a broader community approach due to governance and data-sharing delays. The evaluation of the programme was conducted using mixed methods. The evaluation aimed to assess the extent to which it achieved its intended outcomes, and to identify the conditions that supported or hindered success. Quantitative data were gathered from air quality monitoring devices, participant questionnaires, and programme delivery records. Qualitative data were collected through in-depth interviews with families and programme staff to explore experiences, perceived impacts, and contextual learning. The evaluation also conducted a secondary analysis of programme service survey data. Plans to link evaluation data with routine NHS health records were ultimately not realised due to regulatory barriers, limiting the ability to independently verify health outcomes, though self-reported household data did provide valuable insight. The findings from the self-reported data show a mixed but largely positive impact for participating households. Although wellbeing measured by the World Health Organisation-5 did not show significant short-term change across the programme, qualitative interviews revealed that families consistently reported feeling more informed, confident, and in control of their home environments. More than half of the households interviewed described how they had gained a new understanding of the causes of poor indoor air quality and how to take practical steps to mitigate risks. The installation of air quality monitors was particularly felt to be positive as households were able to review live feedback on pollution levels in their own homes which raised awareness. This direct feedback empowered families to adopt small but meaningful behavioural changes. Families frequently described how they had altered their behaviour to improve indoor air quality. Alongside these behavioural outcomes, families also described a perceived reduction in respiratory symptoms and the need for emergency healthcare. Many parents who were interviewed reported fewer visits to GPs for asthma-related issues and less reliance on inhalers over time. Notably, these accounts were self-reported and could not be validated against NHS utilisation data. Analysis of indoor air-quality readings collected from participating households showed mixed trends across the six monitored indicators and no overall effect of the programme. For carbon dioxide (CO2), particulate matter (PM1 and PM2.5), and humidity, small but statistically significant increases over time were observed at the group level, although the size of these changes was modest and may not reflect meaningful deterioration in household environments. Temperature and volatile organic compounds (VOCs), by contrast, showed very slight downward trends, again with effects that were statistically detectable but small in magnitude. Together, these findings suggest that while indoor air-quality parameters fluctuated over the monitoring period, overall patterns of change were limited, and the data do not indicate substantial or systematic improvement or worsening across households. These results should be interpreted in light of the high variability in daily readings and the multifactorial context of the programme. Our analysis with regard to implementation processes highlighted both barriers and enablers to the successful implementation of the programme. Key challenges included difficulties establishing data-sharing agreements with health partners, which delayed recruitment and limited access to eligible families. In addition, workforce turnover, capacity constraints, and operational demands further limited the efficiency of programme delivery. In some areas, inconsistent communication reduced visibility and local ownership of the programme. Despite these challenges, several enabling factors supported effective delivery. The commitment and motivation of the delivery staff were repeatedly emphasised by families as critical to their positive experience. The relational, trust-based approach helped families engage openly and act on advice. In addition, strong leadership and collaboration between local authority teams and community partners created an environment conducive to innovation and adaptation. Our findings indicate that the programme model has potential for wider replication as an equitable, community-based approach to improving respiratory health. The analysis supports the interpretation that the intervention’s primary impact, at this stage, may be perceptual, rather than environmental. As such, the evaluation is best understood as formative, that is testing feasibility, acceptability, and mechanisms of change, rather than identifying clear causal mechanisms of effect. The evaluation resulted in eight recommendations for future programme development and research: 1. Put data-sharing and referral arrangements in place before the programme begins, so information can be shared smoothly between the programme partners, the NHS, and evaluation partners. 2. Use study designs that track change over time or compare groups (e.g., quasi experimental) to better understand whether the programme is contributing to changes in health or air quality. 3. Collect air-quality data across different seasons and housing types (e.g., older and newer builds), to help distinguish programme effects from normal day-to-day or seasonal variation. 4. Use established tools to measure behaviour change, so changes in household practices can be assessed more consistently. 5. Treat future programmes as opportunities for learning and improvement, focusing on what works, what can be refined, and how communities engage. 6. Design eligibility and recruitment criteria that can be adapted locally, allowing the programme to respond to different community needs and housing contexts. 7. Clearly define and standardise the education and support offer within the programme, combining air-quality feedback with practical, tailored advice for households. 8. Improve local visibility and ownership by aligning branding and communications across boroughs, ensuring the programme feels relevant and accessible in all areas.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.