Kloek 2006.

Methods	Controlled before and after study over 2 years, September 2000 to September 2002. Collaborating partners Lead agency: Municipal health. Strategic involvement (policy making and service planning): Local health planners, primary health care, social services. Commissioning (implementing strategy taking account of resources available): No evidence of additional collaboration at this level. Operational (providing services directly): Primary health care, health promotion, social services. Set in Netherlands.
Participants	Residents in deprived areas (population range 1800 ‐ 6700) in Eindhoven. 4800 residents aged 18‐65 years from three intervention areas and three control areas received a postal questionnaire at baseline. 2781 returned completed questionnaires at baseline (response rate 60%). 1929 returned questionnaires at 2 year follow‐up (69% of respondents at baseline).
Interventions	The programme "Wijkgezondheidswerk" consisted of two coalitions in the intervention areas (one coalition covered two intervention areas which bordered each other) led by the Municipal Health Services with representatives from social work, social welfare, city development department, a neighbourhood organisation representing residents, a general practitioner and researchers. Each coalition assessed the health needs of the neighbourhood to develop neighbourhood action plans related to determinants of health. Lifestyle intervention goals were focused to improve health related behaviour measured by self‐reported fruit consumption, vegetable consumption, physical activity, smoking cessation and excessive alcohol consumption. Examples of interventions include nutrition projects in primary schools, neighbourhood walking classes, gymnastic classes, quit smoking courses and large annual community events related to health.
Outcomes	Primary aim was to improve health‐related behaviours as measured by impact on fruit and vegetable consumption, physical activity, smoking and alcohol consumption. Intermediate aims were to assess health‐related knowledge, attitudes and beliefs.
Notes	No power calculation was reported. The intervention was not delivered in full. Fifty‐three activities were planned but only 43 were implemented. Some elements were delivered to children but only outcomes for adults were measured. Expensive programme to implement, so additional service could explain any improvements rather than the collaboration itself.  Overall risk of bias was high
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment (selection bias)	High risk	Not clear
Blinding (performance bias and detection bias) All outcomes	Low risk	Researchers likely to be aware of status of participants but this is unlikely to have influenced the results as measurement was through postal questionnaire.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Adequate
Selective reporting (reporting bias)	High risk	All available data appear to be presented
Other bias	High risk	Intervention was not delivered in full. Elements were delivered to children but only outcomes for adults were measured. Expensive programme to implement so additional service could explain any improvements rather than the collaboration itself.
Randomisation adequately described/protected?	High risk	Not randomised
Protection against contamination?	High risk	Assessed by authors "The process outcomes clearly showed some contamination of the comparison neighbourhoods, which is almost unavoidable because the comparison neighbourhoods were situated in the same city."
Follow‐up rate adequate?	Low risk	>60% and balanced across both arms
Reliable primary outcome measure?	High risk	Self‐reported behaviours and attitudes
Groups measured at baseline?	Low risk	Groups approximately balanced
Appropriate choice of controls (CBA studies only)?	Low risk	Yes
Contemporaneous data collection (CBA studies only)?	Low risk	Yes
IS THE STUDY AT LOW RISK OF BIAS?	High risk	OVERALL RISK OF BIAS WAS HIGH