Stronger Together: a community-based intervention using Behaviour Change Wheel to promote healthier lifestyles among women with low socioeconomic status: a feasibility study

Socioeconomic status (SES) significantly influences individuals’ health behaviours and outcomes. Women with lower income levels show a higher prevalence of non-communicable diseases. Community-based interventions can improve health behaviours, but such programmes are scarce in Saudi Arabia. This highlights the need for research on the feasibility and preliminary outcomes of these approaches for women with low SES. To address this gap, we evaluated the feasibility of the Stronger Together program, a community-based behaviour change intervention specifically aimed at this demographic. The Stronger Together program was a single-arm feasibility study conducted at AlNahda Society in Riyadh, Saudi Arabia. The five-week intervention included two-hour weekly face-to-face sessions and daily virtual support. We evaluated the feasibility of our recruitment criteria regarding screening and enrolment, intervention completion rate, and attendance and engagement with the intervention. The study was not powered to detect effectiveness; however, we measured the potential efficacy of the program on health outcomes, including weight, dietary behaviour, physical activity, mental health, and quality of life at baseline, post-intervention, and one month later. Statistical analyses included descriptive statistics for baseline characteristics, the Friedman test to compare outcomes across time points, and post-hoc Wilcoxon signed-rank tests. Statistical significance was set at p < .05, and the overall effect size was reported using Kendall’s W. Out of the 70 eligible participants identified by AlNahda society and invited to join the program, 49 attended the introductory session, and 41 agreed to participate. The adherence rates in the weekly sessions ranged from 85% to 93%. At follow-up, 38 participants (93%) completed both the post-intervention and one-month follow-ups. Engagement with the virtual support was strong during the first three weeks, as most participants regularly posted. However, engagement declined during the fourth and fifth weeks of the intervention. The intervention demonstrated preliminary improvements in target behaviours, diet, and physical activity, and resulted in positive changes in weight, mental health, and quality of life. Participants in the obesity group experienced weight reductions, decreasing by 0.7 kg post-intervention and 2.6 kg at one month (p = .003, r = .86). Median daily fruit portions rose from 0.11 to 0.85 (p < .001, r = .60). The mental health (K6) score decreased by 5 points from a median of 10 to 5, and 6 points to 4 at follow-up, both significant with large effects (p < .001, r = .71 and p < .001, r = .75). Activity levels increased immediately post-intervention, with walking rising significantly (p = .010, r = .35) and MET-minutes/week increasing substantially (p < .001, r = .61). This study demonstrated that a community-based intervention aimed at low-income women is feasible and showed preliminary evidence of positive changes in health-related outcomes. This indicates the need for further investigation in a larger, randomised, controlled trial with longer follow-up to evaluate the sustainability of behavioural change and associated health outcomes.