A community-based programme to reduce non-communicable disease risk among persons living in disadvantaged neighbourhoods in three European countries: protocol for a controlled trial

Abstract Background Non-communicable diseases (NCDs) are the leading cause of premature death in Europe and disproportionately affect persons experiencing disadvantages (i.e., low-income populations, migrants and ethnic minorities). The Health Outcomes from Raised Urban Settings (HORUS) evaluation study aims to implement and evaluate a community-based programme, based on the social-ecological model, to reduce key modifiable NCD risk factors. The study is performed in three European cities (Rijeka, Croatia; Rotterdam, The Netherlands, and Valencia, Spain). Methods The HORUS programme will be evaluated using a mixed-methods, controlled study design. A total of 900 participants will be recruited: 150 in the intervention group and 150 in the control group at each study site. Self-reported data will be collected at baseline (T0) and at 9-month follow-up (T1). The primary outcome measured is change in lifestyle across four domains: diet, physical activity, alcohol consumption and smoking. In addition, implementation outcomes will be assessed, including acceptability, appropriateness, feasibility, adoption, penetration, implementation costs, and sustainability. Discussion The HORUS study will generate robust evidence on the effectiveness and implementation of community-based interventions for NCD prevention targeting disadvantaged neighbourhoods. Findings will inform the development of scalable, equity-oriented strategies to promote healthier lifestyles and reduce NCD risk factors in neighbourhoods across Europe. Trial registration ISRCTN registry number is ISRCTN11383698. Date of registration is 4/8/2025. https://www.isrctn.com/ISRCTN11383698 .