Amanda P. Moore

Objective: This scoping review will synthesize existing evidence on oral health interventions developed for Bengali children in the UK and identify the application of behavior change frameworks to their culture. Introduction: Despite improvements in children’s oral health over the past half-century, a higher percentage of Bengali children experience dental caries than other ethnicities in the UK. Dental caries are influenced by oral health behaviors, including parental attitudes, traditional dietary practices, and cultural beliefs about teeth. Certain oral health interventions incorporate behavior change frameworks and techniques, but little is known about their application to different cultures, in particular, the Bengali culture. This scoping review will address these research gaps by synthesizing evidence on oral health interventions developed for UK-based Bengali children and their families. Eligibility criteria: This review will consider all study types presenting an oral health behavior intervention, including diet, toothbrushing, and dental service utilization, for Bengali children and their families in the UK. Interventions will be assessed for the use of behavior change frameworks, intervention target and deliverer, and cultural consideration. This review will include full-text studies from the UK only, published in English. Methods: This review will follow the JBI methodology for scoping reviews. PubMed, Embase (Ovid), CINAHL (EBSCOhost), Dentistry and Oral Sciences Source (DOSS; EBSCOhost), PsycINFO (Ovid), and the Cochrane Database of Systematic Reviews will be searched. Two reviewers will independently screen sources for eligibility. Methodological quality will be assessed using the Mixed Methods Appraisal Tool. Review registration: OSF https://osf.io/mrn27

Background: Despite strong evidence of benefit, in the UK only 40% of eligible patients are referred to Pulmonary Rehabilitation (PR) and there are poor levels of uptake and completion globally. Understanding how current interventions address reported barriers to PR referral and engagement can help understand intervention effectiveness and highlight opportunities for future policy and intervention. Methods: Two systematic reviews were conducted: 1) Review of studies reporting barriers/enablers to PR delivery and engagement behaviours, with extracted barriers/enablers inductively synthesized into themes and coded to the domains of the Theoretical Domains Framework (TDF). 2) Review of existing interventions to improve PR uptake/engagement, specifying component Behaviour Change Techniques (BCTs) using established taxonomies. Interventions were categorised for promise according to evidence of change in behaviour for one or more outcomes. Findings from both reviews were triangulated using the Theories and Techniques tool (TaTT), to assess the extent to which components in current interventions targeted key barriers/enablers. Results: Sixty-three studies were included in the analysis. Barriers and enablers to PR mainly fell under the TDF domains Environment, context and resources; Knowledge; Social Influences; Professional role and identity; and Memory, attention and decision making. There are opportunities to further support referral by considering interventions targeted at memory and decision making and by streamlining referral processes. For patient engagement with PR, the highly represented TDF domains were Environment, context and resources; Social influences; Emotions; Knowledge; and Beliefs about capabilities. Fifty-four percent of referral interventions and 15% of engagement interventions were considered very promising. BCTs in promising interventions targeting patient engagement included provision of social support and guidance on planning and goal setting. Opportunities for improving engagement include consideration of the emotional burden associated with COPD and attending PR. Conclusion: These findings can inform development of new, or refinement of existing, interventions targeting PR for people with COPD.

Background: The COVID-19 pandemic exacerbated pre-existing societal inequities. Our study addresses the dearth of studies on how intersecting factors of disadvantage and discrimination affected pandemic daily life for disabled people from minoritised ethnic groups, aiming to improve their experiences and social, health and well-being outcomes. Objectives: Through an intersectionality lens, to: explore and compare, by location and time, survey and qualitative data on changing needs for social, health and well-being outcomes relate coping strategies/solutions to these explore formal and informal network issues/affordances gain insights from synthesising our data contextualise and explore transferability of findings co-create outputs with stakeholders. Design: Mixed-methods, asset-based, underpinned by embodiment disability models and intersectionality, integrating three strands: (secondary): analysis of existing cohort/panel data, literature review (primary: quantitative): new survey (n = 4326), three times over 18 months (primary: qualitative): semistructured interviews (n = 271), interviewee co-create workshops (n = 104) 5 and 10 months later, mixed stakeholder co-design workshops (n = 30) for rapid-impact solutions to issues, key informant interviews (n = 4). Setting: United Kingdom and Republic of Ireland. Participants: Strand 2: community-dwelling migrants, White British comparators, with/without disability. Strand 3: focus on Arab, South Asian, African, Central/East European, or White British heritage with/without disability. Results: We found strong adherence to pandemic restrictions (where accommodation, economic situations and disability allowed) due to COVID-19 vulnerabilities. High vaccine hesitancy (despite eventual uptake) resulted from side-effect concerns and (mis)trust in the government. Many relied on food banks, local organisations, communities and informal networks. Pandemic-related income loss was common, particularly affecting undocumented migrants. Participants reported a crisis in mental health care, non-holistic social and housing care, and inaccessible, poor-quality and discriminatory remote health/social care. They preferred private care (which they could not easily afford), community or self-help online support. Lower socioeconomic status, mental health and mobility issues reduced well-being. Individual and community assets and coping strategies mitigated some issues, adapted over different pandemic phases, and focused on empowerment, self-reflection, self-care and social connectivity. Technology needs cut across these. Limitations: We could not explore area-level social distancing and infection rates. Data collection was largely online, possibly excluding some older, digitally deprived or more disabled participants. Participants engaged differently in online and face-to-face co-create workshops. Our qualitative data over-represent England and South Asian people and use contestable categories. Conclusions: Different intersecting factors led to different experiences, with low socioeconomic status particularly significant. Overall, disability and minoritised ethnic identities led to worse pandemic experiences. Our co-design work shows how to build on the assets and strengths; simple changes in professional communication and understanding should improve experience. Minoritised groups can easily be involved in policy and practice decision-making, reducing marginalisation, with better сare and outcomes. Future work: More research is needed on: (1) the impact of the post-pandemic economic situation and migration policies on migrant mental health/well-being; (2) supporting empowerment strategies across disadvantaged intersecting identities; and (3) technological deprivation and the cultural and disability-relevant acceptability of remote consultations. We found some differences in the devolved nations, which need elucidation. Study registration: This study is registered as ISRCTN40370, PROSPERO CRD42021262590 and CRD42022355254. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR132914) and is published in full in Health and Social Care Delivery Research; Vol. 13, No. 2. See the NIHR Funding and Awards website for further award information.

Dietary acculturation is a dynamic and complex process and poorly understood. Studies demonstrate that these changes can have short- and long-term health consequences for migrants globally. This chapter describes dietary changes related to migration and the subsequent health consequences associated with them. This chapter also covers aspects of dietary changes related to globalisation, including the increased consumption of processed foods, which have a high content of calories, saturated fat, sugar, and salt. Global consumption of processed foods has been associated with poor diet and obesity, which have a significant impact on global public health.

Objectives: The incidence of type 2 diabetes in UK Black African and Caribbean communities is up to three times higher than in the general population, and engagement with self-management advice is poorer. This study explores the perspective of those living with diabetes to understand how the cultural salience of advice could be improved. Design: Participants were recruited via community venues, faith institutions and primary care. Eight focus groups were conducted with 41 individuals (Black African n = 23, Black Caribbean n = 18). Grounded theory methods were used for analysis. Results: Although motivated to manage the condition, individuals experienced a misalignment between elements of the care provision and cultural norms. Explanatory models of diabetes differed from the biomedical model reducing trust in treatment protocols. A lack of cultural salience reduced the accessibility of advice. Furthermore, elements of self-management advice were seen to conflict directly with some cultural traditions and practices. Individuals had to reconcile the two perspectives in order to proceed with self-management, often prioritising cultural norms and advice from informal sources over healthcare advice. Building personal relationships with the healthcare team improved trust and engagement. Conclusion: Findings suggest the needs in these communities were not being fully met. The healthcare interaction was pivotal in improving trust and engagement and reducing misinformation. However, appropriately informed community support also offers the potential to mitigate misalignment and to improve equity of access.

Pregnant women with metabolic risk factors are at high risk of complications. We aimed to assess whether a Mediterranean-style diet reduces adverse pregnancy outcomes in high-risk women. We conducted a multicentre randomised trial in 5 maternity units (4 in London and 1 in Birmingham) between 12 September 2014 and 29 February 2016. We randomised inner-city pregnant women with metabolic risk factors (obesity, chronic hypertension, or hypertriglyceridaemia) to a Mediterranean-style diet with high intake of nuts, extra virgin olive oil, fruits, vegetables, nonrefined grains, and legumes; moderate to high consumption of fish; low to moderate intake of poultry and dairy products; low intake of red and processed meat; and avoidance of sugary drinks, fast food, and food rich in animal fat versus usual care. Participants received individualised dietary advice at 18, 20, and 28 weeks’ gestation. The primary endpoints were composite maternal (gestational diabetes or preeclampsia) and composite offspring (stillbirth, small for gestational age, or admission to neonatal care unit) outcomes prioritised by a Delphi survey. We used an intention-to-treat (ITT) analysis with multivariable models and identified the stratification variables and prognostic factors a priori. We screened 7,950 and randomised 1,252 women. Baseline data were available for 593 women in the intervention (93.3% follow-up, 553/593) and 612 in the control (95.6% follow-up, 585/612) groups. Over a quarter of randomised women were primigravida (330/1,205; 27%), 60% (729/1,205) were of Black or Asian ethnicity, and 69% (836/1,205) were obese. Women in the intervention arm consumed more nuts (70.1% versus 22.9%; adjusted odds ratio [aOR] 6.8, 95% confidence interval [CI] 4.3–10.6, p ≤ 0.001) and extra virgin olive oil (93.2% versus 49.0%; aOR 32.2, 95% CI 16.0–64.6, p ≤ 0.001) than controls; increased their intake of fish (p < 0.001), white meat (p < 0.001), and pulses (p = 0.05); and reduced their intake of red meat (p < 0.001), butter, margarine, and cream (p < 0.001). There was no significant reduction in the composite maternal (22.8% versus 28.6%; aOR 0.76, 95% CI 0.56–1.03, p = 0.08) or composite offspring (17.3% versus 20.9%; aOR 0.79, 95% CI 0.58–1.08, p = 0.14) outcomes. There was an apparent reduction in the odds of gestational diabetes by 35% (aOR 0.65, 95% CI 0.47–0.91, p = 0.01) but not in other individual components of the composite outcomes. Mothers gained less gestational weight (mean 6.8 versus 8.3 kg; adjusted difference −1.2 Kg, 95% CI −2.2 to −0.2, p = 0.03) with intervention versus control. There was no difference in any of the other maternal and offspring complications between both groups. When we pooled findings from the Effect of Simple, Targeted Diet in Pregnant Women With Metabolic Risk Factors on Pregnancy Outcomes (ESTEEM) trial with similar trials using random effects meta-analysis, we observed a significant reduction in gestational diabetes (odds ratio [OR] 0.67, 95% CI 0.53–0.84, I² = 0%), with no heterogeneity (2 trials, 2,397 women). The study’s limitations include the use of participant reported tools for adherence to the intervention instead of objective biomarkers. A simple, individualised, Mediterranean-style diet in pregnancy did not reduce the overall risk of adverse maternal and offspring complications but has the potential to reduce gestational weight gain and the risk of gestational diabetes. ClinicalTrials.gov NCT02218931.

Purpose of review: Accurate assessment of dietary intake in interventional trials is the key to evaluate changes in dietary behaviour and compliance. We evaluated the use of dietary assessment tools in randomized trials on diet-based interventions in pregnancy by a systematic review.Recent findings: We updated our previous search (until January 2012) on trials of diet and lifestyle interventions in pregnancy using Medline and EMBASE up to December 2015. Two independent reviewers undertook study selection and data extraction. We assessed the characteristics of dietary assessment tools, the timing and frequency of use and any validation undertaken.Two-thirds (39/58, 67%) of the included studies used some form of tools to assess dietary intake. Multiple days’ food diaries were the most commonly used (23/39, 59%). Three studies (3/39, 8%) validated the used tools in a pregnant population. Three studies (3/39, 8%) prespecified the criteria for adherence to the intervention. The use of dietary assessment tools was not associated with study quality, year of publication, journal impact factor, type of journal and the study sample size.Summary: Although self-reporting dietary assessment tools are widely used in interventional dietary trials in pregnancy, the quality and applicability of existing tools are low.