Zeibeda Sattar

Background: South Asian Muslim (SAM) communities remain significantly underserved by mainstream drug and alcohol (D&A) recovery services in England. Cultural and religious misalignment in service design creates structural barriers to engagement. Family members from SAM communities who support individuals with substance use disorders have identified structural, cultural, and religious barriers that hinder engagement with mainstream treatment services. This study builds on this body of evidence by working with service providers, commissioners and community stakeholders through participatory co-production to examine how these barriers can be addressed. Methods: Three participatory co-production workshops were held over a 12-week period. Data were also generated from a field visit to a culturally adapted recovery service and a content analysis of an Islamically adapted 12-step recovery workbook. Participants included commissioners, service providers, community ambassadors and service users (total n = 42 across three workshops; some participants attended more than one workshop). Results: Four interconnected themes that shaped recovery engagement were identified: (1) stigma and izzat operating as a collective structural risk management system; (2) confidentiality functioning as a precondition for engagement rather than a by-product of it; (3) service design, space and visibility as determinants of access; and (4) co-construction of religiously coherent recovery pathways. Low engagement among participants reflected rational risk management, in response to real social consequences, rather than cultural resistance. Conclusions: Findings suggest that inclusive recovery systems may benefit from the adaptation of mainstream services rather than the creation of parallel provision. Six evidence-based design principles are proposed for commissioners and service providers. Findings contribute to the evidence base for equitable health, culturally responsive D&A intervention design and have relevance beyond SAM communities to other marginalised faith communities across England.

This article examines British Muslim school children’s (BMSC’s) food practices and preferences, focusing on halal meal availability in grant-maintained schools. These schools should comply with the school food standards (SFS). This article addresses a research and policy gap on religious dietary inclusion in schools. Using a participatory action research design, 27 participants (19 children and eight parents) from South Asian backgrounds co-designed visual methods (drawing, ranking and recipe creation) to address the research aims. A public involvement and community engagement group shaped the study from inception to dissemination. Thematic analysis identified three themes: (1) religious dietary requirements and school food consumption behaviour; (2) intergenerational preferences and food identity; and (3) food improvements and menu design. BMSC choose vegetarian foods to comply with religious beliefs, given limited halal options. While schools comply with the SFS, limited options exist for religious and cultural inclusion. Findings highlight how participatory methods amplify minority voices and inform inclusive policies. The article argues for mandatory inclusive school food policies rather than current optional policies that contribute to food inequity. We propose the equitable provision of both halal and non-halal options for BMSC, and parents felt that halal provision would promote greater choice, equity and inclusivity. It positions food provision as a religious right and social justice issue under the Equality Act 2010. Further work should explore equitable school meal provision.

Loneliness is a public health issue. This study examines loneliness among older South Asian and Chinese adults, focussing on cultural barriers and shared risk factors. It explores perceptions of these population who face distinctive challenges exacerbated by health inequalities. The intervention incorporated social activities delivered by a third sector organisation to mitigate loneliness among these distinct groups with different religions, migration histories and cultural practices. Methods: A qualitative design, featured semi-structured interviews and focus groups with 28 participants from Northeast England. Activities included exercise, bingo, educational initiatives, and local trips. Data collected over 2023-2024 thematically analysed. Aims and objectives: To understand older South Asian and Chinese people’s perceptions of culturally, religiously and linguistically tailored social activities designed to reduce loneliness. Results: Using a socio-ecological framework, four themes emerged: coping with loneliness; cultural relevance and belonging; health and practical barriers shaping engagement, health benefits of social activities; and ageing, frailty and independence concerns. Participants reported that culturally tailored interventions reduced loneliness by improving emotional, physical and educational wellbeing. Data highlighted how culture, religion and language intersect with ageing, health and social participation. Discussion and conclusion: Culturally tailored activities effectively mitigated loneliness and supported positive health outcomes among older South Asian and Chinese participants. Bilingual staff significantly facilitated engagement. Findings suggest inclusive ageing policies may reduce frailty and dependency risks in these under-researched ethnic minority groups. Future research should explore specific community needs and transfer lessons to other minority ethnic ageing populations.

Despite growing recognition of drug and alcohol (D&A) use as a public health concern, carers from South Asian and Muslim (SAM) communities in the UK remain largely invisible. This article explores how stigma, emotional pressures and faith-based prohibitions shape SAM carers’ experiences of supporting individuals with problematic D&A use, with a culturally informed approach. A qualitative study recruited eight carers, two practitioners and two community ambassadors in two UK regions during July 2023–January 2024. Carers supported individuals whose substance use they identified as problematic, describing patterns consistent with the classification of mental and behavioural disorders in the tenth version of the International Classification of Diseases, though formal verification was not obtained, as this would have excluded ‘hidden carers’. Recognising that SAM frameworks define any use as problematic (lower thresholds than clinical criteria), we used reflexive, community-led sampling. Semi-structured interviews with participatory research group members identified three themes: faith, stigma and silence; social and psychological impacts on SAM families; and religious and cultural barriers to addressing D&A use. Most carers rely on informal networks for support due to a lack of awareness of mainstream services and religious institutions not equipped to address their needs relating to problematic D&A use. Definitional mismatches between cultural (any use is problematic) and clinical frameworks (specific diagnostic criteria) obscure recognition of escalating D&A problems, leaving carers distressed and services inaccessible. This study, led by a SAM community member, gives voice to hidden carers’ experiences and identifies their unique challenges through methodological innovation. Our findings advocate for co-produced, culturally sensitive services that bridge definitional gaps and position SAM carer support within a social justice agenda addressing cultural responsiveness and structural inequities.

Bangladeshi communities experience poor health outcomes and have higher risk factors for vascular dementia. This article explores the perceptions of people living with dementia, as well as the perceptions of their family members and caregivers, and gathers their views on current dementia support services in order to make recommendations to improve the provision of dementia support services in a UK Bangladeshi community. A total of 25 semi-structured face-to-face and virtual interviews were conducted with individuals with dementia, their family caregivers and dementia service providers from a UK Bangladeshi community. The interviews were recorded digitally and transcribed verbatim. NVivo was used for thematic analysis. Family members and caregivers of people living with dementia demonstrated a strong sense of obligation and interpersonal motives for providing care at home. Despite their dedication, care partners struggled to provide adequate care due to work commitments and a lack of dementia knowledge. Cultural and language barriers were identified when accessing health and social care services. This article provides a further look into a UK-based Bangladeshi community’s experience with people living with dementia. Their views can contribute to a better understanding of the perceived challenges that the Bangladeshi community faces in accessing dementia health and social care services and support, thereby enabling better decision making by service providers and policy makers. These findings will also inform the development, delivery and adoption of dementia policy support, as well as the integration of diversity into dementia policy to shape future approaches to care provision.

Women Who Use Drugs (WWUD) are amongst the most stigmatised groups in society and are subject to stigma as they engage with services and within their own recovery communities. WWUD who are also mothers have been found to experience increased stigma and disproportionate surveillance by professionals when accessing services, leading to a constant fear of child removal and apprehension to accessing, engaging and seeking support. In this study, we report findings from a community asset mapping project conducted with drug and alcohol recovery services in the North-East of England. The aim of this study is to examine the gender-specific and recovery-related experiences of WWUD when accessing services and women-only spaces. Semi-structured interviews (n = 13) and focus groups (n = 4) were carried out with professionals working in the recovery community and women in recovery from substance use. A reflexive thematic analysis approach was used to analyse the data, resulting in three themes being identified: (1) The role of peer support in empowering women in recovery; (2) Navigating recovery as a mother; and (3) Working with women in recovery. Findings revealed that gender-specific groups provide a sense of safety, connection, identification, and empowerment for WWUD. This study further highlights the gender-based stigma WWUD experience when accessing services, and the challenges they experience where appropriate spaces are limited in the recovery community. We conclude by recognising the importance of sisterhood for WWUD and recommending the promotion of gender-specific peer support groups and for practitioners working with WWUD to reflect on their own stigmatising behaviour and how this can manifest in the increased monitoring of women and mothers in recovery.

People Who Use Substances (PWUS) are among the most stigmatised groups in society. Stigma associated with substance use is known to be detrimental to the individual’s wellbeing, and substance use is often used as a mechanism by policy makers and services to legitimise exclusion. PWUS often do not benefit from the drug and alcohol services that are available to them. Community Asset Mapping (CAM) is a strengths-based approach involving the re-engagement of communities through active involvement in research. There are criticisms and concerns about equity and the burden on participants involved in CAM projects; however, the broad aim of CAM is to identify and document the strengths and pre-existing resources that exist within a community. In the following study, we utilised CAM processes and principles in a large city in the Northeast of England to enable people with lived experience of substance use and practitioners working in drug treatment services to come together and identify resources in the form of services and groups that support recovery. In the process, we were concerned with identifying, engaging with, and involving groups that were known to the recovery community but also were not part of an existing recovery network. Qualitative data were obtained from semi-structured interviews (n = 13) and focus groups (n = 2). A reflexive thematic analysis approach was used to analyse the transcriptions, and from this we generated four themes: (1) community visibility, (2) ownership of the recovery agenda, (3) the impact of stigma and shame, and (4) the benefits of involvement. Our findings revealed a partly fragmented but also well-established, connectedand resourced local recovery community in the city. We were also able to identify a number of recovery groups and services that had previously not been known to the existing recovery community. Additionally, we identified that public and societal substance-related stigma continued to be a barrier that inhibited individuals and recovery groups from making themselves more visible and available to others.

Within traditional drug and alcohol (D&A) treatment services, the majority of those accessing support are of white ethnicity, with only a small percentage of people from the British South Asian (BSA) and Muslim community engaging in treatment services. This paper aims to explore perceived barriers to accessing traditional D&A services within the British South Asian and Muslim communities, based on qualitative data from interviews with family members and a practitioner. Qualitative data were obtained via 11 semi-structured interviews involving a practitioner (n = 1), and family and friends (n = 10) of those with historic and current D&A use in the community. Reflexive thematic analysis revealed four themes: (1) awareness of drug and alcohol use in the community, (2) drug and alcohol use as a taboo topic and the impact of admitting use, (3) knowledge of services for treatment, (4) how to increase awareness and accessibility of treatment. There was an increasing awareness of D&A use in the BSA and Muslim community. Despite this, limited conversations and misconceptions around D&A use and recovery led to those using D&A and their family members feeling stigmatised within their community and unable to seek support. This paper concludes by recommending increased communication between the BSA and Muslim communities and D&A treatment services to ensure accessibility of treatment by improving cultural competency.

Introduction: British Muslim School Children (BMSC) are required to follow special halal dietary requirements in accordance with their religion, which is often not accounted for in British schools. This often leaves BMSC limited to a vegetarian diet while at school, despite this not being their chosen diet or preference. This study explores the perceptions of key stakeholders regarding fairness and accessibility of school meals for BMSC, as well as discussing school food provision for those maintaining a religious diet in light of social justice. This is in the context of limited knowledge previously being explored in the North East of England regarding procurement and decision-making at a systems level to cater for BMSC.Methods: A qualitative research design was conducted. A total of 62 participants (39 BMSC, 15 parents, and 8 school and catering staff) took part in a semi-structured interview or focus group. Participants were recruited from six schools, with these schools selected based on their differing levels of BMSC in attendance. This project took place between March 2022 and October 2023.Results/discussion: Results suggested that where schools already catered for diverse food requirements, inclusive of BMSC dietary needs, food choices were still limited in the options and amount available. School and catering staff stated that cost implications contributed to their menu development process. Despite this, there was an evident willingness to learn about the cultural food options and how these can be implemented in future school menus. Suggestions discussed included an increase in the use of halal meat in order to provide a more inclusive school food experience for BMSC.

Background: The Enhanced Health for Care homes (EHCH) framework is an innovative response to provide more proactive, preventative approaches to care for residents living in care homes. It involves co-producing a shared vision with primary care. As part of EHCH a UK clinical commissioning group supported GP’s in two localities to implement their preferred delivery approach involving a new Frailty Nurse-led (FN-led) model in care homes alongside an existing General Practitioner-led (GP-led) model. This paper focuses on implementation of the new FN-led model. Methods: A qualitative study design was adopted. Forty-eight qualitative semi-structured interviews were undertaken across six care home sites in a Northern locality: three implementing the FN-led and three engaged in an existing GP-led model. Participants included residents, family members, care home managers, care staff, and health professionals working within the EHCH framework. Results: Two overarching themes were generated from data analysis: Unanticipated implementation issues and Unintended consequences. Unsuccessful attempts to recruit Frailty Nurses (FN) with enhanced clinical skills working at the desired level (UK NHS Band 7) led to an unanticipated evolution in the implementation process of the FN-led model towards ‘training posts’. This prompted misaligned role expectations subsequently provoking unexpected temporary outcomes regarding role-based trust. The existing, well understood nature of the GP-led model may have further exacerbated these unintended consequences. Conclusion: Within the broader remit of embedding EHCH frameworks, the implementation of new FN roles needed to evolve due to unforeseen recruitment issues. Wider contextual factors are not in the control of those developing new initiatives and cannot always be foreseen, highlighting how wider factors can force evolution of planned implementation processes with unintended consequences. However, the unintended consequences in this study highlight the need for careful consideration of information dissemination (content and timing) to key stakeholders, and the influence of existing ways of working.