Title: Acceptability, feasibility and pilot study of a culturally sensitive parental and caregiver, community-based intervention using participatory learning and action groups to optimise infant nutrition and feeding practices in children from South Asian families: NEON (Nurture Early for Optimal Nutrition)
Funder: Department of Health and Social Care

Abstract: Despite WHO and NHS recommendations, most infants in the UK are introduced to solids after 5 months; 22% are weaned appropriately at 6 months. This form of suboptimal infant feeding practice is particularly prevalent in the British South Asian (SA) Diaspora who is at high risk of related adverse short-medium term (e.g. childhood obesity) and long-term (e.g. diabetes) consequences.Few interventions exist that are tailored to infants and young children of different ethnic groups and are respectively not sensitive to socio-cultural beliefs in the SA community. The NHS has limited resources with alternative strategies that utilise community assets. The initial NIHR CLAHRC study showed that parents are concerned about the growth and development of their children but do not directly link feeding practices to longer term health problems. It exposed the need for a low-cost community-based culturally sensitive intervention. The Participatory Learning and Action (PLA) Cycle approach is known to be successful in low-income countries and recognised as a low-cost alternative to traditional approaches. The proposed research has the potential to provide a low-cost solution for SA families in the UK, while posing a long-term impact on children's health.The reverse innovation of an adapted PLA model can be translated across the UK and tailored to other high-risk populations. The model has successfully improved maternal and child health outcomes in low-income settings; a meta-analysis of 7 PLA trials showed reductions in maternal, neonatal and under-five mortality, and maternal depression and improved child growth, maternal home-care, and care-seeking practices. Participants of the initial NIHR CLAHRC funded study self-reported changes in infant feeding and care practices at home as the result of the sessions they attended.I will feasibility test and pilot the adapted PLA group model with SA carers of infants ( Finally, generalizable findings from this study will be used to inform a randomised controlled trial to assess effectiveness prior to scale up across the UK. This will be over a longer period of time (8 years) employing the same mechanisms as used in this research.

Lay abstract: South Asian (SA) children in the UK are more likely to have unfavourable nutrition during the early years of life and, as a result, are at higher risk of being overweight by school age. SA parents are 2-4 times more likely to develop Type 2 diabetes leading to earlier death. Therefore, child nutrition has a significant effect on how they grow.To improve feeding processes in SA households in the UK, I propose to work with families in Newham and Tower Hamlets to understand cultural and family aspects of infant feeding and then generalise these findings on the effectiveness of improvement actions across the UK. This builds on an earlier NIHR funded CLAHRC study (NEON: Nurture Early for Optimal Nutrition) which tested the feasibility of an adapted participatory learning and action (PLA) community mobilisation approach which followed the same objective as my proposed research in the Bangladeshi community in Tower Hamlets. The study showed to be highly acceptable.Almost one in five children in England aged 4-5 years (measured in 2016/17) were either overweight or obese, with highest rates found in children living in low-income areas and children from non-white backgrounds [1]. Newham and Tower Hamlets ranked among the lowest income areas in England [2]. Newham has a very high rate of excess weight among 4-5 year olds. More than 41% of children in year 6 in Newham are obese, compared to the English average of 34%. SA is the major ethnic group in both boroughs and 18% of SA children in Newham are obese or overweight (national average: 22%). This rises to 40% in year 6 (national average: 34%) [3]. The numbers are similar in Tower Hamlets.I seek to work with families from all SA backgrounds in Tower Hamlets and Newham to adapt and pilot a full PLA intervention aimed at empowering SA carers to introduce optimal healthy feeding practices for infants aged 0-24 months over a period of 36 months. More precisely, the model aims to provide group sessions at which SA child carers can meet and discuss local feasible problem solutions. Discussions include the use of diverse resources which have shown to be effective in previous studies conducted with the Bangladeshi community in Tower Hamlets. I propose to work with two different boroughs to conclude with more generalizable results as well as test different methods on how to implement and conduct the PLA groups.Community members have been involved in developing this proposal and will support as research partners. Local families are supported from local health care communities and public health teams. SA parents will be invited to join a Patient and Public Involvement committee to feedback on the model development. Results will be shared with this committee, community facilitators and policy makers to ensure a partnership-wide understanding. Results will also be shared at stakeholder workshops held in the boroughs as well as summarised and published in a final report.Thereafter, I intend to expand this research and implement the methodology across the UK. Solution approaches proposed by SA carers may be of high relevance for families of similar backgrounds in other parts of the UK.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE