Misaligned or misheard?:Physical activity and healthy eating messaging to ethnic minority communities during the COVID-19 pandemic: A qualitative study and scoping review

This mixed-methods study identified physical activity (PA) and healthy eating messages produced during the COVID-19 pandemic and explored how they were received by UK ethnic minority communities. A scoping review of research and grey literature identified categories of PA and healthy eating messaging targeted at ethnic minorities. Individual and group interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. There was active community engagement in all study phases to ensure relevance and co-production of findings. Interviews were held with 41 study participants aged 18-86 years (20 men) residing in England and Wales using digital conferencing and in person. The scoping review identified 24 records containing messages grouped into three categories: 1) PA messages; 2) healthy eating messages; 3) risk messages. Five themes described participants' views of these messages: 1) lack of awareness of messaging; 2) responses to PA messaging; 3) responses to healthy eating messaging; 4) perceptions of risk messaging and 5) perceptions of conflict in messages. The review revealed that physical activity and healthy eating messaging specifically targeting ethnic minority communities is limited. This limited messaging was almost entirely missed by these communities. When received, the messaging was not interpreted as intended, perceived to be conflicting and risk messaging was perceived as blaming. More work with ethnic minority communities needs to be done to co-produce meaningful and appropriate PA and healthy eating messaging in a timely manner.</p

Including the values of UK ethnic minority communities in policies to improve physical activity and healthy eating

Physical activity and healthy eating are important for physical and mental health, yet long-standing inequalities constrain the ability of ethnic minorities in the United Kingdom (UK) to adopt these behaviours. Programmes aimed to improve these behaviours have also often not been engaged with by these communities. This study therefore aimed to: (1) identify the values underlying the physical activity and healthy eating behaviours of UK ethnic minorities and (2) explore how structural, socio-economic and environmental factors interact with these values to influence their physical activity and healthy eating behaviours. The study adopted a relativist ontological and subjectivist epistemological philosophical assumption. Qualitative interviews were used to address research objectives. A total of 10 group and five individual interviews were conducted with 41 participants. All participants were from an ethnic minority background (Black, Asian or Mixed according to the UK Office for National Statistics classification), recruited purposively and aged between 18 and 86 years and were living in England and Wales. Data were analysed using inductive thematic analysis. Community engagement was embedded throughout the study. We found that culture and family, community and social life, and health are important values underlying the physical activity and healthy eating behaviours of UK ethnic minority communities. External factors, including racism and access (geographical, social and economic), interact with these values to drive health behaviours. Using an illustrative guide, we conclude the paper with policy and practice recommendations on how public health programmes on physical activity and healthy eating can be aligned with these values to ensure relevance for ethnic minority communities

What are effective ways of building trust and increasing inclusion of underserved communities in public health research?

Background and objectives: inequalities in public health research engagement have been reported globally; marginalised communities, including ethnic minority groups in the UK, are particularly badly served. This presentation describes co-produced strategies for building trust and increasing inclusion of underserved communities in research. Methods: this study formed one of five Work Packages (WPs) in a nationwide consortium and adopted Community Engagement (CE) and participatory research principles. Distrust caused by previous negative experiences represented major barriers to recruitment from underserved communities. Six actions were taken to build trust and increase inclusion: 1) face-to-face introductory meetings out in the community; 2) early recruitment of CE partners; 3) active involvement of CE partners in project planning, co-chairing and decision-making activities; 4) inviting and responding to feedback about research plans; 5) co-production of participatory workshops; and 6) a transformative action workshop. Results: widespread inclusion of underserved communities was achieved; six CE partners and 41 research participants from Asian, Black and Mixed ethnicities representing all adult age groups were recruited. Our engagement strategies led to the successful co-production of public health interventions to improve physical activity and healthy eating. This also impacted other WPs resulting in 51 CE partners being enrolled across the consortium. Trust was evident in the active participation of those who had initially declined to take part. Four CE partners attended a policy event at the UK Houses of Parliament. CE partners and participants reported that ethnic minority representation within the research team contributed to building trust. Qualitative feedback also showed study participation improved CE partners’ and participants’ confidence, wellbeing and willingness to engage in future research. Conclusions: learning from feedback and facilitating underserved communities to actively drive research processes were effective in increasing trust. Such practices are recommended for research in all global contexts to increase inclusion of marginalised communities

Misaligned or misheard? Physical activity and healthy eating messaging to ethnic minority communities during the COVID-19 pandemic: a qualitative study and scoping review

This mixed-methods study identified physical activity (PA) and healthy eating messages produced during the COVID-19 pandemic and explored how they were received by UK ethnic minority communities. A scoping review of research and grey literature identified categories of PA and healthy eating messaging targeted at ethnic minorities. Individual and group interviews were conducted, audio-recorded, transcribed and analysed using inductive thematic analysis. There was active community engagement in all study phases to ensure relevance and co-production of findings. Interviews were held with 41 study participants aged 18-86 years (20 men) residing in England and Wales using digital conferencing and in person. The scoping review identified 24 records containing messages grouped into three categories: 1) PA messages; 2) healthy eating messages; 3) risk messages. Five themes described participants’ views of these messages: 1) lack of awareness of messaging; 2) responses to PA messaging; 3) responses to healthy eating messaging; 4) perceptions of risk messaging and 5) perceptions of conflict in messages. The review revealed that physical activity and healthy eating messaging specifically targeting ethnic minority communities is limited. This limited messaging was almost entirely missed by these communities. When received, the messaging was not interpreted as intended, perceived to be conflicting and risk messaging was perceived as blaming. More work with ethnic minority communities needs to be done to co-produce meaningful and appropriate PA and healthy eating messaging in a timely manner

Informing public health messages and strategies to raise awareness of pre-conception health: a public consultation

BackgroundDespite growing scientific and policy recognition that optimising health before a potential pregnancy (ie, pre-conception health) improves the lifelong health of reproductive-aged people and any children that they might have, public awareness of pre-conception health is lacking. To inform appropriate public health messages and strategies to increase public awareness, this project aimed to develop recommendations on language use, and identify and prioritise strategies.MethodsA public consultation was undertaken through semistructured online group discussions with people (of any gender) aged 18–50 years in England who were not currently expecting a child. Public contributors were recruited through patient and public involvement groups, Facebook support groups (eg, for people with fertility issues or chronic conditions), and an LGBTQ+ charity. The first round of discussions (Feb 4–March 25, 2021) explored public contributors' knowledge about pre-conception health, their recommendations on appropriate language for public health messages, and ideas on public health strategies. All contributors were invited for a second discussion round (May 24–28, 2021) to refine the language recommendations and prioritise the suggested strategies. Discussions were summarised based on notes taken by two researchers. Ethics approval was not required for this public consultation.Findings54 people joined the first discussion round. Of these, 36 participated in the second round (24 [67%] female, seven [19%] male, five [14%] transgender or non-binary; 13 [36%] from an ethnic minority background). Discussions confirmed a substantial lack of awareness of pre-conception health, but also revealed curiosity and an interest to learn more. Agreed language recommendations included avoiding unfamiliar terms without further explanation (eg, pre-conception health, medical terms); using language that is positive, encouraging, inclusive, and gender-neutral when possible; and using messages that are specific and realistic. School-based education and social media campaigns supported by a trusted source such as the NHS emerged as strategic priorities.InterpretationThis public consultation revealed a desire among diverse groups to learn about pre-conception health and normalise preparation for pregnancy. The views obtained were predominantly from public contributors living in the Southampton area, and did not include people of reproductive age younger than 18 years (ie, those aged 15–17 years). Raising public awareness about pre-conception health should begin in schools and will require adaptation of curricula, alongside development of public awareness campaigns, to reach all people across their reproductive years. Further research is needed to inform and develop these initiatives

Building trust and increasing inclusion in public health research: co-produced strategies for engaging UK ethnic minority communities in research

Patient and Public Involvement and Engagement (PPIE) is essential for improved research outcomes and reduced research waste. To be effective, PPIE should provide opportunities for diverse groups to contribute to all research stages. However, UK ethnic minority communities remain underrepresented in research. This paper describes strategies adopted in a public health research project that were effective in building trust and increasing inclusion of ethnic minority communities. The study team of researchers and PPIE partners reflects lessons learnt during the project and describe six main strategies that built meaningful levels of trust and inclusion: 1) early start to recruitment of PPIE partners; 2) relationship-focused engagement; 3) co-production and consultation activities; 4) open communication and iterative feedback; 5) co-production of project closure activities, and; 6) diverse research team.Meaningful outcomes for the community included the involvement of people from ethnic minorities as research participants and PPIE partners, community wellbeing, co-production of public health recommendations co-presented at the UK Houses of Parliament, and consortium-wide impact evidenced by the enrolment of 51 active PPIE partners.PPIE partners reflect on their research involvement, offering advice to researchers and encouraging people from ethnic minority communities to take part in research. An important message from PPIE partners is that involvement should not be restricted to projects specific to ethnic minorities but become a routine part of general population research, recognising ethnic minorities as an integral part of UK society.In conclusion, this paper demonstrates that with appropriate strategies, inclusion and diversity can be achieved in public health research. We recommend researchers, practitioners and policy makers adopt these strategies when planning their public health projects

What does 'preconception health' mean to people? A public consultation on awareness and use of language.

Introduction: there is growing scientific and policy recognition that optimising health before a potential pregnancy (preconception health) improves reproductive outcomes and the lifelong health of future children. However, public awareness on this topic is low. We conducted a public consultation to develop language recommendations and identify and prioritise approaches to inform research and improve public awareness of preconception health.Methods: a public consultation was undertaken with people of any gender aged 18–50 years living in the United Kingdom who were not currently expecting a child. Public contributors were recruited through patient and public involvement, community and support groups, an existing cohort study, and an LGBTQ+ charity. An initial round of online group discussions (February/March 2021) explored public contributors' knowledge of preconception health, their recommendations for appropriate language, and ideas about public health approaches. In a subsequent discussion round (May 2021), language recommendations were refined and suggested approaches prioritised. Discussions were summarised based on notes taken by two researchers.Results: fifty-four people joined the initial discussion round (66% women, 21% men, 13% nonbinary or transgender; 55% aged 18–30 years, 30% 31–40 years, 15% 41–50 years). Of these, 36 people (67%) participated in the subsequent round. Very few had heard the term ‘preconception health’, understood what it means, or why and for whom it is important. They recommended avoiding unfamiliar terms without further explanation (e.g., preconception health, medical terms), using language that is positive, encouraging and gender-sensitive where possible, and using messages that are specific, nonjudgmental and realistic. The phrases ‘health and well-being during the childbearing years’, ‘health and well-being before pregnancy and parenthood’ and ‘planning for parenthood’ resonated with most public contributors. School-based education, social media campaigns and the National Health Service emerged as priority approaches/settings for raising awareness.Conclusion: this public consultation produced recommendations from a diverse group of people of reproductive age in the United Kingdom to improve language and prioritise approaches that increase public understanding of preconception health in ways that are relevant and appropriate to them. This should begin in schools and will require adaptation of curricula, alongside co-development of public awareness campaigns and guidance for healthcare professionals