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ObjectivesThis research aims to explore the factors that hinder professionals in delivering integrated care for children under 5 in temporary accommodation (TA) and understand their experiences of collaboration during the pandemic to inform recommendations.DesignSemistructured qualitative interviews.SettingEngland, UK.Participants45 professionals working across health, housing, education and non-profit sectors in England. Purposive and snowball sampling was employed to recruit a representation of key professionals across England. Those not eligible to take part in the study included people who did not work with families and/or children in TA settings.Outcome measuresTo explore cross-sector learnings that are applicable to improving integrated care and to tailor recommendations to the needs of families and children under 5 experiencing homelessness in the UK today.ResultsThis study highlights the complex, multilevel barriers that professionals face when delivering integrated care to children under 5 in TA. Findings are organised using a framework that distinguishes between practice-level, organisational and systemic challenges. From siloed working practices and limited training to staffing shortages and restrictive data-sharing policies, these challenges collectively hinder service continuity and collaboration.ConclusionsAlthough this project was conducted during the COVID-19 pandemic, the challenges identified reflect deeper, long-standing issues in service delivery. As services continue to recover and prepare for future crises, these insights remain highly relevant and can inform more resilient, integrated recovery plans to support children in TA beyond the pandemic context. Addressing these barriers, through improved collaboration, training and data-sharing, is key to strengthening care for this vulnerable population.

IntroductionParticipatory learning and action (PLA) is a form of group reflection and learning with documented efficacy in low-income countries to improve social and health outcomes. PLA represents both a learning philosophy and a practical framework that could be applied to a variety of contexts. To date, PLA has not been widely implemented within high-income countries (HICs) to improve health and health-related outcomes. We aim to synthesise the literature currently available by means of a systematic review to form a foundation for future applications of PLA methodology in HICs.Methods and analysisTwo reviewers will independently search predefined terms in the following electronic bibliographic databases: MEDLINE, EMBASE, CINAHL and Cochrane Library. The search terms will encompass PLA and PDSA (Plan-Do-Study-Act) projects, as well as studies using the Triple/Quadruple Aim model. We will include randomised controlled trials that incorporate online or face-to-face components using the PLA/PDSA methodology. Our data will be extracted into a standardised prepiloted form with subsequent narrative review according to the SWiM (Synthesis Without Meta-Analysis) guidelines.Ethics and disseminationNo ethics approval is required for this study. The results of this study will be submitted for publication in a leading peer-reviewed academic journal in this field. Additionally, a report will be produced for the funders of this review, which can be viewed for free on their website.PROSPERO registration numberCRD42020187978.

BackgroundLong covid describes a syndrome of persistent symptoms following COVID-19 and is responsible for substantial healthcare and economic burden. Currently, no effective treatments have been established. Ashwagandha (Withania somnifera (L.) Dunal) is a medicinal herb traditionally used in India for its immune-strengthening and anti-inflammatory properties. Withanolides, a family of steroid-derived molecules unique to Ashwagandha, have been shown to modulate inflammatory pathways in animal models, and several small randomised trials in humans support its effectiveness for reducing symptoms that are also associated with long covid. Therefore, this study aims to assess whether Ashwagandha is effective and safe for improving functional status and reducing symptom burden in adults living with long covid.MethodsA randomised double-blind placebo-controlled trial will be performed at participating general practice (GP) surgeries and long covid clinics across the UK. Individuals diagnosed with long covid will be screened for eligibility and then randomised 1:1 to take 1000 mg daily of Ashwagandha root extract tablets (standardised to <0.9% withanolides) or matching placebo tablets for 3 months (target, n = 2500). Monthly online surveys will be performed to collect patient-reported outcomes, and monthly safety monitoring, including liver function tests, will be conducted by clinical site teams. The primary outcome of the Post-COVID Functional Status Scale score at 3 months will be assessed by baseline-adjusted ordinal logistic regression, according to a pre-published statistical analysis plan. The secondary outcomes included validated quality of life and long covid symptom scales, work status and productivity and adverse events. The trial has been approved as a Clinical Trial of an Investigational Medicinal Produce by the Medicines and Healthcare Regulatory Authority and by the NHS Research Ethics Committee and Health Research Authority.DiscussionTreatments for long covid are urgently needed. This trial will robustly evaluate the safety and efficacy of a candidate treatment with a promising efficacy and safety profile. If found to be effective, the findings will likely influence treatment guidelines and improve health outcomes in those living with long covid.Trial registration numberThis trial was pre-registered on 15/08/2022: ISRCTN12368131

Despite evidence of increasing health uptake and engagement, little is known about the feasibility of undertaking online community engagement and research, especially during a pandemic. 12 Salmons (2016) introduced an e‐research framework that facilitates a holistic approach to undertake community engagement and qualitative research online. 13 Furthermore, social media platforms have been found to be valid tools to engage with communities during times of crises. 13‐15 Consequently, the NEON team decided to adapt the intervention such that community engagement, delivery and evaluation occurred virtually, utilizing the software Zoom. Meetings could also be recorded with the participants’ permission and accessed later to reflect on specific points and/or for those who missed meetings. Since COVID‐19, there has been an increase in anxiety, depression and other mental health morbidity, which may have impacted on CF’s proactiveness to participate online. Other limitations and/or risks of virtual meetings include: (a) loss of body language and non‐verbal cues, particularly if individuals switch off their cameras and (b) risk worsening health inequities by reliance on digital methods as the highest risk, hardest to reach populations are likely those who experience greater digital poverty. 16 After conducting online parent/carer workshops to gather feedback around the COVID‐19 experience, the G2KCP project team is undertaking qualitative focus group discussions (FGD) and semi‐structured interviews online.

ObjectiveThis interdisciplinary qualitative study aims to explore the health, education, engineering and environment factors impacting on feeding practices in rural India. The ultimate goal of the Participatory Approach for Nutrition in Children: Strengthening Health Education Engineering and Environment Linkages project is to identify challenges and opportunities for improvement to subsequently develop socioculturally appropriate, tailored, innovative interventions for the successful implementation of appropriate infant and young child feeding (IYCF) practices locally.DesignQualitative research method, involving five phases: (1) identification of local feeding practices; (2) identification of the local needs and opportunities for children aged 6–24 months; and (3–5) analysis of the gathered qualitative data, intervention design, review and distribution.SettingNine villages in two community development blocks, that is, Ghatol and Kushalgarh, located in the Banswara district in Rajasthan, India.Participants68 participants completed semistructured interviews or focus group discussions including: mothers, grandmothers, auxiliary nurse midwife, Anganwadi worker, ASHA Sahyogini, school teachers and local elected representative.Phenomenon of interestIYCF practices and the factors associated with it.AnalysisThematic analysis.ResultsOur results could be broadly categorised into two domains: (1) the current practices of IYCF and (2) the key drivers and challenges of IYCF. We explicate the complex phenomena and emergent model focusing on: mother’s role and autonomy, knowledge and attitude towards feeding of young children, availability of services and resources that shape these practices set against the context of agriculture and livelihood patterns and its contribution to availability of food as well as on migration cycles thereby affecting the lives of ‘left behind’, and access to basic health, education and infrastructure services.ConclusionsThis interdisciplinary and participatory study explored determinants impacting feeding practices across political, village and household environments. These results shaped the process for cocreation of our context-specific intervention package.

Introduction The Nurture Early for Optimal Nutrition (NEON) study is a multiphase project that aims to optimize feeding, care and dental hygiene practices in South Asian children <2 years in East London, United Kingdom. The multiphase project uses a participatory learning and action (PLA) approach facilitated by a multilingual community facilitator. In this paper, we elaborate on the process and results of the Intervention Development Phase in the context of the wider NEON programme. Methods Qualitative community‐based participatory intervention codevelopment and adaptation. Setting Community centres in East London and online (Zoom) meetings and workshops. Participants In total, 32 participants registered to participate in the Intervention Development Phase. Four Intervention Development workshops were held, attended by 25, 17, 20 and 20 participants, respectively. Results Collaboratively, a culturally sensitive NEON intervention package was developed consisting of (1) PLA group facilitator manual, (2) picture cards detailing recommended and nonrecommended feeding, care and dental hygiene practices with facilitators/barriers to uptake as well as solutions to address these, (3) healthy infant cultural recipes, (4) participatory Community Asset Maps and (5) list of resources and services supporting infant feeding, care and dental hygiene practices. Conclusion The Intervention Development Phase of the NEON programme demonstrates the value of a collaborative approach between researchers, community facilitators and the target population when developing public health interventions. We recommend that interventions to promote infant feeding, care and dental hygiene practices should be codeveloped with communities. Recognizing and taking into account both social and cultural norms may be of particular value for infants from ethnically diverse communities to develop interventions that are both effective in and accepted by these communities. Patient and Public Involvement and Engagement Considerable efforts were placed on Patient/Participant and Public Involvement and Engagement. Five community facilitators were identified, each of which represented one ethnic/language group: (i) Bangladeshi/Bengali and Sylheti, (ii) Pakistani/Urdu, (iii) Indian/Gujrati, (iv) Indian/Punjabi and (v) Sri Lankan/Tamil. The community facilitators were engaged in every step of the study, from the initial drafting of the protocol and study design to the Intervention Development and refinement of the NEON toolkit, as well as the publication and dissemination of the study findings. More specifically, their role in the Intervention Development Phase of the NEON programme was to: 1. Support the development of the study protocol, information sheets and ethics application. 2. Ensure any documents intended for community members are clear, appropriate and sensitively worded. 3. Develop strategies to troubleshoot any logistical challenges of project delivery, for example, recruitment shortfalls. 4. Contribute to the writing of academic papers, in particular reviewing and revising drafts. 5. Develop plain language summaries and assist in dissemination activities, for example, updates on relevant websites. 6. Contribute to the development of the NEON intervention toolkit and recruitment of the community members. 7. Attend and contribute to Intervention Development workshops, ensuring the participant's voices were the focus of the discussion and workshop outcomes.

ObjectiveIndia has been struggling with infant malnutrition for decades. There is a need to identify suitable platforms for community engagement to promote locally feasible, resource efficient Infant and Young Child Feeding (IYCF) interventions. This study aims to explore if and how schools could represent a site for community engagement in rural India, acting as innovation hubs to foster positive change in partnership with the Angawadi centres.DesignFive-phase formative study; A parallel mixed methods approach structured by a socioecological framework was used for data collection at individual, household and community levels. This paper focuses on the qualitative findings.SettingThis study was undertaken in nine villages within two blocks, ‘Ghatol’ and ‘Kushalgarh’, in the Banswara district of Rajasthan, India.Participants17 schools were identified. Interviews were conducted with local opinion leaders and representatives in the education sector, including principals, schoolteachers, block and district education officers. Across the nine study villages, information was gathered from 67 mothers, 58 paternal grandmothers using Focus Discussion Groups (FDGs) and 49 key respondents in Key Informant Interviews.ResultsSchools were considered an important community resource. Challenges included limited parental participation and student absenteeism; however, several drivers and opportunities were identified, which may render schools a suitable intervention delivery site. Enrolment rates were high, with schools and associated staff encouraging parental involvement and student attendance. Existing initiatives, including the mid-day meal, play opportunities and education on health and hygiene, further highlight the potential reliability of schools as a platform for community mobilisation.ConclusionsSchools have been shown to be functional platforms frequently visited and trusted by community members. With teachers and children as change agents, schools could represent a suitable setting for community mobilisation in future wider scale intervention studies. Expanding the supportive environment around schools will be essential to reinforce healthy IYCF practices in the long term.

To explore optimal infant feeding and care practices and their drivers within the British-Bangladeshi population of East London, UK, as an exemplar to inform development of a tailored, coadapted participatory community intervention. Qualitative community-based participatory research. Community and children's centres and National Health Service settings within Tower Hamlets, London, UK. 141 participants completed the community study including: British-Bangladeshi mothers, fathers, grandmothers and grandfathers of infants and young children aged 6-23 months, key informants and lay community members from the British-Bangladeshi population of Tower Hamlets, and health professionals working in Tower Hamlets. 141 participants from all settings and generations identified several infant feeding and care practices and wider socioecological factors that could be targeted to optimise nutritional outcomes. Our modifiable infant feeding and care practices were highlighted: untimely introduction of semi and solid foods, overfeeding, prolonged parent-led feeding and feeding to 'fill the belly'. Wider socioecological determinants were highlighted, categorised here as: (1) society and culture (e.g. equating 'chubby baby' to healthy baby), (2) physical and local environment (e.g. fast food outlets, advertising) and (3) information and awareness (e.g. communication with healthcare professionals around cultural norms). Parenting interventions should be codeveloped with communities and tailored to recognise and take account of social and cultural norms and influence from different generations that inform infant feeding and care practices and may be of particular importance for infants from ethnically diverse communities. In addition, UK infant feeding environment requires better regulation of marketing of foods for infants and young children if it is to optimise nutrition in the early years.

Feeding practices developed during the first 1000 days of life can affect growth, development, and lifetime risk of nutrition related and dental-related diseases. In the UK, barriers to recommended complementary feeding practices among South Asian caregivers include food access, bicultural issues, and inconsistent advice from health professionals and community members. We aimed to improve infant feeding, care, and dental hygiene practices among South Asian communities in East London boroughs by co-developing a culturally sensitive intervention and adapting the WHO-recommended women's group Participatory Learning and Action (PLA) cycles. We developed an intervention package, in collaboration with multilingual community facilitators, community members, and stakeholders from the local health and social care system (ie, health visitors, dieticians, dentists, children's centres, and local authorities), that consisted of: PLA group facilitator manual, picture cards of recommended or non-recommended feeding practices, healthy recipes book, community asset map, and list of local resources and activities. We conducted monthly intervention development meetings with South Asian community facilitators (n=10) and workshops with South Asian community members (n=25). The inclusion criteria were pregnant women, mothers or female carers for infants younger than 2 years, backgrounds from Indian Gujarati or Punjabi, Sri Lankan, Bangladeshi, or Pakistani backgrounds, and living in the London Boroughs of Tower Hamlets, Newham, or Waltham Forest. The community was involved at three levels: researchers assisting in recruitment and data collection, meeting and workshop facilitators, and intervention developers. The primary outcome was to codevelop the intervention toolkit. This study has obtained ethical approval from the UCL Research Ethics Committee (identifier 17269/001). Community members have agreed to participate and given audio or video consent before their participation in the workshops. Verbal consent was witnessed and formally recorded. Between Feb 1, 2020, and Nov 30, 2020, we held eight intervention development meetings in community centres and online. Between Dec 1, 2020, and Feb 28, 2021, four workshops took place online using Zoom. Participants contributed valuable input for intervention development on content, activities, photographs, cultural recipes, artistic design, objectives, schedule, and location. We were able to develop the intervention toolkit with positive perceptions from the community facilitators and community members. We developed a culturally sensitive approach in partnership with health and social care practitioners to address public health issues in a resource-poor ethnically diverse community. Greater use of community assets aligns with the NHS 10-Year Forward Plan. National Institute for Health Research (reference NIHR300020).

IntroductionFeeding practices developed in early life can impact a child’s nutrition, growth, dental health, cognitive development and lifetime risk of chronic diseases. Substantial evidence suggests ethnic health inequalities, and non-recommended complementary infant feeding practices among UK’s South Asian (SA) population. Nurture Early for Optimal Nutrition aims to use women’s group participatory learning and action (PLA) cycles to optimise infant feeding, care and dental hygiene practices in SA infants <2 years in East London.Methods and analysisA three-arm pilot feasibility cluster randomised controlled trial will assess feasibility, acceptability, costs and explore preliminary effectiveness for proposed primary outcome (ie, reporting on body mass index (BMI) z-score). Multilingual SA community facilitators will deliver the intervention, group PLA Cycle, to mothers/carers in respective ethnic/language groups. 12 wards are randomised to face-to-face PLA, online PLA and usual care arms in 1:1:1 ratio. Primary outcomes are feasibility and process measures (ie, BMI z-score, study records, feedback questionnaires, direct observation of intervention and sustainability) for assessment against Go/Stop criteria. Secondary outcomes are cluster-level and economic outcomes (ie, eating behaviour, parental feeding practices, network diffusion, children development performance, level of dental caries, general practitioner utilisation, costs, staff time). Outcomes are measured at baseline, every 2 weeks during intervention, 14 weeks and at 6 months by blinded outcome assessors where possible. This study will use concurrent mixed-methods evaluation. Quantitative analyses include descriptive summary with 95% CI and sample size calculation for the definitive trial. The intervention effect with CI will be estimated for child BMI z-score. Implementation will be evaluated qualitatively using thematic framework analysis.Ethics and disseminationEthics approval was obtained from University College London (UCL), National Health Service (Health Research Authority (HRA) and Health and Care Research Wales (HRCW)). Results will be published in peer-reviewed journals, presented at scientific conferences/workshops with commissioners, partners and participating communities. Plain language summaries will be disseminated through community groups, websites and social media.Trial registration numberIRAS-ID-296259 (ISRCTN10234623).