Improving infant feeding, care, and dental hygiene practices in South Asian infants aged younger than 2 years in east London through women's group participatory learning and action cycles (NEON): a behaviour intervention trial

Abstract

BackgroundFeeding 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. MethodsWe 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. FindingsBetween 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. InterpretationWe 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. FundingNational Institute for Health Research (reference NIHR300020).