Intergenerational differences in healthy eating beliefs among British Pakistanis with type 2 diabetes.

INTRODUCTION: There are growing concerns on how to prevent, slow down and induce remission of type 2 diabetes mellitus (T2DM). Recent evidence has found diet and lifestyle interventions can cause remission of T2DM, however, there are challenges for diverse groups such as British Pakistanis who are four times more at risk of T2DM. There is a need to understand the food behaviours of different generational groups to develop culturally appropriate strategies to support diabetes prevention programmes. AIMS: This study explores beliefs about healthy eating and food practices related to T2DM among British Pakistanis to understand the challenges they face in implementing healthy diets. METHOD: We carried out 26 semi-structured qualitative interviews via telephone and face-to-face. The sample included T2DM British Pakistanis living in Bradford (UK), aged between 18 and 71 with a mean age of 50 (SD = 17.04). Among the participants, 14 were women (54%) and 12 were men (46%), with interviews conducted in both English (76%) and Urdu (24%). Participants were grouped under three generation groups based on age (first generation 65+; second generation 40-64; younger generation 18-39 years). There was no biological link between the generational groups, and they were not part of the same family. Data were analysed using qualitative reflexive thematic analysis. RESULTS: Findings were categorised into three themes: knowledge and awareness of diabetes symptoms; social and family context of food practices and making sense of healthy eating. The family was the fundamental unit of understanding food-related health behaviours. Eating traditional food was perceived as healthy and deemed practical for first generations who were the initial members of their family to settle in the UK as well as the second generations who had parents born in Pakistan. Younger British Pakistanis were born in the UK and reported that they struggled to eat alternative foods within the home and manage their T2DM. CONCLUSION: These findings improve our understanding of how three generations of British Pakistanis with T2DM negotiate healthy diets. There is a need for culturally tailored diet modifications and interventions, where different generational needs can be specifically targeted to adopt healthier diets which should be shared and encouraged.

Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane.

BACKGROUND: The National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital's anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector. METHODS: We conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method. RESULTS: Participants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA's potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions. CONCLUSIONS: The evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.

Activities used by evidence networks to promote evidence-informed decision-making in the health sector- a rapid evidence review.

BACKGROUND: Evidence networks facilitate the exchange of information and foster international relationships among researchers and stakeholders. These networks are instrumental in enabling the integration of scientific evidence into decision-making processes. While there is a global emphasis on evidence-based decision-making at policy and organisational levels, there exists a significant gap in our understanding of the most effective activities to exchange scientific knowledge and use it in practice. The objective of this rapid review was to explore the strategies employed by evidence networks to facilitate the translation of evidence into decision-making processes. This review makes a contribution to global health policymaking by mapping the landscape of knowledge translation in this context and identifying the evidence translation activities that evidence networks have found effective. METHODS: The review was guided by standardised techniques for conducting rapid evidence reviews. Document searching was based on a phased approach, commencing with a comprehensive initial search strategy and progressively refining it with each subsequent search iterations. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed. RESULTS: The review identified 143 articles, after screening 1135 articles. Out of these, 35 articles were included in the review. The studies encompassed a diverse range of countries, with the majority originating from the United States (n = 14), followed by Canada (n = 5), Sweden (n = 2), and various other single locations (n = 14). These studies presented a varied set of implementation strategies such as research-related activities, the creation of teams/task forces/partnerships, meetings/consultations, mobilising/working with communities, influencing policy, activity evaluation, training, trust-building, and regular meetings, as well as community-academic-policymaker engagement. CONCLUSIONS: Evidence networks play a crucial role in developing, sharing, and implementing high-quality research for policy. These networks face challenges like coordinating diverse stakeholders, international collaboration, language barriers, research consistency, knowledge dissemination, capacity building, evaluation, and funding. To enhance their impact, sharing network efforts with wider audiences, including local, national, and international agencies, is essential for evidence-based decision-making to shape evidence-informed policies and programmes effectively.

Frontline Health Care Workers' Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data.

BACKGROUND: The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being. OBJECTIVE: This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels). METHODS: We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs' mental health during the first year of the COVID-19 pandemic. RESULTS: The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW's coping strategies; negative mental health effects; organizational support; social network and support; and public and government support. CONCLUSIONS: These findings demonstrate the need for open conversations, where staff's well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW's well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers.

Volunteering in the community: Understanding personal experiences of South Asians in the United Kingdom.

Upstanding civic action is central to individual and community well-being, particularly when communities comprise rich and diverse membership. However, not all groups in society have the same opportunities and resources to volunteer. This is particularly true for South Asian people, who are often reported to be less likely to volunteer. Research into the experience and meanings that this ethnic group attributes to volunteering has been exceptionally scarce. Informed by a community psychology perspective, this qualitative study conducted nine semistructured interviews with British South Asians involved in formal volunteering activities. The aim was to explore their personal experiences and motivations regarding volunteering for their community of belonging. Results from reflexive thematic analysis were grouped under three themes. These were (1) volunteering cultivated individual well-being, (2) South Asians who volunteer often experience social injustice and marginalisation and (3) volunteering for South Asians is intrinsically tied to religious and cultural motivations. British South Asians faced personal and social obstacles in accessing fundamental health and social care in their communities of belonging. Religion, and community social capital were positive volunteering strategies for British South Asians. Positive impacts of well-being included becoming closer to faith and increased sense of meaning/purpose and recognising of individual strengths. These findings offer valuable insights and recommendations for community organisations and governmental bodies to better promote volunteering for ethnic minorities. We suggest the adoption of cultural and religious sensitivity, along with strategies to remove barriers in access to opportunities and support for volunteering.

Food expenditure, income, and mental health: Outcomes from the UK Household Longitudinal Survey.

The incidence of mental health problems is increasing in the United Kingdom and may be associated with lower dietary quality. Food expenditure is a marker of food insecurity with potential implications for mental health. This analysis considers data collected as part of the United Kingdom Household Longitudinal Survey (UKHLS), also known as 'Understanding Society' (2009-2021) (N = 388,944) to determine the extent to which food expenditure within and outside the household, is associated with mental health, whilst controlling for demographic factors. Mental health was measured using the General Health Questionnaire (GHQ-12) for which responses were on a 4-point scale and reverse-scored so that a higher score represented more favourable mental health. Household food expenditure and food expenditure outside the home were the outcomes. Controlling for socioeconomic and demographic factors, fixed-effects models indicated that better mental health was associated with greater household food expenditure and with greater food expenditure outside the home and that this association persisted post-lockdown. Among those on lower incomes better mental health was associated with lower food expenditure. When people who identified as white and non-white were modelled separately, better mental health was associated with lower food expenditure within and beyond the household only in those who identified as white. These findings imply that the mental health of people residing in the UK, particularly those on lower incomes and those who identify as white, may benefit from spending less of the household budget on food. In achieving United Nations General Assembly (2012) Sustainable Development Goals related to poverty, hunger and in promoting mental health, policies are needed to render food more affordable and to reduce other aspects of expenditure that impact upon food budgeting.

To scope or not to scope? The benefits and challenges of integrating scoping studies in rapid qualitative research and evaluation.

Creating sustainable change and fostering collaborative relationships between researchers and stakeholders is a recognized challenge in the field of evaluation. Identifying programme purpose, cultural context, potential challenges, and engaging stakeholders before an evaluation can produce responsive and impactful evaluations. This paper discusses implementing a targeted scoping study within the framework of rapid qualitative research and evaluation. A scoping study enables collaborative decision-making on evaluation priorities, and functions as an evaluability assessment in time-sensitive contexts. In our experience, a scoping study can be carried out in as little as five days or as long as six weeks. It is timely to revisit the question of what factors influence evaluation outcomes, a scoping study can be used to support an evaluation, address access to data and research, and strengthen communication channels. The methodological approach was used to co-produce an evaluation with an NGO that accurately reflected their needs, recognizing possible challenges and solutions.

"We lost a lot, but something good came out of it too:" Exploring the impact of the COVID-19 pandemic on the mental wellbeing of British Muslim Pakistani women with family responsibilities.

BACKGROUND: The COVID-19 pandemic and associated restrictions caused major disruption globally, shedding light on the unprecedented strain upon the mental health and wellbeing of individuals around the world. Poor mental health in the pandemic is reported to be greater in women, with mothers being at increased risk. It is unclear whether there are differences in the impact of mental wellbeing on some ethnic groups over others. The aim of this study was to explore the experiences of British Muslim Pakistani women with family responsibilities during the COVID-19 pandemic, two years on from the first lockdown. METHODS: Qualitative interviews with women were conducted via telephone using a semi-structured topic guide. The sample included 25 British Muslim Pakistani women with family responsibilities, both English and non-English speaking. Women lived in households that ranged in number and included extended family. Key themes were determined using thematic analysis. RESULTS: Results were grouped under three themes. These were (1) Community, cultural and religious contributors to poor mental wellbeing, (2) religious and cultural mediators of mental distress, and (3) perceived positive impact on lifestyle. British Muslim Pakistani women were psychologically distressed by the high rates of virus transmission and deaths in their communities and at the prospect of older members of their extended family developing the virus. The impact of restrictions on fundamental religious and cultural interactions further exacerbated poor mental wellbeing in this population. Religion, community social capital and larger household structures were all effective coping strategies for British Muslim Pakistani women. Positive impacts of the pandemic included becoming closer to family and faith, and increased work/life harmony. CONCLUSIONS: An exploration of religious and cultural coping mechanisms should be used to inform future national pandemic preparedness plans, as well as effective strategies for building and maintaining social capital. This may increase adherence to physical distancing and other protective behaviours in populations.

The role of patient and public involvement in rapid qualitative studies: Can we carry out meaningful PPIE with time pressures?

INTRODUCTION: Rapid qualitative studies conducted with patient and public involvement can help promote policy-relevant and efficient research. There is a need to understand the experiences of researchers, patients, and members of the public to guide the development of good practice and to determine the extent to which rapid qualitative research can be implemented in PPIE projects. METHODS: We conducted a qualitative study to explore the experiences of research teams that carried out studies using rapid techniques with patient and public involvement. We carried out 26 interviews with researchers, coordinators, patients, carers, service users and members of the public. RESULTS: This study identified needs which related to practical and time constraints. Rapid qualitative research tends to be limited to certain PPIE groups, and particular phases of the research process. Study findings are rarely discussed with PPIE members. The educational needs of rapid qualitative research were also identified. Researchers and PPIE members considered three main issues: a lack of training on patient involvement for researchers, rapid qualitative research training for PPIE members, and the diversity of PPIE members. CONCLUSION: We found that rapid researchers were able to involve patients and members of the public in research despite time pressures. The challenges identified in this study can be used to plan future training programmes for researchers and PPIE panel members and develop strategies to recruit PPIE panel members from a wide range of backgrounds. PUBLIC CONTRIBUTION: The research aim was to explore the experiences of those carrying out rapid qualitative studies with PPIE. As such, the participants of this study included patients, carers, service users and members of the public, who were interviewed individually. A lived experienced researcher and PPIE member for a hospital conducted the design, data collection and analysis of the study. The study brief was to interview researchers only. The lived-experience researcher initiated the inclusion of PPIE members as participants, therefore strengthening the study design. We shared the draft report with the PPIE participants for participant validation and to maintain a continuous feedback relationship. This led to addressing key issues in designing and involving PPIE members in more meaningful and equal ways. Whilst there is agreement on activities which centre on PPIE, there is no consensus on how to achieve these in high quality rapid qualitative studies.