Co-producing with the local community an action plan to reduce consumption of high fat, sugar and salt foods in Newham.

The London Borough of Newham has high levels of Type 2 diabetes and people living with overweight/obesity. These conditions cause a high burden on general practice and hospital services, and are also associated with worse health outcomes from Covid-19. Newham is ethnically diverse with 73% of its population coming from an ethnic minority background. Levels of deprivation are also high in the borough; when ranked against other areas in England, Newham is in the 20% most deprived areas.
Although there are existing services to prevent Type 2 diabetes and encourage weight-loss, these are nationally devised programmes that are not well-suited for this low-income, ethnically diverse population; this means that these programmes may actually be widening inequalities in an area like Newham.

We propose to develop a Food Champions intervention with the local population, where a Food Champion will act to improve Newham's diet on behalf of the population. Co-producing the intervention will ensure that any proposed activities are acceptable to the local population and are addressing issues that they feel are relevant to them.

Proposed methods: Systems approaches aim to take account of the multitude of influences on a behaviour such as diet. We will use a systems approach and work with the local population to develop the job description, training and resources needed for a local Food Champions programme to reduce the consumption of high fat, sugar and salt foods.
1) The first stage will involve a rapid review of published literature and reports on Food Champion programmes with ethnically diverse, low-income adult populations. This review will provide information on what aspects of previous Food Champion programmes have worked. This will also allow us to create a preliminary Theory of Change model for the intervention, which outlines how a Food Champions intervention could improve the diet of Newham residents.
2) Whilst the review is being conducted we will draw a map of all the people we believe are involved in producing, selling and consuming food in Newham - known as a stakeholder map of the food system. A general map for the whole of Newham will be constructed and local residents will have the opportunity to edit this to create eight separate maps for the eight official Community Neighbourhoods in Newham.
2) The stakeholder maps will be used to recruit people to ten groups which will aim to have an appropriate balance of ethnicities, genders and ages. Two groups will consist of people invited from the stakeholders identified in the general map. The other eight groups will be consist of people invited from the eight Community Neighbourhoods and any relevant stakeholders from each area. Each of the ten groups will attend 2 workshops.
During the workshop 1, participants will be asked to draw maps of what they perceive as the causes and consequences of poor diet in Newham. After this workshop, researchers will construct a systems diagram showing the causes and consequences identified in workshop 1 and whether the factors are related. During workshop 2, participants will update this systems map until they feel it is accurate, then use this map to identify areas for action to improve diet in Newham. An experience facilitator will guide the participants through the process.
3) An intervention development group will be set up consisting of community members, the research team, the public health team at Newham and the team that would be responsible for delivering the intervention. A final Theory of Change model for the intervention will be constructed using the findings and suggested actionable areas from the workshops which will outline which factors the Food Champions will act on. The content of the intervention is will be final when agreed by the community members and those who will deliver the Food Champions programme.
4) Draft training manuals and any other necessary resources will be developed.

Background: Newham has a high prevalence of diabetes and obesity; these conditions cause a high burden on primary and secondary health services, and are also associated with worse outcomes from Covid-19. Newham is ethnically diverse with 73% of its population coming from an ethnic minority background. This is particularly relevant as diabetes rates are three times higher in Black African and Black Caribbean groups, and six times higher in South Asian groups. Levels of deprivation are also high, with the borough being within the 20% most deprived areas in England. Although there are existing services to prevent diabetes and encourage weight-loss, these are nationally devised programmes that are not well-suited for this low-income, ethnically diverse population. This is potentially leading to the widening of health inequalities in areas such as Newham.

Proposed methods: We will use co-production methods to develop the job description and training manuals needed for a local Food Champions intervention to reduce the consumption of high fat, sugar and salt foods. We will conduct a rapid realist review of Food Champion projects and construct stakeholder maps of the Newham food system. We will work with community groups from eight areas of Newham, plus 2 more groups recruited from the whole of Newham to co-produce causal loop diagrams, or systems maps, of the factors affecting poor diet in Newham. Each group will be asked to identify suitable areas for action within the system, with guidance from a facilitator. This information will be used by an intervention development group consisting of researchers and local project partners. This group will use the information from the workshops to construct a Theory of Change model to identify what aspects of the Newham food system local Food Champions should act on and what training would be needed. Draft intervention training manuals will then be drafted.