Co-production of 'Health Connections' - a community-based diet, physical activity, and healthy weight intervention for UK Black and Asian adults

What is the problem? Current health communication and behaviour change programmes do not support UK Black and Asian populations in making healthier dietary and physical activity (PA) choices, and maintaining a healthier weight.

We talked to Black Caribbean, Black African and South Asian women and men and to health practitioners to develop this project. In these conversations people shared that they are very motivated to improve their diet and PA behaviours to prevent serious health conditions such as type 2 diabetes. However, some also told us that worrying about or experiencing racism, and other barriers such as time and expense, stopped them from taking part in healthy lifestyle programmes. It was felt that existing services lacked relevance for Black and Asian people and were poorly communicated. When asked what ideal help with health behaviour change would look like to them, services with mental health support delivered by staff of the same ethnic group and similar lived experience were common opinions. The importance of being able to keep eating their traditional foods, and that dancing or walking were popular activities, was also emphasised. Weight loss, if needed, was seen as something that happened naturally, if healthy habits could be maintained. In terms of programme delivery, the need for low cost and flexible sessions, and a preference for community rather than medical settings, was stated. We also looked at existing published research and while there are some studies on what helps and hinders healthy behaviours among Black and South Asian ethnic groups, there has been very little research developing and testing interventions suitable for these groups.

How will the problem be addressed? We have formed a group made up of researchers, members of the public, charities, health professionals, and policy makers. Together we aim to co-design 'Health Connections'- a new intervention tailored to the needs of Black Caribbean, Black African and South Asian men and women, based in communities and delivered by community educators supported by health professionals. We will look at how a culturally sensitive communication campaign and mental health support can be included in an intervention programme to improve diet and PA choices, and promote healthy weight. We will also examine how health professionals can be trained in cultural competency (being able to see things from the point of view of people from other cultures), so that partnerships between health professionals and community educators are improved.

Throughout the project there will be meetings every two months and other activities such as questionnaires and a workshop, and support meetings for group members from the public, to make sure all views are represented. We will conduct interviews with men and women from diverse ethnic groups to understand their experiences, opinions and intervention needs, adding to our existing data. Findings will be summarised in a plain English report. We will also gather examples of existing intervention resources (such as culturally adapted recipes) and local practice. Based on the information gathered, we will make a list of potential programme sessions, their content, and how they will be delivered. The project group will complete questionnaires regarding the list, and discuss the results in a workshop to come to an agreement on the best ideas. Examples of session content (e.g. recipe cards and exercise videos) will be made and we will hold a community event in Leeds, UK, to see what the public think of the ideas and materials. The final stage will be to write a manual documenting the intervention and to share the project findings in publications, presentations, and an infographic. The findings will then be the basis of planning the next phase of research, which will be to carry out a trial to test whether the newly designed intervention can be carried out and is acceptable among Black and South Asian adults.

Current health communication and behaviour change programmes do not support UK Black and Asian populations in making healthier dietary and physical activity (PA) choices, and maintaining a healthier weight. We aim to co-produce 'Health Connections' - an ambitious new intervention tailored to the needs of Black Caribbean, Black African and South Asian men and women, embedded in communities and delivered by peer-educators supported by health professionals. Components will include a culturally sensitive social marketing campaign; equitable, flexible opportunities and psychosocial support to promote favourable diet and PA choices, and healthy weight; and cultural competency training to enhance partnerships between health professionals and peer-educators. The project is underpinned by a systems perspective, positing collective efficacy within communities, behaviour change theory, and co-production. Semi-structured interviews will be conducted with men and women from diverse South Asian ethnic groups to understand their experiences, perspectives and intervention needs, adding to our existing data from Black ethnic groups. We will synthesise the data, literature, existing intervention resources and local practice, and develop the theoretical framework to co-develop intervention goals, programme theory, and a draft logic model of change. A theorised list of potential intervention components, session content, and mode/s of delivery will be explored in a Delphi exercise and workshop to achieve consensus on the intervention format; and we will develop prototype materials, and a formal implementation plan. An intervention manual and a plan for testing and evaluating feasibility and acceptability, and process, outcome, and cost effectiveness within a pilot trial, will be co-designed. Dissemination suitable for a range of stakeholders and audiences will include publications, presentations, and an infographic.