Strategies for engaging UK ethnic minority communities to improve their diets and increase their physical activity: community based participatory research during the COVID-19 pandemic

Abstract

Physical activity and healthy eating are important for good health, contributing to the prevention and management of physical and mental health conditions, and infectious diseases. UK ethnic minority communities often do not engage with efforts to improve these behaviours and continue to have lower physical activity and healthy eating levels compared to the rest of the UK population. Engaging with communities in designing interventions to improve their health can help improve the impact of those interventions. There is a dearth of evidence, however, on the best ways of engaging with ethnic minority communities to improve their health and consequently, how to adapt health improvement efforts to achieve greater impact. This thesis addresses this gap in evidence through a series of studies exploring strategies to engage UK ethnic minority communities in efforts to improve their diet and increase their physical activity. These studies took place during the COVID-19 pandemic, following increasing awareness of higher infection and death rates amongst ethnic minority communities which prompted increased public health actions to address these inequalities. This PhD by publication involved four studies and is underpinned by community-based participatory research (CBPR) and qualitative research methodology. The first study was a scoping review that identified different categories of physical activity and healthy eating messaging targeting ethnic minority communities. Using qualitative interviews and focus group discussions, the second study explored how the available messages were received by ethnic minority communities. Study 3 also adopted qualitative research methods to identify the main values underlying physical activity and healthy eating behaviours among UK ethnic minority communities and to explore how structural, social, economic and environmental factors interact with these values. Study 4 described six main strategies that were key to building trust and increasing the inclusion of ethnic minority communities throughout the PhD and the project within which it was based. Across the qualitative studies (Studies 2 and 3), a total of 41 people aged between 18-86 years old from ethnic minority communities living across the UK were involved (68% Black ethnic group, 53% women). Studies 1 and 2 found that despite a plethora of messaging, messages tailored to ethnic minority communities were limited and much of what was available was either entirely missed or where seen, not well-received. Study 3 identified culture, family, community, social and health as important values that shaped their physical activity and healthy eating behaviour, and that messaging, policies and programmes need to align with these values to ensure they were meaningful and relevant to these communities. A consistent finding across all studies was that community engagement and co-production were useful in ensuring that health promotion activities are relevant to diverse communities and the ways through which this could be achieved were described and presented in Study 4. Collectively, the studies in this PhD demonstrate that actively engaging ethnic minority communities in the development, implementation and dissemination of messaging, policies and programmes to improve physical activity and healthy eating is essential to ensure those 2 interventions are well accepted by the communities. This PhD has also contributed to the evidence base on how efforts to improve physical activity and healthy eating can be made more relevant to ethnic minority communities, reducing health inequalities. Further research is needed to assess the effectiveness of these strategies in improving physical activity and healthy eating behaviours and ultimately, the health and wellbeing of UK ethnic minority communities.

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Identifiers

ORCID for Mary Barker: orcid.org/0000-0003-2976-0217

ORCID for Maria Stokes: orcid.org/0000-0002-4204-0890

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