Pilot Randomised Controlled Trial - Nurture Early for Optimal Nutrition (NEON) Study: Community facilitator-led participatory learning and action (PLA) women's groups to improve infant feeding, care and dental hygiene practices in South Asian infants aged < 2 years in East London (preprint)

ABSTRACT

Background: The first 1000-days of life are a critical window and can result in adverse-health consequences due to inadequate nutrition. South-Asian (SA) communities face significant health-disparities, particularly in maternal and child-health. Community-based-interventions, often employing Participatory-Learning-and-Action (PLA) approaches, have effectively addressed health-inequalities in lower-income-nations. The aim of this study was to assess the feasibility of implementing a PLA-intervention to improve infant-feeding and care-practices in SA communities in London. Methods: Comprehensive-analyses were conducted to assess the feasibility/fidelity of this pilot-randomised-controlled-trial. Summary-statistics were computed to compare key-metrics (participant consent-rates, attendance, retention, intervention-support, perceived-effectiveness) against predefined-progression-rules guiding towards a definitive-trial. Secondary-outcomes were analysed, drawing insights from sources, such as The-Children's-Eating-Behaviour-Questionnaire (CEBQ), Parental-Feeding-Style-Questionnaires (PFSQ), 4-Day-Food-diary, and the Equality-Impact-Assessment (EIA) tool. Video-analysis of children's mealtime behaviour trends was conducted. Feedback-interviews were collected from participants. Results: Process-outcome measures met predefined-progression-rules for a definitive-trial which deemed the intervention as feasible. The secondary-outcomes analysis revealed no significant changes in children's BMI z-scores. This could be attributed to the abbreviated follow-up period of 6-months, reduced from 12-months, due to COVID-19-related delays. CEBQ analysis showed increased food-responsiveness, along with decreased emotional-over/undereating. A similar trend was observed in PFSQ. The EIA-tool found no potential discrimination areas, and video-analysis revealed a decrease in force-feeding-practices. Participant-feedbacks revealed improved awareness and knowledge-sharing. Conclusion: The study validates the feasibility of a community-oriented, co-adapted Participatory-Learning-and-Action approach for optimising infant-care among South-Asians in high-income countries. It underscores the potential of such interventions in promoting health-equity and improving health-outcomes. Further research is required to evaluate their wider impact.