South Asian individuals’ experiences on the NHS low-calorie diet programme: a qualitative study in community settings in England

Abstract

BackgroundExisting literature examines barriers to the provision of ethnically diverse dietary advice, however, is not specific to total diet replacement (TDR). There is a lack of literature from the UK, limiting the potential applicability of existing findings and themes to the UK context. This study addresses this gap in research by interviewing participants of South Asian ethnicity who have undertaken the National Health Service (NHS) low-calorie diet programme (LCD) for people with type 2 diabetes living with overweight or obesity. This study explores factors that may affect the uptake and acceptability of its TDR, food reintroduction and weight maintenance stages. This aims to provide rich data that can inform effective tailoring of future programmes with South Asian participants.ObjectiveTo explore the perspectives of individuals of South Asian ethnicity on an NHS programme using TDR approaches for the management of type 2 diabetes (T2D).DesignQualitative study.SettingIndividuals in the community undertaking the NHS LCD programme.ParticipantsTwelve one-to-one interviews were conducted with individuals from a South Asian ethnicity participating in the NHS LCD.Main outcome measuresQualitative semistructured interviews conducted through different stages of the programme. Reflexive thematic analysis was used to analyse the transcripts.ResultsKey themes highlighted positive and negative experiences of the programme: (1) more work is needed in the programme for person centeredness; (2) it is not the same taste; (3) needing motivation to make changes and feel better; (4) a mixed relationship with the coach; (5) social experiences; (6) culture-related experiences.ConclusionThis study provides important experience-based evidence of the need for culturally tailored T2D programmes. Action to address these findings and improve the tailoring of the NHS LCD may improve experience, retention and outcomes on the programme for people of South Asian ethnicity and thereby reduce inequalities.

A Qualitative evaluation in community settings in England exploring the experiences of coaches delivering the NHS Low Calorie Diet programme pilot to ethnically diverse participants

“… 18 The study highlighted the important and complex role of the coach–participant relationship while many praised the supportive role of coaches, acknowledging their empathy, effective communication skills and provision of resources, others encountered challenges stemming from a lack of cultural understanding. 18 …”

“… 16 Furthermore, we have previously explored the experiences of participants from a South Asian background, who were undertaking the National Health Service (NHS) Low Calorie Diet (LCD) programme.) 18 This study highlighted the importance of adopting a person-centred approach in designing interventions, recognising the influence of culture, motivation and community engagement on health behaviours and outcomes and tailored and culturally appropriate interventions for managing T2D. 18 …”

“… 18 This study highlighted the importance of adopting a person-centred approach in designing interventions, recognising the influence of culture, motivation and community engagement on health behaviours and outcomes and tailored and culturally appropriate interventions for managing T2D. 18 …”

“…This paper on coaches’ perspectives accompanies our previous paper on participant experiences, 18 building on previous findings from the wider Re:Mission study 20 21 to gain greater understanding of the ethnic inequalities identified.…”

fresh start with high hopes: a qualitative evaluation of experiences of the Total Diet Replacement phase of the NHS Low Calorie Diet Programme pilot

“…We have some understanding of how ethnicity and socioeconomic status intersect. This was presented in the paper by Dhir, 20 which interviewed 12 services users identifying as South Asian ethnicity and through the perceptions of the commercial providers. 21 Representation was however strengthened by the addition of reflections from the crosssectional data.…”