{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:33Z","timestamp":1792788753049,"version":"4.5.0"},"reference-count":49,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-12-DSSA-0001"],"award-info":[{"award-number":["ANR-12-DSSA-0001"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001665","name":"Agence Nationale de la Recherche","doi-asserted-by":"publisher","award":["ANR-19-CE36-0006"],"award-info":[{"award-number":["ANR-19-CE36-0006"]}],"id":[{"id":"10.13039\/501100001665","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Fonds Fran\u00e7ais pour l\u2019Alimentation et la Sant\u00e9","award":["FFAS-12-A-010"],"award-info":[{"award-number":["FFAS-12-A-010"]}]},{"name":"Institut de recherche en sant\u00e9 publique","award":["IReSP-15-Pr\u00e9vention-07"],"award-info":[{"award-number":["IReSP-15-Pr\u00e9vention-07"]}],"id":[{"id":"https:\/\/ror.org\/05fw72335","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Institut de recherche en sant\u00e9 publique","award":["AAP-2022-SIP-311921"],"award-info":[{"award-number":["AAP-2022-SIP-311921"]}],"id":[{"id":"https:\/\/ror.org\/05fw72335","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Guy Demarle Enfance & Bien Manger Foundation Price"},{"name":"Joint Programming Initiative \u2018A Healthy Diet for a Healthy Life\u2019 PREPHOBES","id":[{"id":"https:\/\/ror.org\/015zqm698","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Projet F\u00e9d\u00e9ratif Hospitalo Universitaire (FHU) 1000 days of the Lille University Hospital"},{"name":"Fondation Roquette pour la Sant\u00e9"},{"name":"Agence R\u00e9gionale de Sant\u00e9 des Hauts-de-France"},{"DOI":"10.13039\/501100001961","name":"AXA Research Fund","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001961","id-type":"DOI","asserted-by":"publisher"}]},{"name":"D\u00e9l\u00e9gation interminist\u00e9rielle \u00e0 la pr\u00e9vention et \u00e0 la lutte contre la pauvret\u00e9"},{"name":"Bl\u00e9dina"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The ECAIL trial, launched in 2017, was designed to evaluate a multicomponent intervention for childhood obesity prevention among hard-to-reach families. At a maternity hospital in Lille, France, healthcare providers screened pregnant women experiencing social vulnerability, and dietitians delivered a home-based intervention until age 2. The COVID-19 pandemic led to a six-month suspension in 2020. This study compared eligibility and participation before the pandemic and after resumption, and examined how implementation and reach evolved across the pandemic and subsequent cost-of-living crisis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using a convergent mixed-methods design, we analyzed 5,744 eligibility questionnaires distributed at the maternity ward and conducted a focus group with six dieticians delivering the intervention to triangulate quantitative implementation indicators with qualitative implementation data. Inclusion criteria included \u22651 indicator of social vulnerability (e.g., socioeconomic disadvantage, precarious housing, or social isolation). The focus group was recorded, transcribed, and analyzed thematically focusing on reach, acceptability, and adaptation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Eligibility increased from 29.7% (n\u2009=\u2009955) pre-pandemic to 33.6% (n\u2009=\u2009849) after resumption, while the distribution of vulnerability criteria remained similar across periods: 78.3% received social\/medical benefits; employment was not the main source of household income for 58.7%; 24.4% experienced financial hardship; 14.7% reported social isolation; 6.0% lived in precarious housing; and 19.0% had three or more vulnerabilities. Participation among eligible women remained stable (24.6%; n\u2009=\u2009443). Qualitative findings indicated dietitians\u2019 satisfaction and participants\u2019 enthusiasm for the resumption of home visits, particularly in addressing social isolation. After resumption, the introduction of a pre-visit COVID-19 questionnaire was associated with fewer failed home visits. Integration of quantitative and qualitative findings indicated sustained, and in some cases strengthened, provider engagement despite pandemic-related strain on hospital services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study suggests that a complex intervention can maintain reach and acceptability through adaptive implementation under major contextual disruptions. The rapid resumption of home-based services emerged as a promising implementation strategy for engaging and retaining socially disadvantaged families, highlighting the importance of flexible, context-sensitive approaches during social and economic crises.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>\n                      Clinicaltrials.gov NCT03003117; registration date: 21\/12\/2016;\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/study\/NCT03003117\" xlink:type=\"simple\">https:\/\/clinicaltrials.gov\/study\/NCT03003117<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0350372","type":"journal-article","created":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T17:25:13Z","timestamp":1791480313000},"page":"e0350372","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Reach and engagement in the ECAIL trial targeting socially disadvantaged families across the COVID-19 pandemic and cost-of-living crisis: A mixed-methods implementation study"],"prefix":"10.1371","volume":"21","author":[{"given":"Delphine","family":"Poquet","sequence":"first","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9 and Universit\u00e9 Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camille","family":"Le Gal","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris Cit\u00e9 and Universit\u00e9 Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics","place":["Paris, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale","family":"Hincker","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Lille","place":["Lille, France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5369-3910","authenticated-orcid":true,"given":"Laurent","family":"B\u00e9ghin","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Lille","place":["Lille, France"]},{"name":"Universit\u00e9 Lille, Inserm, CHU Lille, INFINITE - 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