{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:15:48Z","timestamp":1788869748297,"version":"build-2803163510"},"update-to":[{"DOI":"10.3310\/nihropenres.14303.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000}}],"reference-count":19,"publisher":"National Institute for Health and Care Research","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","award":["NIHR305165"],"award-info":[{"award-number":["NIHR305165"]}],"id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["openresearch.nihr.ac.uk"],"crossmark-restriction":false},"short-container-title":["NIHR Open Res"],"abstract":"<ns3:p>Background Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes and affects approximately 10\u201320% of pregnancies in the UK. The prevalence of GDM among South Asian women is around twice that of White British women, and they are also twice as likely to develop type 2 diabetes following diagnosis. Although multiple dietary interventions have been explored to improve glycaemic control in GDM, no single dietary approach has proven consistently effective in improving health outcomes. We conducted a patient and public involvement and engagement (PPIE) activity with South Asian women to inform a trial evaluating the acceptability, feasibility, and safety of an intermittent low-energy diet (ILED) in GDM. PPIE input was particularly valuable in addressing lower-than-anticipated recruitment and retention, especially among South Asian women, and provided insights into sociocultural barriers and facilitators to improve trial design and participation. Methods Six South Asian women with lived experience of overweight or obesity in pregnancy, either personally affected by gestational diabetes or with close family experience, participated in one-to-one discussions lasting up to 60\u00a0minutes to provide feedback on trial procedures, methods, and design. Based on these insights, a follow-up discussion group was conducted with eleven South Asian women who had been pregnant in the last five years, were currently pregnant, or planning pregnancy, and who had experience of overweight\/obesity or GDM. Key priorities were identified and translated into practical action points to inform ongoing research. Conclusions Three key priorities emerged as a potential means of enhancing engagement with South Asian women: addressing vulnerability (including trust and loss of control), improving accessibility, and reducing mental load (including competing priorities, emotional wellbeing, and family influence).<\/ns3:p>","DOI":"10.3310\/nihropenres.14303.2","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:59:06Z","timestamp":1788868746000},"page":"77","update-policy":"https:\/\/doi.org\/10.3310\/nihropenres.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["How to improve uptake and adherence to dietary trials in gestational diabetes amongst South Asian women: insights from patient and public involvement and engagement"],"prefix":"10.3310","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8220-4514","authenticated-orcid":false,"given":"Elizabeth","family":"Dapre","sequence":"first","affiliation":[{"name":"Centre for Primary Care and Health Services Research Manchester England M13 9PL The University of Manchester Centre for Primary Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9761-3089","authenticated-orcid":false,"given":"Michelle","family":"Harvie","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics Manchester England M13 9LW Manchester University NHS Foundation Trust"},{"name":"Division of Cancer Sciences Manchester England M13 9NT The University of Manchester Division of Cancer Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Issa","sequence":"additional","affiliation":[{"name":"Diabetes, Endocrinology and Metabolic Services Manchester England M13 9WL Manchester University NHS Foundation Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7635-8354","authenticated-orcid":false,"given":"Brian","family":"McMillan","sequence":"additional","affiliation":[{"name":"Centre for Primary Care and Health Services Research Manchester England M13 9PL The University of Manchester Centre for Primary Care"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Morley","sequence":"additional","affiliation":[{"name":"Division of Psychology and Mental Health Manchester England M13 9PL The University of Manchester Division of Psychology and Mental Health"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6221","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"ref1","article-title":"National Gestational Diabetes Mellitus Audit."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"795-804","DOI":"10.1016\/S2213-8587(15)00255-7","article-title":"Association between hyperglycaemia and adverse perinatal outcomes in south Asian and white British women: analysis of data from the Born in Bradford cohort.","volume":"3","author":"D Farrar","year":"Oct 2015","journal-title":"Lancet Diabetes Endocrinol."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e067946","DOI":"10.1136\/bmj-2021-067946","article-title":"Gestational diabetes mellitus and adverse pregnancy outcomes: systematic review and meta-analysis.","volume":"377","author":"W Ye","year":"2022","journal-title":"BMJ."},{"key":"ref4","article-title":"Leicester researcher reveals health inequalities for Black and South Asian women following gestational diabetes diagnosis."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"636-642","DOI":"10.1093\/fampra\/cmh611","article-title":"South Asian patients\u2019 views and experiences of clinical trial participation.","volume":"21","author":"M Hussain-Gambles","year":"2004","journal-title":"Fam Pract."},{"key":"ref7","article-title":"Diabetes in pregnancy: management from preconception to the postnatal period: NG3.","year":"25\/02\/2015, updated 16\/12\/2020"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"CD009275","DOI":"10.1002\/14651858.CD009275.pub3","article-title":"Different types of dietary advice for women with gestational diabetes mellitus.","volume":"2","author":"S Han","year":"Feb 25 2017","journal-title":"Cochrane Database Syst Rev."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e078264","DOI":"10.1136\/bmjopen-2023-078264","article-title":"Manchester Intermittent Diet in Gestational Diabetes Acceptability Study (MIDDAS-GDM): a two-arm randomised feasibility protocol trial of an intermittent low-energy diet (ILED) in women with gestational diabetes and obesity in Greater Manchester.","volume":"14","author":"E Dapre","year":"Feb 10 2024","journal-title":"BMJ Open."},{"key":"ref10","article-title":"Do I need NHS REC approval?"},{"key":"ref11","article-title":"Do I need ethical approval to run an involvement activity?"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"857-866","DOI":"10.1002\/pd.6782","article-title":"\u2018I Have my Beliefs, but Then I Have my Reality\u2019: Reflections of Black and South Asian Parents Living in England on Screening and Genetic Diagnosis in Pregnancy.","volume":"45","author":"M Peter","year":"Jun 2025","journal-title":"Prenat Diagn."},{"key":"ref13","article-title":"Ethnic Inequalities in Healthcare: A Rapid Evidence Review.","author":"D Kapadia","year":"2022"},{"key":"ref14","article-title":"Diverse voices on data.","author":"B Wilson","year":"2022"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"3-16","DOI":"10.1177\/13591053221101750","article-title":"Putting the \u2018teachable moment\u2019 in context: A view from critical health psychology.","volume":"28","author":"A Locke","year":"Jan 2023","journal-title":"J Health Psychol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1119998","DOI":"10.3389\/fpsyt.2023.1119998","article-title":"Exploring Black and South Asian women\u2019s experiences of help-seeking and engagement in perinatal mental health services in the UK.","volume":"14","author":"M Conneely","year":"2023","journal-title":"Front Psychiatry."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"347-350","DOI":"10.1177\/0141076821994274","article-title":"Patient and public involvement for ethnic minority research: an urgent need for improvement.","volume":"114","author":"W Ekezie","year":"2021 Jul","journal-title":"J R Soc Med."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"e70210","DOI":"10.1111\/hex.70210","article-title":"Understanding Barriers and Facilitators for Ethnic Minority Groups to Audio Recording Recruitment Discussions in Clinical Trials: A Participatory Approach to Improving Informed Consent and Participation.","volume":"28","author":"S Faisal","year":"2025 Apr","journal-title":"Health Expect."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1186\/s13063-022-06542-z","article-title":"Underrepresentation of ethnic minorities in hypertension research-a survey of enablers and barriers among South Asian and African communities in Glasgow.","volume":"23","author":"S Lip","year":"2022 Jul 29","journal-title":"Trials."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"20551029211055264","DOI":"10.1177\/20551029211055264","article-title":"The role of positive psychological constructs in diet and eating behavior among people with metabolic syndrome: A qualitative study.","volume":"9","author":"A Carrillo","year":"Jan-Jun 2022","journal-title":"Health Psychol Open."}],"container-title":["NIHR Open 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status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.3310\/nihropenres.15749.r42162, Eleftheria Taousani, International Hellenic University, Thessaloniki, 08 Sep 2026, version 2, 1 approved","URL":"https:\/\/openresearch.nihr.ac.uk\/articles\/6-77\/v2#referee-response-42162","order":0,"name":"referee-response-42162","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This project is funded by the National Institute for Health Research (NIHR) under its In\u2011Practice Fellowship (Grant Reference Number NIHR305165) and an NIHR\u2011funded trial (Grant Reference Number NIHR201944), and is sponsored by Manchester University NHS Foundation Trust (MFT). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":1,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}