How to improve uptake and adherence to dietary trials in gestational diabetes amongst South Asian women: insights from patient and public involvement and engagement

<ns5:p>Background Gestational diabetes mellitus (GDM) is associated with adverse maternal and neonatal outcomes and affects approximately 10–20% 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 minutes 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).</ns5:p>