Health literacy is essential for making informed healthcare decisions, yet ethnic minority communities often face disparities due to limited access to culturally relevant information. This qualitative study explores how South Asian and Black communities in the United Kingdom (UK) assess health information credibility, examining cultural influences and expectations. Sixty-eight participants (42 South Asian, 26 Black) were recruited using purposive sampling; data collection involved semi-structured interviews (n = 30) and community observations (n = 38). Findings revealed that cultural expectations shape perceptions of healthcare professionals and health information sources. Trusted sources included personal contacts and social media. Health information lacking personal or culturally relevant content led participants to seek alternative sources. While some credibility-seeking behaviours overlap with those observed in the general population, the unique social, cultural, and historical experiences of these populations shape how and why such behaviours are enacted, resulting in distinct patterns of trust and information use. Providers must recognise these dynamics to create personalised, culturally sensitive resources that enhance trust, health literacy, and equity. Tailored approaches, including trusted intermediaries and relevant communication channels, are crucial, while digital platforms must address misinformation.

Abstract Objectives Despite their higher risk of stroke and known inequities in post-stroke outcomes, research amongst minoritised ethnic communities who have experienced stroke is scarce. This study aimed to explore the experiences of Black people in England and identify implications for supported self-management. Methods Between December 2023 and June 2024 qualitative interviews were conducted with 20 Black people living with stroke in England. Interviews were conducted in-person or online, depending on participants’ preferences. Data were analysed iteratively using reflexive thematic analysis. Results Three themes were developed: (1) “My world after stroke” capturing emotional and social identity-related impacts and adjustments; (2)“My support”: Family, Community and Peers, encapsulating different facets of support and the relational nature of self-management; and (3) “Supported self-management as a negotiated partnership with healthcare professionals”, highlighting the varied nature and outcomes of patient-professional interactions and their social embeddedness, including underlying power and historical racial dynamics. Conclusions Our study confirms the need for closer examination of how supported self-management can be provided to different populations. The post-stroke experiences of the Black people who participated in our study were inextricably shaped by their specific familial, social and cultural settings. Their adaptation to and management of the physical and emotional aspects of their condition was enacted across family systems, community and peer networks as well as healthcare services, with varying outcomes. In addition, their interactions and engagement with healthcare professionals were influenced by a broader historical context of discrimination and racism. Our study reveals the importance of delivering supported self-management to Black people living with stroke which responds to their specific social contexts and intersectional identities and which also strives to reduce power imbalances and address historical discrimination, thereby ensuring ‘cultural safety’ in service provision. Overlooking these aspects risks undermining self-management and underserving those who already face significant health inequities.

Research leadership is central to shaping research culture, advancing institutional excellence, and fostering innovation, yet opportunities for leadership development remain unevenly distributed across disciplines, career stages, and professional roles. Inequalities in access risk reproducing privilege in academic research, raising questions about how programmes can support equitable participation and career progression. This paper examines equality, research culture, and career progression in research leadership development through a comparative case study of two research leadership academies: a university-based academy open to researchers across disciplines (Kingston University Rise Research Leadership Academy) and a national academy for applied health and care research (National Institute for Health and Care Research (NIHR) Research Leadership Academy). The study draws on survey data from six cohorts (2023–2025; n = 464), equality, diversity and inclusion monitoring, and longitudinal follow-up at 12 and 24 months. Findings indicate that while both academies enhanced participants’ self-reported leadership skills, confidence, and strategic collaboration, differences in institutional context and programme design shaped who accessed leadership development, and how learning was applied in practice. Inclusive pedagogies, including action learning sets, mentoring, and flexible online delivery, supported participation across career stages and research roles, particularly for applied researchers. Structural and organisational factors affected leadership gains, highlighting persistent barriers to equitable outcomes. The paper contributes to higher education research by conceptualising research leadership development as an equality issue, showing how institutional and national academies can both mitigate and reproduce inequalities, influence research culture, and shape careers. The findings offer evidence-informed insights for designing more inclusive and sustainable research leadership in higher education.

Black people are twice as likely to experience stroke, with first stroke occurring earlier and more likely to experience adverse outcomes that White people. Clinical factors and socio-economic status account for some of this increased risk, suggesting that structural and systemic factors are also involved. The aims of this study was to gain greater understanding of how Black people living with stroke (BPLS) in the UK perceive and experience health care services. Twenty semi -structured interviews were conducted with those living with stroke identifying as African, Afro-Caribbean or of mixed heritage. Findings highlighted that BPLS experience a plethora of barriers while accessing services including healthcare providers (HCPs) failing to acknowledge risk or symptoms, not being believed, leading to delay in seeking treatment. While navigating the system as a Black person, they found that services were misaligned with their culture or age. Participants rejected services due to distrust of treatment, stigma associated with seeking support, lack of representation and previous negative experiences, such as microaggression, stereotyping and racism. Implications for practice will be discussed including the need for a systemic approach to developing cultural safety and humility education, community engagement to improve access to equitable services, advocacy to navigate service, overcoming stigma and building trust.

Black people are twice as likely to experience stroke, more likely to have a stroke younger and have poorer outcomes than White people. Clinical factors and socio-economic status account for only half of the increased risk, suggesting systemic and structural factors are also involved. Lived experience of Black people living with stroke (BPLS) in England is under-researched. Candidacy Theory describes how people access health services, how perceptions of eligibility and suitability are socially constructed, and how this can perpetuate disadvantage. By applying Candidacy Theory to the findings of our qualitative study on the experiences of BPLS in accessing and navigating health services, we identified some key drivers of current inequalities and ways of addressing them. Our study aimed to gain greater understanding of how BPLS in England engage with and experience healthcare services. We applied Candidacy Theory to gain insight into experiences of and inequalities faced by this community and implications for service provision. 20 semi-structured interviews were conducted with adults living with stroke, identifying as African, Caribbean or of mixed heritage. Purposeful sampling included men and women with a broad range of ages and ethnicities, recruited via community and national organisation gatekeepers. Interviews were analysed using Reflexive Thematic Analysis and mapped onto the Candidacy Theory framework. Findings highlighted the plethora of barriers facing BLPS in accessing services, including lack of knowledge of stroke risk or symptoms, and not being believed or listened to by healthcare professionals. While navigating services, participants encountered misalignment with their cultural and age-specific needs. Offers of services were sometimes rejected due to distrust of medical treatment, stigma associated with mental health support, lack of representation, and previous negative experiences, such as microaggression, stereotyping and racism. Participants suggested that trust-building with healthcare professionals could be impeded by historic negative experiences, further exacerbated where there is poor awareness and communication. BPLS face particular disadvantages and barriers in reducing their stroke risk and accessing health services post-stroke. To address these, a holistic, systemic approach is needed, to develop inclusive and “culturally safe” services, build trust and improve accessibility of services.

Research has consistently identified the tendency of minority ethnic groups to more strongly endorse universal conspiracy theories (where the general public is targeted) as well as ingroup conspiratorial beliefs (where one's ethnic group is specifically targeted), but the relationship between these two types of conspiratorial beliefs remains largely unexplored. Across two studies, we assessed the relationship between these beliefs and race/ethnicity in a sample from the United Kingdom (n = 900 across Black, South Asian, and white ethnic/racial groups) and United States (n = 900 across Black, Hispanic, and white ethnic/racial groups). Our cross-sectional results, which take in both COVID and non-COVID conspiratorial beliefs, indicate that ethnic minority groups' greater support for universal conspiratorial beliefs can be fully explained through their support for ingroup conspiracy theories. We also found that, across ethnicities and geographies, the socio-functional variable of lack of collective recognition most substantially mediated the relationship between ethnicity and ingroup conspiratorial belief, while the effect of institutional trust and discrimination varied. We conclude that interventions aimed at decreasing conspiratorial beliefs in ethnic communities should therefore focus on measures that address ingroup, rather than universal, conspiratorial belief and that acknowledging feelings of a lack of group recognition may be a profitable avenue to tackle inequalities associated with conspiratorial belief.

Black, ethnic minority, and refugee communities in England tend to live in unhealthy urban environments and be at greatest risk of poor mental health and wellbeing. Yet these communities are least likely to engage with green and cultural assets that could improve mental health and reduce health inequalities. This research aimed to generate lived experience stories of the relationship and engagement of these communities with green and cultural assets, and how such assets intersect or not with their mental health, migrant status, values, and interests. It is part of a larger “Abundance” study developing and evaluating community-led ways to encourage beneficial engagement with green and cultural assets. A multi-site qualitative study in England using lived experience storytelling. Twenty-seven volunteer community voice champions recruited by five ethnic minority and refugee community organisations in South West London participated in a cycle of collaborative, community experience-focused workshops. The volunteers subsequently collected 156 stories from community members. Data were coded and thematically analysed using deductive and inductive coding approaches. The process was collaborative and reflexive, the intention being to develop themes that were interpretive of the data. Findings highlighted personal, community, and place-based sensitivities of ethnicity, inequality and mental health, intersecting with shared values and engagement with cultural and green assets. Nature and culture provided a sanctuary for escaping the struggles of being a migrant and associated mental health issues. Participants reported finding peace, tranquillity, and clarity of mind from accessing green and cultural spaces. Associated themes included stigma and isolation, mistrust of institutions, barriers to access, staying close to cultural roots, community belonging, and safety of place. The research generated new psychosocial knowledge to be used in co-designing, with ethnic minority and refugee community members, interventions that encourage engagement with cultural and green assets, helping reduce mental health inequalities.

Objectives To describe the impact associated with congenital cytomegalovirus (cCMV) infection and experiences and perceptions of people with experience of CMV in pregnancy and families / caregivers of children diagnosed with cCMV, who responded to a UK National Screening Committee (UK NSC) public consultation on cCMV screening.Methods The public consultation was conducted in 2021-22 on a draft evidence review and was aimed at informing the UK NSC's decision on newborn screening for cCMV. Data were analysed using framework analysis: a subgroup of responses was inductively coded, codes were refined and initial themes identified, before targeted coding of the remainder of the data and identification of final themes and sub-themes.Results Of a total 155 responses, 125 (describing 128 pregnancy/child outcomes) contained information relevant to the coding framework and were included. Most (n = 109) described a live birth of a surviving child, of whom 90% (98/109) were living with symptoms or long-term sequelae of cCMV at the time of the response. Two main themes were identified: missed opportunities and emotional impacts attributed by respondents to not screening for cCMV. Many families described delays in their child's cCMV diagnosis, including due to healthcare professionals' lack of awareness of cCMV, and viewed newborn screening as a solution to avoid delays in diagnostic pathways. Diagnostic delays resulted in a lasting sense of injustice and unfairness due to possible missed opportunities to improve outcomes (e.g., through antiviral treatment or early therapies), as well as uncertainty and anxiety.Conclusions Responses were predominantly from parents and caregivers of children with cCMV who experienced long term disability. They highlight significant gaps in awareness, support and health care for affected children that need addressing, regardless of national screening policy decisions. These responses contribute to the literature on lived experiences of individuals and families affected by cCMV.

The COVID-19 pandemic has highlighted how ethnic minority groups are disproportionally affected by health crises and the potential for community engagement to provide equitable public health information and services. Policymakers, practitioners, and academics have presented community engagement as a way to improve the access and uptake of health services, including vaccination, but the role of community members for health promotion is rarely questioned. We examine ‘community vaccine champions’, who have been acting as advocates, promoting engagement among ethnic minority groups for COVID-19 vaccination in different communities across the United Kingdom. Our research explores how champions working with minoritised groups have experienced and confronted the challenges brought on by the pandemic. Participants were invited to participate in this study as they worked with or for the Black or South Asian community (i.e., community leader, faith leader, or a public or allied health professional) and were working or had worked to increase COVID-19 vaccine uptake. From April 2021 until May 2022, we conducted 12 semi-structured interviews lasting 45-60 minutes via video call. The interviews were inductively coded and analysed following a discourse approach to health communication, where a focus is made to draw out underlying messages and talking points.Our findings highlight the range of different types of champions, who have a variety of roles within their respective community groups. Champions proved adaptive in taking on new positions to promote vaccination, with limited training and preparation, and found that being ‘grassroots’ actors positioned them well to both address local needs and to help build trust between authorities and their communities. A major issue that champions found was the use of ethnic minority classifications and how to address misinformation. Classifications were seen as a problem in how relevant data was collected, as well as in assigning blame to certain groups. Champions also stressed the influence of media and social media misinformation on vaccine decision-making. Still, our informants cautioned taking action based on simplistic assumptions about how misinformation negatively affects vaccine uptake. We conclude by setting out the need for ongoing community support for health issues and the challenges of community engagement for vaccine promotion in a pandemic setting.

Background Vaccination during pregnancy is an important healthcare intervention for safeguarding the health of the mother and their infants. Ethnic disparities in recruitment to vaccine research studies during pregnancy potentially contribute to health inequalities. The aim of the current study was to explore the barriers and enablers influencing the willingness of pregnant women from ethnic minority backgrounds to participate in vaccine research studies. Methods and findings Semi-structured qualitative online interviews were conducted with 23 pregnant women from diverse ethnic backgrounds in the UK. Interviews were transcribed verbatim, and thematically analysed. Our findings suggest that participants perceived vaccines and vaccine research, in principle, to be beneficial to the individual and to society, and understood the value of vaccination in mitigating severity of disease and protecting the health of mothers and their infants. Apprehension over the safety of vaccination in pregnancy was common and reduced willingness to participate. For those that decided to participate in vaccine trials in pregnancy, this was seen as an act of solidarity, a way to contribute to a collective responsibility for the public health of the community. Personal and community connections and representation—seeing people from their own communities represented in in the recruitment process shapped decisions about vaccine trial participating. Trust and mistrust in health systems, shaped by past experiences of interacting with healthcare professionals were likely to inform whether they would consider participating. Practical considerations such as excessive time commitments related to study procedures, travel and organising childcare were barrier to participation. The level of invasiveness of trial procedures were also a concern, although increased monitoring during the trial was seen as a potential benefit, mitigating some safety concerns. Conclusions Our study reinforcing previously identified barriers to vaccine participation among pregnant women from diverse ethnic communities. This study underlines the need to develop tailored interventions that focus on fostering trust with the aid of community engagement to understand cultural contexts, establishing authentic representation, and address practical considerations, to contribute to enhancing vaccine trial participation in pregnancy in those from diverse ethnic communities.

The COVID-19 pandemic disproportionately impacted intersectionally marginalised migrants, revealing systemic disparities in health outcomes and vaccine uptake. Understanding the underlying social and structural factors influencing health behaviours is necessary to develop tailored interventions for migrants, but these factors have been seldom explored. This qualitative study aimed to explore contextual factors shaping COVID-19 vaccination decision-making among Congolese migrants in the UK.A community-based participatory research study was designed and led by a community-academic partnership in London, UK (2021-2022). Peer-led, semi-structured interviews were conducted in Lingala with 32 adult Congolese migrants and explored beliefs, perceptions and lived experiences of migration, healthcare, vaccination and the COVID-19 pandemic. Reflexive thematic analysis generated two themes and a model conceptualising the vaccination decision-making process. Participants and community partners were financially compensated; ethics was granted by the University of London ethics committee (REC: 2021.0128).Participants highlighted the incompatibility of lockdown restrictions with their communal culture, which intensified feelings of exclusion and alienation. Concerns about COVID-19 vaccination were attributed to safety and effectiveness, partly informed by experiences and legacies of racial discrimination and exploitation. Inequality in the pandemic response and COVID-19 outcomes heightened participants' sense that their views and needs were being overlooked, and government sources and information were perceived as coercive. Our model depicts the interplay between institutional trust, belonging, and message perception, which shaped participants' vaccination decisions and led to (non-)engagement with COVID-19 vaccination. This research enhances understanding of how social and contextual factors may influence migrants' engagement with health interventions. It underscores the importance of partnering with migrant communities to understand their needs in context and co-design tailored interventions and inclusive messaging strategies that promote trust and belonging. Implementing systemic changes to address structural inequalities will be crucial to create an environment that supports engagement with health-protective behaviours and enhances health outcomes among migrant communities.

Abstract Background Congenital cytomegalovirus (CMV) infection is a leading cause of sensorineural hearing loss and neuro-disability in childhood. In the absence of a licensed vaccine, adoption of hygiene-based measures may reduce the risk of CMV infection in pregnancy, however these measures are not routinely discussed with pregnant women as part of National Health Service (NHS) antenatal care in the United Kingdom (UK). Methods An exploratory qualitative study was conducted, underpinned by Normalization Process Theory (NPT), to investigate how an educational intervention comprising of a short film about CMV may best be implemented, sustained, and enhanced in real-world routine antenatal care settings. Video, semi-structured interviews were conducted with participants who were recruited using a purposive sample that comprised of midwives providing antenatal care from three NHS hospitals (n = 15) and participants from professional colleges and from organisations or charities providing, or with an interest in, antenatal education or health information in the UK (n = 15). Findings Midwives were reluctant to include CMV as part of early pregnancy discussions about reducing the risk of other infections due to lack of time, knowledge and absence of guidance or policies relating to CMV in antenatal education. However, the educational intervention was perceived to be a useful tool to encourage conversations and empower women to manage risk by all stakeholders, which would overcome some identified barriers. Macro-level challenges such as screening policies and lack of official guidelines to legitimise dissemination were identified. Discussion Successful implementation of education about CMV as part of routine NHS care in the UK will require an increase in awareness and knowledge about CMV amongst midwives. NPT revealed that ‘coherence’ and ‘cognitive participation’ between service members are vital to imbed CMV education in routine practice. ‘Collective action’ and ‘reflexive monitoring’ is required to sustain service changes.

Objective Local authority-led online campaigns offer the possibility of targeted health promotion to connect local services and residents. This study assesses the evidence for medium (e.g., click-trhoughs) and high (off-line behaviour change) levels of public engagement with four local authority-led campaigns across a variety of public health promotions (sexual health, weight loss, and vaccination), online marketing approaches (social media marketing, search engine marketing, and programmatic marketing) and target demographics (language, gender, age, income, ethnicity) undertaken by a London borough local authority. Methods Employing quasi-experimental and observational study designs, engagement with local health services during the course of the campaigns was evaluated. The first three campaigns were evaluated based on an interrupted time series model of intervention assessment comparing outcome variables of interest during the campaign to periods before and after the campaign period. The results of the fourth campaign, an observational case-study, are discussed using descriptive statistics only. Results The analyses of the high engagement data for two of the three campaigns statistically assessed clearly supported the effectiveness of the campaigns. While the effect of high engagement could not be determined in the other two campaigns, they provide data that may be useful in online campaign design. Conclusions The evidence assessed in this study across a variety of platforms, health promotion initiatives, and population targets suggests that local authority-led online marketing campaigns for health promotion may be useful for increasing participation in public health programmes.

Abstract Background Community resilience and health emergency communication are both crucial in promoting a community’s ability to endure crises and recover from emergency events. Yet, a notable gap in theory and evidence exists in the relationship between them. We aim to explore the relationship between community resilience and health emergency communication and to identify strategies and interventions to strengthen their usefulness to each other. Based on the results, a secondary aim was to develop a model of community-centred resilience and health emergency communication. Methods A systematic review of literature published between January 1990 and February 2024 was undertaken following Joanna Briggs Institute guidelines. Electronic databases (Web of Science, Social Science Citation Index, PubMed/MEDLINE) were searched using key terms. Eligibility criteria were developed from the literature and the knowledge of the multidisciplinary team. Inductive thematic analysis generated key themes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings. Results The searches identified 300 articles, of which 86 met the inclusion criteria. Two main themes were identified from the literature: (i) the relationship between emergency communication and community resilience, including subthemes: building trust and collaboration within communities, identifying resources and their distribution, tailoring communication strategies, considering inclusion and equity, and community engagement and feedback and (ii) strategies and interventions, including subthemes: facilitating community structures as channels for communication, respecting personal and private boundaries in health communication, targeting outreach for effective crisis communication, building resilience through training and communication initiatives, and demonstrating commitment to equity and inclusion. Conclusions There is a small, yet valuable, body of evidence to demonstrate the value of bolstering community-centred resilience for emergency preparedness, response and recovery. The model of community-centred resilience and health emergency communication developed can inform policy, research and practice. Further research is required to develop and test community-centred approaches to enhance inclusive risk communication and equitable recovery.

Introduction Migrants positively contribute to host societies yet experience barriers to health and vaccination services and systems and are considered to be an underimmunised group in many European countries. The COVID-19 pandemic has highlighted stark inequities in vaccine uptake, with migrants facing access and informational barriers and lower vaccine confidence. A key challenge, therefore, is developing tailored vaccination interventions, services and systems which account for and respond to the unique drivers of vaccine uptake in different migrant populations. Participatory research approaches, which meaningfully involve communities in co-constructing knowledge and solutions, have generated considerable interest in recent years for those tasked with designing and delivering public health interventions. How such approaches can be used to strengthen initiatives for COVID-19 and routine vaccination merits greater consideration. Methods and analysis LISOLO MALAMU (‘Good Talk’) is a community-based participatory research study which uses qualitative and coproduction methodologies to involve adult Congolese migrants in developing a tailored intervention to increase COVID-19 vaccine uptake. Led by a community–academic coalition, the study will involve (1) semistructured in-depth interviews with adult Congolese migrants (born in Democratic Republic of Congo, >18 years), (2) interviews with professional stakeholders and (3) codesign workshops with adult Congolese migrants. Qualitative data will be analysed collaboratively using reflexive thematic analysis, and behaviour change theory will be used in parallel to support the coproduction of interventions and make recommendations across socioecological levels. The study will run from approximately November 2021 to November 2022. Ethics and dissemination Ethics approval was granted by the St George’s University Research Ethics Committee (REC reference: 2021.0128). Study findings will be disseminated to a range of local, national and international audiences, and a community celebration event will be held to show impact and recognise contributions. Recommendations for implementation and evaluation of prototyped interventions will be made.

Introduction Pregnant women have been historically excluded from interventional research. While recent efforts have been made to improve their involvement, there remains a disparity in the evidence base for treatments available to pregnant women compared with the non-pregnant population. A significant barrier to the enrolment of pregnant women within research is risk perception and a poor understanding of decision-making in this population.Objective Assess the risk perception and influences on decision-making in pregnant women, when considering whether to enrol in a hypothetical interventional research study.Design Semistructured interviews were undertaken, and thematic analysis was undertaken of participant responses.Participants Twelve pregnant women were enrolled from an antenatal outpatient clinic.Results Participants were unanimously positive about enrolling in the proposed hypothetical interventional study. Risk perception was influenced by potential risks to their fetus and their previous experiences of healthcare and research. Participants found the uncertainty in quantifying risk for new research interventions challenging. They were motivated to enrol in research by altruism and found less invasive research interventions more tolerable.Conclusion It is vital to understand how pregnant women balance the perceived risks and benefits of interventional research. This may help clinicians and scientists better communicate risk to pregnant women and address the ongoing under-representation of pregnant women in interventional research.

Background Making high-quality health and care information available to members of the general public is crucial to support populations with self-care and improve health outcomes. While attention has been paid to how the public accesses and uses health information generally (including personal records, commercial product information or reviews on healthcare practitioners and organisations) and how practitioners and policy-makers access health research evidence, no overview exists of the way that the public accesses and uses high quality health and care information. Purpose This scoping review aimed to map research evidence on how the public accesses and uses a specific type of health information, namely health research and information that does not include personal, product and organisational information. Methods Electronic database searches [CINAHL Plus, MEDLINE, PsycInfo, Social Sciences Full Text, Web of Science and SCOPUS] for English language studies of any research design published between 2010–2022 on the public’s access and use of health research or information (as defined above). Data extraction and analysis was informed by the Joanna Briggs Institute protocol for scoping reviews, and reported in accordance with the PRISMA extension for scoping reviews. Results The search identified 4410 records. Following screening of 234 full text studies, 130 studies were included. One-hundred-and-twenty-nine studies reported on the public’s sources of health-research or information; 56 reported the reasons for accessing health research or information and 14 reported on the use of this research and information. The scoping exercise identified a substantial literature on the broader concept of ‘health information’ but a lack of reporting of the general public’s access to and use of health research. It found that ‘traditional’ sources of information are still relevant alongside newer sources; knowledge of barriers to accessing information focused on personal barriers and on independent searching, while less attention had been paid to barriers to access through other people and settings, people’s lived experiences, and the cultural knowledge required. Conclusions The review identified areas where future primary and secondary research would enhance current understanding of how the public accesses and utilises health research or information, and contribute to emerging areas of research.

Abstract Introduction Disparities in the uptake of routine and COVID‐19 vaccinations have been observed in migrant populations, and attributed to issues of mistrust, access and low vaccine confidence. Participatory research approaches and behaviour change theory hold the potential for developing tailored vaccination interventions that address these complex barriers in partnership with communities and should be explored further. Methods This study used a theory‐informed, community‐based participatory research approach to co‐design a culturally tailored behaviour change intervention aimed at increasing COVID‐19 vaccine uptake among Congolese migrants in London, United Kingdom (2021–2022). It was designed and led by a community‐academic partnership in response to unmet needs in the Congolese community as the COVID‐19 pandemic started. Barriers and facilitators to COVID‐19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in‐depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the capability, opportunity, motivation, behaviour model to identify target behaviours and strategies to include in interventions. Interventions were co‐designed and tailored in workshops involving Congolese migrants. Results Thirty‐two Congolese adult migrants (24 (75%) women, mean 14.3 (SD: 7.5) years in the United Kingdom, mean age 52.6 (SD: 11.0) years) took part in in‐depth interviews and 16 (same sample) took part in co‐design workshops. Fourteen barriers and 10 facilitators to COVID‐19 vaccination were identified; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences and environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations and social opportunities. Strategies included culturally tailored behaviour change techniques based on education, persuasion, modelling, enablement and environmental restructuring, which resulted in a co‐designed intervention comprising community‐led workshops, plays and posters. Findings and interventions were disseminated through a community celebration event. Conclusions Our study demonstrates how behavioural theory can be applied to co‐designing tailored interventions with underserved migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities' unique cultural needs and realities. Patient or Public Contribution Patient and public involvement (PPI) were embedded in the participatory study design and approach, with community members co‐producing all stages of the study and co‐authoring this paper. An independent PPI board (St George's Migrant Health Research Group Patient and Public Involvement Advisory Board) comprising five adult migrants with lived experience of accessing healthcare in the United Kingdom were also consulted at significant points over the course of the study.

ABSTRACT Introduction Inequitable uptake of routine and COVID-19 vaccinations has been documented among intersectionally marginalised populations, including migrants, and attributed to issues of mistrust, access, and low vaccine confidence. Novel approaches which seek to share power, build trust and co-design tailored interventions with marginalised or underserved communities must be explored, to promote equitable engagement with vaccination and other health interventions. Methods A theory-informed, qualitative, community-based participatory research study, designed and led by a community-academic partnership, which aimed to understand decision-making related to COVID-19 vaccination among Congolese migrants in the UK and co-design a tailored intervention to strengthen their vaccine uptake (2021-2022). Barriers and facilitators to COVID-19 vaccination, information and communication preferences, and intervention suggestions were explored through qualitative in-depth interviews with Congolese migrants, thematically analysed, and mapped to the theoretical domains framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model to identify target behaviours and strategies to include in interventions. Workshops were done in partnership with Congolese migrants to co-design and tailor interventions. Results 32 Congolese adult migrants (foreign-born and living in UK; 24 (75%) women, mean 14.3 [SD 7.5] years in UK, mean age 52.6 [SD 11.0] years) took part in in-depth interviews and 16 (same sample) took part in co-design workshops. We identified 14 barriers and 10 facilitators to COVID-19 vaccination; most barrier data related to four TDF domains (beliefs about consequences; emotion; social influences; environmental context and resources), and the behavioural diagnosis concluded interventions should target improving psychological capability, reflective and automatic motivations, and social opportunities. Strategies included behaviour change techniques based on education, persuasion, modelling, enablement, and environmental restructuring, which resulted in a co-designed intervention comprising community-led workshops, COVID-19 vaccination plays and posters. Findings and interventions were disseminated through a community celebration event. Conclusions Our study demonstrates how behavioural theory can be applied to co-designing tailored interventions with marginalised migrant communities through a participatory research paradigm to address a range of health issues and inequalities. Future research should build on this empowering approach, with the goal of developing more sensitive vaccination services and interventions which respond to migrant communities’ unique cultural needs and realities. Patient or public contribution Patient and public involvement (PPI) were embedded in the participatory study design and approach. An independent PPI board comprising five adult migrants with lived experience of accessing healthcare in the UK were also consulted at significant points over the course of the study. Practitioner points Research has shown that migrants experience a range of health and vaccination inequalities but are not well included in health research nor the design of interventions to address these. Using community-based participatory methods, we demonstrated that underserved communities, such as migrants, are resilient, resourceful, and use community assets to find real-world solutions to their health needs. Our approach shows how practitioners can adapt and use behavioural theory and design thinking within a participatory research paradigm to meaningfully involve underserved populations in co-designing acceptable and culturally relevant health interventions to address a range of health issues and inequalities.

Congenital human cytomegalovirus (CMV) infection is the most common congenital infection, affecting around 1 in 200 infants in high-income settings. It can have life-long consequences for up to one in four children, including sensorineural hearing loss and neurodisability. Despite the frequency of congenital CMV and the severity for some children, it is a little-known condition by pregnant women, families and healthcare providers. Timely diagnosis of CMV infection in pregnancy is important to facilitate consideration of treatment with valaciclovir, which may reduce the risk of transmission to the fetus or reduce the severity of the outcomes for infected infants. Recognition of features of congenital CMV is important for neonatologists, paediatricians and audiologists to prompt testing for congenital CMV within the first 21 days of life. Early diagnosis gives the opportunity for valganciclovir treatment, where appropriate, to improve outcomes for affected infants. Further research is urgently needed to inform decisions about antenatal and neonatal screening, long-term outcomes for asymptomatic and symptomatic infants, predictors of these outcomes and optimal treatment for women and infants.