PSPREFUGEE NIHR
ARC North Thames
2024-2025

Asylum seekers made up around 18% of immigrants to the UK in 2022 (House of Commons Library, 2022). Around 42% of applicants are nationals of Middle Eastern countries. Iran, Albania, and Eritrea are the top three countries from which applications are received. The proposed research builds on the ARC-supported NEON and CHAMPIONS projects’ evidence to address health needs of refugee/asylum-seeking (RAS) children under 5 as these children have a much higher risk of poor health (Baauw et al., 2019; Thacher, et al., 2016)

Temporary accommodation with poor environmental conditions rarely fits the health/ developmental needs of young children, leading to multimorbidity of issues (respiratory problems, mental health, skin conditions, malnutrition) (Children’s Commissioner, 2019; Croft et al., 2020; Homeless Link and the Young People’s health Partnership, 2018; Parry, Grant & Burke 2016). RAS families and children experience complex interactions of poverty and food insecurity (Allsopp et al., 2014; Stevens, 2020). TA context limits access to communal kitchens (if any), poor ventilation, vermin, and other risks. Unaffordability of nutritious foods leads to diet of cheaper food alternatives, higher in fat, salt, and sugars. These challenges are further compounded by language and cultural barriers, making familiar and appropriate foods less accessible in the UK, putting RAS children at risk of nutritional deficiencies, malnutrition, and overweight (Stevens, 2020).

Healthcare services apply top-down support, thus not tailoring them to the needs of RAS families. According to the RCPCH, refugee or asylum-seeking (RAS) families’ access to healthcare services in the UK is challenging. They may have little knowledge and awareness of services, how they work, and how they are accessed. This is compounded by language and financial barriers (Kang, Tomkow, & Farrington 2019: Pollard & Howard, 2021). Furthermore, mental trauma and past negative experiences may further prevent RAS families from seeking help (Priebe, Giacco, & El-Nagib, 2016). On health service side, they often have little awareness of these communities and their needs and, therefore, may lack cultural awareness and understanding necessary to effectively support these vulnerable populations (Robertshaw, Dhesi, & Jones, 2017).

The first 5 years of the child’s life is a critical period to ensure adequate growth and development, which will impact on the foundations of cognitive, educational, and physical development (Likar & Pateel, 2002; Granthan-McGregor, et al., 2007; Walker, et al., 2011). It is therefore important to ensure that families are supported in providing their children with adequate parenting that will meet their health and developmental needs (like nutrition and play) from an earlier stage in life into adolescence (e.g. Schwarzenberg., et al., 2018).

However, there has been limited research in co-developing a culturally appropriate nutritional and health intervention to support RAS families with limited resources who have now settled in the UK (Nur et al., 2021). Research by our partners shows that providing targeted and culturally nuanced responses to parenting aids in supporting families to provide improved outcomes for children (Parry & Abbott 2017). The parenting programs need to specifically address the needs of the community, their culture, and parenting practice (Parry & Abbott 2017; Parry & Abbott 2017b). The study aims to address this gap in research but also to translate the evidence into public health policies for the benefit of children by improving their health and well-being, educational attainment and to maintain a healthy and active life in the long term. Targeted early years interventions centred on the intersection of RAS parenting and environmental vulnerabilities are needed to reduce lifetime inequalities.

​

​

​

​

​

Parenting practice is culturally nuanced. Furthermore, parenting is also shaped by the environment within which parenting takes place and the needs of the child. Therefore, this project aims to be responsive and learn from RAS families in TA about their parenting needs that are culturally relevant to them and cannot be prescriptive about a specific parenting theme. However, we will use the SHE Framework co-developed with families in the CHAMPIONS project to inform this process and support comprehensive data collection. Currently we neither know the priorities of families for culturally sensitive parenting in TA nor how they achieve (or struggle to achieve) them. This project is the unique opportunity for us to not only explore what those priorities are, but also co-develop some of the solutions that are aligned to the Healthy Child Programme and the SHE framework (CHAMPIONS) whilst respecting the assets the RAS families hold and therefore ensure we do not disempower them even further, following the traumatic experiences many have encountered.

Therefore, the overall aim is to develop a culturally and environmentally sensitive parenting support programme, for parents of children 0 to 5 years, who are refugees or asylum seekers living in resource limited settings. Specifically, this project aims to directly identify and translate cultural parenting practice of a specific group pf refugees/asylum seekers within the Temporary Accommodation context into the UK standards of the Healthy Child Programme (HCP) to ensure the delivery of the program is culturally respectful and embedded within culture and community. Parenting is also a value laden process and RAS families have experienced extensive trauma both in their journeys to the UK and while in the UK. Therefore, sharing about parenting will be a vulnerable process for them, especially around legal and social care concerns of losing their children (which is shown by our data to be one of the key concerns when engaging with services around their needs and the needs of the child). In order to do that, families need to feel safe and ready to share their stories with the researchers, so their trauma and trust of the research team need to be addressed first and foremost.

The co-creative process with the families will:

• Develop trust and sense of security with RAS families through trauma-based theatre process. à Outcomes: Trauma Informed Theatre methodology for specific topic & group + peer reviewed journal article 1 reflecting evidence from this approach.

• Identify what culturally relevant parenting practice is within the selected group of RAS families & Understand how culturally meaningful parenting practice is limited or translated to TA environment in the UK à Outcomes: Literature review; Interviews + peer reviewed journal article 2

• Uncover gaps between culturally relevant parenting practice and Healthy Child Programme and translate cultural parenting practice to the UK standards of the Healthy Child Programme à Outcomes: Interview analysis and mapping + peer reviewed journal article 3 Learn how best to work with RSA families to develop culturally meaningful impact for HCP à Outcomes: Methodology/protocol.