Holistic approaches which include a religious element are a promising intervention within obesity, but have not been explored in the UK. Objective: To conduct a feasibility study of a three-month, Christian-based intuitive-eating programme in a church. Methods: A total of 18 adults participated. Ethical approval was granted by Coventry University Ethics Committee. Participant and facilitator experience was investigated qualitatively. Results showed participants accepted the programme and engaged well with its spiritual component. Lay facilitators managed to adequately run the programme, although some difficulties identified training needs. Clinical, psychological and spiritual measures were analysed using intention to treat; baseline observation carried forward to input missing data. Mental well-being, anxiety, depression, quality of life, pain/discomfort uncontrolled-eating, emotional-eating, cognitive-restrained-eating, intuitive-eating and Body Mass Index (BMI) improved significantly post-intervention. There were improvements in spiritual well-being, and reductions in energy, fat and saturated fat intake. Between the end of the intervention and a six-month follow-up, there were no statistically significant changes. However, the extent that weight and BMI returned to baseline levels meant that the reduction from baseline was no longer significant or clinically important. Mean changes in other variables, including uncontrolled eating, emotional eating, mental well-being and anxiety remained statistically improved from baseline. At six-month follow-up, improvements in intuitive eating were fully sustained at this time point and total fat, saturated fat and sugar intake had reduced further even though these values did not reach statistical significance. Conclusion: It is feasible to recruit to, deliver and evaluate Taste & See in a UK church, with lay volunteers. Clinical outcomes were positive, but a larger, controlled study is needed.

Background: One million people in England and Wales experience sexual violence and abuse each year, with nearly half experiencing serious sexual offences; around 30,000 survivors access sexual assault referral centres. Objectives: This research was commissioned by National Institute for Health and Care Research to evaluate access, interventions and care pathways for survivors, especially those provided through sexual assault referral centres. Design, setting, participants: The sexual assault referral centres care pathway was investigated through six sub-studies. There were two Cochrane Reviews (4274 participants). Seventy-two providers and 5 survivors were interviewed at eight sites; the children and young people study involved 12 participants from two sexual assault referral centres. A cohort study involving three-wave data collection over 1 year (21 sites; 2602 service users screened, 337 recruited) used a multilevel modelling framework to explore risk factors for burden of post-traumatic stress disorder symptoms at baseline and change at 1 year. We analysed costs and outcomes and conducted a narrative analysis (41 survivors). We worked closely with survivors and prioritised the safety/welfare of participants and researchers. Results: Cochrane Reviews identified large effects from psychosocial interventions for post-traumatic stress disorder and depression. Sexual assault referral centres delivered a high-quality frontline service for survivors but groups experiencing domestic abuse and some ethnic and cultural minorities were under-represented. The qualitative research emphasised inter-agency collaboration for survivor benefit. The cohort study identified a risk ‘triad’ of adverse childhood experiences, poor mental health and economic deprivation, which was associated with baseline trauma burden. There were important improvements in trauma symptoms a year later. These improvements were unrelated to different sexual assault referral centre models. Costs and other outcomes were also similar across models. Harmful policing and justice practices/procedures were identified by 25% of participants. In this context, trauma-competent interviewing techniques, regular/timely updates and conveying case decisions with care signalled good practice. Limitations: The cohort study lacked a comparison group, reducing confidence in the finding that access to sexual assault referral centres explained the reduction observed in post-traumatic stress disorder. Conclusions and future work: Barriers to access call for concerted efforts to implement trauma-informed universal health services. The risk ‘triad’ underscores the value of holistic approaches to care at sexual assault referral centres and timely follow-on care. Poor mental health was the main barrier to service access beyond sexual assault referral centres. The persistence of trauma symptoms a year after accessing sexual assault referral centres signals urgent need for tackling counselling wait-lists, expanding support options and commitment to lifelong care. Multidisciplinary evaluation of sexual assault referral centres for better health provides a foundation for advancing trauma-informed practices in the context of sexual violence and abuse. Study registration: This study is registered as ISRCTN30846825 https://doi.org/10.1186/ISRCTN30846825 Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 16/117/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 35. See the NIHR Funding and Awards website for further award information.

Quantitative evidence is beginning to document the successful outcomes achieved from holistic interventions that include a spiritual element as an approach to self-manage obesity in the community. However, qualitative research, which helps us understand the reasons behind their success, is scarce. Our aim was to explore participants’ acceptance of and engagement with the Taste & See programme. Semi-structured interviews were carried out after participants had completed the Taste & See programme. Interviews were transcribed and analysed using deductive thematic analysis. Themes showing that ‘God and food issues had been kept separate’ at the start of the programme and that participants then ‘Began to use faith as a resource’ were identified. Also, while ‘Eating freely was a challenge’ initially, participants later found ‘empowerment and enjoyment in freedom’. ‘Addressing more than just a weight problem’ was valued highly and there were benefits and difficulties that arose from ‘Coping with other group members’. The rich level of evaluation provided through this study identifies that the participants found the programme a novel experience. The intervention was acceptable and participants engaged well with the programme content.