Exploring factors affecting the implementation of blended diets for children and young people (0-25 years) with enteral feeding tubes in health, education and social care settings in the UK: A realist approach

Background Blended diets are becoming more widely used for children and young people (Coad et al., 2017).

Standard practice is to use commercial formula; however, some families choose a blended diet consisting of everyday foods blended to a puree.

Emerging evidence has demonstrated benefits of blended diets on symptoms, such as reflux, and social interactions around food and mealtimes (Durnan et al., 2021). However, some families report lacking support particularly in health, education and social care settings. Consequently, individuals' access to such settings is affected or their use of blended diet is compromised.

Research Question What are the factors affecting implementation of blended diets for children and young people in health, education and social care settings across the UK: what works for whom, under what circumstances and why?

Aim To understand the context and mechanisms affecting the use of blended diets for children and young people in health, education and social care settings in the UK. Objectives Assess prevalence of the use of blended diets for children and young people across the UK.

Explore views and experiences of families and professionals (defined below) to determine the context and underlying mechanisms affecting the use of blended diets.

Identify key features of an intervention to support the delivery of blended diets in health, education and social care settings.

Assess the feasibility of an intervention to support the delivery of blended diets in health, education and social care settings.

Methods This sequential mixed methods realist study, comprises four work packages: Work package 1: Cross-sectional survey to assess the point prevalence of blended diet use for children and young people across the UK.

Work package 2: Interviews with families (parents/carers and children and young people where appropriate and they can consent) of individuals who use a blended diet and professionals (see inclusion criteria) who work with them; thematic analysis will identify themes within the data. Context-mechanism-outcome configurations will be constructed from the coded data.

Work package 3: Stakeholder consolidation workshops with families and professionals (as above) to synthesise findings from work packages 1&2 and identify key priorities for intervention design.

Work package 4: Focus groups with experts (families and professionals as above) to assess feasibility of a proposed intervention supporting implementation of blended diets in health, education and social care settings.

Timelines for delivery Work package 1: Month 3-9 Work package 2: Month 6-18 Work package 3: Month 18-24 Work package 4: Month 24-30 Integration and dissemination: Month 30-36 Anticipated impact and dissemination This research will generate knowledge on how, when and for whom blended diets can be used effectively informing intervention development.

This will underpin post-doctoral research to further refine and pilot an intervention facilitating implementation of blended diets. Long-term, this will enable blended diets to be more widely used. As such, more individuals may experience benefits of blended diets. In addition, cost savings may be associated with a reduction in formula and medications.

This research will be disseminated through peer reviewed journals, conference and patient groups and charities.