Harnessing Positive Deviance in Diet & Physical Activity to Support Healthy Ageing among African and Caribbean Communities in the UK: A Qualitative Protocol

1.0 Background & Rationale Ethnic minority groups in the UK experience significant and persistent health inequalities. These populations are more likely to reside in socioeconomically deprived areas and face systemic disadvantages compared to their White British counterparts (Aspinall, 2002; Watkinson, Sutton and Turner, 2021). Research has consistently demonstrated higher rates of early-onset obesity and non-communicable diseases (NCDs) such as type 2 diabetes and cardiovascular disease among these communities, contributing to reduced life expectancy and diminished quality of life in later years (Raleigh and Holmes, 2023). In particular, African and Caribbean communities bear a disproportionate burden of NCDs, exacerbating premature mortality and widening existing health disparities. For instance, women from Black Caribbean and Black African backgrounds have the highest rates of overweight and obesity in the UK, at 74% and 73% respectively (NHS Digital, 2022). Despite numerous public health initiatives aimed at promoting healthier behaviours, including improved diet and increased physical activity (PA), these inequalities remain entrenched (Bann et al., 2017). This persistence suggests that existing interventions may lack cultural sensitivity and fail to address the unique needs of diverse communities. Established evidence indicates that lifestyle behaviours, including diet and physical activity at midlife, are crucial determinants of healthy ageing, modulate the ageing process and are major modifiable factors for NCDs (Kuh et al., 2007; Giudici, 2021; Lambrinoudaki et al., 2013). Accordingly, culturally responsive interventions that target midlife lifestyle behaviours could play a crucial role in improving health trajectories and healthy ageing within African and Caribbean populations. Asset-based approaches focus on community strengths and resources, exploring successes to learn from them (Martin-Kerry et al., 2023). Positive deviance is an example of an asset-based approach used to engage communities in healthier behaviours by identifying and learning from those who excel in specific outcomes. This approach assumes that solutions already exist within communities and positive deviants succeed by demonstrating uncommon or different behaviours. Positive deviants are individuals within high-risk groups who achieve better health outcomes than their peers despite facing similar challenges (Bader and Reinbott, 2016; Positive Deviance Initiative, 2010). These “positive deviants” often engage in unique, health-promoting behaviours deeply embedded in cultural practices and community norms. However, existing public health campaigns such as those promoting healthy eating often overlook these cultural dimensions, leading to a lack of relevance and impact among African and Caribbean communities (Osei-Kwasi et al., 2016). By identifying and amplifying these culturally situated positive behaviours, the Positive Deviance approach offers a pathway to design interventions that are community-driven, empowering, and sustainable (Osei-Kwasi et al., 2021) This study draws on co-produced qualitative data to explore diet and physical activity behaviours among African and Caribbean communities in the UK. The findings will inform the development of a conceptual framework to guide the creation of culturally tailored public health interventions aimed at supporting community empowerment and healthy ageing.