Abstract
The widespread use of food banks in the UK is a key indicator of both food insecurity and the inadequacies of social safety nets. While quantitative measures of food insecurity capture the scale of the issue, understanding the lived experiences of individuals navigating food bank systems provides a deeper, more nuanced perspective. This paper draws on a multi-method qualitative PhD study in two urban areas that investigated the extent to which emergency food parcels intersect with household dietary practices. It reflects upon methodological considerations of conducting interviews and ethnographic observations with stigmatised and vulnerable communities against the backdrop of a global pandemic and social distancing measures. Particularly, the paper draws attention to ethical complexities of researcher-participant dynamics, where the researcher only experiences the precarity of aid contexts intermittently and can leave the field to return to their everyday life. Participants, on the other hand, remain situated in these contexts, navigating the challenging realities under investigation. As a result, it is difficult to balance the expectations of those in crisis, who are consumed by immediacy, with the elongated timescales and distal impact that often characterises the research process. Reflections also explore the intricacies of conducting ethnographic fieldwork in food banks, utilising Participatory Action Research and insider–outsider positionality as guiding frameworks. By examining shifting positionality and relational dynamics in the field, the paper highlights issues of power, trust, and responsibility in research with vulnerable communities or stigmatised environments.
Introduction
Food insecurity is a persistent and growing public health concern, exacerbated by economic instability and the lasting impact of the COVID-19 pandemic (Power et al., 2020). Food banks play a prominent and ever-expanding role in mitigating its effects. In the United Kingdom (UK), food banks, classified as not-for-profit charitable organisations, distribute emergency food provisions to those who experience hunger or food shortage as a result of economic and social hardship (Loopstra & Tarasuk, 2013; Riches, 2003). Over two thousand food banks are estimated to operate in the UK (Independent Food Aid Network, 2023).
Food bank use was rising prior to 2019, the COVID-19 pandemic and the subsequent cost-of-living crisis exacerbated this rise, having widespread impacts on global health, financial and food systems (Aday & Aday, 2020; Capodistrias et al., 2022; Cummins et al., 2021; Power et al., 2020). Economically vulnerable households were forced into states of deprivation and precarity. Access to, and availability of, food was constrained leading to the further embedding of food banks as vulnerability to food insecurity and malnutrition increased (Power et al., 2020). Reliance on emergency food parcels has surged, underscoring the need to understand not only the nutritional implications but also the cultural and social dynamics influencing household food provisioning practices.
Historically, epidemiological, and quantitative research methods have dominated public health research (Lane-Fall, 2023). The expansion of food aid provision has generated extensive research interest, with studies exploring food bank usage, nutritional adequacy of food parcels, and the drivers of food insecurity. Within this research landscape, qualitative methods have been instrumental in understanding the realities of those navigating economic precarity and food insecurity (Institute of Medicine, 2011). At a broader level, qualitative methods contribute significantly to public health research by capturing contextual and theoretical insights into the everyday lives, perceptions and behaviours that shape health and wellbeing (Stickley et al., 2022). Interviews, ethnographic studies and participatory approaches have illuminated the moral economies of food aid, the emotional and psychological dimensions of food insecurity, and the ways in which individuals employ coping strategies within constrained food environments (Rizvi et al., 2022; Rombach et al., 2018; Wainwright et al., 2018). Such research highlights the need to redefine food insecurity as a social, cultural, and political phenomenon shaped by structural inequalities.
This paper focuses on the first author’s PhD project (Ndlovu, 2023), which explored the extent to which emergency food parcels intersect with household food practices in two urban areas in England. The paper has been co-authored to incorporate broader methodological and theoretical perspectives. We adopt a layered approach and provide a rounded commentary by utilising fieldnotes and participant quotes. Additionally, this paper is informed by a dual theoretical framework that draws on principles from Participatory Action Research (PAR) (Jacobson, 1993) and insider–outsider positionality (Merton, 1972). The combination of these approaches provides a lens to interpret the research process, particularly the role of the researcher, power dynamics and the generation of knowledge in relation to impact (Milligan, 2016). In doing so, the paper offers a novel analysis of how ethically and socially complex contexts, such as food banks and the wider food aid landscape, shape the lived experiences of low-income households or those living under precarious circumstances. Special attention is given to the fluidity of the first author’s positionality, as an insider (by their sociocultural understanding of faith and food aid) and an outsider (shaped by their role as a researcher and affiliation to a Western academic institution).
We reflect on the methodological considerations of conducting remote and in-person qualitative research during the COVID-19 pandemic, a period marked by heightened vulnerability and shifting social contracts due to social distancing measures (Hosseinzadeh et al., 2022). We conclude by offering insights to the broader discourse on drawn-out research timelines and the distal impacts of research, whereby the research itself is oriented towards systemic outcomes rather than immediate relief to those affected (Mason, 2021). In exploring the complexity of ‘doing’ research on emergency food parcels and household food practices, the paper adds a critical reflexivity that is often absent or overlooked in traditional public health research. Ultimately, this paper, contributes to methodological debates regarding trustworthiness and reflexivity which can be practiced or disrupted within ethnographic research.
Theoretical Framing
This paper is informed by a dual theoretical framework that draws on principles from PAR and insider–outsider positionality.
PAR is a qualitative approach rooted in social justice and critical theory and is characterised by the active involvement of participants, whereby research is conducted
In qualitative research, particularly ethnography, there is a long-standing debate about the position of the researcher in relation to the concepts of insider and outsider, which are used to describe a researcher’s relationship to the participants and the community or context being studied (Rowe, 2014). An insider is someone who shares key characteristics, lived experiences, cultural backgrounds, or a social position with participants (Kanuha, 2000). In contrast, an outsider is positioned as separate or different. In this way, the researcher’s perspective affects access, interpretation, and representation (Gary & Holmes, 2020). Each position offers different advantages and limitations.
Researchers who are considered insiders can foster rapport, trust, and deeper insights (Dwyer & Buckle, 2009). However, researchers who are deemed as outsiders are viewed as more distant or unfamiliar with the group or setting, which can lead to greater objectivity, but also potential barriers in access or interpretation (Gary & Holmes, 2020).
The dichotomy of the insider–outsider status can be argued as being simplistic as researchers rarely fall neatly into one category or the other (Bayeck, 2022; Htong Kham, 2024; Merriam et al., 2001; Zou, 2023). Instead, we align with the perspective put forward by Mercer (2007) and Dwyer and Buckle (2009), which suggests that positionality is a dynamic concept shaped by context, identity, discourses and evolving relationships in the field. A researcher may be an insider in some respects and an outsider in others. In our study, the first author adopted a flexible stance, engaging in a continuous process of negotiation in their dual role as volunteer and researcher.
Ethical Considerations
Full ethical approval was obtained from LSHTM Ethics Committee (ID 19175). Participation was voluntary and all participants provided informed consent prior to participation. All participants were provided with a participant information sheet and consent form. Prior to each interview, participants were provided with a verbal explanation of the study, giving space for any questions to be addressed. Thereafter, audio recorded verbal and/or written informed consent were obtained. Clarity was provided on the consent process and voluntary participation was ensured with participants understanding that participation was not obligatory and that they could withdraw at any time without consequence. For food bank users whose initial language was not English, a third party such as a friend or relative or a volunteer was present during the process of obtaining consent to support understanding and informed consent. Given the sensitivity of the topics discussed, particular care was taken to ensure confidentiality and anonymity. Pseudonyms were used throughout the final write up, and all identifiable information was removed.
Ensuring Trustworthiness
To ensure trustworthiness, we drew on established strategies to support the credibility, transferability, dependability, and confirmability as introduced by Lincoln and Guba (1985).
Credibility
Credibility was supported through a mixed approach to data collection that included both remote and in-person prolonged and persistent engagement. However, prolonged engagement, often assumed to enhance credibility, in a deeply unequal setting can raise ethical concerns around dependency or perceived exploitation (Cubellis et al., 2021).
As part of the remote data collection process, the first author engaged in repeat conversations with participants. These informal check-ins, typically two to three conversations per participant, functioned as a form of prolonged engagement, allowing for trust to develop remotely and improving the credibility of the insights shared during formal interviews. This approach also allowed for more in-depth and contextually grounded discussions during the recorded interviews, enhancing the credibility and ethical integrity of the data.
In-person fieldwork conducted as a volunteer-ethnographer involved volunteering, conducting observations of interactions and practices, interviews, and informal dialogue with staff and users over a 3-month period. This structure of fieldwork allowed for informal and ongoing validation of participants perspectives.
The first author regularly interacted with many of the same participants, including one individual who had previously used the food bank and was now volunteering, seeing them multiple times per week. These repeat encounters enabled the author to revisit topics raised in earlier interviews, ask for clarification and cross-check key insights from interviews with participants as a form of cross-participant triangulation to test and reflect on emerging interpretations. For example, the concept of 7-day provision, a practice where some users accessed emergency food aid providers on a regular basis throughout the week, first emerged in a conversation with a staff member. The first author then followed up with other managers and volunteers to explore whether this was a shared phenomenon and explored similar practices with food bank users by discussing how and when they accessed food aid services in relation to other sources, including pantries, community kitchens and larders. These repeated, layered conversations across participant roles helped validate and contextualise the concept and shaped a key theme in the findings.
Transferability
While qualitative research does not aim for broad generalisability, transferability was supported by providing thick descriptions to contextualise participant accounts within the food bank setting, interactions, and day-to-day food practices. For example, descriptions were not only on what participants said during interviews, but also the settings and emotions in which those conversations occurred. These contextual details allow readers to assess how the insights might resonate with or inform similar settings or populations.
Dependability
To support dependability, a consistent and clearly documented approach to data collection and analysis was applied. Participants were recruited using purposive (Palinkas et al., 2015) and snowball (Gierczyk et al., 2024) sampling techniques through food bank staff email introductions. Remote and in-person data were collected through repeat interviews, observational fieldnotes, and informal conversations, over a period of 9 months in total.
These consistent procedures allowed for meaningful comparison across various sources. All interviews were transcribed verbatim, and detailed fieldnotes were written after each interview as well as the recording of voice memos immediately after each visit at the food bank. Thematic analysis was employed to code transcripts and fieldnotes, supported by ongoing memo-writing to track emerging patterns and questions. These were refined through repeated readings and listening of audio recordings, constant comparison, detailed notetaking, and discussions with supervisors. Together, these practices supported the transparency and consistency of the analytic process, contributing to the dependability of the findings.
Confirmability
Lastly, confirmability was addressed through ongoing reflexivity. The embedded role of the first author as a volunteer-researcher denotes the complexity of navigating and negotiating their shifting positionality while maintaining analytical distance (Haarmans et al., 2022). The first author regularly interrogated how their assumptions, background, and emotional responses might influence the interpretation of data, and worked to centre participants perspectives through careful use of direct quotes and inductive analysis. Reflexive journaling was also used to capture shifts in interpretation, positionality, and key methodological decisions, creating an audit trail alongside the documentation of transcripts, fieldnotes, voice memos, coding framework and memos. Additionally, multiple data sources were used, including interviews, observations and fieldnotes, to triangulate findings. Participant experiences and perspectives were prioritised using direct quotes and thick description. In addition, emerging findings and interpretations were regularly discussed with academic supervisors, providing a form of peer debriefing to test assumptions and analytical rigour.
The use of Interviewing and Ethnography as Research Tools
The data collection discussed in this paper took place in two urban areas in England from February to October 2021. Food banks faced logistical pressures on staff, volunteers and supply and subsequently remote engagement introduced limitations in terms of building rapport (Cummins et al., 2021; Power et al., 2020). Conducting qualitative research during the COVID-19 pandemic required adapting methodological approaches to accommodate for restrictions (Crean et al., 2025; Tremblay et al., 2021). Prolonged engagement utilised conversational interviewing as a technique to building rapport and the role of a volunteer was adopted during fieldwork (Dado et al., 2023).
Conversational interviewing, which closely resembles everyday discussions, focuses on a more informal dialogic style between the researcher and participant (Swain & King, 2022). As part of the remote data collection process, the first author engaged in repeat conversations with food bank managers and some volunteers via telephone or video conferencing prior to formal interviews. The first author adopted conversational interviewing as a participant-led approach in establishing contact and rapport with food bank managers.
Initially, rapport-building was prioritised at the start of each conversation, taking time to repeatedly check-in with managers since the previous interaction, before delving into interview topics. Typically ranging from 20 to 30 minutes, conversations often took place on MS Teams/Zoom or over the telephone and if the participant was needed at the food bank, they could pause and resume on another day, ensuring minimal disruption to their responsibilities. Thereafter, interviews were arranged at a time convenient for participants, allowing them to indicate how much time they could commit, given the demands of managing food banks. The use of conversational interviewing and remote data collection in this study underscores the need for methodological flexibility when navigating research within crisis-affected settings to ensure that the experiences of vulnerable communities can still be captured despite logistical constraints.
Similarly, the researcher was embedded as a ‘volunteer ethnographer’ (Garthwaite, 2016) acting as a food bank volunteer while conducting ethnographic observations. This positioning enabled prolonged engagement as a means of pursuing empathetic involvement and building trust and rapport not solely based on research needs and objectives (Garthwaite, 2016). This duality meant that the researcher was able to observe and record the everyday experiences and practices of volunteers and users from a shared perspective, while simultaneously foregrounding issues of power inherent in insider-outsider dynamics and extending ethnographic methodology into a more participatory and responsive or reciprocal research process.
Prior to formal data collection, the first author visited each food bank on one occasion to introduce themselves, the project and assume the role of a volunteer to build rapport and familiarity with volunteers. Formal volunteering and observations were conducted between July – September 2021 in Brent and in October 2021 in Portsmouth. Between July and September 2021, the first author conducted ethnographic observations over a six-week period in Brent, completing eleven observations across two food banks. In October, they conducted a further ten days of observations in Portsmouth, totalling nine observations across five food banks. In total, approximately 39 hours were spent observing food bank operations, volunteer and staff interactions and food bank user experiences.
Most importantly, however, was finding the balance as a volunteer ethnographer when conducting fieldwork, particularly in how the first author managed their level of participation as a volunteer, while observing and recording data. The degree to which one is involved as a volunteer when conducting ethnographic observation is not determined by the researcher but rather the organisation “
Another example of adapting research methods to the needs of the environment and those participating was the removal of photo elicitation. Initially, photo elicitation was intended as a method of data collection to capture participant’s experiences with emergency food parcels. However, it became evident that this approach posed emotional and social challenges. Many food bank users were reluctant to the idea of visually documenting their meals or kitchen environment, expressing discomfort. In this way, food insecurity is an emotional and physical experience as well as a material experience (Bruening et al., 2017; Leung et al., 2020). While use of visual data can be valuable in some contexts, they may not always be appropriate for vulnerable communities, particularly when the subject matter intersects with issues of stigma and identity. The methodological adjustment to removing photo elicitation in this study highlights the need for ongoing reflexivity in qualitative research, ensuring methods of data collection are sensitive to participant’s lived experiences.
Navigating the Researcher-Participant Relationship and Negotiating Positionality
Food banks are emotionally and ethically complex settings (Parr et al., 2021). The study of food insecurity through qualitative and ethnographic methods requires careful reflection on the part of the researcher as they can function as mediators and interpreters of meaning. The relationships between a researcher and participants in qualitative research are inherently complex, shaped by factors such as power, trust, and positionality (Jadallah, 2024). Engagement involves navigating ethical issues, power dynamics, and the potential for proximity and distance in the researcher-participant relationship (Garrels et al., 2022). In this way, the positionality of researchers plays a crucial role in the research process.
Positionality is influenced by numerous factors including cultural background, personal experiences and the specific research context. We use positionality here to describe the ways in which a researcher’s beliefs, experiences, and role in the research can shape how they understand and respond to the social and political context of their work (Darwin Holmes, 2020). Further to this, we as researchers are part of the social worlds we wish to investigate, hence our presence and viewpoints may influence the behaviour of respondents and environments (Finlay, 1998). This is because data collection, interpretation and analysis can be influenced by our values and beliefs as we can never be separate from them. As such, the process of reflexivity involves the researcher being aware of how their cultural, political and social positioning, along with their personal ethics, identity, values and level of expertise, may impact the research process (Bourke, 2014; Bryman, 2016; Darwin Holmes, 2020).
Similar to the experiences described by (Dahal & White, 2022), the first author shared similar social characteristics with participants, which helped foster a sense of inclusion and facilitated access to the field. The social identities of the first author as a Black, educated, Zimbabwean-born, Christian female researcher positioned them as an insider and an outsider, which played a significant role in shaping interactions. There were several times where the first author debated on how much they should share during the conversations and interviews they would have with volunteers and users. There was a desire to stay neutral or distant as a researcher but there were elements that the first author could relate. While neutrality is often considered ideal in research (Charmaz, 2014), in practice it is not fully achievable, particularly in qualitative work. As researchers, we are embedded in the social worlds we study, and our perspectives, identities, and values inevitably shape how we engage with participants and our interpretation of data (Darwin Holmes, 2020; Hammersley & Atkinson, 2007).
As such, as the interviews progressed, the first author felt it useful to disclose their social identities of being a Christian and being Zimbabwean as they provided a sense of familiarity and cultural understanding, particularly when discussing food practices and the role of religious faith in food aid. For example, upon hearing that the first author was from Zimbabwe, one participant who was from North Africa immediately began referring to them as ‘my sister,’ influencing the rapport and dynamics of their interaction. In this way, researchers are not neutral observers but are positioned in relation to the people, institutions, and discourses they study (Dwyer & Buckle, 2009).
Conversely, the first author’s role as an academic researcher introduced an outsider element. The first author had to navigate the balance between fostering trust and acknowledging the inherent separation in experiences. While the first author was an expert in nutrition, as a nutritionist, and having conducted prior research on food banks, they were not an expert as having participated with or within the food bank. Subsequently, in their role as a researcher, they assumed the identity of a naïve researcher proposed by Adams (2021) which contributed to the co-construction of knowledge. From the beginning, the aim of the study was to explore the food banking system and how people interact with and within it and incorporate the food parcel within their existing dietary practices. As such, each interview and conversation began with the following sentence
One of the most striking moments during fieldwork was how, as a PhD student, with limited financial resources, the first author found themselves unexpectedly relating to those using food banks and their coping strategies. Certain daily routines were adopted during fieldwork such as relying on ready-made food and seeking out discounted or near-expiry items. These food practices under physical and financial constraints mirrored aspects of the food-related routines participants described as part of their food provisioning tactics. While for the researcher these food practices were experienced during a temporary period of fieldwork, for participants they represented ongoing experiences shaped by long-term precarity.
As a researcher, who is a Christian, studying food banks, the first author is aware of the tension between advocating for their end and the moral and theological reasoning that underpins their existence. Within the dominant public health discourse, food banks are not the cause of household food insecurity but rather a response to and a symptom of deeper structural failures related to poverty and household precarity (Sosenko et al., 2022).
Many food banks are often affiliated with faith-based organisations, founded on a religious ethos of compassion and communal responsibility (Allen, 2016). Seven of the eight food banks were faith-based, two Islamic food banks and five Christian food banks. Volunteers framed their approach to supporting food banks users as through a religious lens, often citing the Bible or Hadith on feeding the hungry. As facilitators of caregiving, volunteers expressed a moral and social underpinning as to why the food bank incorporated this form of caregiving within their provisions, portraying a pursuit of social justice (Allen, 2016).
Several volunteers described their role as not only meeting people’s food needs but also their “spiritual needs” and emphasising “respect and with dignity” in their interactions, highlighting the religious dimensions of their motivations. As one food bank manager explained
The Disconnect Between Research Timescales and the Immediate Needs of Participants
A longstanding challenge of qualitative and ethnographic research is the misalignment between the elongated timescales of the research process to publication and the immediacy of need in participants’ lives (Dumas & Anderson, 2014). This contrast raises important questions about the role of research and the immediacy of those in crisis. For participants, involvement in research may come with expectations, whether implicit or explicit, that their contributions will lead to substantial outcomes. During fieldwork, moments arose where participants inquired about the impact of the research. Comments such as “how is this going to help us” or “so what’s gonna happen after you finish” highlight the disillusionment that can accompany research without visible change. This echoes broader critiques of extractive research practices especially in vulnerable communities, where participants’ insights inform academic discourse but rarely translate into meaningful improvements in their lived conditions, which are often dictated by economic hardship.
In the context of temporality within the research cycle and evidence-based policy, qualitative research frequently undergoes a lengthy, bureaucratic process of translation before it can influence policy or practice (Porter, 2010). While research is being written, submitted, and reviewed, people are still living the challenges we have documented, yet the system demands patience and validation before action can be taken. Rich, messy, and deeply personal narratives are frequently deconstructed and simplified to fit within dominant policy discourses or they risk misalignment with current policy priorities as while “research evidence plays a role in policy but does not drive it” (Naude et al., 2015, p. 1). This misalignment reflects broader dynamics, whereby the production of knowledge is governed by institutions and timelines that may be detached to the realities of those being researched. There are however ways to mitigate this gap. More participatory and action-oriented approaches, such as feeding findings back to communities, engaging in advocacy, or collaborating with practitioners, can help bridge the gap between research and impact (Williams et al., 2024).
Conclusion
This paper has reflected on the methodological considerations of conducting qualitative research, interviews, and ethnographic observations, with stigmatised and vulnerable communities in two localities in the South of England. These reflections highlight the unique value of qualitative methods for unpacking complexity within the broader structural framing of food insecurity and the lived experiences of food bank users and volunteers.
By combining interviews with ethnographic observations, particularly immersing in the daily operations of food parcel distributions, and engaging with staff, volunteers and users, this study provides a nuanced exploration of understanding of food insecurity that is often obscured in quantitative research. The use of ethnographic observations and interviews in researching stigmatising issues and vulnerable communities presents both significant opportunities and ethical dilemmas, especially in the context of temporal dissonance. Incorporating aspects of PAR can mitigate these risks by focusing on and incorporating the lived experiences of those most affected. Central to this lies the dichotomy of insider-outsider, which challenges static notions of researcher positionality. Recognising and engaging with this oscillation allows for a more nuanced understanding of power, reflexivity, and the production of knowledge in researching contemporary public health issues using qualitative research methods.
In contrast to policymaking, which is often fast-paced, and outcome-driven, qualitative methods are deliberately open-ended and iterative in nature. In this way, they allow for the emergence of meaning through dialogue and contextual richness which is particularly important when exploring stigmatising public health issues. However, the process of knowledge production remains a dilemma in narrowing the inequalities gap. In qualitative research, particularly with vulnerable or stigmatized communities, we are often part of the world we are studying. The discussion of insider-outsider positionality in this paper illuminates the blurred researcher-participant relationship.
The traditional ‘objective distance’ is not feasible or practical as researchers’ identities, values, and relationships shape what questions are being asked and how data is interpreted and written up (Small & Calarco, 2022). As such, knowledge production is not derived from neutrality, but from situatedness, embedded within structures, including power dynamics (Thambinathan & Kinsella, 2021). This was intensified by the pandemic which amplified the researcher’s capacity (and sometimes necessity) to retreat. As researchers can ‘retreat’ to materially stable conditions in contrast to the lived realities of the participants that we have become deeply embedded with, especially in the context of ethnography.
Acknowledging these dilemmas of positionality and identity, which may shift with proximity or distance to communities depending on the topic or area, is integral to the validity and integrity of qualitative research. Theoretical rigour, therefore, remains essential for ensuring that research is analytically robust, reflexively grounded and contributions are meaningful (Busetto et al., 2020). For researchers, especially those new to the field, this work highlights the importance of maintaining methodological rigour, reflexivity and a socio-political awareness of structures that shape public health issues. These reflections extend existing debates on ethics in qualitative research by foregrounding the relational nature of knowledge production in unequal contexts.
This study also underscored the temporal disjuncture between research impact and the lived realities of participants. In this study, while the fieldwork concluded, participants continued to experience ongoing struggles with food insecurity. This raises important questions about the role of qualitative researchers in public health, not only in interpreting and disseminating findings, but also in relation to the extent to which research can contribute to tangible change for the communities studied.
In conclusion, qualitative methods are demonstrably vital to advancing public health research and knowledge. For novice researchers, these insights emphasise the importance of embracing the methodological messiness and greyness of qualitative research.
Footnotes
Acknowledgments
I would like to express my appreciation to the volunteers, managers, recipients and public health teams for their time and knowledge. I would also like to thank my supervisors (Dr Claire Thompson and Professor Steven Cummins) for their continued support with my PhD journey.
Ethical Considerations
Ethical approval was obtained from LSHTM Ethics Committee (ID: 19175).
Consent to Participate
Informed written consent was obtained from all participants.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study is funded by the National Institute for Health and Care Research (NIHR) School for Public Health Research (SPHR) (Grant Reference Number PD-SPH-2015). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The NIHR School for Public Health Research is a partnership between the Universities of Bristol, Cambridge and Sheffield; Imperial; and University College London; The London School for Hygiene and Tropical Medicine (LSHTM); LiLaC – a collaboration between the Universities of Liverpool and Lancaster; and Fuse – The Centre for Translational Research in Public Health a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. CT is supported by the by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration (ARC) East of England. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability Statement
Raw data are not publicly available to preserve participant confidentiality.
