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BACKGROUND AND OBJECTIVE: For many health outcomes, there are an array of published methods, however not all have been validated in the target population. So, it is better to first pilot the selected tools and research strategies thus can reduce cost, effort and time in a larger project. The objective of this study was to present the significance of the pilot study by using an example of an observational study in a tertiary care hospital in Pakistan. METHODOLOGY: This pilot study was carried out in a tertiary hospital located in Peshawar, Pakistan. The data (Socio-demographics, anthropometric measurements, biochemical tests, blood pressure measurement and diet intake) was collected from the un-paid female caregivers looking after hemodialysis-dependent family members The caregiver experience was assessed using the Zarit burden interview (ZBI) scale. Pregnant and lactating caregivers were excluded. RESULTS: Data were collected from 20 participants. The decision to participate in the study was based on male family members. Females were reluctant for providing anthropometric measurements and were not aware of monthly income. The majorities were interested in blood pressure measurement and blood tests as offered free of cost. Almost all participants reported positive aspects of caregiving, thus ZBI was not found suitable in the selected sample. CONCLUSION: The results of the pilot study highlighted the strengths and limitations of the selected data collection tools. The results of the survey can be useful for the healthcare professionals involved in researching on South Asian family caregivers.

Objective: To assess the reliability and validity of the COPE (Carers of Older People in Europe) index tool among the caregivers of dialysis-dependent patients in Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: The study was conducted at the Dialysis Unit of Pakistan Kidney Patients Association Rawalpindi, Bahria International Hospital Rawalpindi and Fauji Foundation Hospital Rawalpindi, Pakistan, from December 2018 to January 2019. Methods: A 15-item COPE index questionnaire was administered, and data were collected from 124 caregivers of patients undergoing regular hemodialysis. A Principal Component Analysis (PCA) was performed on all items of the COPE index to retain the underlying components. Further, Cronbach's alpha was used to assess the internal consistency of the retained component structure and loadings obtained from the PCA and the entire instrument separately. Results: The PCA analysis revealed that, with the context of this study, the COPE index had good internal consistency for the negative aspects of caregiving and social support (Cronbach's alpha scores were 0.864 and 0.781, respectively). For the positive impact items, a Cronbach's alpha score of 0.655 indicated modest internal consistency. Cronbach's alpha of 0.714 for the entire 15 items indicated that the COPE index had good overall internal consistency in our study population. Conclusion: The COPE index was found to be a valid tool for use in Pakistan to assess the caregiver experience, including both positive and negative aspects of caregiving.

Background: Zinc biofortified wheat may be a sustainable strategy to increase zinc intake in areas where fortification and dietary diversification are not feasible or are limited by household purchasing power. This convergent mixed methods study aimed to explore the farmers’ and millers’ experiences and attitudes towards the production and processing of zinc biofortified wheat in Pakistan. Methods: A telephone survey was conducted with farmers (n = 418) who were provided with Zincol-2016 biofortified wheat seed for the 2019–2020 growing season, as part of a wheat grain micronutrient mapping study across Punjab Province. The survey explored the farmers’ experiences of growing Zincol-2016 and whether they opted to grow it again in the subsequent season. Semi-structured focus group discussions were undertaken in a separate group of farmers in Khyber Pakhtunkhwa (KP) province (n = 12) who grew Zincol-2016 for the BiZiFED2 RCT. Millers were also interviewed in KP, both those who had processed Zincol-2016 for the trial (n = 12) and those who had no experience of processing biofortified wheat (n = 12). Survey data were analyzed using descriptive statistics and transcripts of focus groups were analyzed using thematic analysis. Results: Nearly half of farmers who responded to the survey (47%) re-cultivated Zincol-2016 in the following season. The drivers for Zincol-2016 re-cultivation were seed availability (100%), grain yield and growth resistance (98%), quality of the flour from the previous harvest (97%) and nutritional benefit (94.5%). Discussions with farmers suggested that the main motivators for potential scale-up of biofortified wheat were the perceived quality of the grain, wheat, and flour. Millers saw it as an opportunity to expand their business. Farmers and millers valued the health benefits of the wheat. Challenges for scale-up include the need of additional support to produce it, unfamiliarity with the biofortification process, production costs, and external t

Introduction Micronutrient deficiencies, commonly referred to as ‘hidden hunger’, affect more than two billion people worldwide, with zinc and iron-deficiency frequently reported. The aim of this study is to examine the impact of consuming zinc biofortified flour (Zincol-2016) on biochemical and functional measures of status in adolescent girls and children living in a low-resource setting in Pakistan. Methods and analysis We are conducting a pragmatic, cluster-randomised, double-blind, controlled trial. A total of 482 households have been recruited from two catchment areas approximately 30–40 km distance from Peshawar. Household inclusion criteria are the presence of both an adolescent girl, aged 10–16 years, and a child aged 1–5 years. The study duration is 12 months, divided into two 6-month phases. During phase 1, all households will be provided with locally procured flour from standard varieties of wheat. During phase 2, clusters will be paired, and randomised to either the control or intervention arm of the study. The intervention arm will be provided with zinc biofortified wheat flour, with a target zinc concentration of 40 mg/kg. The control arm will be provided with locally procured wheat flour from standard varieties with an expected zinc concentration of 20 mg/kg. The primary outcome measure is plasma zinc concentration. Secondary outcomes include anthropometric measurements, biomarkers of iron and zinc status, and the presence and duration of respiratory tract infections and diarrhoea. Ethics and dissemination Ethical approval was granted from the University of Central Lancashire STEMH Ethics Committee (reference number: STEMH 1014) and Khyber Medical University Ethics Committee (DIR/KMU-EB/BZ/000683). The final study methods will be published in peer-reviewed journals, alongside the study outcomes. In addition, findings will be disseminated to the scientific community via conference presentations and abstracts and communicated to the study participants

Background: Family centred care (FCC) is currently a valued philosophy within neonatal care; an approach that places the parents at the heart of all decision-making and engagement in the care of their infant. However, to date, there is a lack of clarity regarding the definition of FCC and limited evidence of FCCs effectiveness in relation to parental, infant or staff outcomes. Discussion: In this paper we present a new perspective to neonatal care based on Aaron Antonovksy's Sense of Coherence (SOC) theory of well-being and positive health. Whilst the SOC was originally conceptualised as a psychological-based construct, the SOCs three underpinning concepts of comprehensibility, manageability and meaningfulness provide a theoretical lens through which to consider and reflect upon meaningful care provision in this particular care environment. By drawing on available FCC research, we consider how the SOC concepts considered from both a parental and professional perspective need to be addressed. The debate offered in this paper is not presented to reduce the importance or significance of FCC within neonatal care, but, rather, how consideration of the SOC offers the basis through which meaningful and effective FCC may be delivered. Practice based implications contextualised within the SOC constructs are also detailed. Summary: Consideration of the SOC constructs from both a parental and professional perspective need to be addressed in FCC provision. Service delivery and care practices need to be comprehensible, meaningful and manageable in order to achieve and promote positive well-being and health for all concerned.