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Peer-reviewedCC BY 4.0PLOS One

Reach and engagement in the ECAIL trial targeting socially disadvantaged families across the COVID-19 pandemic and cost-of-living crisis: A mixed-methods implementation study

  • Delphine Poquet1
  • Camille Le Gal2
  • Pascale Hincker3
  • Laurent Béghin4
  • Dominique Deplanque5
  • Damien Subtil6
  • Oriane Sion7
  • Benjamin Cavalli
  • Lucie Vanhoutte
  • Victoria Jacobsen
  • Ketevan Marr
  • Ioannis Sakellaris
5 more authors
  • Blandine de Lauzon Guillain
  • Marie-Aline Charles
  • Delphine Ley
  • Priscille Sauvegrain
  • Sandrine Lioret
7 affiliations
  1. 1Université Paris Cité and Université Sorbonne Paris Nord, Inserm, INRAE, Centre for Research in Epidemiology and Statistics, Paris, France
  2. 2Université Lille, Inserm, CHU Lille, Clinical Investigation Center, CIC 1403, Lille, France
  3. 3Université Lille, Inserm, CHU Lille, INFINITE - Institute for Translational Research in Inflammation, Lille, France
  4. 4Université Lille, Women and Newborn Mother Unit, CHU Lille, EA 2694, METRICS, Evaluation of Health Technologies and Medical Practices, Lille, France
  5. 5Research and Content Department, Association Programme Malin, Paris, France
  6. 6Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, CHU Lille, Lille, France
  7. 7Universitary Department of Midwifery, Sorbonne Université, Paris, France
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Abstract

Background: The ECAIL trial, launched in 2017, was designed to evaluate a multicomponent intervention for childhood obesity prevention among hard-to-reach families. At a maternity hospital in Lille, France, healthcare providers screened pregnant women experiencing social vulnerability, and dietitians delivered a home-based intervention until age 2. The COVID-19 pandemic led to a six-month suspension in 2020. This study compared eligibility and participation before the pandemic and after resumption, and examined how implementation and reach evolved across the pandemic and subsequent cost-of-living crisis. Methods: Using a convergent mixed-methods design, we analyzed 5,744 eligibility questionnaires distributed at the maternity ward and conducted a focus group with six dieticians delivering the intervention to triangulate quantitative implementation indicators with qualitative implementation data. Inclusion criteria included ≥1 indicator of social vulnerability (e.g., socioeconomic disadvantage, precarious housing, or social isolation). The focus group was recorded, transcribed, and analyzed thematically focusing on reach, acceptability, and adaptation. Results: Eligibility increased from 29.7% (n = 955) pre-pandemic to 33.6% (n = 849) after resumption, while the distribution of vulnerability criteria remained similar across periods: 78.3% received social/medical benefits; employment was not the main source of household income for 58.7%; 24.4% experienced financial hardship; 14.7% reported social isolation; 6.0% lived in precarious housing; and 19.0% had three or more vulnerabilities. Participation among eligible women remained stable (24.6%; n = 443). Qualitative findings indicated dietitians’ satisfaction and participants’ enthusiasm for the resumption of home visits, particularly in addressing social isolation. After resumption, the introduction of a pre-visit COVID-19 questionnaire was associated with fewer failed home visits. Integration of quantitative and qualitative findings indicated sustained, and in some cases strengthened, provider engagement despite pandemic-related strain on hospital services. Conclusions: This study suggests that a complex intervention can maintain reach and acceptability through adaptive implementation under major contextual disruptions. The rapid resumption of home-based services emerged as a promising implementation strategy for engaging and retaining socially disadvantaged families, highlighting the importance of flexible, context-sensitive approaches during social and economic crises. Trial registration: Clinicaltrials.gov NCT03003117; registration date: 21/12/2016; https://clinicaltrials.gov/study/NCT03003117.

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Cite

BibTeXRIS
BibTeX
@article{poquet2026reach,
  title = {{Reach and engagement in the ECAIL trial targeting socially disadvantaged families across the COVID-19 pandemic and cost-of-living crisis: A mixed-methods implementation study}},
  author = {Delphine Poquet and Camille Le Gal and Pascale Hincker and Laurent Béghin and Dominique Deplanque and Damien Subtil and Oriane Sion and Benjamin Cavalli and Lucie Vanhoutte and Victoria Jacobsen and Ketevan Marr and Ioannis Sakellaris and Blandine de Lauzon Guillain and Marie-Aline Charles and Delphine Ley and Priscille Sauvegrain and Sandrine Lioret},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0350372},
  url = {https://doi.org/10.1371/journal.pone.0350372},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Reach and engagement in the ECAIL trial targeting socially disadvantaged families across the COVID-19 pandemic and cost-of-living crisis: A mixed-methods implementation study
AU  - Delphine Poquet
AU  - Camille Le Gal
AU  - Pascale Hincker
AU  - Laurent Béghin
AU  - Dominique Deplanque
AU  - Damien Subtil
AU  - Oriane Sion
AU  - Benjamin Cavalli
AU  - Lucie Vanhoutte
AU  - Victoria Jacobsen
AU  - Ketevan Marr
AU  - Ioannis Sakellaris
AU  - Blandine de Lauzon Guillain
AU  - Marie-Aline Charles
AU  - Delphine Ley
AU  - Priscille Sauvegrain
AU  - Sandrine Lioret
PY  - 2026
DA  - 2026/10/08
JO  - PLOS One
DO  - 10.1371/journal.pone.0350372
UR  - https://doi.org/10.1371/journal.pone.0350372
AB  - Background: The ECAIL trial, launched in 2017, was designed to evaluate a multicomponent intervention for childhood obesity prevention among hard-to-reach families. At a maternity hospital in Lille, France, healthcare providers screened pregnant women experiencing social vulnerability, and dietitians delivered a home-based intervention until age 2. The COVID-19 pandemic led to a six-month suspension in 2020. This study compared eligibility and participation before the pandemic and after resumption, and examined how implementation and reach evolved across the pandemic and subsequent cost-of-living crisis. Methods: Using a convergent mixed-methods design, we analyzed 5,744 eligibility questionnaires distributed at the maternity ward and conducted a focus group with six dieticians delivering the intervention to triangulate quantitative implementation indicators with qualitative implementation data. Inclusion criteria included ≥1 indicator of social vulnerability (e.g., socioeconomic disadvantage, precarious housing, or social isolation). The focus group was recorded, transcribed, and analyzed thematically focusing on reach, acceptability, and adaptation. Results: Eligibility increased from 29.7% (n = 955) pre-pandemic to 33.6% (n = 849) after resumption, while the distribution of vulnerability criteria remained similar across periods: 78.3% received social/medical benefits; employment was not the main source of household income for 58.7%; 24.4% experienced financial hardship; 14.7% reported social isolation; 6.0% lived in precarious housing; and 19.0% had three or more vulnerabilities. Participation among eligible women remained stable (24.6%; n = 443). Qualitative findings indicated dietitians’ satisfaction and participants’ enthusiasm for the resumption of home visits, particularly in addressing social isolation. After resumption, the introduction of a pre-visit COVID-19 questionnaire was associated with fewer failed home visits. Integration of quantitative and qualitative findings indicated sustained, and in some cases strengthened, provider engagement despite pandemic-related strain on hospital services. Conclusions: This study suggests that a complex intervention can maintain reach and acceptability through adaptive implementation under major contextual disruptions. The rapid resumption of home-based services emerged as a promising implementation strategy for engaging and retaining socially disadvantaged families, highlighting the importance of flexible, context-sensitive approaches during social and economic crises. Trial registration: Clinicaltrials.gov NCT03003117; registration date: 21/12/2016; https://clinicaltrials.gov/study/NCT03003117.
SN  - 1932-6203
ER  -