Living Beyond Cancer: A Community-Led Intervention for African-Caribbean Cancer Survivors in Manchester

Living Beyond Cancer: A Community-Led Intervention for African-Caribbean Cancer Survivors in Manchester | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Living Beyond Cancer: A Community-Led Intervention for African-Caribbean Cancer Survivors in Manchester Odunola Fridauz Atitebi This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8186875/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: Disparities in cancer outcomes are often due to cultural barriers, limited support reflective of individual needs, and lower trust in mainstream services. This paper examines a culturally tailored nutrition and cooking project designed to address inequities in post-treatment cancer survivorship among African-Caribbean communities by strengthening nutrition confidence, wellbeing, and social connection. Method: Seventeen participants took part in the project over a period of six-month. A mixed-method evaluation was employed, using pre- and post-project questionnaires (5-point likert scales) across five outcome domains: nutrition knowledge, cooking skills, social connection, access to nutritious food, and overall well-being. Quantitative data were analysed using the Wilcoxon Signed-Rank test with rank biserial correlations to assess effect sizes. Qualitative feedback was gathered through open-ended survey responses and session reflections. Results: Significant improvements were observed in four of the five domains: nutrition knowledge (W = 0.00, p = 0.002, r = -1.00), cooking skills (W = 3.00, p = 0.021, r = -0.87), well-being (W = 11.00, p = 0.021, r = -0.72), and social connection (W = 2.00, p = 0.015, r = -0.91). No significant change was observed in access to nutritious food (W = 36.50, p = 0.358). Qualitative data highlighted increased confidence in adapting traditional dishes to healthier versions, enhanced peer support, and reduced feelings of isolation. Conclusions: The Cook and Thrive model demonstrates how culturally tailored health interventions can meaningfully improve nutrition confidence, psychosocial well-being, and social connectedness among African and Caribbean cancer survivors. Implications for Cancer Survivors The findings highlight that living well beyond cancer requires more than medical follow-up; it requires support that acknowledges cultural identity, emotional wellbeing, and the practical realities of everyday life. Such approaches can reduce psychological distress, strengthen self-management, and address persistent inequalities in post-treatment support for minority communities. Cultural Cancer Survivors Nutrition and well-being Background The diagnosis and treatment of cancer have a significant impact on the affected individuals, their families, and carers [ 1 ] . In the UK, there are more cancer patients than ever before. Considering the populations growing ethnic diversity, more efforts are needed to understand the factors contributing to disproportionate cancer outcomes [ 1 ] . Under-utilisation of support services appears to be an important contributor to the poor health outcomes particularly among people from diverse backgrounds such as the African and Caribbean communities [ 2 ] .Qualitative research conducted by the Northern Cancer Alliance reported that Support groups suitable for people from diverse cultural backgrounds were inaccessible to certain individuals [ 3 ] . Those participants specifically highlighted their wish to interact with people from their ethnic and cultural heritage or to be in an atmosphere that seems inviting and accepting to them. Some participants believed that doctors had not provided them with pertinent information on welfare help or asked enough questions about their individual needs and circumstances. For some people, other types of support such as having access to financial advice were also found to be pertinent and insufficient [ 3 ] .Additionally, a few individuals reported a lack of adequate post-treatment support. Some mentioned the significance of having access to information about hospices and individualised care catered to their needs (such as diet and lifestyle), while others felt that their unique circumstances and preferences had not been taken into consideration when they were given information about post-treatment care [ 3 ] . Members of ethnically diverse communities usually turn to faith, community support services and resilience to cope with their cancer diagnosis [ 4 , 5 , 6 ] .Developing culturally responsive treatments requires an understanding of these aspects and acknowledging these barriers. Cancer disproportionately affects diverse populations in the form of depression, anxiety and are often faced with stigma, misdiagnosis, missed diagnosis and limited culturally sensitive and competent. Nonetheless, culturally relevant, approaches are especially impactful in the context of survivorship, where people may cope with isolation, altered identity, and disconnection from support systems [ 7 ] . Services that acknowledge lived experience, tradition and community voice can fill critical gaps left in services especially for those historically excluded from mainstream care [ 7 , 8 ] . The latest strategy (National Cancer Plan) for improving cancer outcomes highlights the shift from hospital to community model to empower patients and ensure the best is available for all and to ensure the number of people surviving cancer increases [ 9 ]. This article presents findings from cook and thrives, a culturally informed nutrition project designed to support members of the African and Caribbean community affected by cancer to explore the relationship between food and culture and empower them to make healthy food, meals and informed eating choices. Introduction More people are surviving cancer, and increasing research is helping them live longer and more meaningful lives. Despite the increasing cancer survivorship, survivors are still impacted with the psychosocial and physical side effects of their treatment. A typical example of this side effect is Cancer Related Fatigue (CRF) characterised by a stressful and persistent sense of physical, emotional, or cognitive tiredness, associated with the cancer or its treatment, which is not proportional to recent activity and interferes with normal daily functioning [ 10 ] . One of the recommended strategies to help an individual preserve health and quality of life before or after treatment is to eat a balanced diet and exercise frequently [ 11 ] . Cook and thrive is a community led project aimed at supporting members of the African and Caribbean community affected by cancer. The project was designed as part of response to the lack of culturally sensitive support, after treatment support that addressed psychosocial well-being through culturally relevant practices such as shared cooking, food storytelling and nutritional education. Food was used as a creative tool for healing and connection at the intersection of public health, cultural identity, and creative engagement. The Project was delivered by Can-Survive UK (CSUK), a community-based cancer support organisation located in Manchester in collaboration with a certified nutritionist. During the project, participants learnt how to prepare healthy cultural meals in one-pot. The goals of this project were to improve the nutritional knowledge of participants, improve cooking skills, their access to nutritious meals and reduce isolation and improve the overall well-being of the participants. Twelve sessions were delivered over a period of six months consisting of 3-hour sessions hosted in an accessible community centre, a mix of cooking demonstration, practical food preparation, guided discussion on the nutritional benefits of ingredients, cultural food practices, opportunities for participants to share food stories. In between the sessions other well-being and support activities such as chair-based exercise, art therapy, talking therapy. Creativity was central to the project design; a typical example is the introduction of a smoothie bike to exercise for those who could and to also make a smoothie. The bike operated by converting participants' pedalling energy into power for a blender, allowing them to prepare fruit and vegetable smoothies. This approach reflects broader evidence on the use of smoothie bikes as engaging tools to encourage nutrition and physical activity at the same time. The use of smoothie bikes has been documented in existing literature as an innovative approach to combine dietary education with physical activity [ 12 ] . Participants were able to express themselves through food, co-create meals, many highlighted how excited they were to be able to make the popular Ackee and salt fish which is the Jamaican national dish after learning from the class. It served as an opportunity to reflect on the historical, cultural and emotional importance of ingredients, traditions and memories. For example, from historical context Ackee symbolises adaptation, survival and pride [ 13 ] . Similarly, in parts of Nigeria, particularly among the Yoruba tribe, salt is traditionally used in naming ceremonies to bless newborn’s life with meaning, endurance and value just as salt brings out the essence of food [ 14 ] . In another session the participants learnt how to cook yam porridge, a dish rich in both flavour and symbolism. In many West African cultures, yam is more than a staple crop, it represents life, prosperity and renewal [ 15 ] . The new yam festival is widely celebrated in Nigeria to mark the end of harvest and beginning of a new season [ 15 ] . Other recipes featured during the project include, Domoda, Callaloo, Caribbean fish stew, Apple coconut rice pudding, fruit rumbler and cheesecake. These sessions culminated in the development of a cook and thrive cookbook, which served as a creative health artifact capturing the recipes, reflections and lived experiences of participants. Methods The impact of cook and thrive was accessed using a combination of pre- and post-project surveys and qualitative feedback. This evaluation focused on how participants experienced changes in knowledge of nutrition, well-being improvement, acquisition of new skills in relation to cooking and reduced isolation through the project. Qualitative and quantitative data were collected to capture both measurable changes and participants perspectives to provide depth and context on how they experienced the project. This combination ensured that the evaluation was not limited to just quantifiable outcomes but outcomes that are reflective of the cultural and psychosocial dimensions of survivorship support as recommended in existing literature [ 16 ] . Participants Beneficiaries of this project consist of existing service users of CSUK and other members of the African and Caribbean community that have been impacted by cancer. 33 registered to participate in the classes however only 17 completed, many were unable to attend regularly due to ongoing health challenges related to their cancer treatment. Consent and Ethics This project was conducted as a community health and well-being initiative, not as the conventional academic research requiring institutional ethical review. However, all participants were informed of the purpose of the evaluation and gave verbal and written consent for their feedback to be used. Consent to fill the pre and post evaluation survey at the start and end of the project was sought from each participant. Consent was also sought to use participants' feedback and quotes anonymously. Quotes have been included with participants permission and are not linked to identifiable information. The project was delivered in line with the organisation’s confidentiality and safeguarding policies. Evaluation tools and measures Feedback was collected using simple accessible surveys at the start and end of the project. These included five outcomes which are: Knowledge of nutrition, cooking skills and confidence, social connection, frequency of access to nutritious meals and overall well-being. Each of the measured outcomes was rated on a scale point of 1–5, 1 being the lowest and 5 the highest. Participants were also allowed to share open-text comments, reflections, and stories about their experiences. Data extraction and analysis Survey responses were analysed using Jamovi (version 2.6.44) an open-source alternative to Statistical package for the social sciences (SPSS) [ 17 , 18 ] .Given that the scores were from rating scales (ordinal in nature) and the group was small (17 participants), the Wilcoxon Signed-Ranked Test was used to assess the changes in outcome measures from the beginning (pre-survey) to the end of the project ( post-survey). Qualitative feedback was thematically analysed and grouped using an inductive approach. Key themes around cultural identity, healthier habits, nutrition knowledge and empowerment, and motivation to socialise. Anonymised quotes were collated to illustrate the reflection of participants and the creative cultural elements of the project Results Table 1 Quantitative evaluation of cook and thrive outcomes. Outcome Wilcoxon value (w) p-value standard (< 0.05) Interpretation Nutrition Knowledge 0.00 0.002 Significant improvement Cooking skills and confidence 3.00 0.021 Significant improvement Social Connection 2.00 0.155 Significant improvement Frequency of access to nutritious meal 36.50 0.358 Not statistically significant Overall well-being 11.00 0.021 Significant improvement Qualitative results Participants also shared qualitative reflections. Key themes that emerged from the feedback includes: 1. Healthier Habits Participants adopted new cooking techniques, reduced unhealthy ingredients and gained nutritional awareness. “Ever since I started attending the cooking class, I have now reduced my sugar and salt intake and my cooking at home has improved”-Participant T “The class has been helpful, before I used a lot of oil to fry my chicken but now, I only just brown it in the pot with very little or no oil”- Participant R “I tried the fruit rumbler recipe from the class at home and the family loved it. I now have fruit rumbler for breakfast”-Participant S 2. Motivation and Empowerment The sessions helped participants feel more active, engaged and emotionally uplifted. “I always look forward to the cooking class because I enjoy the laughter and comradeship”- Participant C “The cooking sessions have been fantastic. They really got everyone engaged and active, each person had something to do, which helped shift our focus away from personal challenges. It felt therapeutic, almost like a form of art where you create something meaningful, take it home, and even try different variations of the recipe later. The sessions were not only enjoyable but also practical, and the nutritionist who facilitated them was truly amazing”- Participant G For some it was an opportunity to be out and about and for others it was engaging according to participant D: The cooking classes always keep us busy. I have never used a smoothie bike before let alone use one to make a smoothie. I really enjoyed exercising with it and making a smoothie with it. 3. Cultural connection Participants valued seeing their own cultural foods and traditions reflected in the sessions. “I really enjoyed the classes, especially the nutritional facts about the ingredients used, my favourite session was that of the Yam porridge. I was fascinated about the simplicity of the Yam porridge recipe yet it was very delicious. It reminded me of home (Nigeria), especially the celebration of the new yam festival in my hometown. My partner really enjoyed it when I prepared the same recipe at home”-Participant Y “I am from Jamaica, and Ackee and salt fish is one of my best foods, but I have never cooked it until I attended the cooking sessions. I like that the recipe is very simple and straightforward. My best session is the one where Ackee and saltfish was made”- Participant K These results highlight the combined impact of cultural relevance, creative engagement, and peer support in improving post-treatment outcomes for African and Caribbean individuals affected by cancer. Discussion The findings support the role of culturally relevant creative health interventions in improving health outcomes. The intervention succeeded by embedding public health aims within a culturally familiar, creative format 19 . The cook and thrive project align with emerging public health strategies that position creative health as an important component of long-term recovery, social inclusion, and emotional well-being for individuals living beyond a cancer diagnosis [ 20 , 21 ] . Outcomes from this project also align with existing broader evidence supporting the psychosocial benefits of cooking nutrition interventions. Findings from a systematic review conducted in 2018 highlighted that cooking-based projects or interventions contributed to improved self-esteem, social connection, and mental well-being across various populations [ 20 ] . This reinforces the relevance of the cook and thrive model and its demonstrated impact in supporting both well-being and cultural expression after cancer treatment. Importantly, the cook and thrive project showcases a practical and scalable model of how creativity through food and culture can be incorporated into public health delivery. Its success lies in being community rooted, led by participants lived experience and cultural identities. The lack of very significant changes in food access based on the project result suggests structural issues beyond the scope of the project such as financial support. Nonetheless participants benefitted positively from the model Limitation: As a small-scale evaluation model with a sample size of 17 participants, the findings should be interpreted with caution. The primary aim of this initiative was not academic research but to develop a practical, community-led model of creative health that could be adopted or replicated in other settings. While statistical tests present rigour in findings and explore change, the real strength lies in lived experiences captured and the project's adaptability. Future iterations could benefit from larger sample sizes, longitudinal follow-up and integration with broader health system metrics. Recommendations Considering the success of the project the model could inform the implementation of the Greater Manchester creative health strategy and similar regional or national policies [ 22 ] . It demonstrates how culturally designed interventions, co-produced with service users can enhance community well-being and address health inequalities to promote health equity. Local authorities and public health bodies can consider integrating similar creative and culturally grounded models into survivorship care and broader public health planning. Conclusion CSUK’s cook and thrive project demonstrates that incorporating culturally aligned initiatives or interventions can meaningfully improve well-being and nutritional confidence among African and Caribbean cancer survivors. It presents a replicable and inclusive model for culturally responsive health and well-being public health strategy and practice. Declarations Author Contribution A.O wrote the main manuscript text and reviewed it Acknowledgement The author wishes to acknowledge the entire team at Can-Survive UK for their support in delivering this project and extends special thanks to the nutritionist who facilitated the Cook and Thrive sessions. This work was made possible through funding from the Manchester City Council Cost of Living Fund, whose support is gratefully acknowledged. References Abraham S, Foreman N, Sidat Z, Sandhu P, Marrone D, Headley C, et al. Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups. Br J Nurs. 2022;31(10):S14–24. Purushotham A, Bains S, Lewison G, Szmukler G, Sullivan R. Cancer and mental health—a clinical and research unmet need. Annals of Oncology [Internet]. 2013;24(9):2274–8. Available from: https://academic.oup.com/annonc/article/24/9/2274/202440 Northern cancer alliance. 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Perspect Public Health. 2025;145(3):130–1. Dadswell A, Bungay H. Social prescribing of cultural opportunities to support health and wellbeing: the importance of language, community engagement, and inclusion in developing local approaches. BMC Prim Care. 2025;26(1). Department of Health and Social Care. Shaping the National Cancer Plan [Internet]. GOV.UK. 2025. Available from: https://www.gov.uk/government/calls-for-evidence/shaping-the-national-cancer-plan/shaping-the-national-cancer-plan Pritlove C, Capone G, Kita H, Gladman S, Maganti M, Jones JM. Cooking for Vitality: Pilot Study of an Innovative Culinary Nutrition Intervention for Cancer-Related Fatigue in Cancer Survivors. Nutrients. 2020;12(9):2760. Fred Hutchinson Cancer Centre. Cook for Your Life [Internet]. Cook for Your Life. 2024 [cited 2025 Aug 4]. Available from: https://www.cookforyourlife.org/healthy-survivorship/ Ferrari T, Smathers C. Blender Bikes: Blending Nutrition and Physical Activity. 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Available from: https://www.researchgate.net/publication/320245128_Festival_identity_and_social_integration_A_study_of_the_New_Yam_Festival_in_Otun-Ekiti_Southwest_Nigeria Wasti SP, Simkhada P, van Teijlingen E, Sathian B, Banerjee I. The Growing Importance of mixed-methods Research in Health. Nepal Journal of Epidemiology [Internet]. 2022;12(1):1175–8. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9057171/ Jamovi. jamovi - Stats. Open. Now. [Internet]. Jamovi.org. 2022. Available from: https://www.jamovi.org/ Kerby DS. The Simple Difference Formula: An Approach to Teaching Nonparametric Correlation. Compr Psychol. 2014;3:11.IT.3.1. Clift S. What is the evidence on the role of the arts in improving health and well-being? A scoping review. Nordic J Arts Cult Health. 2020;2(01):77–83. Channing J, Smith-Charles H. Creativity and collaboration in public health. Perspect Public Health. 2025;145(3):125–6. Farmer N, Touchton-Leonard K, Ross A. Psychosocial Benefits of Cooking Interventions: A Systematic Review. Health Education & Behavior [Internet]. 2018;45(2):167–80. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862744/ The Greater Manchester Creative Health Strategy. The Greater Manchester Creative Health Strategy [Internet]. 2022. Available from: https://gmintegratedcare.org.uk/wp-content/uploads/2022/11/gm-creative-health-strategy-low-res.pdf Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8186875","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":553482141,"identity":"cc8d24c2-81f0-4b06-9a4b-48f18dc1a546","order_by":0,"name":"Odunola Fridauz Atitebi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBUlEQVRIiWNgGAWjYFCCBCAuYJCD89ngLB58WgwYjEnXktiAKYNDCz97jtmDDwZ26f3tZw8w/my7l9gnkXyA4eOeWgaDMwewapHseWNuOMMgOXfGmbwEZt624sQ2ibQExhnPjjMYnMViM8hJN3LMpHkMmHM3MOSY/2ZsSzBm4zljwMxz4BiDwXnsDoNqqU834H9jAHQYSMv5D8RoOZxgIJFjwMDbliDHxt7DANRSg9Nhkj3PyiRnGBw3nHHjDdA950Ba2gwOzjhwgEcSh/f52ZO3SXyoqJbn788xYPxRlsAj38z88MGHA3VyfGcSsLsMKwAafxhnROIEdSTrGAWjYBSMgmELADesVikszxXLAAAAAElFTkSuQmCC","orcid":"","institution":"Can-Survive UK","correspondingAuthor":true,"prefix":"","firstName":"Odunola","middleName":"Fridauz","lastName":"Atitebi","suffix":""}],"badges":[],"createdAt":"2025-11-23 16:53:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8186875/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8186875/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":97425945,"identity":"7f716278-4a91-48ef-8aeb-fadf97c9a066","added_by":"auto","created_at":"2025-12-04 09:13:49","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":30592,"visible":true,"origin":"","legend":"","description":"","filename":"LivingBeyondCancerSpinger.docx","url":"https://assets-eu.researchsquare.com/files/rs-8186875/v1/929001db3804f430d0b2ade6.docx"},{"id":97425944,"identity":"25e62bc6-d974-4923-b6bc-6f6428c56678","added_by":"auto","created_at":"2025-12-04 09:13:49","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":4330,"visible":true,"origin":"","legend":"","description":"","filename":"acfba66bf9e842da8905f836be621c22.json","url":"https://assets-eu.researchsquare.com/files/rs-8186875/v1/56ae48affe6f95bba43b3f02.json"},{"id":97425946,"identity":"8168a7e8-b4bb-4be8-8e0b-06538a7eaa6f","added_by":"auto","created_at":"2025-12-04 09:13:49","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":55108,"visible":true,"origin":"","legend":"","description":"","filename":"acfba66bf9e842da8905f836be621c221enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8186875/v1/2a76c3412b088b0cc71c0c5e.xml"},{"id":97667108,"identity":"1809954d-c32d-46f3-8608-d4f1b87e5c59","added_by":"auto","created_at":"2025-12-08 09:22:43","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":51517,"visible":true,"origin":"","legend":"","description":"","filename":"acfba66bf9e842da8905f836be621c221structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8186875/v1/5f78d25b9ba1d17933ee4e69.xml"},{"id":97425947,"identity":"f47ad975-c642-4615-9212-918be91ebdc8","added_by":"auto","created_at":"2025-12-04 09:13:49","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":60817,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8186875/v1/a5437b28582448462c92ec27.html"},{"id":101204543,"identity":"f0f1904d-e8bd-49b9-b355-29058a891ddb","added_by":"auto","created_at":"2026-01-27 09:43:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":453425,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8186875/v1/c72a8a5e-4070-4fec-a00b-37ac037bc1c0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Living Beyond Cancer: A Community-Led Intervention for African-Caribbean Cancer Survivors in Manchester","fulltext":[{"header":"Background","content":"\u003cp\u003eThe diagnosis and treatment of cancer have a significant impact on the affected individuals, their families, and carers \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e1\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. In the UK, there are more cancer patients than ever before. Considering the populations growing ethnic diversity, more efforts are needed to understand the factors contributing to disproportionate cancer outcomes \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e1\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Under-utilisation of support services appears to be an important contributor to the poor health outcomes particularly among people from diverse backgrounds such as the African and Caribbean communities \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e2\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.Qualitative research conducted by the Northern Cancer Alliance reported that Support groups suitable for people from diverse cultural backgrounds were inaccessible to certain individuals \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Those participants specifically highlighted their wish to interact with people from their ethnic and cultural heritage or to be in an atmosphere that seems inviting and accepting to them. Some participants believed that doctors had not provided them with pertinent information on welfare help or asked enough questions about their individual needs and circumstances. For some people, other types of support such as having access to financial advice were also found to be pertinent and insufficient \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.Additionally, a few individuals reported a lack of adequate post-treatment support. Some mentioned the significance of having access to information about hospices and individualised care catered to their needs (such as diet and lifestyle), while others felt that their unique circumstances and preferences had not been taken into consideration when they were given information about post-treatment care \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e3\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Members of ethnically diverse communities usually turn to faith, community support services and resilience to cope with their cancer diagnosis \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e4\u003c/sup\u003e\u003csup\u003e, \u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e6\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.Developing culturally responsive treatments requires an understanding of these aspects and acknowledging these barriers. Cancer disproportionately affects diverse populations in the form of depression, anxiety and are often faced with stigma, misdiagnosis, missed diagnosis and limited culturally sensitive and competent. Nonetheless, culturally relevant, approaches are especially impactful in the context of survivorship, where people may cope with isolation, altered identity, and disconnection from support systems \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e. Services that acknowledge lived experience, tradition and community voice can fill critical gaps left in services especially for those historically excluded from mainstream care \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e7\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e8\u003c/sup\u003e\u003csup\u003e]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe latest strategy (National Cancer Plan) for improving cancer outcomes highlights the shift from hospital to community model to empower patients and ensure the best is available for all and to ensure the number of people surviving cancer increases \u003csup\u003e[\u003c/sup\u003e\u003csup\u003e9\u003c/sup\u003e\u003csup\u003e].\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThis article presents findings from cook and thrives, a culturally informed nutrition project designed to support members of the African and Caribbean community affected by cancer to explore the relationship between food and culture and empower them to make healthy food, meals and informed eating choices.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eMore people are surviving cancer, and increasing research is helping them live longer and more meaningful lives. Despite the increasing cancer survivorship, survivors are still impacted with the psychosocial and physical side effects of their treatment. A typical example of this side effect is Cancer Related Fatigue (CRF) characterised by a stressful and persistent sense of physical, emotional, or cognitive tiredness, associated with the cancer or its treatment, which is not proportional to recent activity and interferes with normal daily functioning \u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e. One of the recommended strategies to help an individual preserve health and quality of life before or after treatment is to eat a balanced diet and exercise frequently \u003csup\u003e[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eCook and thrive is a community led project aimed at supporting members of the African and Caribbean community affected by cancer. The project was designed as part of response to the lack of culturally sensitive support, after treatment support that addressed psychosocial well-being through culturally relevant practices such as shared cooking, food storytelling and nutritional education. Food was used as a creative tool for healing and connection at the intersection of public health, cultural identity, and creative engagement.\u003c/p\u003e\u003cp\u003eThe Project was delivered by Can-Survive UK (CSUK), a community-based cancer support organisation located in Manchester in collaboration with a certified nutritionist. During the project, participants learnt how to prepare healthy cultural meals in one-pot. The goals of this project were to improve the nutritional knowledge of participants, improve cooking skills, their access to nutritious meals and reduce isolation and improve the overall well-being of the participants. Twelve sessions were delivered over a period of six months consisting of 3-hour sessions hosted in an accessible community centre, a mix of cooking demonstration, practical food preparation, guided discussion on the nutritional benefits of ingredients, cultural food practices, opportunities for participants to share food stories. In between the sessions other well-being and support activities such as chair-based exercise, art therapy, talking therapy.\u003c/p\u003e\u003cp\u003eCreativity was central to the project design; a typical example is the introduction of a smoothie bike to exercise for those who could and to also make a smoothie. The bike operated by converting participants' pedalling energy into power for a blender, allowing them to prepare fruit and vegetable smoothies. This approach reflects broader evidence on the use of smoothie bikes as engaging tools to encourage nutrition and physical activity at the same time. The use of smoothie bikes has been documented in existing literature as an innovative approach to combine dietary education with physical activity \u003csup\u003e[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/sup\u003e. Participants were able to express themselves through food, co-create meals, many highlighted how excited they were to be able to make the popular Ackee and salt fish which is the Jamaican national dish after learning from the class. It served as an opportunity to reflect on the historical, cultural and emotional importance of ingredients, traditions and memories. For example, from historical context Ackee symbolises adaptation, survival and pride \u003csup\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/sup\u003e. Similarly, in parts of Nigeria, particularly among the Yoruba tribe, salt is traditionally used in naming ceremonies to bless newborn\u0026rsquo;s life with meaning, endurance and value just as salt brings out the essence of food \u003csup\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003e In another session the participants learnt how to cook yam porridge, a dish rich in both flavour and symbolism. In many West African cultures, yam is more than a staple crop, it represents life, prosperity and renewal \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. The new yam festival is widely celebrated in Nigeria to mark the end of harvest and beginning of a new season \u003csup\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/sup\u003e. Other recipes featured during the project include, Domoda, Callaloo, Caribbean fish stew, Apple coconut rice pudding, fruit rumbler and cheesecake. These sessions culminated in the development of a cook and thrive cookbook, which served as a creative health artifact capturing the recipes, reflections and lived experiences of participants.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe impact of cook and thrive was accessed using a combination of pre- and post-project surveys and qualitative feedback. This evaluation focused on how participants experienced changes in knowledge of nutrition, well-being improvement, acquisition of new skills in relation to cooking and reduced isolation through the project. Qualitative and quantitative data were collected to capture both measurable changes and participants perspectives to provide depth and context on how they experienced the project. This combination ensured that the evaluation was not limited to just quantifiable outcomes but outcomes that are reflective of the cultural and psychosocial dimensions of survivorship support as recommended in existing literature \u003csup\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eParticipants\u003c/h2\u003e\u003cp\u003eBeneficiaries of this project consist of existing service users of CSUK and other members of the African and Caribbean community that have been impacted by cancer.\u003c/p\u003e\u003cp\u003e33 registered to participate in the classes however only 17 completed, many were unable to attend regularly due to ongoing health challenges related to their cancer treatment.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eConsent and Ethics\u003c/h3\u003e\n\u003cp\u003e This project was conducted as a community health and well-being initiative, not as the conventional academic research requiring institutional ethical review. However, all participants were informed of the purpose of the evaluation and gave verbal and written consent for their feedback to be used.\u003c/p\u003e\u003cp\u003e Consent to fill the pre and post evaluation survey at the start and end of the project was sought from each participant. Consent was also sought to use participants' feedback and quotes anonymously. Quotes have been included with participants permission and are not linked to identifiable information. The project was delivered in line with the organisation\u0026rsquo;s confidentiality and safeguarding policies.\u003c/p\u003e\n\u003ch3\u003eEvaluation tools and measures\u003c/h3\u003e\n\u003cp\u003eFeedback was collected using simple accessible surveys at the start and end of the project. These included five outcomes which are: Knowledge of nutrition, cooking skills and confidence, social connection, frequency of access to nutritious meals and overall well-being.\u003c/p\u003e\u003cp\u003eEach of the measured outcomes was rated on a scale point of 1\u0026ndash;5, 1 being the lowest and 5 the highest. Participants were also allowed to share open-text comments, reflections, and stories about their experiences.\u003c/p\u003e\n\u003ch3\u003eData extraction and analysis\u003c/h3\u003e\n\u003cp\u003eSurvey responses were analysed using Jamovi (version 2.6.44) an open-source alternative to Statistical package for the social sciences (SPSS) \u003csup\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/sup\u003e.Given that the scores were from rating scales (ordinal in nature) and the group was small (17 participants), the Wilcoxon Signed-Ranked Test was used to assess the changes in outcome measures from the beginning (pre-survey) to the end of the project ( post-survey).\u003c/p\u003e\u003cp\u003eQualitative feedback was thematically analysed and grouped using an inductive approach. Key themes around cultural identity, healthier habits, nutrition knowledge and empowerment, and motivation to socialise. Anonymised quotes were collated to illustrate the reflection of participants and the creative cultural elements of the project\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eQuantitative evaluation of cook and thrive outcomes.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWilcoxon value\u003c/p\u003e\u003cp\u003e(w)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003cp\u003estandard (\u0026lt;\u0026thinsp;0.05)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eInterpretation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNutrition Knowledge\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.002\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificant improvement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCooking skills and confidence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificant improvement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSocial Connection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e2.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.155\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificant improvement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFrequency of access to nutritious meal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e36.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot statistically significant\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOverall well-being\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSignificant improvement\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eQualitative results\u003c/h2\u003e\u003cp\u003eParticipants also shared qualitative reflections. Key themes that emerged from the feedback includes:\u003c/p\u003e\u003cp\u003e\u003cb\u003e1. Healthier Habits\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants adopted new cooking techniques, reduced unhealthy ingredients and gained nutritional awareness. \u0026ldquo;Ever since I started attending the cooking class, I have now reduced my sugar and salt intake and my cooking at home has improved\u0026rdquo;-Participant T\u003c/p\u003e\u003cp\u003e\u0026ldquo;The class has been helpful, before I used a lot of oil to fry my chicken but now, I only just brown it in the pot with very little or no oil\u0026rdquo;- Participant R\u003c/p\u003e\u003cp\u003e\u0026ldquo;I tried the fruit rumbler recipe from the class at home and the family loved it. I now have fruit rumbler for breakfast\u0026rdquo;-Participant S\u003c/p\u003e\u003cp\u003e\u003cb\u003e2. Motivation and Empowerment\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The sessions helped participants feel more active, engaged and emotionally uplifted.\u003c/p\u003e\u003cp\u003e\u0026ldquo;I always look forward to the cooking class because I enjoy the laughter and comradeship\u0026rdquo;- Participant C\u003c/p\u003e\u003cp\u003e\u0026ldquo;The cooking sessions have been fantastic. They really got everyone engaged and active, each person had something to do, which helped shift our focus away from personal challenges. It felt therapeutic, almost like a form of art where you create something meaningful, take it home, and even try different variations of the recipe later. The sessions were not only enjoyable but also practical, and the nutritionist who facilitated them was truly amazing\u0026rdquo;- Participant G\u003c/p\u003e\u003cp\u003eFor some it was an opportunity to be out and about and for others it was engaging according to participant D:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eThe cooking classes always keep us busy. I have never used a smoothie bike before let alone use one to make a smoothie. I really enjoyed exercising with it and making a smoothie with it.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003e3. Cultural connection\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Participants valued seeing their own cultural foods and traditions reflected in the sessions.\u003c/p\u003e\u003cp\u003e\u0026ldquo;I really enjoyed the classes, especially the nutritional facts about the ingredients used, my favourite session was that of the Yam porridge. I was fascinated about the simplicity of the Yam porridge recipe yet it was very delicious. It reminded me of home (Nigeria), especially the celebration of the new yam festival in my hometown. My partner really enjoyed it when I prepared the same recipe at home\u0026rdquo;-Participant Y\u003c/p\u003e\u003cp\u003e\u0026ldquo;I am from Jamaica, and Ackee and salt fish is one of my best foods, but I have never cooked it until I attended the cooking sessions. I like that the recipe is very simple and straightforward. My best session is the one where Ackee and saltfish was made\u0026rdquo;- Participant K\u003c/p\u003e\u003cp\u003eThese results highlight the combined impact of cultural relevance, creative engagement, and peer support in improving post-treatment outcomes for African and Caribbean individuals affected by cancer.\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings support the role of culturally relevant creative health interventions in improving health outcomes. The intervention succeeded by embedding public health aims within a culturally familiar, creative format \u003csup\u003e19\u003c/sup\u003e. The cook and thrive project align with emerging public health strategies that position creative health as an important component of long-term recovery, social inclusion, and emotional well-being for individuals living beyond a cancer diagnosis \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/sup\u003e. Outcomes from this project also align with existing broader evidence supporting the psychosocial benefits of cooking nutrition interventions. Findings from a systematic review conducted in 2018 highlighted that cooking-based projects or interventions contributed to improved self-esteem, social connection, and mental well-being across various populations \u003csup\u003e[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/sup\u003e. This reinforces the relevance of the cook and thrive model and its demonstrated impact in supporting both well-being and cultural expression after cancer treatment. Importantly, the cook and thrive project showcases a practical and scalable model of how creativity through food and culture can be incorporated into public health delivery. Its success lies in being community rooted, led by participants lived experience and cultural identities. The lack of very significant changes in food access based on the project result suggests structural issues beyond the scope of the project such as financial support. Nonetheless participants benefitted positively from the model\u003c/p\u003e\n\u003ch3\u003eLimitation:\u003c/h3\u003e\n\u003cp\u003eAs a small-scale evaluation model with a sample size of 17 participants, the findings should be interpreted with caution. The primary aim of this initiative was not academic research but to develop a practical, community-led model of creative health that could be adopted or replicated in other settings. While statistical tests present rigour in findings and explore change, the real strength lies in lived experiences captured and the project's adaptability. Future iterations could benefit from larger sample sizes, longitudinal follow-up and integration with broader health system metrics.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eRecommendations\u003c/h2\u003e\u003cp\u003eConsidering the success of the project the model could inform the implementation of the Greater Manchester creative health strategy and similar regional or national policies \u003csup\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e. It demonstrates how culturally designed interventions, co-produced with service users can enhance community well-being and address health inequalities to promote health equity. Local authorities and public health bodies can consider integrating similar creative and culturally grounded models into survivorship care and broader public health planning.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCSUK\u0026rsquo;s cook and thrive project demonstrates that incorporating culturally aligned initiatives or interventions can meaningfully improve well-being and nutritional confidence among African and Caribbean cancer survivors. It presents a replicable and inclusive model for culturally responsive health and well-being public health strategy and practice.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.O wrote the main manuscript text and reviewed it\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe author wishes to acknowledge the entire team at Can-Survive UK for their support in delivering this project and extends special thanks to the nutritionist who facilitated the Cook and Thrive sessions. This work was made possible through funding from the Manchester City Council Cost of Living Fund, whose support is gratefully acknowledged.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAbraham S, Foreman N, Sidat Z, Sandhu P, Marrone D, Headley C, et al. Inequalities in cancer screening, prevention and service engagement between UK ethnic minority groups. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862744/\u003c/span\u003e\u003cspan address=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5862744/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eThe Greater Manchester Creative Health Strategy. The Greater Manchester Creative Health Strategy [Internet]. 2022. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://gmintegratedcare.org.uk/wp-content/uploads/2022/11/gm-creative-health-strategy-low-res.pdf\u003c/span\u003e\u003cspan address=\"https://gmintegratedcare.org.uk/wp-content/uploads/2022/11/gm-creative-health-strategy-low-res.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Cultural, Cancer, Survivors, Nutrition and well-being","lastPublishedDoi":"10.21203/rs.3.rs-8186875/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8186875/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eDisparities in cancer outcomes are often due to cultural barriers, limited support reflective of individual needs, and lower trust in mainstream services. This paper examines a culturally tailored nutrition and cooking project designed to address inequities in post-treatment cancer survivorship among African-Caribbean communities by strengthening nutrition confidence, wellbeing, and social connection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod:\u003cbr\u003e\n \u0026nbsp;\u003c/strong\u003eSeventeen participants took part in the project over a period of six-month. A mixed-method evaluation was employed, using pre- and post-project questionnaires (5-point likert scales) across five outcome domains: nutrition knowledge, cooking skills, social connection, access to nutritious food, and overall well-being. Quantitative data were analysed using the Wilcoxon Signed-Rank test with rank biserial correlations to assess effect sizes. Qualitative feedback was gathered through open-ended survey responses and session reflections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003cbr\u003e\n \u0026nbsp;\u003c/strong\u003eSignificant improvements were observed in four of the five domains: nutrition knowledge (W = 0.00, p = 0.002, r = -1.00), cooking skills (W = 3.00, p = 0.021, r = -0.87), well-being (W = 11.00, p = 0.021, r = -0.72), and social connection (W = 2.00, p = 0.015, r = -0.91). No significant change was observed in access to nutritious food (W = 36.50, p = 0.358). Qualitative data highlighted increased confidence in adapting traditional dishes to healthier versions, enhanced peer support, and reduced feelings of isolation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003cbr\u003e\n \u0026nbsp;\u003c/strong\u003eThe Cook and Thrive model demonstrates how culturally tailored health interventions can meaningfully improve nutrition confidence, psychosocial well-being, and social connectedness among African and Caribbean cancer survivors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Cancer Survivors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe findings highlight that living well beyond cancer requires more than medical follow-up; it requires support that acknowledges cultural identity, emotional wellbeing, and the practical realities of everyday life. Such approaches can reduce psychological distress, strengthen self-management, and address persistent inequalities in post-treatment support for minority communities.\u003c/p\u003e","manuscriptTitle":"Living Beyond Cancer: A Community-Led Intervention for African-Caribbean Cancer Survivors in Manchester","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-04 09:13:44","doi":"10.21203/rs.3.rs-8186875/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ac72f851-b197-4dad-a88b-b5bfb9073882","owner":[],"postedDate":"December 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-23T17:10:18+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-04 09:13:44","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8186875","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8186875","identity":"rs-8186875","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}