Exploring factors affecting the use of blended diets for children and young people in health, education and social care settings in the UK: The protocol for a realist mixed methods study

Background Enteral tube feeding provides supplementary or alternative nutrition for individuals who cannot meet their nutritional needs orally and remains essential for a number of children and young people with complex health needs. Commercial formula remains standard practice in the UK, although increasing numbers of children and their families are choosing a blended diet and reporting significant physical and social benefits. However, support for families in using blended diets varies across health, education and social settings in the UK. Aim To explore factors affecting the use of blended diets in health, education and social care settings. Methods This sequential mixed methods study uses a realist approach to understand what works for who under what circumstances and why. A point prevalence study of blended diet use in the UK will identify a stratified sample of professionals and families for interviews exploring their experiences. A Delphi study will prioritise key issues identified in the interview data. Summary This paper presents a novel, realist mixed methods protocol to investigate the contextual factors influencing the use of blended diets for children and young people across health, education and social care settings in the UK. Grounded in lived-experience, it addresses a critical gap in the evidence-base responding to family-identified priorities. Integrating qualitative and quantitative data enhances explanatory power and applicability to practice. Findings will inform future interventions and policy development, aiming to improve support and equity in blended diet provision. This research offers a robust foundation for advancing personalised enteral feeding approaches within multidisciplinary care.