A mixed methods realist evaluation and economic appraisal of how health screening, education and prevention interventions in mosques impact the health and wellbeing of Muslim communities.

Research question: Do health checks in mosques improve people’s health literacy, engagement with healthy behaviour changes and health services? And are they cost effective? What works for whom, why, and in what circumstances? Background: Cardiovascular disease (CVD) is the main cause of death among Muslim communities. Although it is largely preventable through early identification and prevention interventions, these are often inaccessible due to language, cultural and system barriers. Increasing risk awareness and access to prevention interventions, in trusted places like mosques, may address these barriers and improve Muslim’s engagement with health interventions. Aim: To provide evidence to determine the impact on people's health literacy, healthy behaviour change, engagement with health and care services and the cost-effectiveness of a clinic in mosques programme. Objectives: 1. To-develop initial programme theories (IPTs), to explain how a health clinic delivered in mosques may improve people’s health and wellbeing, for whom, in what circumstances and why? 2. To test and refine our theories by using existing data and generating mixed method evidence to develop context–mechanism–outcome (CMO) configurations of the health clinic in mosques programme. 3. To undertake an economic appraisal that outlines the resource use and outcomes associated with different CMO configurations. 4. To understand stakeholders’ views on how current and potential income streams for mosques can be used to support the sustainability and scalability of the health clinic in mosques programme. Methods: A mixed methods realist evaluation consisting of three work-packages (WPs). WP1: Generating IPTs based on existing evidence, expert stakeholder group consultation and codesign workshops with mosques and community organisations. IPTs, in the form of if…then statements will provide hypothetical explanation as to how the clinic in mosques programme may work, for whom and why. These will then be empirically tested in WP2. WP2: Implementing the clinic in 14 mosques in England and Wales to test the IPTs developed in WP1. Quantitative evidence of key clinical and behavioural variables will be collected at baseline (prior to intervention) and at 1-, 3-, 6-, and 12-months post-intervention. We will also interview people who have attended the clinic and those who delivered it. All data will be synthesized in the form of CMO configurations to provide detailed explanations of what works, for whom, how and in what circumstances. WP3: Undertaking a cost-consequence analysis to systematically evaluate the resources used and outcomes achieved by the intervention, using data collected in WP2. Outcomes will be measured using validated health-related quality-of-life metrics, such as EQ-5D-5L value, alongside clinical measures. The sustainability and scalability of the programme will be explored through interviews with mosque leaders. Timelines for delivery: 36 months Dissemination and impact: The findings of this work could impact practice within a year of completion. All co-designed materials will be available to patients and the public for free and shared with mosques and community organisations nationally. We will work with PPIE members to ensure widespread dissemination of findings in accessible formats and will publish our findings in high-impact, open access journals.