Adherence to a Mediterranean diet in a rural Appalachian food desert

Barriers and Facilitators Associated with the Adoption of and Adherence to a Mediterranean Style Diet in Adults: A Systematic Review of Published Observational and Qualitative Studies

“…Characteristics of the included studies and ratings of risk of bias are shown in Table 1 and Table 2 . Of the 18 included studies, 12 were observational studies, all cross-sectional in design [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], and 6 were qualitative studies [ 26 , 27 , 28 , 29 , 30 , 31 ]. Four studies, all qualitative [ 26 , 27 , 28 , 30 ] were related to adoption of MedDiet and 14 studies, both qualitative [ 29 , 31 ] and observation studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] were related to adherence to MedDiet.…”

“…Of the 18 included studies, 12 were observational studies, all cross-sectional in design [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ], and 6 were qualitative studies [ 26 , 27 , 28 , 29 , 30 , 31 ]. Four studies, all qualitative [ 26 , 27 , 28 , 30 ] were related to adoption of MedDiet and 14 studies, both qualitative [ 29 , 31 ] and observation studies [ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ] were related to adherence to MedDiet. Four studies were based in Mediterranean regions—one each from Italy [ 14 ] and Greece [ 17 ], and two from Spain [ 15 , 16 ], and all others were conducted in non-Mediterranean regions.…”

Barriers and facilitators to adoption of and adherence to a Mediterranean style diet in adults: a systematic review of observational and qualitative studies

“…Characteristics of the included studies and ratings of risk of bias are shown in Tables 1 and 2. Of the 18 included studies, 12 were observational studies, all cross-sectional in design [14][15][16][17][18][19][20][21][22][23][24][25], and 6 were qualitative studies [26][27][28][29][30][31]. Four studies, all qualitative [26][27][28]30] were related to adoption of MedDiet and 14 studies, both qualitative [29,31] and observation studies [14][15][16][17][18][19][20][21][22][23][24][25] were related to adherence to MedDiet.…”

“…Difficult to purchase food items (e.g., little support to find and locate items in supermarket) [29,30] Seasonal availability of foods [24,28] Limited access, selection and choices [19,24,27] Increased access to fresh foods [24] Availability of diet in catering outlets [24] Good access to budget supermarkets and good transport [26] Cognitive Absence of nutrition education (e.g., limited knowledge of the health benefits of MedDiet foods) [18,19,21,27,28,30] Lack of knowledge of how to incorporate the food components of the MedDiet into meals [24,27] Complex & contradictory dietary information (e.g., conflicting reports from media) [28,30] Complexity and size of meal plans [31] Concerns over specific foods (e.g., fats & oils) [28] Concerns over food safety (e.g., pesticide residues) [19] Low food literacy [24] Low health appeal and perceived healthfulness [18,21,24] Negative perceived outcomes, e.g., increased body weight [20,30] Lack of understanding of the importance of nutrition [26] Nutritional attitudes and beliefs [26,28] Good nutrition knowledge and skills [26] Improved diet quality [24,29] Physical benefits, e.g., disease prevention [24,26,28,29] Appearance/body weight related benefits, inc. weight loss…”

“…Lower education level [14,16,19,21] Lower SES [16] Gender: Being male [14] Gender: Males were less likely to understand the health implications of the MedDiet and less amenable to making chages [27] Age: Younger [14,16] Age: Younger people were concerned about the cost [27] Higher education attainment [16,18,23,25] Lower education attainment [18] Gender: Being female [14,15,22] Age: Being older [16] Financial Increased food costs [19,24,[27][28][29][30][31] Greater food expenses on high consumption items, e.g., legumes, Lower food expenses on low consumption items, e.g., meat [25] Wasteful/Foods easily spoil (e.g., fruits and vegetables) [19,24] Poor storage facilities [19] Lower incomes [14,19,27] High food insecurity [17] Higher household income [25] Occupation (Professional/managerial) [25] Relative expense of plant-vs animal based foods [28] Good value for money [18,21,24,26] Lifestyle Sedentary lifestyle [16] Habit of smoking [16,…”