Applying the Stages of Change Model in a Nutrition Education Programme for the Promotion of Fruit and Vegetable Consumption among People with Severe Mental Disorders (DIETMENT)

Abstract

Despite growing evidence of the benefits of adequate intake of fruit and vegetables (F&V) and the recommendation to consume five servings daily, the adoption of these habits is poor among people with severe mental disorder (SMD). The main aim of the present study is to determine changes in the intake of F&V and motivation to do so among people with SMDs after participating in a food education programme. A community-based randomized controlled trial was conducted in Spain, with the intervention group (IG) participating in a food education programme based on the stages of change model to promote consumption of F&V and the control group (CG) receiving three informative sessions on basic healthy eating. The main outcomes were related to the intake of F&V and stages of change. Data collection was performed at baseline, post intervention, and 12-month follow-up. Seventy-four participants enrolled in the study and sixty completed the 12-month follow-up. An increase in motivation towards the intake of F&V was observed in the IG but not in the CG (McNemar’s test p = 0.016, p = 0.625). No significant difference was observed for the intake of fruit, vegetables, or F&V. Basing food education strategies on the stages of change model shows positive results, increasing the awareness and disposition of people with SMD towards the intake of F&V. More research is needed to identify the most appropriate eating intervention to increase the intake of F&V.

Metabolic impact of a nutrition education program for the promotion of fruit and vegetable consumption with people with severe mental disorders (DIETMENT)

“…A randomized community-based clinical trial was conducted between January 2019 and September 2020. The study protocol, methodological aspects of data source and study population and results of the main study have been published in detail elsewhere [ 10 , 11 ].⁠ We recruited participants with SMDs who were part of a psychosocial rehabilitation center (Osona Psychopedagogical Medical Center) located in Vic, Barcelona, Spain. This centre serves 160,821 people (according to the 2019 census) and attends to approximately 325 patients in a community rehabilitation area annually.…”

“…All sessions were conducted by the same dietitian-nutritionist. For more information about the intervention, see Vilamala-Orra et al [ 10 ]. In the control group, three voluntary group sessions were offered to the participants’ relatives as support agents to facilitate the change of habits (60 min).…”

“…In the case of people with severe mental disorder (SMD), there is a difficulty in maintaining healthy lifestyle habits, including the consumption of F&V. Several implemented intervention strategies have been aimed at people with SMD and focused on increasing the practice of physical activity and improving diet quality [ 8 , 9 ]. Our group has recently published a study employing the Transtheoretical Model to promote healthy eating behaviors [ 10 ]. The study aimed to investigate changes in fruit and vegetable intake and the motivation to do so among people with SMD after participating in a food education program based on the stages of change model.…”

Effectiveness of a Transtheoretical Model-Based Intervention to Improve Blood Pressure Control of Hypertensive Patients in China: A Clustered Randomized Controlled Trial

“…Several studies have designed and implemented interventions based on TTM and obtained good effects such as successful weight loss among obesity adults and nutrition improve among mental disorder patients ( 8 , 9 ). It also has been proved that TTM-based intervention could help hypertensive patients to improve their dietary and exercise ( 10 , 11 ).…”

Novel Nutrition Education Approaches for Health Promotion: From Investigating Problems to Finding Solutions

“…In another randomized community-based controlled trial, Mireia Vilamala-Orra et al [11] investigated the implementation of the "Stages of Change Model" as part of a NE program delivered to patients with severe mental disorders. The intervention lasted 4 months and consisted of a food education strategy that was aimed in promoting the consumption of fruit and vegetables, as part of 15 group sessions (duration of 90 min per session) that were held on a weekly basis.…”