Feasibility of the AusMed Diet Program: Translating the Mediterranean Diet for Older Australians

Abstract

The Mediterranean diet pattern (MEDI) is associated with a lower risk of chronic conditions related to ageing. Adherence research mostly comes from Mediterranean countries with high cultural acceptability. This study examines the feasibility of a MEDI intervention designed specifically for older Australians (AusMed). Phase 1 involved a consumer research group (n = 17) presentation of program materials with surveys after each section. In-depth individual semi-structured interviews (n = 6) were then conducted. All participants reported increased knowledge and confidence in adherence to the MEDI, with the majority preferring a booklet format (70%) and group delivery (58%). Three themes emerged from interviews—1. barriers (complexity, perceived cost and food preferences), 2. additional support and 3. individualisation of materials. Program materials were modified accordingly. Phase 2 was a 2-week trial of the modified program (n = 15). Participants received a group counselling session, program manual and food hamper. Adherence to the MEDI was measured by the Mediterranean Diet Score (MDS). All participants increased their adherence after the 2-week trial, from a mean score of 5.4 ± 2.4 (low adherence) to a mean score of 9.6 ± 2.0 (moderate to high adherence). All found that text message support helped achieve their goals and were confident to continue the dietary change.

Understanding the Self-Perceived Barriers and Enablers toward Adopting a Mediterranean Diet in Australia: An Application of the Theory of Planned Behaviour Framework

“…Self-perceived barriers toward following a MedDiet have previously been explored [ 34 , 35 , 38 , 46 , 47 , 48 ]; however, to the best of our knowledge, this is the first study to comprehensively explore this relationship in Australian adults. Our results provide new insights into the factors which underpin people’s intention to follow a MedDiet.…”

“…These barriers are consistent with those previously reported for both general healthy eating [ 53 , 54 ] and towards adopting a MedDiet in non-Mediterranean countries [ 36 , 37 , 46 , 55 ]. Nevertheless, complexity of the dietary pattern, individual food preferences, and perceived additional costs were previously identified as important barriers to adherence in older Australian adults [ 35 ]. These differences are likely explained by participant characteristics, with the majority of participants in the aforementioned study being retired and many reporting household incomes above the highest possible aged pension [ 56 ], suggesting time and cost are less likely to be perceived as important barriers.…”

“…Furthermore, in a review of Australian randomized control trials using a MedDiet intervention [ 31 ], our group previously reported excellent dietary adherence, albeit with the use of a range of intensive, yet successful strategies to facilitate dietary compliance, including one-on-one dietary counselling, food provisions, written resources (recipes, daily/weekly meal plans, shopping lists, label reading information), and cooking classes. Zacharia et al [ 35 ] also showed that acceptance of a MedDiet intervention can be improved with the provision of simplified and individualized resources (menu plans, recipes, shopping lists). Moreover, participants in this study also identified group education settings and the utilisation of mHealth strategies (website, downloadable applications, and text messaging) as preferable methods to supplement nutrition education and support behaviour change [ 35 ].…”

“…Nevertheless, there is little knowledge of the perceived enablers (ease) or barriers (difficulty) that determine the behavioural intention to adhere to a MedDiet, particularly in Australia. Two previous feasibility studies delivering a MedDiet intervention targeted at Australian older adults reported that participants felt confident in their ability to maintain long-term adherence to the dietary pattern [ 34 , 35 ]. Irrespectively however, Davis et al [ 34 ] reported the palatability of key foods, in particular natural Greek yoghurt, an inadequate offering of red meat, and an overall lack of variety in the diet as key barriers towards adherence.…”

“…Irrespectively however, Davis et al [ 34 ] reported the palatability of key foods, in particular natural Greek yoghurt, an inadequate offering of red meat, and an overall lack of variety in the diet as key barriers towards adherence. However, Zacharia et al [ 35 ] identified the complexity of the dietary pattern, individual food preferences, and perceived cost as important barriers to adherence. Similarly, Middleton et al [ 36 ] previously reported that middle-aged adults from the United Kingdom identified purchasing, organising, and preparing of food as key perceived barriers when attempting to adopt principles of the MedDiet.…”