Implementing a Mediterranean diet intervention into a RCT: Lessons learned from a non-Mediterranean based country

Abstract

IntroductionIn light of the accumulating scientific evidence, the Mediterranean diet (MD) is suggested to have a positive effect on cardiovascular health, particularly in relation to chronic disease development (1-4). Recommendations strongly encourage a Mediterranean-like dietary pattern for prevention of major chronic diseases (5, 6). In the United Kingdom, several credible organisations that provide dietary information have promoted consumption of the MD to the public, including NHS Choices (7) and Patient.co.uk (8). Little is known about the pragmatic and cultural perspectives of adopting the MD in this non-Mediterranean country and the concept of how British citizens incorporate a Mediterranean diet (MD) into daily life (e.g. food availability, cost, personal preferences and preparation) has remained unexplored. This study addresses this gap and highlights the barriers and facilitators to eating the MD, based on a small sample of British citizens who had participated in an experimental study in the north-east of England (9, 10). The previous study investigated the combined effects of the MD and an exercise intervention on lower-and upper-limb cutaneous microvascular function in a healthy middle-aged population. MethodsThis study was granted ethical approval by a University of Lincoln ethics committee. A qualitative methodology was employed to investigate participant experiences regarding barriers and facilitators which impacted upon their experience whist eating the MD during the experimental trial. This type of inquiry is important to investigate food-related behaviour, understanding 'how' and 'why' individuals act regarding food choices and consumption (11). This study used semi-structured focus groups with the expectation that rich contextual information from the participants' views and perspectives would be generated.A purposive sample (n=11) of adult participants, who had previously enrolled on an 8-week MD intervention study (9), was approached by email invitation. The invitation outlined the opportunity to discuss the experience of attempting the MD with other participants involved in the original study, in a University location at a mutually convenient time. All participants were encouraged to attend a focus group with their co-habiting partner (if relevant) to discuss their experiences at home during the trial. Each participant received a £10 shopping voucher for participation.Eight of the eleven participants from the original study (9) took part in this study. Three co-habiting partners also attended. In total, 11 participants (mean age = 54.3±4.0 years) attended three focus groups (mean time = 32±10 minutes) which were staged up to two months after the original study at a University location at a mutually convenient time.Focus group discussions were facilitated by the lead researcher and an experienced qualitative researcher and were Thematic analysis from the focus groups revealed that participants considered that the MD intervention had introduced a better quality of food, widening the food-hor...

Effect of a Mediterranean type diet on inflammatory and cartilage degradation biomarkers in patients with osteoarthritis

“…Support was also offered from a registered Dietician (employed by Arthritis Action), via telephone, which included answering questions and providing guidance on the diet. This intervention/advice is consistent with being member of Arthritis Action and considered advisable when implementing the Mediterranean diet to people from non-Mediterranean countries (8). …”

Barriers to adopting a Mediterranean diet in Northern European adults at high risk of developing cardiovascular disease

“…Most of these barriers are consistent with barriers to general healthy eating that are established in the dietary change literature (15)(16)(17)(18)(19) and have been identified as barriers to following a MD in other non-Mediterranean populations (20,21,37) . Knowledge of the specific composition of a MD was limited; therefore, there is a need for further education on this dietary pattern that offers significant health benefits for this at risk group.…”

“…Intervention studies to encourage MD adoption conducted in Northern European populations, although limited in number, have reported increases in MD adherence (13,14) . To our knowledge, only two small qualitative studies have investigated barriers to consuming a MD in the UK in one region (20,21) . Although barriers to general dietary change are well documented in the literature (15)(16)(17)(18)(19) , there is very limited information on specific barriers that may exist in relation to the adoption of a MD by Northern European populations.…”

Workplace Physical Activity and Health Risks: A Need for Effective Screening and Intervention Strategies

“…For example, often-reported barriers to workplace physical activity interventions, particularly the ones conducted on-site, include organisational policies such as managerial consent and flexible working hours, job demands, lack of time and energy, self-efficacy for exercise [3,12]. Similar barriers have been reported to workplace interventions aimed at adopting a healthy dietary pattern, which included work stress, lack of time for food preparation and availability of healthy food items [11].…”