Centre for Public Health, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK.
Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Fern Barrow, Talbot Campus, Bournemouth, BH12 5BB, UK.
BMC Public Health. 2018 Oct 22;18(1):1194. doi: 10.1186/s12889-018-6108-z.
Mediterranean diet (MD) interventions are demonstrated to significantly reduce cardiovascular disease (CVD) risk but are typically resource intensive and delivered by health professionals. There is considerable interest to develop interventions that target sustained dietary behaviour change and that are feasible to scale-up for wider public health benefit. The aim of this paper is to describe the process used to develop a peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk.
The Medical Research Council (MRC) and Behaviour Change Wheel (BCW) frameworks and the COM-B (Capability, Opportunity, Motivation, Behaviour) theoretical model were used to guide the intervention development process. We used a combination of evidence synthesis and qualitative research with the target population, health professionals, and community health personnel to develop the intervention over three main stages: (1) we identified the evidence base and selected dietary behaviours that needed to change, (2) we developed a theoretical basis for how the intervention might encourage behaviour change towards a MD and selected intervention functions that could drive the desired MD behaviour change, and (3) we defined the intervention content and modelled outcomes.
A theory-based, culturally tailored, peer support intervention was developed to specifically target behaviour change towards a MD in the target population. The intervention was a group-based program delivered by trained peer volunteers over 12-months, and incorporated strategies to enhance social support, self-efficacy, problem-solving, knowledge, and attitudes to address identified barriers to adopting a MD from the COM-B analysis.
The MRC and BCW frameworks provided a systematic and complementary process for development of a theory-based peer support intervention to encourage dietary behaviour change towards a MD in non-Mediterranean adults at high CVD risk. The next step is to evaluate feasibility, acceptability, and diet behaviour change outcomes in response to the peer support intervention (change towards a MD and nutrient biomarkers) using a randomized controlled trial design.
地中海饮食（MD）干预措施已被证明可显著降低心血管疾病（CVD）风险，但通常需要大量资源，并由健康专业人员提供。人们非常有兴趣开发针对持续的饮食行为改变的干预措施，这些干预措施可行且可扩大规模，以惠及更广泛的公众健康。本文旨在描述开发一种同伴支持干预措施的过程，以鼓励非地中海地区高 CVD 风险成年人朝着 MD 饮食改变饮食行为。
采用医学研究委员会（MRC）和行为改变车轮（BCW）框架以及 COM-B（能力、机会、动机、行为）理论模型来指导干预措施的开发过程。我们使用证据综合和与目标人群、健康专业人员和社区卫生人员进行的定性研究相结合的方法，在三个主要阶段开发干预措施：（1）我们确定了证据基础，并选择了需要改变的饮食行为；（2）我们开发了一个理论基础，说明干预措施如何鼓励朝着 MD 饮食改变行为，并选择了可以推动所需 MD 行为改变的干预功能；（3）我们定义了干预内容并模拟了结果。
开发了一种基于理论、文化上量身定制的同伴支持干预措施，专门针对目标人群朝着 MD 饮食改变行为。该干预措施是一个由经过培训的同伴志愿者在 12 个月内提供的小组方案，并结合了增强社会支持、自我效能、解决问题、知识和态度的策略，以解决 COM-B 分析中确定的采用 MD 的障碍。
MRC 和 BCW 框架为开发基于理论的同伴支持干预措施提供了一个系统和互补的过程，以鼓励非地中海地区高 CVD 风险成年人朝着 MD 饮食改变饮食行为。下一步是使用随机对照试验设计评估该同伴支持干预措施对饮食行为改变的可行性、可接受性和效果（朝着 MD 饮食改变和营养生物标志物）。
