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        Process Evaluation of a complex Intervention: Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED)
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        Process Evaluation of a complex Intervention: Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED)
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Epidemiological studies and RCTs have demonstrated that adherence to a Mediterranean diet (MD) can reduce cardiovascular disease (CVD) risk 1 , 2 . However, methods used to achieve dietary change are intensive and expensive. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet (TEAM-MED) study aimed to develop a cost-effective method of encouraging MD change in a high CVD risk population through the development and feasibility testing of a 12-month group peer support intervention. The aim of the present study was to conduct a process evaluation of the TEAM-MED peer support intervention within a feasibility study, as per MRC guidance.

Participants (n = 75) at high CVD risk were recruited (44 % female, mean (SD) age 57·1 (6·7) y). MD adherence was low (MD Score 2·1 (0·9); 14-point scale). Participants were randomised to: minimal intervention, intensive intervention with dietetic support, group support and provision of key MD foods, or group peer support programme. Peer support was evaluated through observations, semi-structured interviews, and questionnaires.

It was challenging to recruit people at high risk of CVD with low MD adherence. Attendance declined across meetings, primarily due to personal factors but also due to interpersonal (interactions between group members and with peer supporter) and intervention organisation aspects. Groups ran with high levels of fidelity to the protocol, in terms of number and format of meetings. Participant and peer supporter interviews and questionnaires revealed high levels of acceptability for the peer support intervention: ‘I found that it was a year of my life that has made a great big difference. I didn't expect it to, I didn't think I would stick it but I have done it and I've reaped the benefits.’ -group member, ‘I really enjoyed the sessions and [..] seeing how the group progressed and so I got a lot of personal satisfaction out of it that way.’ –peer supporter. A tolerance questionnaire also revealed high levels of acceptability for the MD, mean acceptability for the diet can be seen in the table. Participants were invited to score MD components from -2 being very unacceptable to 2 being very acceptable.

Individual MD components rated most acceptable were: consuming fruit and vegetables, wholegrains and olive oil. Changes towards a MD rated least acceptable were: a low amount of sweet foods, a moderate amount of alcohol and consuming pulses/legumes.

Group peer support was an acceptable intervention to encourage people at high CVD risk to consume a MD. Process evaluation within this feasibility study has identified potential areas for modification in the TEAM-MED peer support intervention, prior to a full scale trial.

1. Sofi, F, Macchi, C, Abbate, R, Gensini, GF, Casini, A. (2014) Public Health Nutr. Dec;17(12), 2769–82.
2. Estruch, R, Ros, E, Salas-Salvadó, J, Covas, M-I, Corella, D, Arós, F, et al. (2013) N Engl J Med. Apr 4;368(14), 1279–90.