Peer support to encourage adoption and maintenance of Mediterranean diet: a feasibility and pilot study.

Lead Research Organisation: Queen's University of Belfast
Department Name: Centre for Public Health

Abstract

This research will determine whether using peer support encourages people at high risk of developing cardiovascular disease to change their diet towards a Mediterranean Diet [eating more wholegrain cereal foods, more fruit and vegetables, more fish (particularly oily fish), legumes and nuts, less red meat, more poultry and use of olive-oil based fats]. Initial work will explore the perceived potential effectiveness of different strategies of peer support and seek a consensus opinion on what might work best, by talking to people at high risk of cardiovascular disease, health professionals and healthcare-linked charities and community groups. This peer support method will then be tested over one year, in comparison with an already-proven Mediterranean Diet-promoting intervention, and a minimal intervention (overall n=75). Adherence to the diet will be assessed using a questionnaire which been shown to accurately determine how closely a Mediterranean Diet is being followed, and through the use of blood sample analysis to assess nutritional status. Throughout the study, researchers will talk to all those involved with the study (for example participants, peer supporters and healthcare professionals), to explore ways in which the peer support intervention can be improved. The results of this study will be used to guide the design of a larger study to determine whether a peer support intervention to promote a change in diet towards a Mediterranean Diet can reduce the chance of people at high risk of cardiovascular disease developing diabetes.

Technical Summary

Type 2 diabetes is a growing public health problem. It has been recently shown that the Mediterranean diet reduces risk of type 2 diabetes in people at high risk of cardiovascular disease, yet studies showing a benefit of the Mediterranean Diet often use very intensive methods of encouraging behaviour change, which would be expensive if rolled out to the 'at risk' or general population. Peer support strategies may be an important, flexible, low-cost method of encouraging dietary change. This project will, using focus groups (n=12) conducted with people at high risk of cardiovascular disease and interviews with relevant stakeholders including healthcare professionals, examine the feasibility of using peer support strategies to encourage adoption of the Mediterranean Diet in people at high risk of cardiovascular disease. These focus groups will inform the development of a peer support intervention. Once an appropriate peer support intervention has been developed, pilot data regarding the feasibility of using the peer support intervention, in comparison with minimal intervention and an intervention already shown to increase adherence to Mediterranean Diet, will be collected. This pilot trial will be conducted over a 1 year period in participants at high risk of cardiovascular disease (n=75). Endpoints will include the Mediterranean Diet Score, biomarkers of nutritional status, quality of life, and process evaluation data. Pilot study data will subsequently inform a large scale intervention study.

Planned Impact

Apart from academic beneficiaries, there are a number of other potential beneficiaries and impacts of the proposed research. Public Sector: evidence for the use of peer support strategies to promote adherence to the Mediterranean Diet, as proposed here, will help to build a stronger evidence base to underpin public health policies (at all levels, from local to international) for the promotion of a healthy diet and prevention of chronic disease. This will include direct extension of the evidence base specifically for Mediterranean Diet and diabetes risk, but will also include contributing to knowledge regarding the potential use of peer support interventions that have been developed in collaboration with the target group for other behaviour changes. Third Sector: voluntary organisations and charities involved in healthcare, health promotion and disease prevention will benefit from this research, in terms of ultimately having direct evidence of a benefit of a peer support intervention promoting adherence to the Mediterranean Diet in reducing the risk of diabetes, but, again, through more general increased knowledge of the potential effectiveness of carefully designed peer support strategies, and how at risk groups view diet, dietary change and the use of peer support to produce dietary change. General Public: The impacts described above, through influencing public health policy and health promotion activities, have the potential to impact on quality of life, health and well-being in the general population, by improving diet quality and reducing disease risk. As the proposed research is planned to involve a broad range of participants at high risk of cardiovascular disease, including those from deprived and affluent backgrounds, both genders and a range of ages, our results will be generalisable, but we will also be able to explore whether attitudes to diet, dietary change and the use of peer support to achieve dietary change differ according to socioeconomic background, age and gender. Therefore there is the possibility of knowledge generation in this project regarding how successful peer support strategies may need to be flexible and vary according to the specific target population. Finally, if the PDRA employed on the project decides not to continue in academic research after the study has been completed, then they will have developed valuable scientific methodology, communication, project management, data management and analysis (quantitative and qualitative) skills that will be of value to all employment sectors.

Publications

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McEvoy C (2013) Effect of diet on vascular health in Reviews in Clinical Gerontology

 
Description Inclusion of guidelines on the design conduct and reporting of human intervention studies to determine the health benefits of food (published in British Journal of Nutrition) in the Equator network - {JW}
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
 
Description CARDI Ageing Research Leadership Programme: Reference: LP3-04
Amount £193,578 (GBP)
Funding ID ROS/JEE/LP3-04 
Organisation American Federation for Aging Research 
Sector Charity/Non Profit
Country Unknown
Start 07/2015 
End 06/2018
 
Description Department for the Economy PhD studentship - Damian Cole {JW}
Amount £65,000 (GBP)
Organisation Department for the Economy, Northern Ireland 
Sector Public
Country United Kingdom
Start 10/2017 
End 09/2020
 
Description Department of Employment and Learning PhD studentship (Christina Erwin) - {JW}
Amount £70,000 (GBP)
Funding ID Christina Erwin 
Organisation Government of Northern Ireland 
Department Department for Employment and Learning Northern Ireland (DELNI)
Sector Public
Country United Kingdom
Start 10/2014 
End 09/2017
 
Description PhD studentship
Amount £65,000 (GBP)
Organisation Government of Northern Ireland 
Department Department for Employment and Learning Northern Ireland (DELNI)
Sector Public
Country United Kingdom
Start 10/2015 
End 09/2018
 
Description Research fellowship - Dr Claire McEvoy
Amount £193,578 (GBP)
Organisation Centre for Ageing Research and Development in Ireland (CARDI) 
Sector Charity/Non Profit
Country Ireland
Start 07/2015 
End 06/2018
 
Description Researcher funding for behavioural skills training - {CME}
Amount £620 (GBP)
Organisation Health and Social Care in Northern Ireland (HSCNI) 
Sector Public
Country United Kingdom
Start 09/2013 
End 01/2014
 
Description Researcher training and development fund for behaviour change taxonomy workshop - {CME}
Amount £1,787 (GBP)
Organisation Queen's University Belfast 
Sector Academic/University
Country United Kingdom
Start 03/2014 
End 07/2014
 
Description Scientific Research Grants 2015
Amount £80,000 (GBP)
Organisation Northern Ireland Chest Heart and Stroke Association (NICHS) 
Sector Charity/Non Profit
Country United Kingdom
Start 12/2015 
End 05/2017
 
Description Wellcome Trust seed funding
Amount £76,820 (GBP)
Organisation Wellcome Trust 
Department Wellcome Trust Bloomsbury Centre
Sector Academic/University
Country United Kingdom
Start 09/2016 
End 04/2018
 
Title peer support Mediterranean diet group programme 
Description This intervention is a theory-based peer support group programme for dietary behaviour change towards a Mediterranean diet in adults at high cardiovascular risk. The programme is delivered by two trained peer supporters over 12 months and is currently being field tested in a pilot randomised controlled trial. 
Type Preventative Intervention - Behavioural risk modification
Current Stage Of Development Initial development
Year Development Stage Completed 2013
Development Status Under active development/distribution
Impact The feasibility of the intervention is currently being tested 
 
Description "Gruelling Ordeals" public event 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Around 60 members of the public attended an evening entitled "Gruelling Ordeals: the Irish Workhouse Diet, 1850-1950", organised by the Institute for Collaborative Research in the Humanities, QUB and held at Duncairn Arts Centre Belfast. I presented an overview of differences in the diet of those at the extremes of the socioeconomic spectrum then and now.
Year(s) Of Engagement Activity 2015
 
Description Career presentation to undergraduate students 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Undergraduate students
Results and Impact Invited speaker at CPH Research Experience Seminar (Career) for UG students which stimulated discussion regarding career options.
Year(s) Of Engagement Activity 2015
 
Description Celebrating Science at QUB Feb 2015 (CME) 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact Dr McEvoy took part in an exhibition showcasing Nutrition Research at QUB and provided the opportunity for members of the public to learn about the impact of research for public health benefit.
Year(s) Of Engagement Activity 2015
 
Description IGFS Industry stakeholder event: Nov 2014 (CME) 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Dr Claire McEvoy provided an exhibition of nutrition and health research undertaken by the Centre for Public Health to regional food industry stakeholders and academic delegates. As a result of this activity, links were made with 'College of Agriculture, Food and Rural Enterprise', Good Food Northern Ireland and a private food supplement manufacturer.

As a result of this activity, links were made with a number of industry stakeholders and further future activities are planned to identify areas for mutual research collaborations.
Year(s) Of Engagement Activity 2014
 
Description Mediterranean diet and heart health talk - {CME} 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact 25 people attended a public information talk gvien by Dr Claire McEvoy, with discussion afterwards

Some attendees requested information about NPRI funded Mediterranean diet study (TEAM-MED)
Year(s) Of Engagement Activity 2013,2014
 
Description Mediterranean diet and heart health talk - {CME} 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other academic audiences (collaborators, peers etc.)
Results and Impact 60 Queen's University employees attended this talk, given by Dr Claire McEvoy, which stimulated discussion afterwards

Some attendees requested further information about taking part in a NPRI funded Mediterranean diet study (TEAM-MED)
Year(s) Of Engagement Activity 2014
 
Description Northern Ireland Science Festival event "The Mediterranean Diet - what makes it so healthy?" 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Northern Ireland Science Festival event "The Mediterranean Diet - what makes it so healthy?". Worked together with the Culinary Arts Management students from Ulster University and the Academy restaurant to provide a Mediterranean meal and presented information on the Mediterranean Diet and NPRI research to the general public.
Year(s) Of Engagement Activity 2017
 
Description Northern Ireland contribution to FSA Strategic plan 'Food we can trust' delivery for 2015-20. 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Third sector organisations
Results and Impact Dr McEvoy contributed to the Northern Ireland Annex to the FSA's Strategic plan for 2015-20. It sets out what will be undertaken in Northern Ireland to progress towards the FSA strategic outcomes over the next five years and deliver the Agency's strategic goals. In particular this is to protect public health and consumers' interests in relation to food, so that food is safe and what it says it is, that we have access to an affordable healthy diet, and can make informed choices about what we eat, now and in the future.
Year(s) Of Engagement Activity 2015
 
Description Organising committee, Mediterranean Diet meeting 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Organising committee - International Conference on Mediterranean Diet and Health: a lifelong approach, March 30th-April 1st 2017, Ostuni, Italy
Year(s) Of Engagement Activity 2017
 
Description Public engagement event Belfast 2013 - {JW} 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact 30 people attended an interactive talk about the Mediterranean Diet and the potential health benefits, with discussion afterwards

Attendees requested further information about on-going research as it developed
Year(s) Of Engagement Activity 2013
 
Description Radio interviews (TEAM-MED) - {CME} 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Following Dr Claire McEvoy's interview, approximately 300 people requested information about a NPRI funded Mediterranean diet study (TEAM-MED)

16 suitable participants were recruited to take part in a NPRI funded Mediterranean diet study (TEAM-MED)
Year(s) Of Engagement Activity 2014
 
Description Research stand at local food market as part of Northern Ireland Science Festival 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Manned a research stand as part of Northern Ireland Science Festival at St George's market. Working with Royal Society of Biology, Biochemical Society and the Nutrition Society, as well as the Love Food Hate Waste campaign to put together a range of activities around nutrition and health.
Year(s) Of Engagement Activity 2016
 
Description Seafish UK campaign 
Form Of Engagement Activity A magazine, newsletter or online publication
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Partnered with Seafish UK to highlight casestudies involving TEAM-MED participants who successfully incorporated 2 or more servings/wk fresh fish into their diet. Participants shared their stories and provided practical ways to aid successful dietary behaviour change and these were included in Seafish campaign materials and picked up by national newspaper.
Year(s) Of Engagement Activity 2016
 
Description The TEAM-MED study talk at U3A Newry - {CME} 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Local
Primary Audience Public/other audiences
Results and Impact 10 adults attended a talk given by Dr Claire McEvoy, to raise awareness of the TEAM-MED study (NPRI funded)

Attendees requested further information about the study and 1 person was recruited to take part in the trial.
Information about the study was included in the charity website.
Year(s) Of Engagement Activity 2014