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

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.

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.

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.