Follow-up of a web-based tailored intervention promoting the Mediterranean diet in Scotland

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Abstract

Objective

To assess the impact of a 3-month follow-up of a 6-month quasi-experimental study conducted to evaluate a web-based, tailored-feedback intervention promoting four key components of the Mediterranean diet.

Methods

Fifty-three (intervention) and nineteen (control) healthy females, 25–55 years, employed at two Universities in Glasgow, Scotland, between 2003 and 2004 participated. Participants received tailored dietary and psychosocial feedback and Internet education, or minimal dietary feedback and general healthy-eating brochures, respectively. Dietary intake using 7d-estimated food diaries and blood lipids were assessed at baseline, 6 (post-test) and 9 months (follow-up).

Results

Intention-to-treat analyses for between-group comparisons over time showed that the intervention group had increased their vegetable intake over 9 months and had more favourable levels of HDL-cholesterol and ratio of total:HDL-cholesterol over the 9-month assessment, compared with the control group. Within-group comparisons showed that, except for fruit consumption, the intervention group sustained their dietary improvement at 9 months, compared with baseline.

Conclusion

This intervention proved successful at sustaining most of the favourable dietary and blood lipid profile changes achieved over the 6-month intervention at the 3-month follow-up.

Practice implications

This intervention can be effective in promoting a Mediterranean-style diet in work settings.

Introduction

Feedback that is tailored to an individual's needs according to their specific behaviours and psychosocial and environmental factors that may affect these behaviours is a strategy that can be used to modify eating habits [1]. This approach has been applied in several computer-tailored nutrition interventions and has been shown to be more effective in promoting favourable dietary changes compared with non-tailored nutrition education [2], [3], [4], [5]. A recent systematic review showed that 20 out of 26 studies that promoted nutrition behaviour change via computer-tailoring were successful at encouraging healthier dietary habits, most notably a reduction in dietary fat [6].

In recent years, the Internet has been a primary source of health information [7]. In addition, the Internet is one of the most preferred nutrition information sources [8], therefore offering a promising means of delivering nutrition education and promoting dietary behaviour change to large numbers at a relatively low-cost. Web-based, interactive computer programs have been used to assess dietary habits and provide nutrition education and tailored feedback on-screen. Some studies have shown that this is an effective method to reduce total fat intake [9], [10] and promote healthier eating habits [11], as well as positively influence psychosocial determinants of dietary behaviour change [10].

Some studies reporting results of computer-tailored or interactive computer-tailored nutrition interventions have reported short, or no follow-up evaluations, so the impact of their interventions in the longer term could not be defined [1]. Studies reporting dietary assessment results for both post-intervention and follow-up periods, with follow-up times ranging from 1 month to 1 year, suggest that the positive effect of tailored feedback persists over time, at least for some behaviours [2], [4], [12], [13], [14], [15].

The Mediterranean Eating in Scotland Experience (MESE) project investigated the effect of a 6-month intervention using manually delivered tailored dietary and psychosocial feedback and internet technology, compared with minimally tailored dietary feedback and general nutrition printed materials, in order to promote an improved consumption of four key food components of the traditional Mediterranean diet (vegetables; fruits, nuts and seeds; legumes; and MUFA:SFA ratio) to Scottish female employees [16], [17]. This study is novel in that no research has evaluated the combined effects of a healthy-eating website promoting the Mediterranean diet and tailored dietary and psychosocial feedback through e-mails, in order to encourage dietary change. Results from the immediate post-test evaluation showed that at the end of the trial, the intervention was more effective in increasing intake of fruits, nuts and seeds (34.9 g/d vs. −23.2 g/d; P = 0.022), as well as increasing HDL-cholesterol levels (0.22 mmol/l vs. 0.06 mmol/l; P = 0.036) and decreasing the total:HDL-cholesterol ratio (−0.44 vs. −0.11; P = 0.006), compared to the control condition. Although participants in the control group increased their intake of legumes compared with baseline, within-group comparisons were more favourable for participants in the intervention group, who had significantly increased the intake of all key components and improved their blood lipid profile at the end of 6 months [16]. The current paper reports on the 3-month follow-up evaluation of this project.

Section snippets

Participants

Fifty-three women were recruited from the University of Glasgow to serve as the intervention group and nineteen women from Glasgow Caledonian University, to serve as the control group. The intervention and control groups were recruited from different Universities in order to avoid any potential cross-contamination between the groups. As participants could be recruited from the same department, recruiting and randomising employees of the same department into an intervention and a control group

Results

Attrition at 9 months was 32% (n = 17) and 21% (n = 4) for the intervention and control group, respectively. Participation flow and measurements provided by participants at baseline, 6 and 9 months are illustrated in Fig. 1. Based on the ‘intention-to-treat’ model, dietary analyses were performed for 53 participants in the intervention group and 19 participants in the control group and analysis of blood lipids for the 46 participants in the intervention group and 16 participants in the control

Discussion

The MESE study showed that the combined approach of web-based education and provision of manually delivered tailored dietary and psychosocial feedback was more successful in promoting the consumption of vegetables and leading to more favourable blood lipid profiles, compared with minimally tailored dietary feedback and general healthy-eating brochures. Additional favourable within-group differences were reported among the intervention group regarding all four components of the Mediterranean

Acknowledgements

The authors confirm that there are no conflicts of interest associated with this project. A. Papadaki was supported by the Greek State Scholarships Foundation (I.K.Y.). The authors would like to thank Mr. Joe Murray for his assistance with the website's development, Mrs Julie Armstrong for her help in recruiting the control group and all respondents who participated in the study for their cooperation.

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