The Mediterranean Eating in Scotland Experience (MESE) project : evaluation of an Internet-based, tailored intervention promoting the Mediterranean diet
A 6-month intervention study with a quasi-experimental design and a 3-month follow-up was conducted to evaluate the effectiveness of an Internet-based, step-wise, tailored-feedback intervention promoting four key components of the Mediterranean diet (vegetables, fruits, nuts and seeds, legumes and ratio of monounsaturated to saturated fat). Fifty-three (intervention group) and nineteen (control group) healthy females, aged 25-55 years, were recruited from the Universities of Glasgow and Glasgow Caledonian, Scotland, respectively. Participants in the intervention group received tailored dietary and psychosocial feedback and Internet nutrition education over a 6-month period, while participants in the control group were provided with minimally-tailored dietary feedback and general healthy-eating brochures. Internet education was provided via an innovative Mediterranean Eating website. Between group comparisons carried out on an "intention-to-treat" basis, providing the strongest evidence of the effect of the intervention, showed that participants in the intervention group had made more favourable changes to their fruit, nut and seed intake over the 6-month intervention, as well as increased their vegetable intake over the 9-month trial. Over both the 6-month intervention and 9-month trial, participants in the intervention group had more favourable levels of HDL-cholesterol and ration of total:HDL-cholesterol, a higher proportion progressed through the stages of behavioural change regarding legumes and olive intake and self-efficacy skills were generally increased, compared with the control group. Participants in the control group however, showed more favourable urinary electrolyte levels throughout the study. Within group comparisons showed that at 6 months, participants in the intervention group had significantly increased their intake of vegetables, fruits, legumes, as well as the MUFA:SFA ratio in their diet, had increased their mean total MDS and had significantly increased plasma HDL-cholesterol levels and a reduced ratio of total:HDL-cholesterol, as well as higher nutrition knowledge scores compared with baseline. In addition, a higher percentage of participants in this group were in the action and maintenance stage of behavioural change for vegetables, legumes and olive oil consumption, as well as generally showing more favourable attitudes and self-efficacy skills towards consumption of most of the food components promoted by the study at 6 months. These changes were generally maintained at 9 months, when additional decreases in blood pressure and an increase in total cholesterol, compared with baseline, were reported. Participants in the control group increased their intake of legumes, as well as their mean total MDS, and had significantly reduced urinary sodium levels at 6 months, compared with baseline. In addition, a higher efficacy skills generally decreased, compared with baseline. These changes were not maintained at 9 months, but at this time point participants in this group had a higher nutrition knowledge score, compared with baseline.