Translating Evidence for a Mediterranean-Style Dietary Pattern into Routine Care for Coronary Heart Disease and Type 2 Diabetes: Implementation and Evaluation in a Targeted Public Health Service in Australia †
Abstract
1. Introduction
Study Background and Context
2. Materials and Methods
- Implementation (aligned to Knowledge-to-Action framework stage ‘Select, tailor and implement interventions’) with detailed methods regarding the target routine healthcare setting described in Section 2.1 and implementation strategies in Section 2.2 and Table 2;
- Evaluation (aligned to Knowledge-to-Action framework stages ‘Monitor knowledge use’ and ‘Evaluate outcomes’ with methods described in Section 2.3, Section 2.4, Section 2.5 and Section 2.6).
2.1. Target Services and Clinicians
2.2. Implementation Strategies
2.3. Post-Implementation Evaluation Surveys
- Penetration (reach and impact of the implementation to targeted clinicians and patients);
- Acceptability (clinician satisfaction with aspects of the intended MDP approach in practice, including credibility, content, and complexity);
- Feasibility (clinician perception of the actual fit or utility of the practice within the setting);
- Adoption (clinicians’ action to employ the MDP approach in practice, with confirmation from patients);
- Sustainability (perceived ongoing strategies required for routinisation by clinicians).
2.4. Clinician Survey Recruitment and Questions
2.5. Patient Survey Recruitment and Questions
2.6. Data Analysis
3. Results
3.1. Clinician Surveys
3.1.1. Penetration
3.1.2. Acceptability
3.1.3. Feasibility
3.1.4. Adoption
3.1.5. Sustainability (Perceived Requirements)
3.2. Patient Surveys
4. Discussion
4.1. Strengths and Limitations
4.2. Novelty and Future Directions
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Identified Practice Gaps, Barriers and Enablers * | Relevant TDF Domains |
---|---|
| Professional role and identity Knowledge Skills Beliefs about capabilities Environmental context and resources Social influences Beliefs about consequences Memory, attention and decision processes |
ERIC Strategy | TDF Domain/s | Description of Activities Executed Within or Across Services Between May 2021 and October 2022 | Services Engaged with Activity | Key Challenges During Implementation Period | |||
---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | ||||
Facilitation | Environmental context and resources | Facilitator employed in research assistant role for project management and planning, execution and oversight of all activities
| √ | √ | √ | √ |
|
Build a coalition | Professional role and identity Environmental context and resources | Project team from across services recruited by facilitator
| √ | √ | √ | × |
|
Inform local opinion leaders | Social influences Environmental context and resources | Opinion leader/s from relevant services engaged (including some project team members and other medical and nursing service directors) |
| ||||
| √ | √ | √ | √ | |||
| √ | √ | √ | √ | |||
Identify and prepare champions | Professional role and identity Knowledge Skills Beliefs about consequences | Clinical dietitian/s consulted on pre-implementation findings and implementation ideas |
| ||||
| √ | √ | √ | √ | |||
| √ | √ | √ | √ | |||
| √ | √ | × | × | |||
Interested diabetes educator and nurses helped engage clinicians and consumers, provided feedback, and supported access to materials in clinical areas | √ | √ | √ | √ | |||
Develop educational materials | Knowledge Skills Memory attention and decision processes | MDP materials appropriate for use across disease specialities were sourced, created or adapted at varying stages based on consumer/clinician feedback Clinician materials:
| √ | √ | √ | √ |
|
Distribute educational materials | Knowledge Skills Memory attention and decision processes |
| √ | √ | √ | √ |
|
| √ | √ | √ | √ | |||
| √ | √ | √ | √ | |||
| √ | × | × | × | |||
| × | √ | √ | √ | |||
| |||||||
| √ | √ | × | × | |||
| √ | × | × | NA | |||
| × | √ | × | × | |||
Conduct educational meetings | Knowledge Skills Beliefs about capabilities Beliefs about consequences | Education sessions delivered to clinical teams by the facilitator
| √ | √ | √ | √ |
|
Clinical dietitian delivered part of practical section if available/confident | √ | P * | × | √ | |||
Conduct local consensus discussions | Environmental context and resources Social influences Beliefs about capabilities | Discussions were facilitated with teams ~4–6 months after initial education session
| √ | × | P | √ |
|
Clinical dietitians were involved as feasible | √ | NA | P * | √ | |||
Create a learning collaborative | TDF Domains and activities for this strategy are deemed to overlap with those utilised for ‘distribute education materials’, ‘conduct educational meetings’ and ‘conduct local consensus discussions’ | ||||||
Obtain and use consumers and family feedback | Beliefs about consequences | Consumers from target services were consulted
| √ | √ | × | √ |
|
In consensus discussions, clinicians were facilitated to provide feedback that consumers had given on approach and materials, which informed adaptions and ongoing education | √ | × | √ | √ | |||
Capture and share local knowledge Identify early adopters | Social influences Beliefs about capabilities |
| √ | P * | √ | √ |
|
Global challenges experienced |
|
Variable | n (%) |
---|---|
Age | |
20 to 29 years | 12 (21.1) |
30 to 39 years | 16 (28.1) |
40 to 49 years | 9 (15.8) |
50 to 59 years | 13 (22.8) |
60 to 69 years | 3 (5.3) |
Not reported | 4 (7.0) |
Gender | |
Female | 39 (68.4) |
Male | 15 (26.3) |
Non-binary/third gender | 1 (1.8) |
Prefer not to say | 2 (3.5) |
Region of birth | |
Australia | 39 (68.4) |
Outside Australia | 16 (28.1) |
Asia | 7 (12.3) |
United Kingdom | 4 (7.0) |
Oceania | 2 (3.5) |
Africa | 2 (3.5) |
Europe | 1 (1.8) |
Not reported | 2 (3.5) |
Mediterranean background * | 0 (0.0) |
Health professional role | |
Dietitian | 7 (12.3) |
Nurse | 16 (28.1) |
Nurse Practitioner | 6 (10.5) |
Diabetes Educator | 7 (12.3) |
Doctor, Consultant/Senior Medical Officer | 12 (21.1) |
Doctor, Advanced Trainee/Registrar | 2 (3.5) |
Doctor, Resident/House officer | 1 (1.8) |
Occupational Therapist | 2 (3.5) |
Physiotherapist | 1 (1.8) |
Psychologist | 1 (1.8) |
Pharmacist | 1 (1.8) |
Podiatrist | 1 (1.8) |
Duration in role | |
<1 year | 7 (12.3) |
1 to 2 years | 8 (14.0) |
>2 to 5 years | 6 (10.5) |
>5 to 10 years | 6 (10.5) |
>10 to 15 years | 9 (15.8) |
>15 to 20 years | 7 (12.3) |
>20 years | 14 (24.6) |
Duration working with coronary heart disease and/or type 2 diabetes patients | |
<1 year | 4 (7.0) |
1 to 2 years | 5 (8.8) |
>2 to 5 years | 5 (8.8) |
>5 to 10 years | 7 (12.3) |
>10 to 15 years | 10 (17.5) |
>15 to 20 years | 10 (17.5) |
>20 years | 16 (28.1) |
Relevant target service/s within past year ^ | |
Hospital 1 Diabetes | 13 (22.8) |
Hospital 1 Cardiology | 23 (40.4) |
Hospital 2 Cardiology | 13 (22.8) |
Community Chronic Disease Service | 14 (24.6) |
Clinical setting/s within target services ^ | |
Inpatient unit/s | 30 (54.5) |
Outpatient clinic/s | 30 (54.5) |
Heart recovery, cardiac rehabilitation or heart failure service | 21 (38.2) |
Community clinic/s | 12 (21.1) |
Practice Variable | Total Cohort (n = 57) | Dietitian (n = 7) | Nurse/Diabetes Educator (n = 29) | Doctor (n = 15) | Other Allied Health (n = 6) | p-Value * |
---|---|---|---|---|---|---|
Education sessions delivered to clinical teams in routine formats | ||||||
Attended an education session | ||||||
Yes, in-person or via online meeting | 29 (50.9) | 3 (42.9) | 13 (44.8) | 12 (80.0) | 1 (16.7) | |
Yes, watched a recording | 8 (14.0) | 3 (42.9) | 5 (17.2) | 0 (0.0) | 0 (0.0) | |
No, but colleagues who attended passed on information | 7 (12.30) | 1 (14.3) | 4 (13.8) | 1 (6.7) | 1 (16.7) | |
No | 13 (22.8) | 0 (0.0) | 7 (24.1) | 2 (13.3) | 4 (66.7) | |
If had not attended (n = 20), expressed would be interested in session | 16 (80.0) | 1 (100.0) | 10 (90.0) | 1 (33.3) | 4 (80.0) | |
Expressed having learnt from the session (n = 36) ^ | ||||||
Yes | 36 (100.0) | 6 (100.0) | 17 (100.0) | 12 (100.0) | 1 (100.0) | |
No or cannot recall | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
No, it only confirmed my existing knowledge | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Improved knowledge of current dietary evidence/guidelines for heart disease or diabetes | 27 (75.0) | 5 (83.3) | 11 (64.7) | 10 (83.3) | 1 (100.0) | 0.581 |
Helped understand gaps between dietary evidence and routine care for heart disease or diabetes | 20 (55.6) | 3 (50.0) | 10 (58.8) | 6 (50.0) | 1 (100.0) | 0.777 |
Improved knowledge of the food principles of a Mediterranean-style or heart healthy dietary pattern | 27 (75.0) | 5 (83.3) | 12 (70.6) | 9 (75.0) | 1 (100.0) | 0.866 |
Directed to patient education materials | 23 (63.9) | 3 (50.0) | 10 (58.8) | 9 (75.0) | 1 (100.0) | 0.594 |
Improved confidence to discuss diet with relevant patients | 19 (52.8) | 3 (50.0) | 9 (52.9) | 6 (50.0) | 1 (100.0) | 0.813 |
Useful for application to own dietary habits | 19 (52.8) | 3 (50.0) | 9 (52.9) | 6 (50.0) | 1 (100.0) | 0.813 |
Education session changed practice | 31 (86.1) | 6 (100.0) | 13 (76.5) | 11 (91.7) | 1 (100.0) | 0.430 |
Access of electronic resources provided to clinical teams † (n = 55) | ||||||
Yes, at least 1 or more | 37 (67.3) | 6 (85.7) | 18 (66.7) | 10 (66.7) | 3 (50.0) | 0.593 |
No, do not recall or do not know how to access | 11 (20.0) | 0 (0.0) | 7 (25.9) | 2 (13.3) | 2 (33.3) | |
No, aware exist but have not accessed | 7 (12.7) | 1 (14.3) | 2 (7.4) | 3 (20.0) | 1 (16.7) | |
Copy of the slides presented in education session | 23 (41.8) | 4 (57.1) | 12 (44.4) | 6 (40.0) | 1 (16.7) | 0.506 |
Copies of patient education materials | 28 (50.9) | 6 (85.7) | 12 (44.4) | 9 (60.0) | 1 (16.7) | 0.067 |
Publication/s of a particular study | 9 (16.4) | 1 (14.3) | 5 (18.5) | 1 (6.7) | 2 (33.3) | 0.492 |
Guidelines or evidence summaries | 15 (27.3) | 4 (57.1) | 8 (29.6) | 3 (20.0) | 0 (0.0) | 0.118 |
Orientation, handover or caseload material related to diet for clinicians who commenced their role in a target service within the past year (n = 22) | ||||||
Yes, related to Mediterranean-style or heart-healthy dietary pattern | 8 (36.4) | 4 (66.7) | 3 (33.3) | 0 (0.0) | 1 (25.0) | 0.335 |
Yes, but other dietary approach | 2 (9.1) | 1 (16.7) | 1 (11.1) | 0 (0.0) | 0 (0.0) | |
Nil related to diet | 12 (54.5) | 1 (16.7) | 5 (55.6) | 3 (100.0) | 3 (75.0) |
Question and Response Options | Total Cohort (n = 57) | Dietitian (n = 7) | Nurse/Diabetes Educator (n = 27) | Doctor (n = 15) | Other Allied Health (n = 6) | p-Value ** |
---|---|---|---|---|---|---|
Questions related to acceptability of approach | ||||||
Recommending this would align with scientific evidence (n = 55) † | ||||||
Agree/strongly agree | 55 (100.0) | 7 (100.0) | 27 (100.0) | 15 (100.0) | 6 (100.0) | |
Disagree/strongly disagree | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
This approach is too complex to raise or recommend (n = 55) † | NR | |||||
Most of the time or always | 4 (7.2) | 0 (0.0) | 2 (7.4) | 1 (6.7) | 2 (33.3) | |
Sometimes | 20 (36.4) | 1 (14.3) | 13 (48.1) | 5 (33.3) | 2 (33.3) | |
Rarely or never | 31 (56.4) | 6 (85.7) | 12 (44.4) | 9 (60.0) | 2 (33.3) | |
This dietary pattern would be appropriate to recommend (n = 55) † | ||||||
Agree/strongly agree | 52 (94.5) | 7 (100.0) | 25 (92.6) | 15 (100.0) | 5 (83.3) | |
Disagree/strongly disagree | 3 (5.5) | 0 (0.0) | 2 (7.4) | 0 (0.0) | 1 (16.7) | |
Questions related to feasibility of approach | ||||||
Enough time to raise/recommend this in inpatient setting (n = 32) ^ | 0.402 | |||||
Most of the time or always | 14 (43.8) | 4 (100.0) | 8 (53.3) | 1 (10.0) | 1 (33.3) | |
Sometimes | 9 (28.1) | 0 (0.0) | 3 (20.0) | 5 (50.0) | 1 (33.3) | |
Rarely or never | 9 (28.1) | 0 (0.0) | 4 (26.7) | 4 (40.0) | 1 (33.3) | |
Enough time to raise/recommend this in outpatient or community setting (n = 39) ^† | ||||||
Most of the time or always | 23 (59.0) | 6 (85.8) | 9 (75.0) | 7 (46.7) | 1 (20.0) | |
Sometimes | 12 (30.8) | 1 (14.3) | 3 (25.0) | 6 (40.0) | 2 (40.0) | |
Rarely or never | 4 (10.3) | 0 (0.0) | 0 (0.0) | 2 (13.3) | 2 (40.0) | |
Enough time to raise/recommend this in cardiac rehabilitation (n = 17) ^ | 0.096 | |||||
Most of the time or always | 10 (58.8) | 1 (50.0) | 8 (80.0) | 1 (100.0) | 0 (0.0) | |
Sometimes | 6 (35.3) | 1 (50.0) | 2 (20.0) | 0 (0.0) | 3 (75.0) | |
Rarely or never | 1 (5.9) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (25.0) | |
Patients would be able to improve their eating habits to better align with this dietary pattern (n = 55) † | 0.097 | |||||
Most of the time or always | 32 (58.2) | 5 (61.4) | 18 (66.6) | 6 (40.0) | 3 (50.0) | |
Sometimes | 21 (38.2) | 2 (28.6) | 9 (33.3) | 7 (46.7) | 3 (50.0) | |
Rarely or never | 2 (3.6) | 0 (0.0) | 0 (0.0) | 2 (13.3) | 0 (0.0) | |
Questions related to adoption of approach | ||||||
Advice would align to these dietary pattern principles (n = 55) † | 0.266 | |||||
Most of the time or always | 47 (85.4) | 7 (100.0) | 23 (85.2) | 13 (86.7) | 4 (66.7) | |
Sometimes | 7 (12.7) | 0 (0.0) | 4 (14.8) | 2 (13.3) | 1 (16.7) | |
Rarely or never | 1 (1.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (16.7) | |
Diet-related education materials or tools provided align to these dietary pattern principles (n = 53) ^† | ||||||
Most of the time or always | 44 (80.0) | 7 (100.0) | 22 (81.5) | 12 (80.0) | 3 (75.0) | |
Sometimes | 8 (14.5) | 0 (0.0) | 5 (18.5) | 3 (20.0) | 0 (0.0) | |
Rarely or never | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
I don’t know if it would | 1 (1.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 1 (25.0) | |
Focus on foods or meals more than nutrients or calories in diet-related assessment, advice or information (n = 54) ^ | 0.140 | |||||
Most of the time or always | 38 (70.4) | 6 (85.7) | 21 (72.4) | 10 (66.7) | 1 (33.3) | |
Sometimes | 11 (20.4) | 1 (14.3) | 5 (17.2) | 4 (26.7) | 1 (33.3) | |
Rarely or never | 5 (9.3) | 0 (0.00 | 3 (10.3) | 1 (6.7) | 1 (33.3) | |
Focus on what to include more than what to restrict or cut out in diet-related assessment, advice or information (n = 51) ^# | 0.519 | |||||
Most of the time or always | 29 (56.9) | 6 (85.7) | 14 (51.9) | 7 (46.7) | 2 (66.7) | |
Sometimes | 16 (31.4) | 1 (14.3) | 9 (34.6) | 6 (40.0) | 0 (0.0) | |
Rarely or never | 6 (11.8) | 0 (0.00 | 3 (14.3) | 2 (13.3) | 1 (33.3) | |
Used at least one or more of the recommended patient education materials (n = 55) † | 45 (81.8) | 7 (100.0) | 23 (85.2) | 12 (80.0) | 3 (50.0) | 0.630 |
Types of recommended patient education materials | ||||||
Related to a Mediterranean-style diet (factsheet or website) | 32 (58.2) | 7 (100.0) | 15 (55.6) | 9 (60.0) | 1 (16.7) | |
Related to a heart healthy dietary pattern (factsheet, National Heart Foundation resources and/or videos) | 31 (56.4) | 6 (85.7) | 16 (59.3) | 6 (40.0) | 3 (50.0) | |
Specific factsheet displayed in clinic rooms | ||||||
2-page health service Mediterranean-style diet | 29 (52.7) | 7 (100.0) | 13 (48.1) | 9 (60.0) | 0 (0.0) | |
Heart Foundation heart healthy eating principles Pictorial | 18 (32.7) | 2 (28.6) | 10 (37.0) | 4 (26.7) | 2 (33.30) | |
Healthy convenient meal preparation/pre-prepared meals | 18 (32.7) | 7 (100.0) | 8 (29.6) | 3 (20.0) | 0 (0.0) | |
Perceived sustainability requirements (where practice adopted, what would be important to maintain this) (n = 53) ‡ | ||||||
Access to hardcopy patient education materials | 45 (84.9) | 6 (85.7) | 21 (80.8) | 14 (93.3) | 4 (80.0) | 0.735 |
Access to electronic patient education materials | 32 (60.4) | 5 (71.4) | 18 (69.2) | 7 (46.7) | 2 (40.0) | 0.354 |
Refreshers or updates on evidence | 28 (52.8) | 6 (85.7) | 15 (57.7) | 3 (20.0) | 4 (80.0) | 0.010 ** |
Refreshers or updates on practical tips/tools | 31 (58.5) | 6 (85.7) | 15 (57.7) | 6 (40.0) | 4 (80.0) | 0.157 |
Access to or relationship with dietitian | 33 (62.3) | 3 (42.9) | 18 (69.2) | 11 (73.3) | 1 (20.0) | 0.100 |
Variable | n (%) |
---|---|
Age | |
20 to 29 years | 1 (1.8) |
30 to 39 years | 2 (3.6) |
40 to 49 years | 6 (10.9) |
50 to 59 years | 15 (27.3) |
60 to 69 years | 21 (38.2) |
70 to 79 years | 9 (16.4) |
80 to 89 years | 1 (1.8) |
Gender | |
Male | 39 (70.9) |
Female | 16 (29.1) |
Non-binary/third gender | 0 (0.0) |
Prefer not to say | 0 (0.0) |
Region of birth | |
Australia | 35 (63.6) |
Outside Australia | 20 (36.4) |
Asia | 2 (3.6) |
United Kingdom | 3 (5.5) |
Oceania | 10 (18.2) |
Africa | 1 (1.8) |
Europe | 4 (7.3) |
Mediterranean background * | 6 (10.9) |
English second language | 11 (20.0) |
Relevant diagnosed health condition/s | |
Coronary heart disease | 41 (74.5) |
Type 2 diabetes | 28 (50.9) |
Both conditions | 14 (25.5) |
Relevant target service recently accessed ^ | |
Hospital 1 diabetes | 13 (23.6) |
Hospital 1 cardiology | 31 (56.4) |
Hospital 2 cardiology | 14 (25.0) |
Community Chronic Disease Service | 19 (34.5) |
Clinical setting/s accessed within target sevices ^ | |
Inpatient unit/s | 28 (50.9) |
Outpatient clinic/s | 33 (60.0) |
Cardiac rehabilitation | 22 (40.0) |
Community clinic/s | 12 (21.8) |
Received care from dietitian of target service/s | |
No, was not offered | 21 (38.2) |
No, was offered but declined | 2 (3.6) |
Yes | 32 (58.2) |
Inpatient setting only | 3 (9.4) |
Outpatient clinic only | 15 (46.9) |
Cardiac rehabilitation only | 9 (28.1) |
All 3 of the above | 2 (6.3) |
Inpatient setting and outpatient clinic | 1 (3.1) |
Inpatient setting and cardiac rehabilitation | 2 (6.3) |
Whether respondent would have liked to see dietitian (n = 21) | |
Yes | 11 (47.8) |
Unsure how dietitian could help | 4 (17.4) |
No | 6 (26.1) |
Received diet-related care from other health professional/s of target service/s | |
No | 22 (40.0) |
Yes | 33 (60.0) |
Doctor | 18 (32.7) |
Nurse and/or diabetes educator | 26 (47.3) |
Allied health professional # | 10 (18.2) |
Nature of Diet-Related Care | By Dietitian/s (n = 32) | By Other Health Professional/s (n = 33) |
---|---|---|
Topics discussed or were taught about that align to principles of a Mediterranean-style or heart-healthy dietary pattern | ||
A Mediterranean-style diet or way of eating | 19 (59.4) | 6 (18.2) |
Foods to eat for a healthy heart | 22 (68.8) | 11 (33.3) |
Including fruits and vegetables | 28 (87.5) | 10 (30.3) |
Choosing whole grain or brown breads and cereals | 26 (81.3) | 9 (27.3) |
Including legumes | 23 (71.9) | 7 (21.2) |
Including fish/seafood | 24 (75.0) | 7 (21.2) |
Including nuts/seeds | 23 (71.9) | 6 (18.2) |
Including yoghurt, milk or cheese | 21 (65.6) | 7 (21.2) |
Using extra virgin olive oil | 20 (62.5) | 6 (18.2) |
Limiting red meat | 21 (65.6) | 7 (21.2) |
Limiting processed foods or sweets | 26 (81.3) | 7 (21.2) |
Cooking meals or preparing food at home | 14 (43.8) | 4 (21.1) |
Using herbs or spices rather than salt | 18 (56.3) | 7 (21.2) |
Choosing water as your main drink | 24 (75.0) | 12 (36.4) |
At least one or more of the above topics | 32 (100.0) | 22 (66.7) |
Other topics discussed or were educated about | ||
Limiting intake of carbohydrate | 20 (62.5) | 7 (21.2) |
Limiting intake of fat or saturated fat | 23 (71.9) | 5 (15.2) |
Limiting intake of salt or sodium | 22 (68.8) | 9 (27.3) |
Weight loss or restricting calories | 15 (46.9) | 9 (27.3) |
Managing fluid intake | 17 (53.1) | 9 (27.3) |
Topics of information materials given, recommended or directed that align with Mediterranean-style or heart-healthy dietary pattern | ||
Provided at least 1 or more of the listed information material | (n = 32) | (n = 33) |
Yes | 28 (87.5) | 23 (69.7) |
Provided material but cannot recall details | 1 (3.1) | 3 (9.1) |
No | 3 (9.4) | 7 (21.2) |
Related to a Mediterranean-style diet (factsheet, website and/or book) | 20 (62.5) | 9 (27.3) |
Related to a heart healthy eating pattern (factsheet, Heart Foundation resources and/or videos) | 24 (75.0) | 18 (54.5) |
Related to heart healthy food plate portions | 19 (59.4) | 9 (27.3) |
Related to heart healthy foods for snacks | 12 (37.5) | 7 (21.2) |
Related to healthy convenient meal preparation or pre-prepared meals | 9 (28.1) | 6 (18.2) |
Read/watched relevant information materials provided | (n = 28) | (n = 26) |
Yes, all of it | 16 (50.0) | 11 (42.3) |
Yes, some of it | 11 (34.4) | 12 (46.2) |
No | 1 (3.1) | 3 (11.5) |
For relevant participants | ||
Exposure to information on Mediterranean-style or heart-healthy dietary pattern in clinic settings * | ||
On information boards on the ward (n = 28) | 11 (39.3) | |
TV slides, poster or factsheet in outpatient waiting area (n = 33) | 15 (45.5) | |
Poster or factsheet in cardiac rehabilitation (n = 22) | 14 (63.6) | |
Influence of diet-related care (n = 44) ^ | ||
Dietary advice or information taught something new | ||
Yes, all was new | 8 (18.2) | |
Yes, some was new | 29 (65.9) | |
No | 7 (15.9) | |
Dietary changes as a result of care | ||
Yes, already made changes | 42 (95.5) | |
Yes, plan to make changes | 2 (4.5) | |
No | 0 (0.0) |
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Mayr, H.L.; Hayes, L.; Wang, W.Y.S.; Murray, E.; Kelly, J.T.; Palmer, M.; Hickman, I.J. Translating Evidence for a Mediterranean-Style Dietary Pattern into Routine Care for Coronary Heart Disease and Type 2 Diabetes: Implementation and Evaluation in a Targeted Public Health Service in Australia. Healthcare 2025, 13, 506. https://doi.org/10.3390/healthcare13050506
Mayr HL, Hayes L, Wang WYS, Murray E, Kelly JT, Palmer M, Hickman IJ. Translating Evidence for a Mediterranean-Style Dietary Pattern into Routine Care for Coronary Heart Disease and Type 2 Diabetes: Implementation and Evaluation in a Targeted Public Health Service in Australia. Healthcare. 2025; 13(5):506. https://doi.org/10.3390/healthcare13050506
Chicago/Turabian StyleMayr, Hannah L., Lisa Hayes, William Y. S. Wang, Eryn Murray, Jaimon T. Kelly, Michelle Palmer, and Ingrid J. Hickman. 2025. "Translating Evidence for a Mediterranean-Style Dietary Pattern into Routine Care for Coronary Heart Disease and Type 2 Diabetes: Implementation and Evaluation in a Targeted Public Health Service in Australia" Healthcare 13, no. 5: 506. https://doi.org/10.3390/healthcare13050506
APA StyleMayr, H. L., Hayes, L., Wang, W. Y. S., Murray, E., Kelly, J. T., Palmer, M., & Hickman, I. J. (2025). Translating Evidence for a Mediterranean-Style Dietary Pattern into Routine Care for Coronary Heart Disease and Type 2 Diabetes: Implementation and Evaluation in a Targeted Public Health Service in Australia. Healthcare, 13(5), 506. https://doi.org/10.3390/healthcare13050506