SEARCHSYSTEMATIC_REVIEWgeriatrics, nutrition

systematic_review·geriatrics, nutrition, public_health, preventive_medicine, cardiology, endocrinology·PMC10005068

Behaviour Change Techniques Used in Mediterranean Diet Interventions for Older Adults: A Systematic Scoping Review

Nutrients · 3 authors, 3 centres

AI SUMMARY

FIDELITY 100%

POPULATIONOlder adults (average age >55 years), including those with comorbidities such as CVD, metabolic syndrome, type 2 diabetes, cognitive impairment, hypertension, rheumatoid arthritis, knee osteoarthritis, breast cancer, prostate cancer, Parkinson's disease, and transplant recipients, as well as healthy participants.

INTERVENTIONMediterranean or anti-inflammatory diet interventions, delivered individually or in groups, in-person or via telehealth, ranging from 4 weeks to 2 years.

COMPARISONUsual care, standard care, general healthy eating guidelines, low-fat dietary principles, basic written Mediterranean diet instructions, habitual diet, or no control group (pre/post designs).

This summary was generated by AI from a single paper. It has not been reviewed by a clinician and is not clinical advice. Verify against the source before acting on it.

AGENT 01 · STRUCTURED SUMMARY

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TL;DR

This scoping review of 31 Mediterranean diet interventions for adults aged 55+ found that while behaviour change techniques are commonly used (mean 5 techniques per intervention), 80% of available techniques are not being utilized, and only 2 of 31 studies reported using behaviour change theory. The most common techniques were instruction on how to perform the behaviour, social support, and providing information from a credible source. The findings highlight a critical need for integrating established behaviour change taxonomies and theoretical frameworks into the design and reporting of nutrition interventions for older adults to improve long-term adherence and translation into practice.

Full summary

4,836 CHARS

**Background:** Older adults represent a growing proportion of the population, and while the Mediterranean diet protects against age-related chronic conditions including cardiovascular disease, type 2 diabetes, metabolic syndrome, cancer, and cognitive decline, adherence among older adults is generally low to moderate. Understanding the effective components—specifically behaviour change techniques—of dietary interventions is essential for improving long-term adherence and translating evidence into practice. This scoping review aimed to identify and describe behaviour change techniques used in Mediterranean diet interventions for older adults (≥55 years).

**Methods:** A systematic scoping review was conducted following PRISMA-ScR guidelines, with a protocol prospectively registered at Open Science Framework. Six databases (Medline, Embase, CINAHL, Web of Science, Scopus, PsycINFO) were searched from inception to August 2022. Eligible studies included randomized and non-randomized experimental studies involving a Mediterranean or anti-inflammatory diet intervention in adults with an average age >55 years. Screening was conducted independently by two authors, with discrepancies resolved by a senior author. Behaviour change techniques were assessed using the Behaviour Change Technique Taxonomy version 1 (BCTTv1), which describes 93 hierarchical techniques grouped into 16 categories. Coding was performed by one reviewer after completing online BCTTv1 training, using full texts, protocols, and supplementary materials. Where interventions mentioned 'education', techniques 4.1 (instruction on performing the behaviour) and 5.1 (information on health consequences) were coded; 'training' was coded as 4.1.

**Key Results:** From 2385 articles (2384 from database search + 1 from manual search), 31 studies were included. Studies were published between 2005 and 2022, comprising 25 randomized controlled trials and 6 non-randomized studies, with sample sizes ranging from n=15 to n=7447. Studies were conducted across 12 countries, most commonly the USA (n=8), Spain (n=7), and Australia (n=6). Intervention length ranged from 4 weeks to 2 years; only 6 studies (19.4%) included longitudinal follow-up (6 weeks to 12 months post-intervention). Nineteen interventions (61.3%) were diet-only; 12 (38.7%) combined diet and physical activity. Interventions were predominantly delivered individually (51.6%), in-person (48.4%), and by dietitians (61.3%). Ten BCTTv1 categories and 19 techniques were reported across the 31 interventions. The mean number of techniques was 5.1 (range 2–9). The most common BCTTv1 categories were 'Shaping knowledge' (n=31), 'Social support' (n=24), 'Comparison of outcomes' (n=16), 'Natural consequences' (n=15), 'Antecedents' (n=12), and 'Goals and planning' (n=11). The most common individual techniques were: 4.1 Instruction on how to perform the behaviour (n=31), 3.1 Social support (unspecified) (n=24), 9.1 Credible source (n=16), 5.1 Information about health consequences (n=15), 12.5 Adding objects to the environment (n=12), and 1.1 Goal setting (behaviour) (n=9). Only one study directly referenced the BCTTv1 in intervention development. The majority of interventions (93.5%, n=29) did not report using any behaviour change theory; the two that did used social cognitive theory and cognitive learning theory. Four interventions (12.9%) were based on motivational interviewing.

**Clinical Implications:** This review reveals that while behaviour change techniques are commonly embedded in Mediterranean diet interventions for older adults, their use is largely atheoretical and unsystematic, with 80% of available BCTTv1 techniques never utilized. Education and instruction dominate, yet evidence suggests knowledge alone is insufficient for sustained behaviour change—capability, motivation, and opportunity must all be addressed. The predominance of resource-intensive, in-person delivery models raises concerns about real-world scalability and equity, particularly given the limited availability of specialist nutrition services in rural and disadvantaged areas. Only three studies delivered interventions solely via digital means, despite high internet access among older adults (93% in Australia) and growing evidence for digital nutrition interventions. The authors recommend that clinicians and researchers adopt established behaviour change taxonomies (e.g., BCTTv1) and frameworks such as RE-AIM when designing, reporting, and evaluating interventions to improve replicability, translation, and population-level impact. The review's limitations include reliance on published reports (behaviour change techniques may be under-reported), subjective coding (only one study used BCTTv1), and potential over-reporting of education-related techniques due to coding assumptions.

PICO

PPOPULATION

Older adults (average age >55 years), including those with comorbidities such as CVD, metabolic syndrome, type 2 diabetes, cognitive impairment, hypertension, rheumatoid arthritis, knee osteoarthritis, breast cancer, prostate cancer, Parkinson's disease, and transplant recipients, as well as healthy participants.

IINTERVENTION

Mediterranean or anti-inflammatory diet interventions, delivered individually or in groups, in-person or via telehealth, ranging from 4 weeks to 2 years.

OOUTCOME

Behaviour change techniques used (coded via BCTTv1), dietary outcome measures (adherence, food/nutrient intake, biomarkers), intervention delivery format, and use of behaviour change theory.

STUDY TYPE

systematic_review

SPECIALTY

geriatrics

SUMMARISED BY

AI pipeline

FIDELITY CHECK

100% · A

ORIGINAL PAPER

PMC10005068

Behaviour Change Techniques Used in Mediterranean Diet Interventions for Older Adults: A Systematic Scoping Review

Nutrients

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ABSTRACT

Mediterranean diet interventions have demonstrated positive effects in the prevention and management of several chronic conditions in older adults. Understanding the effective components of behavioural interventions is essential for long-term health behaviour change and translating evidence-based interventions into practice. The aim of this scoping review is to provide an overview of the current Mediterranean diet interventions for older adults (≥55 years) and describe the behaviour change techniques used as part of the interventions. A scoping review systematically searched Medline, Embase, CINAHL, Web of Science, Scopus, and PsycINFO from inception until August 2022. Eligible studies were randomized and non-randomized experimental studies involving a Mediterranean or anti-inflammatory diet intervention in older adults (average age > 55 years). Screening was conducted independently by two authors, with discrepancies being resolved by the senior author. Behaviour change techniques were assessed using the Behaviour Change Technique Taxonomy (version 1), which details 93 hierarchical techniques grouped into 16 categories. From 2385 articles, 31 studies were included in the final synthesis. Ten behaviour change taxonomy groupings and 19 techniques were reported across the 31 interventions. The mean number of techniques used was 5, with a range from 2 to 9. Common techniques included instruction on how to perform the behaviour ( n = 31), social support ( n = 24), providing information from a credible source ( n = 16), information about health consequences ( n = 15), and adding objects to the environment ( n = 12). Although behaviour change techniques are commonly reported across interventions, the use of the Behaviour Change Technique Taxonomy for intervention development is rare, and more than 80% of the available techniques are not being utilised. Integrating behaviour change techniques in the development and reporting of nutrition interventions for older adults is essential for effectively targeting behaviours in both research and practice.

CITATION EXPORT

Ashlee Turner, Haley M. LaMonica, Victoria M. Flood. Behaviour Change Techniques Used in Mediterranean Diet Interventions for Older Adults: A Systematic Scoping Review. Nutrients. (2023). https://doi.org/10.3390/nu15051189

AUTHORS

3 · 3 CENTRES

Ashlee Turner, Haley M. LaMonica, Victoria M. Flood

1Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
2Translational Research Collective, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
3University Centre for Rural Health, Faculty of Medicine and Health, The University of Sydney, Northern Rivers, Lismore, NSW 2480, Australia

EDITOR / REVIEWER

Herbert Ryan Marini