Summary: In a qualitative study, older Spanish adults with metabolic syndrome in a Mediterranean diet and lifestyle trial described what helped and hindered their adherence, with sustained support from the research team emerging as the strongest facilitator and limited partner support among the main barriers.
PICO Summary
| Element | Detail |
|---|---|
| Population | 17 Spanish adults aged 60–81 with overweight/obesity and metabolic syndrome, within a randomised lifestyle trial; qualitative interview study, Spain. |
| Intervention | A Mediterranean diet and healthy-lifestyle behavioural intervention with continuous researcher contact, peer support, and nutritional education; this paper analyses participants’ adherence experiences. |
| Comparison | Not applicable; this is a qualitative thematic analysis rather than an outcome comparison. |
| Outcome | Reported facilitators included perceived improvements in vitality, psychological wellbeing, and physical performance, plus nutritional literacy and a trust-based relationship with the research team. Women emphasised empowerment, autonomy, and promoting family health. Barriers included low motivation, disease burden, mobility limits, and limited partner support, with women highlighting emotional and relational factors. |
Expert Commentary
This is a qualitative study and should be read for the implementation insight it offers rather than for effect sizes, since its job is to illuminate the lived experience behind adherence, which quantitative trials of the Mediterranean diet, abundant and convincing on efficacy, cannot capture. The most actionable finding is that sustained, trust-based contact with the team was the strongest facilitator, which directly indicts the common practice of one-off dietary counselling and argues for ongoing support. The gendered pattern is also practically useful, with women drawing motivation from their role in family food preparation, a lever clinicians can engage, while limited partner support emerged as a real barrier when a spouse maintained unhealthy habits or resisted changing the household food environment. The limitations are inherent to the design and context: a small sample of 17, a Spanish population culturally fluent in this diet so findings may not transfer to less familiar settings, trial participants who may be more motivated than usual, and no linkage of individual barriers to objective outcomes. Can I use this with my patients? Yes, to design support better. It reinforces building regular follow-up, peer connection, and family involvement into Mediterranean-diet recommendations, paying particular attention to patients with mobility limits or unsupportive home food environments.
References
Massó Guijarro P, Durán-Luque M, Rojas-Medina C, Cano-Ibáñez N. Participants’ perspectives on health impact, barriers and facilitators to adherence in a Mediterranean diet lifestyle trial. Nutrients. 2025;18(1):63. doi:10.3390/nu18010063