Facilitators and Barriers in Mediterranean Diet Adherence: Insights from a Lifestyle Trial

In a qualitative study of 24 older Spanish adults enrolled in a lifestyle trial of the Mediterranean diet, semi-structured interviews and thematic analysis identified perceived vitality and psychological well‑being, improved nutritional literacy, and trust in the care team as facilitators of adherence; low motivation, disease burden, and limited partner support were key barriers. These patient-level drivers can help shape follow-up and support strategies to improve adherence.

Adherence remains the principal obstacle to translating dietary patterns into measurable clinical benefit. Participant perspectives point to modifiable behavioral targets—most notably increased vitality as an early, reinforcing outcome—that clinicians can monitor and use to support change.

Perceived vitality and psychological well‑being emerged as primary facilitators. Clinicians can use early reports of increased energy as an opportunity for positive reinforcement. Improved nutritional literacy was a second facilitator, suggesting brief literacy checks and practical meal-planning coaching to bolster confidence. Trust in a continuous research or care team functioned as an external facilitator, indicating that a consistent touchpoint or team member supports commitment. When these mechanisms are actively monitored and reinforced, adherence is more likely.

Low motivation, multimorbidity, and absent partner or social support commonly limited sustained adherence. Address low intrinsic motivation with brief motivational interviewing and targeted goal‑setting during routine visits. For patients with high disease burden or mobility limits, adapt dietary plans to functional capacity and comorbidity constraints so goals remain achievable. When partner or social support is lacking, enlist community resources, caregiver education, or partner-focused strategies to create a supportive environment and improve feasibility.

Participants linked perceived vitality to gains in psychological well‑being and some improvements in physical function and symptom burden—providing both subjective reward and potential objective targets for follow-up. Simple patient‑reported outcome queries for vitality and mood offer measurable touchpoints clinicians can track at visits. These psychological benefits therefore act as practical motivators for sustained behavior change.

Key Takeaways:

• Participant-reported vitality, psychological well‑being, and nutritional literacy are practical, measurable facilitators of adherence in older adults.
• Low motivation, multimorbidity, and absent partner support are common but addressable barriers using brief, tailored strategies.
• Implement brief literacy checks, vitality queries, and consistent team touchpoints as actionable steps to boost adherence and sustain dietary change.