Abstract
The Mediterranean diet (MD) has significant benefits for cardiovascular disease (CVD), yet clinicians lack reliable tools to measure patient knowledge. This study aimed to develop a short tool to test knowledge of MD related to cardiac health. Themes included foods to reduce CVD risk factors, quantification of servings, and common MD dietary patterns; a maximum score of 42 was determined for correct responses. Content validity was assessed through expert consensus in a Delphi survey. A 70% level of agreement was set for each domain tested. Repeatability was assessed via a test-retest protocol in a sample with self-reported CVD, advertised through social media and administered online. Ten and six of twenty-five invited experts responded to round one and two of the Delphi survey respectively. All items achieved greater than 70% consensus. Twenty people completed the repeatability study. A paired t-test found no significant difference in mean scores between the two test periods (Test one, 28 (standard deviation (SD) 5.4). Test two 29.5, (SD 5.5), p = 0.174) and a Bland-Altman Plot indicated no bias between the two surveys. The Med-NKQ demonstrated good content validity and reliability in people with CVD, and is short and easy to administer, making it practical in clinical and research settings.
Highlights
Cardiovascular disease (CVD) is the number one cause of death worldwide [1]
Instrument construction was informed by previously published systematic reviews, meta-analyses, randomized controlled trials, prospective cohort studies, position papers, and best practice guidelines from peak cardiac health and nutrition bodies, national dietary guidelines (Table S1), and clinical experience leading CVD group education programs, including knowledge of commonly observed dietary misconceptions [3,5,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55]
The tool focused on three major themes: (1) Dietary patterns, foods, and nutrients for reducing cardiac risk factors such as hypertension and hyperlipidaemia; (2) testing of ability to quantify serving sizes, read labels and identify key cardioprotective nutrients; and (3) Core Mediterranean diet foods, dietary patterns, and meal selection
Summary
Cardiovascular disease (CVD) is the number one cause of death worldwide [1]. 30% of all global deaths are attributed to the disease, many of which are considered preventable through lifestyle modification [1,2,3]. The Mediterranean diet has demonstrated benefits for the prevention of both primary and secondary cardiac events [4,5,6]. A traditional definition of the Mediterranean diet is regarded as one that is mostly plant based, high in vegetables, especially leafy greens, fruit, whole grains, and legumes; moderate in dairy; and low in meat products. It has been suggested that whilst many of these individual components of the diet have demonstrated benefits for cardiac health, the combined effects of the dietary pattern as a whole diet approach provide additional protective benefits [8]
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