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 †

Background:
A Mediterranean-style dietary pattern (MDP) is embedded across coronary heart disease (CHD) and type 2 diabetes (T2D) clinical guidelines. However, MDP evidence has not consistently been translated into practice. This study aimed to develop, integrate and evaluate implementation strategies to support clinicians in translating MDP evidence into routine care for CHD and T2D in the local context of a public health service.

Methods:
This study documents the implementation and evaluation phases of a broader knowledge translation project guided by the Knowledge-to-Action cycle. Multi-disciplinary clinicians in the cardiology and diabetes services of two large metropolitan hospitals and a post-acute community service were targeted. Strategies were prioritised utilising theory and stakeholder engagement and included facilitation, building a coalition, the engagement of clinical champions and local opinion leaders, educational meetings, consensus discussions, sharing local knowledge, consumer consultation, and the development and distribution of education materials. Surveys were conducted with clinicians and patients of targeted services to evaluate the reach, acceptability, feasibility, adoption and perceived sustainability of MDP in practice.

Results:
In total, 57 clinicians (7 dietitians, 29 nurses/diabetes educators, 15 doctors and 6 other allied health professionals) and 55 patients completed post-implementation evaluation surveys. The majority of clinicians agreed an MDP is appropriate to recommend in their clinical setting (95%), and most of the time/always their advice (85%) aligns. Education sessions were attended by 65% of clinicians, of which the majority indicated improved knowledge (100%) and change in practice (86%). Factors deemed most important to maintaining an MDP approach in practice were hard-copy education materials (85%) and access to a dietitian (62%). Of the patients who had received care from a dietitian of targeted services (n = 32, 58%), 100% recalled having discussed ≥1 MDP topic and 89% received education material. Of the patients who had received dietary advice from non-dietetic clinicians (n = 33, 60%), 67% recalled having discussed ≥1 MDP topic and 70% received education material.

Conclusions:
Targeted and theory-informed implementation reached the majority of surveyed clinicians and patients, and positively influenced the adoption, acceptability and feasibility of an MDP approach in routine care. Ongoing sustainability strategies are crucial with rotating clinician roles.