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Background The aim of the study was to identify and compare components of the COM-B (capability, opportunity, motivation and behaviour) model, that influences behaviour to modify dietary patterns in 40–55-year olds living in Northern Ireland (NI) and Italy, in order to reduce the risk of cognitive decline in later life. Methods This was a qualitative study examining factors influencing Mediterranean-DASH (Dietary Approaches to Stop Hypertension) Intervention for Neurodegenerative Delay (MIND) diet behaviour. This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework to further understand behaviour. Twenty-five Northern Irish and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40 and 55 years. Results Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) reported as a facilitator to the Italian sample only. Conclusions Cross-cultural differences in relation to psychosocial barriers and facilitators were found in both samples. More barriers than facilitators towards uptake of the MIND diet were found. There is a need for interventions that increase capability, opportunity, and motivation to aid behaviour change. The findings from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel.

Background: The aim of this study was to develop a “behavioural diagnosis” of factors influencing the uptake of the MIND diet in 40-55-year olds according to the COM-B model, in order to reduce the risk of cognitive decline in later life. Comparing a Mediterranean (Italy) and non-Mediterranean (Northern Ireland) country to inform an intervention. This study also sought to identify intervention functions and behaviour change techniques (BCTs) that are likely to be effective in changing MIND diet behaviour. Methods: This was a qualitative study that was used to elicit beliefs surrounding Capability, Opportunity, Motivation and Behaviour (COM-B) with adhering to a diet associated with a reduced risk of cognitive decline, the Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND diet). This study further elaborated the COM-B components into the 14 domains of the Theoretical Domains Framework (TDF) to further understand behaviour. Twenty-five Northern Irish (NI) and Italian participants were recruited onto the study, to take part in either a focus group or an interview. Participants were both male and female aged between 40-55 years. Results: Thematic analysis revealed that the main barriers to the uptake of the MIND diet were; time, work environment (opportunity), taste preference and convenience (motivation). Culture (motivation), seasonal foods and lack of family support (opportunity) to be a barrier to the Italian sample only. The main facilitators reported were; improved health, memory, planning and organisation (motivation) and access to good quality food (opportunity). Cooking skills, knowledge (capability) and heathy work lunch (opportunity) being a facilitator to the Italian sample only. Five intervention functions and fifteen BCTs were identified for possible inclusion in intervention development. Conclusions: The “behavioural diagnosis” provides comparisons and valuable insight into the personal, social and environmental factors that participants report as barriers and facilitators to the uptake of the MIND diet in the two samples. More barriers to healthy dietary change were found than facilitators. There is a need for interventions that increase capability, opportunity and motivation to aid behaviour change. The “behavioural diagnosis” from this study will be used to design a behaviour change intervention using the subsequent steps from the Behaviour Change Wheel (BCW).

Summary Background & aims In hospitalized patients, lack of appetite, i.e., disease-associated anorexia, is the main factor determining insufficient food intake and weight loss, which in turn increase morbidity and mortality. Controversies exist on which tool should be preferred when diagnosing anorexia. Aim of the study was to evaluate in hospitalized medical patients, the performance of 4 different tools [i.e., self-assessment of appetite, FAACT-ESPEN score, visual analog scale (VAS), and the Anorexia Questionnaire (AQ)] in assessing disease-associated anorexia and predicting nutritional and clinical variables. Materials and methods Hospitalized patients consecutively admitted to the Internal Medicine ward at our institution were considered. After informed consent was obtained, patients were asked to self-assess their appetite vs the previous month. The VAS, the FAACT-ESPEN score and the Anorexia Questionnaire were also submitted. Food intake immediately following the interview was recorded. Nutritional (i.e., body weight, height), functional (i.e., handgrip strength) and clinical variables (i.e., length of stay) were registered upon admission and before discharge. Results We studied 105 patients (74M:31F; 66.2 ± 16.3 yrs). The prevalence of anorexia as assessed by patients' self assessment, FAACT-ESPEN score, and the Anorexia Questionnaire was 23%, 10% and 48%, respectively. VAS did not show any correlation with food intake. Anorexic patients as identified by the self assessment of appetite showed reduced food intake and weaker handgrip strength than non-anorexic. The FAACT-ESPEN score correlated with body weight, food intake and handgrip strength, but was not related with length of stay. Anorexic patients as identified by the Anorexia Questionnaire showed reduced food intake, lower body weight, weaker handgrip strength and longer hospital stay than non-anorexic patients. Discussion The prevalence of anorexia significantly varies according to the diagnostic tool used. Except for VAS, all the tested tools identify patients with impaired nutritional and functional variables. However, only the Anorexia Questionnaire identifies patients with longer hospital stay. Our results suggest that in clinical practice, modification of appetite reflects different underlying mechanisms whose impacts on clinical outcome measures may differ. Therefore, an ideal anorexia assessment tool does not appear to exist, but it should be chosen according to the outcome measures to be assessed (i.e., Anorexia Questionnaire to predict length of stay).