Applying the Stages of Change Model in a Nutrition Education Programme for the Promotion of Fruit and Vegetable Consumption among People with Severe Mental Disorders (DIETMENT).

Nutrients. 2021;13(6)

Plain language summary

People with severe mental disorders are prone to follow poor dietary choices. Seventy-four participants with severe mental disorders were enrolled in this community-based randomised controlled trial to evaluate changes in fruit and vegetable consumption, as well as changes in their motivation to consume five portions of fruits and vegetables a day. The participants with severe mental disorders in the intervention group participated in a food education programme (DIETMENT) based on the stages of change model to promote the consumption of fruit and vegetables prior to the evaluation. The intervention group showed an increase of 23% in fruit and vegetable consumption when compared to the control group, even though the difference was not statistically significant. The food education programme based on the stages of change model increased motivation, awareness and disposition in participants in the intervention group. In order to identify appropriate strategies for increasing fruit and vegetable consumption in patients with severe mental disorders, there is a need to conduct more robust studies. The results of this study may, however, provide healthcare professionals with a greater understanding of how a food education programme based on the stages of change framework encourages patients with severe mental disorders to consume fruit and vegetables.


Despite growing evidence of the benefits of adequate intake of fruit and vegetables (F&V) and the recommendation to consume five servings daily, the adoption of these habits is poor among people with severe mental disorder (SMD). The main aim of the present study is to determine changes in the intake of F&V and motivation to do so among people with SMDs after participating in a food education programme. A community-based randomized controlled trial was conducted in Spain, with the intervention group (IG) participating in a food education programme based on the stages of change model to promote consumption of F&V and the control group (CG) receiving three informative sessions on basic healthy eating. The main outcomes were related to the intake of F&V and stages of change. Data collection was performed at baseline, post intervention, and 12-month follow-up. Seventy-four participants enrolled in the study and sixty completed the 12-month follow-up. An increase in motivation towards the intake of F&V was observed in the IG but not in the CG (McNemar's test p = 0.016, p = 0.625). No significant difference was observed for the intake of fruit, vegetables, or F&V. Basing food education strategies on the stages of change model shows positive results, increasing the awareness and disposition of people with SMD towards the intake of F&V. More research is needed to identify the most appropriate eating intervention to increase the intake of F&V.

Lifestyle medicine

Fundamental Clinical Imbalances : Neurological
Patient Centred Factors : Mediators/Fruits and vegetables
Environmental Inputs : Diet ; Nutrients ; Psychosocial influences
Personal Lifestyle Factors : Nutrition ; Psychological
Functional Laboratory Testing : Not applicable
Bioactive Substances : Fruits ; Vegetables

Methodological quality

Jadad score : 3
Allocation concealment : No