000161796 001__ 161796 000161796 005__ 20251017144636.0 000161796 0247_ $$2doi$$a10.1186/s12889-022-14590-y 000161796 0248_ $$2sideral$$a133618 000161796 037__ $$aART-2022-133618 000161796 041__ $$aeng 000161796 100__ $$aRecio-Rodriguez, Jose I. 000161796 245__ $$aEffectiveness of a multiple health-behaviour-change intervention in increasing adherence to the Mediterranean Diet in adults (EIRA study): a randomized controlled hybrid trial 000161796 260__ $$c2022 000161796 5060_ $$aAccess copy available to the general public$$fUnrestricted 000161796 5203_ $$aBackground The present study describes the effectiveness of a complex intervention that addresses multiple lifestyles to promote healthy behaviours in increasing adherence to the Mediterranean diet (MD). Methods Cluster-randomised, hybrid clinical trial controlled with two parallel groups. The study was carried out in 26 primary Spanish healthcare centres. People aged 45–75 years who presented at least two of the following criteria were included: smoker, low adherence to the MD or insufficient level of physical activity. The intervention group (IG) had three different levels of action: individual, group, and community, with the aim of acting on the behaviours related to smoking, diet and physical activity at the same time. The individual intervention included personalised recommendations and agreements on the objectives to attain. Group sessions were adapted to the context of each healthcare centre. The community intervention was focused on the social prescription of resources and activities performed in the environment of the community of each healthcare centre. Control group (CG) received brief advice given in the usual visits to the doctor’s office. The primary outcome was the change, after 12 months, in the number of participants in each group with good adherence to the MD pattern. Secondary outcomes included the change in the total score of the MD adherence score (MEDAS) and the change in some cardiovascular risk factors. Results Three thousand sixty-two participants were included (IG = 1,481, CG = 1,581). Low adherence to the MD was present in 1,384 (93.5%) participants, of whom 1,233 initiated the intervention and conducted at least one individual visit with a healthcare professional. A greater increase (13.7%; 95% CI, 9.9–17.5; p < 0.001) was obtained by IG in the number of participants who reached 9 points or more (good adherence) in the MEDAS at the final visit. Moreover, the effect attributable to the intervention obtained a greater increase (0.50 points; 95% CI, 0.35 to 0.66; p < 0.001) in IG. Conclusions A complex intervention modelled and carried out by primary healthcare professionals, within a real clinical healthcare context, achieved a global increase in the adherence to the MD compared to the brief advice. Trial registration ClinicalTrials.gov Identifier: NCT03136211. Retrospectively registered on 02/05/2017 https://clinicaltrials.gov/ct2/show/NCT03136211 000161796 540__ $$9info:eu-repo/semantics/openAccess$$aby$$uhttps://creativecommons.org/licenses/by/4.0/deed.es 000161796 590__ $$a4.5$$b2022 000161796 591__ $$aPUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH$$b66 / 207 = 0.319$$c2022$$dQ2$$eT1 000161796 592__ $$a1.307$$b2022 000161796 593__ $$aPublic Health, Environmental and Occupational Health$$c2022$$dQ1 000161796 594__ $$a6.1$$b2022 000161796 655_4 $$ainfo:eu-repo/semantics/article$$vinfo:eu-repo/semantics/publishedVersion 000161796 700__ $$aGarcia-Ortiz, Luis 000161796 700__ $$aGarcia-Yu, Irene A. 000161796 700__ $$aLugones-Sanchez, Cristina 000161796 700__ $$aZabaleta-del Olmo, Edurne 000161796 700__ $$aBolibar, Bonaventura 000161796 700__ $$aCasajuana-Closas, Marc 000161796 700__ $$aLopez-Jimenez, Tomas 000161796 700__ $$aLlobera, Joan 000161796 700__ $$aRamos, Rafel 000161796 700__ $$aPombo, Haizea 000161796 700__ $$aMotrico, Emma 000161796 700__ $$aGil-Girbau, Montserrat 000161796 700__ $$0(orcid)0000-0002-6409-9041$$aLopez-Mendez, Fatima 000161796 700__ $$aRepresas-Carrera, Francisco 000161796 700__ $$aMaderuelo-Fernandez, Jose A. 000161796 773__ $$g22, 1 (2022), 2127 [14 pp.]$$pBMC Public Health$$tBMC PUBLIC HEALTH$$x1471-2458 000161796 8564_ $$s1435834$$uhttps://zaguan.unizar.es/record/161796/files/texto_completo.pdf$$yVersión publicada 000161796 8564_ $$s2295954$$uhttps://zaguan.unizar.es/record/161796/files/texto_completo.jpg?subformat=icon$$xicon$$yVersión publicada 000161796 909CO $$ooai:zaguan.unizar.es:161796$$particulos$$pdriver 000161796 951__ $$a2025-10-17-14:29:11 000161796 980__ $$aARTICLE