Table 1 Summary table of MCI participant interview quotes matched to TDF domain
TDF domain (Michie et al. 2014) | COM-B component | Sub-theme | MCI Participant Interview Representative Quotations (All patient quotes unless otherwise stated) |
|---|---|---|---|
Knowledge | Capability (psychological) | Mediterranean diet knowledge | “I had no clear knowledge that there was an association with memory” “I never thought about diet helping memory but I was aware that diets were important in other things” “Well we knew that the Mediterranean diet was so healthy, but we didn’t know it was significant in memory” (relative of participant 008) “I’ve heard of the Mediterranean diet as being a very healthy diet” |
Skills | Capability (physical) | Cooking Current diet | “Maybe a lot of people in mid 80s don’t do a lot of cooking” “Well my wife for instance, years gone by you would have cooked with lard or something like that, but now would be oils like olive oil or rapeseed oil” “We eat, my husband and I, both make sure we have vegetables, make sure we have fruit, it’s the in-between things that we eat are not so good” |
Optimism | Motivation (reflective) | Perceived benefits and motivation to change | “I really want to give it a go, for two reasons, for the memory and also it is healthy eating … I’ve put on a lot of weight... so I was hoping that this healthy eating will be able to decrease that” “The people who have this kind of diet don’t have the same memory loss as early” “The payoff is obviously magnificent because if it retards or reduces memory loss then it’s a positive” “I’m not going to have turkey and bean mash for my Christmas dinner... Now, saying I wouldn’t but if I was told my life depended on it, I would do it … ” “It would all depend on whether I thought it was going to be something that was good for me... the main thing is that you must want to do it” “I know things like that, that things would be better, I would still be careless, I know I would be” “If it helps, I definitely would try it” “I am prepared to try these” |
Environmental context and resources | Opportunity (physical) | Evaluation of the THINK-MED resource THINK-MED calendar THINK-MED recipes | “It’s attractive... it’s an attractive booklet … it just appealed … Probably with the pictures, print everything”, “It was very attractive, I thought it was very informative” (relative of participant 002) “Clear and easy to understand” “I thought there was a good introduction on mild cognitive impairment which I wasn’t really totally familiar with, what it implied” “I thought that was an interesting diagram too (MD pyramid)” “Reading those with diagrams on it is much easier and it tells you how much you should eat of those meals” “I had a rough idea about it, and then from reading your information, put more of a shape to it … and took away a lot of the hesitancy I had about it” “I think it’s an interesting diet and the resource is colourful” “The word wholegrain … I don’t think everybody would necessarily know what that term means” “Perhaps it would help if they were numbered or identified in some way that people would know which one to read first … they were probably in the order that you wanted them to be looked at, but once you took them out they got mixed up” “I would be thinking where that is? Which menu or book is that in to find that, to prepare it?” “The recipes that you have each month, I’m not sure, wasn’t sure whether they were suggested recipes for this particular month for any reason?” “you can write down things, something that you are going to do, maybe something that you have done that day” “Some of the recipes are impractical … like ourselves, when you’re pensioners and that, would have a smallish lunch, but it wouldn’t be anything very elaborate that would take long to cook or prepare” “Olive oil or rapeseed oil, she thought the amounts were too much … she thinks that some of the recipes are impractical, and unlikely to be used (wife)” “Yes some of them looked very attractive...”, “I think you could use them as a base... and then maybe change some ingredients to suit what we would like, like turkey and bean mash, we wouldn’t be fans of turkey but could change it to chicken” (relative of participant 002) “And they are not too difficult, well I mean at least I don’t think they are too difficult... Which is good because I like really simple recipes although my husband does the cooking I am starting to do more and more … ” (relative of participant 008) |
Goals | Motivation (reflective) | Goal setting | “The goal setting was quite interesting and perhaps a useful thing for people to attempt … the idea of breaking it down in to sort of small steps” “I don’t think, I would sit down and make a list of dietary goals and try and achieve them” “I don’t think I would participate in the study, because I wouldn’t be bothered, doing all that” “I think you would have to do that otherwise you wouldn’t stick to it … but if you have it written down, I think you are more inclined to stick to it” (relative of participant 002) “I really can’t see me doing that, I think that would be the right thing to do, but I just can’t see me doing that” “I would be inclined now to write it down … as I say about the memory loss … one thing I’ve started doing now, is I put down dates” |
Intentions | Motivation (reflective) | Encouraged to change Not everyday | “I think it would probably encourage us to make a few additional changes that perhaps we haven’t made before … I think my wife will look at the recipes and maybe pick out, one or two that would suit us” “we have resolved independently that I don’t want to eat steak again” “I’ve changed to my brown rice and I am using up my ordinary pasta first and will change that” “well I have already changed to wholegrain bread … we would have had red meat regularly, now cut that out quite a good bit” “I’m not going to have turkey and bean mash for my Christmas dinner” “Probably a Mediterranean diet wouldn’t appeal to me on a Sunday … I probably wouldn’t want to do it every day and so on and so forth” |
Beliefs about capabilities | Motivation (reflective) | Delivery of information Challenges: cost Challenges: support Challenges: age Challenges: enthusiasm | “Maybe there are others who would need a bit of help or support throughout but I find it very simple to understand … I’m happy just doing it myself” “My first reaction was shock when I saw how much information there was … when I opened it up I realised it was quite well spaced out and it wasn’t just quite as much information as I first anticipated” “it was too much all at once … overwhelming … all I would have liked would have been less of it” “Well I know sometimes there’s hints about the price and maybe if you couldn’t afford the stuff and the fresh vegetables and fruit” “Or maybe they think it is more expensive to go and buy all the ingredients” (Relative of participant 002) “well expense would for a lot of pensioners, it would put them off … so now you have to watch the purse as well, like olive oil is dearer than other oils” “I would still be careless, I know I would be, so I would have to rely on my son from now on a bit … when he last visited, he had a look at this, and he will probably ask me have you done this?” “Well I think I would be very happy because my wife and I are doing it together… which is a way of support and in doing that we can work out the menus” “when you get to 80, you’re more … just whatever comes to your head at any moment” “My problem might be that I will lose enthusiasm” |
Reinforcement | Motivation (automatic) | Reminders | “reminders … just to remind you, maybe that wee pyramid so like a - remember this - type thing” (relative of participant 002) “especially when your memory is not that good, it would maybe trigger something off “using a diary in my pocket and writing down what I’ve got to do during the day and refer to that then because it’s something I can keep on myself and if I get caught during the day I can pull it out” |
Memory, attention and decision processes | Capability (psychological) | Effects of MCI | “Now and again my memory just lapses, you know during talking about something I would go along and suddenly my memory would drop, off the face of the earth … ” “I find that I need to write it all down, write it out again … so that I would write out breakfasts, lunches and I know that they are in here … because if I read it last night, what I am going to have for my breakfast, that’s gone” “well I’ve a feeling that my memory isn’t as good, in fact I’m sure it’s not, I just see a deterioration” “what I find at the moment is that in the morning I have to refer or ask my wife what’s happening today, once that’s done, I don’t forget about it” “I think the thing that frightens people and frightens me as well so it does is the thought of constant and deepening memory loss and one would like to try and fight that” “I would say my brain has got duller since I have been sitting in the house on my own … no I don’t write it out … I like to go by the picture and go back and think of what I did” |
Behavioural regulation | Capability (psychological) | Planning | “The meal planning and shopping lists, would people actually use them? I suppose some people would and others wouldn’t” “yea something to work towards … just looking at it rather than thinking what will I have to eat … think that is a good idea, it just takes a bit of preparation, I think it would be better to plan ahead, try and plan for a week” |