Increasing engagement with a Mediterranean diet and walking program for healthy ageing: Participant and clinician...

To explore participant and clinician experiences of a Mediterranean diet and walking intervention (MedWalk), with a focus on how behaviour change support, communication, and feedback processes influenced engagement.

A nested qualitative study was conducted within the MedWalk randomised controlled trial. Nineteen intervention-arm participants were purposively sampled to capture variation in behavioural response to the intervention, alongside five clinicians who delivered the dietary, walking, and behaviour change components. Semi-structured interviews were conducted and analysed using reflexive thematic analysis. Participant and clinician transcripts were initially coded separately before themes were integrated across datasets.

Four themes were identified: (1) learning to live well, (2) supported, not directed, (3) tracking progress, seeking feedback, and (4) the power of the group. Participants valued autonomy-supportive communication and credible guidance. Clinicians described intentionally applying MI-consistent relational strategies, including reflective listening to support engagement. A key divergence emerged in expectations around feedback: clinicians emphasised reflective dialogue to evoke self-recognition, whereas participants sought clearer indicators of progress. Group-based walking enhanced social connection and accountability, requiring facilitation to maintain behavioural focus.

Engagement was shaped not only by intervention content but also by how behaviour change support was communicated and enacted. Findings indicate that reliance on reflective, autonomy-supportive communication alone may not meet participants' expectations for feedback, and that integrating explicit, interpretable indicators of progress may strengthen engagement in lifestyle interventions for older adults.

Interventions targeting diet and physical activity should prioritise relational communication skills and incorporate structured approaches to feedback that provide clear, personalised, and interpretable indicators of progress. Group-based components should be intentionally designed and facilitated to support social connection, shared problem-solving, and peer accountability.