Development of a Mediterranean Diet Nutrition Knowledge Questionnaire (Med-NKQ) for use in cardiovascular disease education programs

Background: The Mediterranean diet (MD) has significant benefits for cardiovascular health, yet clinicians and researchers lack reliable tools to measure patient knowledge. This thesis aims to develop a reliable MD nutrition knowledge tool. Methods: A 20-item tool (Med-NKQ) was developed to test knowledge of MD relevant to cardiovascular disease (CVD). Themes included CVD risk factors, cardioprotective nutrients, quantifying serve sizes, label reading and common MD foods and patterns. The tool underwent content validity via an expert Delphi survey and was tested for repeatability among people with self-reported CVD, using a test-retest protocol. Participants were recruited through social media and completed an online survey which was repeated two weeks later. A paired sample t test, Pearson’s correlation and Bland Altman plot were used to compare the two test periods. Results: Delphi Survey: Ten out of 25 invited experts responded to round one and six responded to round two. All items achieved expert consensus at the end of round two. Repeatability testing: 32 participants were recruited and 20 completed the survey twice. Participants were mostly male and 50 years or older. A paired sample t test showed no significant difference in the mean total scores of test one (28, SD 5.4) compared to test two (29.5, SD 5.5) (t= 1.41, p=0.174). Pearson’s correlation was significant between the two test scores (r= 0.59, p= 0.006). A Bland Altman plot indicated no bias between the two survey responses. Discussion: The Med-NKQ is a reliable tool for assessing MD nutrition knowledge relevant to CVD. It is short and easy to administer, making it practical in clinical and research settings. It can be administered online leading to potential use in remote education and e-health. The Med-NKQ will contribute to future clinical practice and research studies