A Pilot Study on Ad Libitum Mediterranean Diet Intervention for Women with PCOS: A Mixed-Methods Exploration of Acceptability, Adherence, and Participant Lived Experience

Nicole Scannell ¹

Anthony Villani ¹

Lisa MORAN ²

Evangeline Mantzioris ³

Stephanie Cowan ²

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School of Health, University of the Sunshine Coast, Sunshine Coast, QLD 4556, Australia |

Monash Centre for Health Research and Implementation (MCHRI), School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3168, Australia |

UniSA: Clinical & Health Sciences, Alliance for Research in Exercise, Nutrition, and Activity (ARENA), University of South Australia, Adelaide, SA 5000, Australia

Publication type: Journal Article

Publication date: 2025-03-21

MDPI

Journal: Nutrients

scimago Q1

SJR: 1.301

CiteScore: 9.2

Impact factor: 4.8

ISSN: 20726643

DOI: 10.3390/nu17071105

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Abstract

Background/Objectives: A healthy diet is essential for managing Polycystic Ovary Syndrome (PCOS), yet optimal recommendations remain unclear, highlighting the need to explore alternative lifestyle interventions. The Mediterranean diet (MedDiet) supports cardiometabolic health; however, challenges with adherence within this population are unknown. This study examines the acceptability and experiences of an ad libitum MedDiet in women with PCOS, offering recommendations for implementation. Methods: A 12-week MedDiet intervention was conducted with women aged 18–45 years, diagnosed with PCOS and a BMI ≥ 25 kg/m2 (n = 12). Adherence was assessed using the Mediterranean Diet Adherence Screener. Surveys and semi-structured interviews, guided by the Capability, Opportunity, Motivation–Behaviour (COM-B) model, explored participants’ experiences. Thematic analysis identified barriers and facilitators, which were mapped to the COM-B and Theoretical Domains Framework (TDF), with all findings subsequently aligned with the Behaviour Change Wheel to inform implementation strategies. Results: MedDiet adherence significantly improved from baseline to week 12 (Baseline: 4.1 ± 1.8; week 12: 8.3 ± 2.3; p = 0.001), alongside increases in knowledge (p = 0.004), cooking confidence (p = 0.01), and time management (p = 0.01). Adherence factors were mapped to 12 of the 14 TDF domains. Key facilitators included health benefits, reduced weight pressure, educational resources, and simple guidelines. Barriers involved organisation, food availability, and external influences. Effective implementation should integrate MedDiet education, behaviour change support, practical resources, and professional training for nutrition professionals and healthcare providers to support referrals and weight-neutral dietary management. Conclusions: A short-term ad libitum MedDiet is acceptable for women with PCOS. Strategies for patients and healthcare providers, aligned with the intervention functions of education, training, and enablement, are key to supporting adherence.