Development and Validation of the PREVESMED Questionnaire: A Comprehensive Tool for Assessing Adherence to a Mediterranean Lifestyle.

Abstract

Background: The Mediterranean lifestyle is widely recognized for its role in reducing the risk of chronic diseases, including cardiovascular diseases, type 2 diabetes, and cancer. The PREVESMED questionnaire was developed to evaluate adherence to this lifestyle, integrating dietary and non-dietary behaviors. Unlike existing tools, PREVESMED incorporates underexplored elements such as eating pace, herbal tea consumption, and physical activity, providing a multidimensional approach to lifestyle assessment.

Methods: The validation of PREVESMED was carried out as part of a planned interim analysis using data collected from participants in the PREVES-ENERGY survey, a cross-sectional study targeting 1,000 adults aged 18 years and above. To assess the reliability of the PREVESMED scale, internal consistency was evaluated using Cronbach's alpha, ensuring an acceptable level of reliability. To investigate the relationships between lifestyle factors, individual questionnaire items, and adherence to Mediterranean lifestyle according to the PREVESMED scale, a correlation analysis was performed. Additionally, to identify significant predictors of better adherence, a multivariable linear regression model was utilized, highlighting key factors influencing adherence. Finally, an exploratory factor analysis (EFA) was conducted to reveal the underlying structure of the PREVESMED scale, identifying key dimensions and their contributions to the total variance.

Results: The cohort analyzed for the preliminary validation of the PREVESMED questionnaire consisted of 268 participants, in line with the protocol's planned sample size. Internal consistency analysis demonstrated acceptable reliability (Cronbach's alpha = 0.628). In the correlation analysis, the strongest associations with the total PREVESMED score emerged for physical activity, extra virgin olive oil use, and fruit/vegetable consumption, whereas daily alcohol intake showed the weakest correlation. The multivariable linear regression highlighted higher education, lower BMI, nonsmoking status, higher WHO-5 scores, and older age as significant predictors of better adherence. Exploratory factor analysis identified five factors explaining 59.32% of the total variance.

Conclusion: Our findings suggest that the PREVESMED questionnaire is a promising, multidimensional tool for evaluating adherence to a Mediterranean lifestyle, demonstrating acceptable reliability and significant associations with key health indicators. Further refinement and extended validation - encompassing test-retest reliability, weighted scoring, and biomarker correlations - will strengthen its applicability across diverse populations.