An intervention study to improve food shopping and prevent cardiovascular disease among patients in primary care: the PC SHOP trial

INTERVENTION: Participants are randomly allocated to either a control or intervention group. Intervention 1: Brief advice session This intervention consists of a single one‐to‐one appointment with the health professional (HP) in which they will receive advice on the importance of dietary change and motivation to reduce SFA based on the British Heart Foundation “Cut the Saturated Fat” chart, which will be provided as printed educational material. This session is aimed to inform participants about the benefits of saturated fat reduction and encourage them to attempt it. Dietary advice is particularly focused on explaining the different sources of fat and the most appropriate changes proposed in the BHF guidance to decrease SFA, primarily by substitution with lower SFA options (e.g. change from regular beef to lean beef); or with mono‐ and polyunsaturated fat sources (e.g. change from butter to low‐fat vegetable spread). Intervention 2: Brief advice session and shopping report In addition to the brief advice session detailed above, participants in this intervention arm receive a personalised report with the nutritional composition of foods and beverages purchased from Tesco over the last three months (baseline) and subsequent months (monthly over the three months of follow up). This report includes information on total energy (calories) and saturated fat as a % of total energy, and the major food contributors to SFA. Participants receive monthly reports to allow them to chart their progress in reducing SFA in their grocery purchases. This information is accompanied by a list with suggestions for one‐for‐one swaps for foods high in SFA for lower SFA foods to support dietary change. Control group Participants in the control group (usual care) are recruited into the study and will be informed by post of their elevated risk and their blood tests by the study team. They are then seen again at three months for collecting outcome measures. CONDITION: Adults with high LDL cholesterol ; Nutritional, Metabolic, Endocrine ; Adults with high LDL cholesterol PRIMARY OUTCOME: Change in SFA intake is measured using the 2 x 24h dietary recalls using the Web‐Q instrument at baseline and 3 months (follow up). SECONDARY OUTCOME: 1. Changes in SFA from total purchases and the proportion of food items with low SFA (e.g. products with =1.5 grams of SFA per 100 grams of the product) is measured using purchasing records obtained from the supermarket at baseline and 3 months (follow up).; 2. Changes in LDL‐cholesterol, HDL‐cholesterol, total cholesterol and triglycerides is measured using blood samples taken at baseline and 3 months (follow up).; 3. Changes in energy intake, total fat, total sugars, fibre and salt; and high SFA food groups (updated 19/03/2018) is measured using 2x24h dietary recalls using the Web‐Q instrument at baseline and 3 months (follow up).; 4. Changes in energy density, total fat, sugar, fibre and salt from purchases is measured using purchasing records obtained from the supermarket at baseline and 3 months (follow up).; 5. Changes in systolic and diastolic blood pressure is measured using an electronic blood pressure monitors at baseline and 3 months (follow up).; 6. Changes (absolute (kg) and relative (%)) in body weight is measured using a calibrated electronic platform scale at baseline and 3 months (follow up).; 7. Feasibility and process measures: ; 7.1. Willingness of participants to take part in the study and be randomised is measured using recruitment rates at baseline.; 7.2. Programme attendance and retention is measured using follow up and completion rates at 3 months.; 7.3. Acceptability of the intervention for participants and health professionals; uptake of knowledge, motivation and swaps accepted is measured using non validated questionnaires at baseline and 3 months (follow up).; INCLUSION CRITERIA: 1. Participant is willing and able to give informed consent for participation in the study 2. Male or Female, aged 18 years or above 3. With confirmed LDL cholesterol above 3 mmol/L at recruitment 4. Express a desire for support to improve the nutritional quality of their diet to reduce their CVD risk 5. Primarily responsible for household shopping (e.g. complete at least half of their household shopping) 6. Shops mainly at Tesco (e.g. at least once/week instore and/or online) using a Tesco’s storecard. They need to have had a Tesco’s storecard for at least 3 months before recruitment 7. Computer literate Screening criteria: 1. Age =18 years with a blood test in the GP records which indicate LDL‐cholesterol >3.5 mmol/L or total cholesterol >5.5 mmol/L in the past 24 months 2. Who will likely benefit from a lower SFA diet with no pre‐existing conditions that warrant exclusion.