Background
Methods
The community-based salt reduction program
COMBI | Action |
---|---|
Administrative mobilization and public advocacy to engage stakeholders | A series of meetings were held with local government (12 meetings), local doctors (7 meetings) and allied health professionals (6 meetings) all ranging in duration from 0.5–1.0 h. |
Community mobilization | A series of meetings were held with five of the largest employers in Lithgow (2 meetings), the local business association (1 meeting), business owners (predominately cafe, pub and restaurant owners–20 meetings) and community groups (11 meetings) all ranging in duration from 0.5–2.0 h. |
Two specific tools (salt substitute and ‘FoodSwitch’ smartphone application) were used to encourage reduction in salt consumption as well as acting as talking points to engage the community on the topic of the intervention. | |
Advertising | Local channels of communication including letter box flyers, newspapers, radio and social media were all targeted with information and stories about the program. A series of specific advertising initiatives was scheduled for the period of the intervention during which two letter box drops, seven pieces of print media, one radio interview (replayed), one radio community announcement (replayed) and bi-weekly social media posts were done. |
Interpersonal communication | Information booths were established in the two main shopping areas and manned for 80 days for about four hours on each occasion. About 500 individual homes were door-knocked by two team members who each worked on this activity for an average of 25 days. The salt substitute and smartphone application were used as talking points to engage individuals about the importance of reducing salt consumption as well as providing practical ways to achieve a reduction. |
Point of service contact using tools to support interactions | The salt substitute was made available for use by consumers free-of-charge at local cafes and restaurants. In addition, government buildings and medical centers held stocks of the salt substitute that consumers could take at no cost. Approximately 8,000 (64 g) packs of salt substitute were provided to the community during the course of the intervention. The smartphone application, ‘FoodSwitch’ that enable consumers to identify lower salt packaged foods was available as a free download. |
Selection of participants for baseline and follow-up surveys
Data collection
Outcomes
Cost data
Statistical analyses
Results
Baseline | Follow-up | ||||||
---|---|---|---|---|---|---|---|
Random (n = 306) | Volunteer (n = 113) | Random followed from baseline (n = 101) | Random new (n = 106) | Volunteer followed from baseline (n = 36) | Volunteer new (n = 329) |
P value* | |
Female (%) | 53 | 61 | 56 | 61 | 61 | 58 | 0.25 |
Age, years range (mean) | 20–88 (58) | 20–84 (49) | 29–90 (64) | 21–90 (60) | 22–83 (60) | 20–89 (52) | 0.49‡ |
Height, cm mean (SD) | 168 (10) | 167 (8.8) | 166 (9.6) | 166 (10.2) | 168 (8.9) | 167 (10) | 0.38 |
Weight, kg mean (SD) | 82 (17.1) | 84 (20.6) | 82 (16.9) | 84 (24.1) | 86 (26) | 82 (19.9) | 0.90 |
BMI, kg/m2 mean (SD) | 29 (5.1) | 30 (6.6) | 29 (5.9) | 30 (7.0) | 30 (8.3) | 29 (6.6) | 0.45 |
Systolic bp, mmHg mean | 127 | 124 | 127 | 133 | 131 | 126 | 0.10 |
Diastolic bp, mmHg mean | 79 | 79 | 78 | 81 | 82 | 80 | 0.27 |
Creatinine mmol mean (SD) | 12.0 (3.8) | 12.0 (4.2) | 11.0 (3.6) | 12.0 (4.3) | 12 (3.8) | 12 (4.4) | 0.31 |
Urine volume, ml mean (SD) | 1930 (808) | 2012 (868) | 1957 (859) | 2082 (875) | 1867 (747) | 1930 (823) | 0.94 |
Education (%) | 0.01 | ||||||
Secondary | 64 | 56 | 55 | 49 | 50 | 45 | |
Tertiary | 26 | 33 | 40 | 46 | 44 | 47 | |
Postgraduate | 10 | 12 | 5 | 5 | 6 | 8 | |
Health Status (%) | |||||||
Very good | 50 | 49 | 33 | 30 | 19 | 31 | 0.12 |
Good | 30 | 24 | 42 | 44 | 42 | 43 | |
Fair | 20 | 27 | 25 | 26 | 39 | 26 | |
Smoking status (%) | |||||||
Current smoker (>1/day) | 8 | 22 | 7 | 6 | 14 | 18 | 0.67 |
Ever smoked (>1/day) | 41 | 53 | 37 | 39 | 50 | 42 | |
Alcohol consumption (time since last drink) One week or less | 62 | 43 | 58 | 58 | 40 | 53 | |
12 months or more | 38 | 57 | 42 | 42 | 60 | 47 | 0.20 |
Have you ever been told by a nurse of doctor that you have (%) | |||||||
High blood pressure | 44 | 30 | 55 | 42 | 50 | 40 | 0.02 |
Heart attack | 8 | 4 | 11 | 9 | 6 | 3 | 0.62 |
Stroke | 4 | 2 | 6 | 3 | 3 | 2 | 0.57 |
Angina | 7 | 4 | 8 | 7 | 11 | 5 | 0.93 |
Diabetes | 11 | 7 | 13 | 15 | 11 | 11 | 0.25 |
Prescription Medication † (%) | |||||||
Antihypertensive | 22 | 20 | 37 | 31 | 26 | 23 | 0.03 |
Lipid lowering | 16 | 18 | 30 | 22 | 14 | 17 | 0.20 |
Aspirin | 8 | 3 | 21 | 14 | 9 | 8 | 0.01 |
Glucose lowering | 5 | 9 | 9 | 11 | 12 | 7 | 0.13 |
Any prescription medication | 66 | 53 | 79 | 83 | 60 | 60 | 0.10 |
Effects on urinary salt excretion
Effects on knowledge, attitudes and behaviors towards salt
Baseline | Follow-up | Adjusted prevalence ratio (95 % CI) | ||
---|---|---|---|---|
2011 (n=419) Unadjusted prevalence, % | 2014 (n=572) Unadjusted prevalence, % |
P-value | ||
Do you add salt to your food at the table? | ||||
Always | 21.2 | 19.4 | 0.98 (0.75–1.28) | 0.88 |
Do you add salt to food when cooking? | ||||
Always | 19.1 | 20.1 | 1.14 (0.88–1.48) | 0.32 |
How much salt do you think you consume? | ||||
Too much | 27.9 | 30.1 | 1.10 (0.89–1.35) | 0.37 |
Maximum salt consumption recommendation? | ||||
Correctly identified as <6 g | 18.2 | 28.7 | 1.53 (1.19–1.96) | 0.001 |
High salt cause serious health problems? | ||||
Yes | 95.0 | 95.3 | 1.0 (0.97–1.02) | 0.76 |
How important is lowering salt in your diet? | ||||
Important | 63.7 | 78.2 | 1.23 (1.13–1.34) | <0.001 |
Do you do anything to regularly control your salt intake? | ||||
Yes | 63.3 | 60.1 | 0.94 (0.85–1.04) | 0.22 |
Do you avoid processed foods? | ||||
Yes | 44.2 | 35.3 | 0.80 (0.68–0.94) | 0.006 |
Do you check food labels? | ||||
Yes | 30.0 | 24.5 | 0.77 (0.62–0.95) | 0.02 |
Do you buy low salt alternatives? | ||||
Yes | 33.9 | 32.0 | 0.94 (0.78–1.13) | 0.48 |
Do you use spices? | ||||
Yes | 4.8 | 28.3 | 5.83 (3.70–9.20) | <0.001 |
Do you avoid eating out | ||||
Yes | 20.8 | 34.4 | 1.58 (1.26–1.99) | <0.001 |