Barriers, Enablers, and Perceptions on Dietary Salt Reduction in the Out-of-Home Sectors: A Scoping Review

Michael, Viola; You, Yee Xing; Shahar, Suzana; Manaf, Zahara Abdul; Haron, Hasnah; Shahrir, Siti Nurbaya; Majid, Hazreen Abdul; Chia, Yook Chin; Brown, Mhairi K.; He, Feng J; MacGregor, Graham A.

doi:10.3390/ijerph18158099

Cited by 13 publications

(16 citation statements)

References 86 publications

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“…The starting point may be involving reporters in salt reduction program to increase media coverage to increase public knowledge and healthy behaviors related to salt and health [30]. Evidence showed that although use of media is an important strategy to implement the NMSAP priority actions including food labeling, it may be insufficient to create change in the absence of other strategies to create an enabling environment based on increases in knowledge, but not necessarily behaviors, through mass media campaigns [31]. Other important facilitators noted by participants for the implementation of the NSMAP priority actions include favorable existing advertising strategies on smoking, public interest in health issues, and existence of school feeding programs.…”

Section: Discussionmentioning

confidence: 99%

Stakeholder perspectives on Nigeria’s national sodium reduction program: Lessons for implementation and scale-up

et al. 2023

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Background To reduce excess dietary sodium consumption, Nigeria’s 2019 National Multi-sectoral Action Plan (NMSAP) for the Prevention and Control of Non-communicable Diseases includes policies based on the World Health Organization SHAKE package. Priority actions and strategies include mandatory sodium limits in processed foods, advertising restrictions, mass-media campaigns, school-based interventions, and improved front-of-package labeling. We conducted a formative qualitative evaluation of stakeholders’ knowledge, and potential barriers as well as effective strategies to implement these NMSAP priority actions. Methods From January 2021 to February 2021, key informant interviews (n = 23) and focus group discussions (n = 5) were conducted with regulators, food producers, consumers, food retailers and restaurant managers, academia, and healthcare workers in Nigeria. Building on RE-AIM and the Consolidated Framework for Implementation Research, we conducted directed content qualitative analysis to identify anticipated implementation outcomes, barriers, and facilitators to implementation of the NMSAP sodium reduction priority actions. Results Most stakeholders reported high appropriateness of the NMSAP because excess dietary sodium consumption is common in Nigeria and associated with high hypertension prevalence. Participants identified multiple barriers to adoption and acceptability of implementing the priority actions (e.g., poor population knowledge on the impact of excess salt intake on health, potential profit loss, resistance to change in taste) as well as facilitators to implementation (e.g., learning from favorable existing smoking reduction and advertising strategies). Key strategies to strengthen NMSAP implementation included consumer education, mandatory and improved front-of-package labeling, legislative initiatives to establish maximum sodium content limits in foods and ingredients, strengthening regulation and enforcement of food advertising restrictions, and integrating nutrition education into school curriculum. Conclusion We found that implementation and scale-up of the Nigeria NMSAP priority actions are feasible and will require several implementation strategies ranging from community-focused education to strengthening current and planned regulation and enforcement, and improvement of front-of-package labeling quality, consistency, and use.

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Section: Discussionmentioning

confidence: 99%

Stakeholder perspectives on Nigeria’s national sodium reduction program: Lessons for implementation and scale-up

et al. 2023

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“…This approach has not resulted in reported sales losses, product substitutions or increased table-side salt usage (41)(42)(43) . Adopting this strategy to prepare out-ofhome foods could involve gradually incorporating alternative ingredients such as herbs and spices and salt substitutes (27) .…”

Section: Discussionmentioning

confidence: 99%

“…Notably, these initiatives have yet to target the informal sector, specifically street food vendors. Nevertheless, several studies ( 27 ) , a case study-based framework ( 28 ) and an informative toolkit ( 29 ) have collectively provided insights into the existing challenges associated with salt reduction in this sector and enablers or suggestions to overcome them. In this qualitative study, the researchers identified specific barriers and enablers related to reducing salt content in foods within this sector, as perceived by Malaysian consumers and food operators.…”

Section: Discussionmentioning

confidence: 99%

Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in Malaysia (MySaltOH) from the perspective of street food vendors, caterers and consumers

Zainal Arifen,

Haron,

Shahar

et al. 2023

Public Health Nutr.

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Objective: To explore the perspectives, barriers, and enablers on salt reduction in out-of-home sectors in Malaysia among street food vendors, caterers, and consumers. Design: A qualitative study involving 22 focus group discussions and six in-depth interviews was conducted, recorded and transcribed verbatim. An inductive thematic analysis approach was employed to analyze the data. Setting: Two in-depth interviews and 22 focus group discussions were conducted face-to-face. Four in-depth interviews were conducted online. Participants: Focus group discussions were conducted among 23 street food vendors, 21 caterers, and 76 consumers of various eateries. In-depth interviews were conducted among two street food vendors, and four caterers, individually. Results: Consumers and food operators perceived a high salt intake within Malaysia’s out-of-home food sectors. Food operators emphasized the necessity for a comprehensive salt reduction policy in the out-of-home sector involving all stakeholders. Consumers faced limited awareness and knowledge, counterproductive practices among food operators, and challenges in accessing affordable low-sodium food products; whereas food operators faced the lack of standardized guidelines and effective enforcement mechanisms, and uncooperative consumer practices. Both groups expressed that food quality and price of salt were also the barriers, and they advocated for awareness promotion, enhanced regulation of manufactured food products, and stricter enforcement targeting vendors. Consumers also suggested promoting and recognizing health-conscious food premises; whereas food operators suggested on knowledge enhancement tailored to them, strategies for gaining consumers acceptance, and maintaining food quality. Conclusions: These findings provide valuable insights that serve as foundational evidence for developing and implementing salt reduction policies within Malaysia’s out-of-home sectors.

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“…This study aimed to determine the perceptions, barriers and enablers of salt reduction in the out-of-home sectors among the policy-makers, nongovernmental organizations (NGOs) and researchers, as well as the food industry. This study is part of a larger study on "Developing a policy to reduce the salt content of food consumed outside the home in Malaysia, " involving all formal and informal sectors [14,15].…”

Section: Introductionmentioning

confidence: 99%

Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries

Harun

You

Manaf

et al. 2023

Health Res Policy Sys

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Background High salt intake is a major cause of hypertension and cardiovascular diseases. The out-of-home sectors have been identified as one of the contributors of high salt intake in the population. The National Salt Reduction Policy of Malaysia was initiated in 2015; however, out-of-home sectors are yet to be emphasized and perception by policy-makers and the food industries towards salt reduction are yet unknown. This study aimed to determine the perceptions, barriers and enablers towards salt reduction in the out-of-home sector in Malaysia, as well as among policy-makers and the food industries. Methods This is a qualitative study via semi-structured in-depth interviews (IDI) and focus group discussions (FGD) involving several stakeholders consisting of policy-makers from five ministries, five nongovernment organizations (NGOs) and food science/food technology researchers from five regions (West, North, East, and South Peninsular and East Malaysia/Borneo), as well as the food industries. The IDI and FGD sessions were recorded, transcribed verbatim and analysed thematically using Nvivo software version 12. Results All participants agreed that salt intake in Malaysia is high and leads to hypertension and cardiovascular diseases. Lack of awareness, poor eating culture and behaviour and frequent eating out were among the causes of high salt intake. Awareness campaigns and education, sodium content labelling and product reformulation were strategies that have been implemented by the government; whilst for the food industries, some of them have tried to reduce salt and labelled the sodium content on their food products. However, there were several barriers including perceived poor consumer acceptance, lack of knowledge and resources, and challenges in reformulation, as well as unavailability of guidelines and salt targets. Hence, several enablers have been suggested, which include prioritizing the salt reduction strategy, creating more awareness, collaboration and engagement, research and technology particularly for reformulation and shelf-life stability, incentives and salt tax. Conclusions Salt reduction efforts of the out-of-home sector in Malaysia could be achieved through several measures or enablers that can overcome the barriers currently faced by stakeholders, especially policy-makers, food industries and the consumers themselves. This study will benefit the policy-makers to improve the salt reduction policy of out-of-home sectors and highlight the concerns among the food industries on the policy.

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Barriers, Enablers, and Perceptions on Dietary Salt Reduction in the Out-of-Home Sectors: A Scoping Review

Cited by 13 publications

References 86 publications

Stakeholder perspectives on Nigeria’s national sodium reduction program: Lessons for implementation and scale-up

Stakeholder perspectives on Nigeria’s national sodium reduction program: Lessons for implementation and scale-up

Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in Malaysia (MySaltOH) from the perspective of street food vendors, caterers and consumers

Perceptions, barriers and enablers of salt reduction in Malaysian out-of-home sectors (MySaltOH): from the point of view of policy-makers and food industries

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