Protocol for the implementation and evaluation of a community‐based behavior change intervention to reduce dietary salt intake in India

Abstract

Excess dietary salt intake is well established as a leading cause of high blood pressure and associated cardiovascular disease, yet current salt intake in India is nearly 11 g per day, more than twice World Health Organization maximum recommended intake of 5 g per day. Although dietary survey data from India indicate that the main sources of dietary salt are salt added during cooking at home, and few salt reduction efforts have focused on interventions at the household level. As a result, there is little evidence of the effectiveness of behavior change programs to reduce salt intake at the household level. The study aims to develop and implement a community based behavioral change intervention to reduce salt intake delivered by front line community‐based health volunteers; and evaluate the preliminary effectiveness, acceptability, and feasibility of delivering a salt reduction behavior change program and potential to support future scale‐up. The study is a pre‐post intervention design, and outcomes will be evaluated from a random sample of 1500 participants from 28 villages in two primary health centers in Siddipet, Telangana. Primary outcome is change in salt‐related KAB (knowledge, attitude, and behavior) score, and secondary outcomes will be changes in salt intake measured by 24 h urinary sodium excretion and change in scores using the subscales of the COM‐B (“capability”, “opportunity”, “motivation” and “behavior”) tool. Findings will be used to inform future public health policies to support implementation of scalable community‐based interventions to reduce salt intake and control hypertension, the leading‐cause of death in India.

Formation and Implementation of Public Health Policy Toward Salt Reduction in Food Consumption

“…In low-and middle-income countries, a 15% reduction in salt intake in the population, 13.8 million deaths will prevent over 10 years at the cost of only $0.4 per person per year. 7,[18][19][20][21][22] The use of social power to drive solutions is consistent with the recommendations of the World Health Organization. 23 It shows that 3 main strategies that are likely to be the key to success in reducing the amount of sodium consumption among the population are as follows: 1) Modification and development of products to reduce the amount of sodium salt; 2) Educating and creating awareness regarding health and excessively used of dietary salt; and 3) Environmental modification that facilitates healthy food choices and create mechanisms and management processes to reduce salt and sodium consumption.…”

“…In low- and middle-income countries, a 15% reduction in salt intake in the population, 13.8 million deaths will prevent over 10 years at the cost of only $0.4 per person per year. 7,18-22…”