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Article

Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study

by
Xuejun Yin
1,
Maoyi Tian
1,2,3,*,
Lingli Sun
2,
Jacqui Webster
1,
Kathy Trieu
1,
Mark D. Huffman
1,4,
J. Jaime Miranda
1,5,6,
Matti Marklund
1,7,8,
Jason H. Y. Wu
1,
Laura K. Cobb
9,
Hongling Chu
10,
Sallie-Anne Pearson
11,
Bruce Neal
1,12 and
Hueiming Liu
1,13
1
The George Institute for Global Health, University of New South Wales, Sydney, NSW 2050, Australia
2
The George Institute for Global Health, Peking University Health Science Center, Beijing 100600, China
3
School of Public Health, Harbin Medical University, Harbin 150081, China
4
Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
5
CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
6
Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima 15074, Peru
7
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
8
Department of Public Health and Caring Sciences, Uppsala University, 75236 Uppsala, Sweden
9
Resolve to Save Lives, an Initiative of Vital Strategies, New York, NY 10005, USA
10
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100083, China
11
Centre for Big Data Research in Health, University of New South Wales, Sydney, NSW 2052, Australia
12
School of Public Health, Imperial College London, London SW7 2BX, UK
13
Sydney Institute for Women, Children and Their Families, Sydney Local Health District, Sydney, NSW 2050, Australia
 
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*
Author to whom correspondence should be addressed.
Nutrients 2021, 13(9), 3225; https://doi.org/10.3390/nu13093225
Submission received: 3 August 2021 / Revised: 6 September 2021 / Accepted: 13 September 2021 / Published: 17 September 2021
(This article belongs to the Section Nutrition and Public Health)
Review Reports Versions Notes

Abstract

Widespread use of reduced-sodium salts can potentially lower excessive population-level dietary sodium intake. This study aimed to identify key barriers and facilitators to implementing reduced-sodium salt as a population level intervention. Semi-structured interviews were conducted with key informants from academia, the salt manufacturing industry, and government. We used the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework to inform our interview guides and data analysis. Eighteen key informants from nine countries across five World Health Organization regions participated in the study from January 2020 to July 2020. Participants were concerned about the lack of robust evidence on safety for specific populations such as those with renal impairment. Taste and price compared to regular salt and an understanding of the potential health benefits of reduced-sodium salt were identified as critical factors influencing the adoption of reduced-sodium salts. Higher production costs, low profit return, and reduced market demand for reduced-sodium salts were key barriers for industry in implementation. Participants provided recommendations as potential strategies to enhance the uptake. There are presently substantial barriers to the widespread use of reduced-sodium salt but there are also clear opportunities to take actions that would increase uptake.
Keywords: reduced-sodium salt; salt substitute; low-sodium salt; sodium reduction; potassium; key informant interview; qualitative study reduced-sodium salt; salt substitute; low-sodium salt; sodium reduction; potassium; key informant interview; qualitative study

Share and Cite

MDPI and ACS Style

Yin, X.; Tian, M.; Sun, L.; Webster, J.; Trieu, K.; Huffman, M.D.; Miranda, J.J.; Marklund, M.; Wu, J.H.Y.; Cobb, L.K.; et al. Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study. Nutrients 2021, 13, 3225. https://doi.org/10.3390/nu13093225

AMA Style

Yin X, Tian M, Sun L, Webster J, Trieu K, Huffman MD, Miranda JJ, Marklund M, Wu JHY, Cobb LK, et al. Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study. Nutrients. 2021; 13(9):3225. https://doi.org/10.3390/nu13093225

Chicago/Turabian Style

Yin, Xuejun, Maoyi Tian, Lingli Sun, Jacqui Webster, Kathy Trieu, Mark D. Huffman, J. Jaime Miranda, Matti Marklund, Jason H. Y. Wu, Laura K. Cobb, and et al. 2021. "Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study" Nutrients 13, no. 9: 3225. https://doi.org/10.3390/nu13093225

APA Style

Yin, X., Tian, M., Sun, L., Webster, J., Trieu, K., Huffman, M. D., Miranda, J. J., Marklund, M., Wu, J. H. Y., Cobb, L. K., Chu, H., Pearson, S.-A., Neal, B., & Liu, H. (2021). Barriers and Facilitators to Implementing Reduced-Sodium Salts as a Population-Level Intervention: A Qualitative Study. Nutrients, 13(9), 3225. https://doi.org/10.3390/nu13093225

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