Assessing knowledge, attitudes, and behaviours toward salt and sugar consumption in the Central Division of Fiji

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Abstract
Background: Excessive salt and sugar intake influence the global burden of non-communicable diseases. This study aimed to describe the knowledge, attitudes and behaviours (KAB) of Fijian adults relating to salt and sugar consumption to inform policy interventions in Fiji. Methods: A randomised stratified sample of 700 adults in the Central Division of Fiji were selected. Questions on salt-related KAB were adapted from the World Health Organization Noncommunicable Disease Risk Factor survey, and questions on sugar were developed following a similar structure. Locally trained research assistants collected data. For analyses, population and sample weights were applied, and difference between predefined subgroups (sex, age, ethnicity and area of residence) were compared using weighted chi-square tests. Results: 534 adults participated (response rate,76%). Over 80% of participants (82% (95% CI 78.5 to 84.9%)) identified that consuming too much salt or salty sauce can lead to hypertension. More than 90% recognized that consuming too much sugar can lead to diabetes (92.3% (89.7 to 94.3%)). Approximately 80% of participants thought it was somewhat or very important to lower salt and sugar intake in their diet (79.8% (95%CI, 76.1 to 83.0) and 84.2% (80.8 to 87.1%), respectively). However, self-reported behaviours did not align, with almost 40% adding salt or salty sauces as standard practice when cooking (37.3% (32.7 to 42.2%)) and 65% (60.6 to 68.5%) reporting that they add sugar to drinks daily. Younger compared to older individuals (18 to 44 years vs 45 years and older) and men compared to women, had lower levels of KAB. Conclusion: Despite having knowledge of the health impacts of consuming excess salt and sugar and positive attitudes towards reducing consumption, many people reported behaviours likely to contribute to high salt and sugar intake. These findings highlight the need for interventions that incentivise healthier choices, through behaviour change communications and the creation of supportive food environments.
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