Milena Sia Perin

Background: Nowadays, mobile health technology has been increasingly used for treatment and prevention at all levels of health care. Associating this technology with the promotion of healthy salt consumption—both cost-effective and cost-saving public health strategies—can reduce this risk factor that contributes significantly to the increase of noncommunicable diseases worldwide. Objective: We aim to assess the usability and the efficacy of a mobile app intervention—“Sal na Medida” app—on the promotion of a healthy salt intake among adults, based on the Behavior Change Wheel framework. Additionally, to investigate if intention, self-efficacy, and habit variables mediated the effect of intervention on salt intake behavior. Methods: An experimental, randomized, and longitudinal study that evaluated the intervention effect with assessments at baseline, postintervention (1 mo), and at follow-up (2 mo). Sociodemographic and clinical data were collected from participants recruited at primary health care centers. The behavior of salt intake and per capita salt consumption were the primary outcomes. Psychosocial variables of intention, self-efficacy, and habit were assessed as possible mediators. Usability was evaluated after 1 month and 2 months of using the app. Results: Eighty-six participants were randomized in the intervention group (IG; n=43) or control group (CG; n=43). Most of the participants were female (IG: n=36, 84% and CG: n=37, 86%). Usability of app intervention scored 77.8 points (on a scale of 0 to 100) among IG participants. There was a significant reduction in salt intake in IG according to the variables of per capita salt and the behavior of salt intake. Furthermore, at the end of the follow-up, individuals in IG were 63% more likely to have a lower salt intake than those in the CG. The regression analysis showed an increase in intention and the perception of self-efficacy, and a more pronounced reduction in the habit of using more than 3 g of salt/day in preparing meals in IG when compared to CG. Habit and self-efficacy were identified as mediators of the intervention’s effect. Conclusions: The theory-based mobile app intervention for reducing salt intake has shown promise both in terms of usability and efficacy among adults. Conducting further studies to assess its potential for implementation on a larger scale would be valuable for determining its real-world impact and feasibility.

Background: There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population’s context. Objective: This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. Methods: This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. Results: Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. Conclusions: Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. Trial Registration: The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq International Registered Report Identifier (IRRID): DERR1-10.2196/37853

BACKGROUND There is sound evidence associating high salt intake and a greater risk of cardiovascular and noncardiovascular diseases. High salt intake has been observed in several populations worldwide. Therefore, promoting healthier salt consumption has been encouraged as a low-cost strategy to reduce this risk factor. However, these strategies need to be sound, built on theoretical and methodological bases, and consider the target population’s context. OBJECTIVE This protocol aims to describe a mobile phone app intervention to promote healthy salt intake among adults. METHODS This is an experimental and longitudinal study protocol conducted in three modules. Module 1 refers to the planning of the intervention based on the Behaviour Change Wheel framework. Module 2 is the development of the mobile phone app intervention based on the date of module 1. In module 3, the intervention will be evaluated using a randomized controlled study, with three steps of data collection in a 2-month follow-up in a sample of 86 adults (43 participants for each group: the control group and intervention group) recruited from the primary health care centers of a Brazilian town. The discretionary salt intake questionnaire will assess salt consumption, the app usability will be assessed using the System Usability Scale, and psychosocial variables (habit, intention, and self-efficacy) will also be measured. RESULTS Recruitment began in October 2021, and the follow-up will end in August 2022. The results of this study are expected to be published in 2023. CONCLUSIONS Results from this study will help people to control salt intake when cooking at home, will stimulate self-care, will work as an alternative or supportive method in the relationship between health care professionals and patients, and will contribute to implementing the app intervention to promote healthy salt intake on a large scale. CLINICALTRIAL The Brazilian Clinical Trials Registry RBR-4s8qyyq; https://ensaiosclinicos.gov.br/rg/RBR-4s8qyyq INTERNATIONAL REGISTERED REPORT DERR1-10.2196/37853

The relationship between salt intake and cardiovascular diseases is a contemporary scientific controversy, which has been attributed to the limits of the measures of salt intake used in the studies. Thus, this article sought to systematically review the literature on the methods used to estimate salt intake in different study designs. Of the 124 articles, 60.5% used only biochemical measures, 26.6% only self-report measures and 12.9% reported the combined use of both methods. The 24-hour urinary sodium excretion was the predominant biochemical method (79.1%) and the Food Frequency Questionnaire was the predominant self-report measure (36.4%). Interventional studies used mostly 24-hour urinary sodium excretion; while longitudinal studies used self-report measures. The question guiding the study and its design, as well as constraints related to costs, sample size and feasibility seems to influence the choice of the type of measurement.

Objective: To assess salt intake and its dietary sources using biochemical and self-report methods and to characterize salt intake according to sociodemographic and disease-related variables in a sample of the Brazilian population.Design: Population-based cross-sectional survey.Setting: Salt intake was assessed by biochemical (24 h urinary Na excretion) and self-report methods (sodium FFQ, 24 h dietary recall, seasoned-salt questionnaire, discretionary-salt questionnaire and total reported salt intake).Participants: Adults and older people (n 517) aged 20–80 years, living in Artur Nogueira, São Paulo, Brazil.Results: Mean salt intake based on 24 h urinary Na excretion and total reported salt intake was 10·5 and 11·0 g/d, respectively; both measures were significantly correlated. Discretionary salt and seasoned salt were the most important sources of salt intake (68·2 %). Men in the study consumed more salt than women as estimated by 24 h urinary Na excretion (11·7 v. 9·6 g salt/d; P<0·0001). Participants known to be hypertensive added more salt to their meals but consumed less salty ultra-processed foods. Waist circumference in both sexes and BMI were positively correlated with salt intake estimated by 24 h urinary Na excretion. In addition, regression analysis revealed that being a young male or having a high waist circumference was a predictor of higher salt intake.Conclusions: Salt intake in this population was well above the recommended amount. The main source of salt intake came from salt added during cooking. Salt intake varied according to sex and waist circumference.

OBJECTIVE: to evaluate the relationship between the behaviors of salt consumption and socio-demographic and clinical variables. METHOD: sodium consumption was evaluated using the methods: self-reporting (considering 3 different behaviors related to salt consumption), 24- hr dietary recall, discretionary salt, food frequency questionnaire, estimation of total sodium intake and 24-hr urinary excretion of sodium (n=108). RESULTS: elevated salt intake according to the different measurements of consumption of the nutrient was associated with the variables: male sex, low level of schooling and monthly income, being Caucasian, and being professionally inactive; and with the clinical variables: elevated Body Mass Index, tensional levels, ventricular hypertrophy and the number of medications used. CONCLUSION: the data obtained shows a heterogenous association between the different behaviors related to salt consumption and the socio-demographic and clinical variables. This data can be used to optimize the directing of educational activities with a view to reducing salt consumption among hypertensives.