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.
Highlights
High blood pressure is a major risk factor for cardiovascular disease and premature death worldwide [1]
We found out that their business was concentrated on the production of salt for industrial purposes, that salt for human consumption was a minor part of their business and, reduced-sodium salts were less of a priority
A safety trial on reduced-sodium salts demonstrated that a considerable part of the sodium in regular salt could be replaced by potassium and magnesium salts without causing potassium or magnesium toxicity [27]
Summary
High blood pressure is a major risk factor for cardiovascular disease and premature death worldwide [1]. The reduction of the UK population’s sodium intake was mainly achieved by working with the food industry on gradual reformulation of packaged foods on a voluntary basis [8]. This programme may not have the same impact in East, Central, and South Asia and many low- and middle-income countries where most sodium comes from salt added during cooking [9,10]. Reduced-sodium salts with added potassium have the promise, as a population intervention, to meet the WHO sodium and potassium targets, and subsequently reduce the disease burden attributable to high blood pressure [11]
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