Effects of an Advocacy Trial on Food Industry Salt Reduction Efforts-An Interim Process Evaluation.

Helen Trevena,Elizabeth K Dunford,Anne Marie Thow,Bruce Neal,Kristina Petersen,Jason H Y Wu

doi:10.3390/nu9101128

Abstract

The decisions made by food companies are a potent factor shaping the nutritional quality of the food supply. A number of non-governmental organizations (NGOs) advocate for corporate action to reduce salt levels in foods, but few data define the effectiveness of advocacy. This present report describes the process evaluation of an advocacy intervention delivered by one Australian NGO directly to food companies to reduce the salt content of processed foods. Food companies were randomly assigned to intervention (n = 22) or control (n = 23) groups. Intervention group companies were exposed to pre-planned and opportunistic communications, and control companies to background activities. Seven pre-defined interim outcome measures provided an indication of the effect of the intervention and were assessed using intention-to-treat analysis. These were supplemented by qualitative data from nine semi-structured interviews. The mean number of public communications supporting healthy food made by intervention companies was 1.5 versus 1.8 for control companies (p = 0.63). Other outcomes, including the mean number of news articles, comments and reports (1.2 vs. 1.4; p = 0.72), a published nutrition policy (23% vs. 44%; p = 0.21), public commitment to the Australian government’s Food and Health Dialogue (FHD) (41% vs. 61%; p = 0.24), evidence of a salt reduction plan (23% vs. 30%; p = 0.56), and mean number of communications with the NGO (15 vs. 11; p = 0.28) were also not significantly different. Qualitative data indicated the advocacy trial had little effect. The absence of detectable effects of the advocacy intervention on the interim markers indicates there may be no impact of the NGO advocacy trial on the primary outcome of salt reduction in processed foods.

Highlights

Salt reduction has been a recent focus of efforts to improve the quality of the packaged food supply in a number of countries around the world [1,2]
There is some limited evidence that advocacy targeting public health does have the potential to influence corporate behaviour [26,27,28] but few studies have robustly assessed the effects of advocacy trials on food company actions [29]
An intervention was designed to assess the effects of advocacy by a non-governmental organization (NGO) to food companies and is described in the study protocol [30]

Summary

Introduction

Salt reduction has been a recent focus of efforts to improve the quality of the packaged food supply in a number of countries around the world [1,2]. In Australia, the estimated mean salt intake in adults is 8–10 g/day [3,4]—about double the World Health Organization (WHO) recommended maximum of 5 g/day [5] and the 2017 Suggested Dietary Target of the Australian government . While there remains some debate about the effects of salt on health [9,10], systematic overviews that summarize the totality of the available data are indicative of harm [11,12]. On this basis, the WHO recommends that all member states seek to achieve a 30% reduction in the mean population intake of salt by 2025 [13]. The intervention sought to promote voluntary salt reduction in Australia and was aligned with the goals of the Australian Food and Health Dialogue (FHD) [31]—a public–private voluntary food reformulation initiative with an aim to reduce salt in processed foods

Methods

Results

Discussion

Conclusion