Abstract
Systematic reviews of trials consistently demonstrate that reducing salt intake lowers blood pressure. However, there is limited evidence on how interventions function in the real world to achieve sustained population-wide salt reduction. Process evaluations are crucial for understanding how and why an intervention resulted in its observed effect in that setting, particularly for complex interventions. This project presents the detailed protocol for a process evaluation of a statewide strategy to lower salt intake in Victoria, Australia. We describe the pragmatic methods used to collect and analyse data on six process evaluation dimensions: reach, dose or adoption, fidelity, effectiveness, context and cost, informed by Linnan and Steckler’s framework and RE-AIM. Data collection methods include routinely collected administrative data; surveys of processed foods, the population, food industry and organizations; targeted campaign evaluation and semi-structured interviews. Quantitative and qualitative data will be triangulated to provide validation or context for one another. This process evaluation will contribute new knowledge about what components of the intervention are important to salt reduction strategies and how the interventions cause reduced salt intake, to inform the transferability of the program to other Australian states and territories. This protocol can be adapted for other population-based, complex, disease prevention interventions.
Highlights
Unhealthy diets are major causes of death and disability worldwide, second only to high blood pressure [1,2]
The aim of this study protocol is to describe the methodology of the process evaluation of the Victorian Salt Reduction Partnership, to promote transparency and share the approach, which can be adapted for use in other complex interventions
The public awareness campaigns consist of several phases focusing on communicating messages campaigns consist of several focusing on sources communicating aboutThe thepublic healthawareness risk of high salt intake, current levelsphases of consumption, of salt inmessages the diet about the health risk of high salt intake, current levels of consumption, sources of salt in the diet and and and approaches to lower salt intake, with an aim to improve attitudes to salt reduction action approaches salt intake, with an aim improve attitudes to salt aged reduction and the the adoptiontooflower salt-lowering behaviours
Summary
Unhealthy diets are major causes of death and disability worldwide, second only to high blood pressure [1,2]. Population-wide salt reduction is crucial in Australia where average salt consumed is almost double the recommended amount of 5 g/day, causing increased blood pressure—the leading risk factor for death and disease in Australia [13]. Explore the extent to which the interventions were implemented as planned; examine how each intervention component contributed to overall goal of lower salt consumption relative to the causal pathways specified in the logic model and identify and assess the relative influence of contextual factors that affect implementation and outcomes. The aim of this study protocol is to describe the methodology of the process evaluation of the Victorian Salt Reduction Partnership, to promote transparency and share the approach, which can be adapted for use in other complex interventions
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