Dataset Information

Strengthening national salt reduction strategies using multiple methods process evaluations: case studies from Malaysia and Mongolia.

ABSTRACT:

Objective

To understand the extent to which national salt reduction strategies in Malaysia and Mongolia were implemented and achieving their intended outcomes.

Design

Multiple methods process evaluations conducted at the mid-point of strategy implementation, guided by theoretical frameworks.

Setting

Malaysia (2018-2019) and Mongolia (2020-2021).

Participants

Desk-based reviews of related documents, interviews with key stakeholders (n 12 Malaysia, n 10 Mongolia), focus group discussions with health professionals in Malaysia (n 43) and health provider surveys in Mongolia (n 12).

Results

Both countries generated high-quality local evidence about salt intake and levels in foods and culturally specific education resources. In Malaysia, education and reformulation activities were delivered with moderate dose (quantity) but reach among the population was low. Within 5 years, Mongolia implemented education among schools, health professionals and food producers on salt reduction with high reach, but with moderate dose (quantity) and reach among the general population. Both countries faced challenges in implementing legislative interventions (mandatory salt labelling and salt limits in packaged foods) and both could improve the scaling up of their reformulation and education activities.

Conclusions

In the first half of Malaysia's and Mongolia's strategies, both countries generated necessary evidence and education materials, mobilised health professionals to deliver salt reduction education and achieved small-scale reformulation in foods. Both subsequently should focus on implementing regulatory policies and achieving population-wide reach and impact. Process evaluations of existing salt reduction strategies can help strengthen intervention delivery, aiding achievement of WHO's 30 % reduction in salt intake by 2025 target.

SUBMITTER: McKenzie BL

PROVIDER: S-EPMC10966880 | biostudies-literature | 2024 Feb

REPOSITORIES: biostudies-literature

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Publications

Strengthening national salt reduction strategies using multiple methods process evaluations: case studies from Malaysia and Mongolia.

McKenzie Briar L BL Mustapha Feisul Idzwan FI Battumur Bat-Erdene BE Batsaikhan Enkhtungalag E Chandran Arunah A Michael Viola V Webster Jacqui J Trieu Kathy K

Public health nutrition 20240212 1

<h4>Objective</h4>To understand the extent to which national salt reduction strategies in Malaysia and Mongolia were implemented and achieving their intended outcomes.<h4>Design</h4>Multiple methods process evaluations conducted at the mid-point of strategy implementation, guided by theoretical frameworks.<h4>Setting</h4>Malaysia (2018-2019) and Mongolia (2020-2021).<h4>Participants</h4>Desk-based reviews of related documents, interviews with key stakeholders (<i>n</i> 12 Malaysia, <i>n</i> 10 M ...[more]

PMID: 38343162

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Project description:BackgroundDeveloping effective implementation strategies requires adequate tracking and reporting on their application. Guidelines exist for defining and reporting on implementation strategy characteristics, but not for describing how strategies are adapted and modified in practice. We built on existing implementation science methods to provide novel methods for tracking strategy modifications.MethodsThese methods were developed within a stepped-wedge trial of an implementation strategy package designed to help community clinics adopt social determinants of health-related activities: in brief, an 'Implementation Support Team' supports clinics through a multi-step process. These methods involve five components: 1) describe planned strategy; 2) track its use; 3) monitor barriers; 4) describe modifications; and 5) identify / describe new strategies. We used the Expert Recommendations for Implementing Change taxonomy to categorize strategies, Proctor et al.'s reporting framework to describe them, the Consolidated Framework for Implementation Research to code barriers / contextual factors necessitating modifications, and elements of the Framework for Reporting Adaptations and Modifications-Enhanced to describe strategy modifications.ResultsWe present three examples of the use of these methods: 1) modifications made to a facilitation-focused strategy (clinics reported that certain meetings were too frequent, so their frequency was reduced in subsequent wedges); 2) a clinic-level strategy addition which involved connecting one study clinic seeking help with community health worker-related workflows to another that already had such a workflow in place; 3) a study-level strategy addition which involved providing assistance in overcoming previously encountered (rather than de novo) challenges.ConclusionsThese methods for tracking modifications made to implementation strategies build on existing methods, frameworks, and guidelines; however, as none of these were a perfect fit, we made additions to several frameworks as indicated, and used certain frameworks' components selectively. While these methods are time-intensive, and more work is needed to streamline them, they are among the first such methods presented to implementation science. As such, they may be used in research on assessing effective strategy modifications and for replication and scale-up of effective strategies. We present these methods to guide others seeking to document implementation strategies and modifications to their studies.Trial registrationclinicaltrials.gov ID: NCT03607617 (first posted 31/07/2018).

Project description:BackgroundEvidence for recommended interventions to reduce population salt intake come from high-income countries, but it is unknown if these can be successfully replicated in low- and middle-income countries. This process evaluation investigated the reach, dose/adoption, fidelity, cost, and context of a national salt reduction program of interventions in Samoa.MethodsMonitoring and Action on Salt in Samoa (MASIMA) was a pre- and post-intervention study of a government-led strategy to lower population salt intake comprising awareness campaigns, community mobilization and policy and environmental changes. Data relating to the five process evaluation dimensions were collected from routinely collected data, a post-intervention survey and stakeholder interviews. Chi-squared tests assessed differences in quantitative survey responses among groups. Thematic analysis of qualitative interview responses was undertaken and triangulated with the quantitative data.ResultsAwareness campaigns, school nutrition standards, and community mobilization interventions were implemented with moderate reach and fidelity. Higher than expected costs of campaigns and limited opportunity (one-off) to mobilize community leaders to disseminate salt reduction messages were key implementation challenges, which meant intervention dose was low. Environmental-level initiatives including engagement with the food industry to voluntary reduce salt in foods and the introduction of salt-related regulations were more challenging to implement within 18-months, particularly given the delay in the passing of the Food Act which provides for enforcement of regulations. Contextual factors that hindered the interventions' mechanism of effect include the food culture, higher cost, and lower availability of healthy low-salt foods relative to unhealthy foods and salty taste preference.ConclusionAlthough individual and community-based interventions helped increase awareness about the importance of salt reduction in Samoa, legislative backing was needed to alter the food environment to achieve population reduction in salt intake. It was not possible to engage the food industry to lower salt in foods through a voluntary approach in Samoa's current context, although such initiatives were successful in some high-income countries. Future individual and environmental-level interventions to reduce salt intake need to address the contextual influences of food choices. In Samoa, this means salt reduction strategies need to ensure consuming lower salt is affordable, widely available, and perceived as flavorsome.

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Project description:BackgroundSalt reduction is a cost-effective, and rather challenging public health strategy for controlling chronic diseases. The AppSalt program is a school-based multi-component mobile health (mhealth) salt reduction program designed to tackle the high salt intake in China. This mixed-methods process evaluation was conducted to investigate the implementation of this program across sites, identify factors associated with the implementation, and collect evidence to optimize the intervention design for future scale-up.MethodsMixed methods were used sequentially to collect data regarding five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data were collected during the intervention process. Participation rate of intervention activities was calculated and compared across cities. The quantitative data was used for the selection of representative intervention participants for the qualitative interviews. Qualitative data were collected in face-to-face semi-structured interviews with purposively selected students (n = 33), adult family members (n = 33), teachers (n = 9), heads of schools (n = 9), key informants from local health, and education departments (n = 8). Thematic analysis technique was applied to analyze the interview transcripts using NVivo. The qualitative data were triangulated with the quantitative data during the interpretation phase.ResultsThe total number of families recruited for the intervention was 1,124. The overall retention rate of the AppSalt program was 97%. The intervention was implemented to a high level of fidelity against the protocol. About 80% of intervention participants completed all the app-based salt reduction courses, with a significant difference across the three cities (Shijiazhuang: 95%; Luzhou: 73%; Yueyang: 64%). The smartphone app in this program was perceived as a feasible and engaging health education tool by most intervention participants and key stakeholders. Through the interviews with participants and key stakeholders, we identified some barriers to implementing this program at primary schools, including the left-behind children who usually live with their grandparents and have limited access of smartphones; perceived adverse effects of smartphones on children (e.g., eyesight damage); and overlooked health education curriculum at Chinese primary schools.ConclusionThis process evaluation demonstrated the feasibility and acceptability of using smartphone applications delivered through the education system to engage families in China to reduce excessive salt intake.Clinical trial registrationThe AppSalt study was registered at www.chictr.org.cn, identifier: ChiCTR1800017553. The date of registration is August 3, 2018.

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Dataset Information

Strengthening national salt reduction strategies using multiple methods process evaluations: case studies from Malaysia and Mongolia.

Objective

Design

Setting

Participants

Results

Conclusions

Publications

Strengthening national salt reduction strategies using multiple methods process evaluations: case studies from Malaysia and Mongolia.

Similar Datasets

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