[Analysis of the determinants of salt-restriction behavior among urban and rural residents in Beijing with health belief model].

OBJECTIVE: To investigate salt-restriction behavior and explore related determinants among Beijing residents, so as to provide scientific basis for salt-restriction intervention. METHODS: The health belief model (HBM) was applied in designing the questionnaire, in which respondents' demographic characteristics, salt-restriction behavior, knowledge on hypertension, perceived susceptibility to hypertension, perceived severity of hypertension, perceived benefits of salt-restriction, perceived subjective barriers of salt-restriction, perceived objective barriers of salt-restriction, self-efficacy and cues to action were measured. Altogether 799 residentsresponsible for cooking in Xicheng district (396 urban residents) and Shunyi district (403 rural residents) in Beijing were investigated by the questionnaire, salt intake follow up, and 24-hour urinary sodium (24HUNa) determination. RESULTS: In the study, 54.0% (214/396) of urban respondents and 26.3% (106/403) of rural respondents used a salt-restriction-spoon with high frequencies (everyday and often), while 27.5% (109/396) and 12.4% (50/403) used it correctly. The daily salt intake was (5.85±4.17) g and (7.74±4.67) g, and the 24HUNa was (113.70± 72.57) mmoL and (212.18±105.01) mmoL for urban and rural respondents, respectively. Perceived objective barriers of salt-restriction was animportant determinant of salt-restriction behavior for both the rural (OR=0.92; 95%CI: 0.88-0.96; P<0.01) and urban respondents (OR=0.87;95%CI: 0.83-0.91;P<0.01), which was perceived obviously more by rural respondents than by urban ones. Another important determinant of rural respondents' salt-restriction behavior was the owning status of salt-restriction-spoon (OR=2.18;95%CI: 1.04-4.57;P=0.04). CONCLUSION: It is necessary to improve current salt-restriction-spoon, enhance its owning rate,and popularize its correct way of using, especially among rural residents.

Determinants of salt-restriction-spoon using behavior in China: application of the health belief model.

BACKGROUND: The two-gram salt-restriction-spoons, which can be used to reduce the salt intake of people, had been handed out for free by the Chinese government to the citizens several years ago, but only a small fraction of residents use such a spoon currently. Since no studies have been conducted to investigate relevant influencing factors, this study was designed to explore the determinants of salt-restriction-spoon using behavior (SRB) in China. METHODS: This cross-sectional study was conducted in Beijing, China. Altogether 269 rural residents and 244 urban residents aged over 18 were selected by convenience sampling method in 2012. Variables measured in a questionnaire designed according to the Health Belief Model (HBM) included socio-demographics, perceived susceptibility, perceived severity, perceived benefits, perceived objective barriers, perceived subjective barriers, self-efficacy, knowledge of hypertension, cues to action, and SRB. Answers to the questionnaire were obtained from all the participants, and 24-hour urine samples were collected to determine the 24-hour urinary sodium excretion (24HUNa). Path analyses were used to explore the determinants of SRB. RESULTS: Approximately 22.7% and 45.3% of residents used a salt-restriction-spoon everyday in the rural and urban areas, respectively. The average 24HUNa was 211.19±98.39 mmol for rural residents and 109.22±58.18 mmol for urban residents. Path analyses shown that perceived objective barriers, perceived benefits, perceived severity, knowledge and age were related to SRB and 24HUNa for both rural and urban participants, among which perceived objective barrier (ß =  - 0.442 and ß =  - 0.543, respectively) was the most important determinant. CONCLUSION: Improvement of the current salt-restriction-spoon and education on the right usage of the salt-restriction-spoon, the severity of hypertension, and the benefit of salt reduction are necessary, especially among those who are relatively young but at risk of hypertension, those who have lower education levels, and those who live in the rural areas.

Salt-restriction-spoon improved the salt intake among residents in China.

OBJECTIVE: To evaluate the effect of an improved salt-restriction spoon on the attitude of salt-restriction, the using rate of salt-restriction-spoon, the actual salt intake, and 24-hour urinary sodium excretion (24HUNa). DESIGN: A community intervention study. SETTING: Two villages in Beijing. PARTICIPANTS: 403 local adult residents being responsible for home cooking. INTERVENTION: Participants were randomly assigned to the intervention group or the control group. Those in the intervention group were provided with an improved salt-restriction-spoon and health education, and were informed of their actual salt intake and 24HUNa. Not any intervention was given to those in the control group. MAIN OUTCOME MEASURES: The scores on the variables of Health Belief Model, the using rate of salt-restriction-spoon, the actual salt intake, and 24HUNa. ANALYSIS: Covariance analyses, Chi-square tests, Student's t tests, and repeated measures analyses of variance. RESULTS: After 6 months of intervention, the intervention group felt significantly less objective barriers, and got access to significantly more cues to action as compared to the control group. The using rate and the correctly using rate of salt-restriction-spoon were significantly higher in the intervention group. The daily salt intake decreased by 1.42 g in the intervention group and by 0.28 g in the control group, and repeated measures analysis of variance showed significant change over time (F = 7.044, P<0.001) and significant difference between groups by time (F = 2.589, P = 0.041). The 24HUNa decreased by 34.84 mmol in the intervention group and by 33.65 mmol in the control group, and repeated measures analysis of variance showed significant change over time (F = 14.648, P<0.001) without significant difference between groups by time (F = 0.222, P = 0.870). CONCLUSIONS: The intervention effect was acceptable, therefore, the improved salt-restriction-spoon and corresponding health education could be considered as an alternative for salt reduction strategy in China and other countries where salt intake comes mainly from home cooking.