Korean J Community Nutr.  2015 Dec;20(6):433-446. 10.5720/kjcn.2015.20.6.433.

Evaluation of Consumer Nutrition Education Program to Reduce Sodium Intake Based on Social Cognitive Theory

• Ahn SH
• Kwon JS
• Kim KM
• Yoon JS
• Kim HK

• KMID: 2152497
• DOI: http://doi.org/10.5720/kjcn.2015.20.6.433

Abstract

OBJECTIVES
This study was performed to evaluate the consumer education program for reducing sodium intake based on social cognitive theory (SCT) and investigate consumer perceptions of environmental, cognitive and behavioral factors.
METHODS
Consumers (n=4,439) were recruited nationwide in Korea to participate in a nutrition education program for reducing sodium intake which was targeted on senior housewives (SH), parents (P), and office workers (OW). Questions regarding main factors of SCT were asked both before and after the education program.
RESULTS
SH and P recognized external social efforts and information to reduce sodium including nutrition labeling more than OW. The main barriers to practice reducing sodium intake were limited choice of low sodium food and menu, interference with social relationship when dining with others, and limited information, knowledge and skills. SH had lower barriers to practice reducing sodium intake and OW perceived 'preference to soup or stew' and 'preference to Kimchi, salted fish and fermented sauces' as barriers more than other groups at the baseline. Less than 50% of participants knew the relationship between sodium and salt, sodium in nutrition labeling, and recommended sodium intake. In addition, OW had little knowledge for capability to reduce sodium intake and lower self-efficacy to practice compared with SH and P. After education, positive outcome expectations such as lowering blood pressure, prevention of cardiovascular disease and osteoporosis were increased and barriers to practice reducing sodium intake were decreased in all groups (p < 0.05). The knowledge for behavioral capability and self-efficacy to reduce sodium intake were also improved but OW had still lower scores compared with other groups.
CONCLUSIONS
These results suggested that nutrition education programs could be an effective tool to impact general population by facilitating awareness and increased capability to reduce sodium intake.

Keyword

nutrition education program; reducing sodium intake; consumer; social cognitive theory

MeSH Terms

Blood Pressure
Cardiovascular Diseases
Education*
Food Labeling
Humans
Korea
Osteoporosis
Parents
Sodium*
Sodium

Reference

1. Antonios TF, MacGregor GA. Deleterious effects of salt intake other than effects on blood pressure. Clin Exp Pharmacol Physiol. 1995; 22(3):180–184.

2. He FJ, Li J, MacGregor GA. Effects of longer term modest salt reduction on blood pressure. Cochrane systematic review and meta-analysis of randomised trials. BMJ. 2013; 346:f1325.

3. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014; 371(7):624–634.

4. Webster JL, Dunford EK, Hawkes C, Neal B. Salt reduction initiatives around the world. J Hypertens. 2011; 29(6):1043–1050.

5. Asaria P, Chisholm D, Mathers C, Ezzati M, Beaglehole R. Chronic disease prevention: health effects and financial costs of strategies to reduce salt intake and control tobacco use. Lancet. 2007; 370(9604):2044–2053.

6. Cobiac LJ, Vos T, Veerman JL. Cost-effectiveness of interventions to reduce dietary intake. Heart. 2010; 96(23):1920–1925.

7. World Health Organization. Guideline: sodium intake for adults and children [internet]. 2012. cited 2015 Jan 12. Available from: http://www.who.int/nutrition/publications/guidelines/sodium_intake_printversion.pdf/.

8. Elliott P, Brown I. Sodium intakes around the world [internet]. 2007. cited 2015 Jan 13. Available from: www.who.int/dietphysicalactivity/Elliot-brown-2007.pdf/.

9. Ministry of Health and Welfare, Korea Centers for Disease Control and Prevention. Korea Health Statistics 2013: Korea National Health and Nutritional Examination Survey (KNHANES V-2) [internet]. 2014. cited 2015 Jan 13. Available from: https://knhanes.cdc.go.kr/knhanes/index.do/.

10. Dötsch M, Busch J, Batenberg M, Liem G, Tareilus E, Mueller R, et al. Strategies to reduce sodium consumption: A food industry perspective. Crit Rev Food Sci Nutr. 2009; 49(10):841–851.

11. Paik HY. Nutritional review of salt. Proceedings of Spring Symposium of The Korean Society of Food Science and Nutrition. 1987 Jun 13; 92: 106.

12. Kim SM. A baseline study on housewife-consumer education in the information society. Korean J Hum Ecol. 2004; 13(3):425–440.

13. Park NR, Sohn SH. The effects of food safety education on children\'s food safety knowledge, belief, attitude, and behavior. Consum Policy Educ Rev. 2010; 6(1):47–66.

14. Jung EJ, Son SM, Kwon JS. The effect of sodium reduction education program of a public health center on the blood pressure, blood biochemical profile and sodium intake of hypertensive adults. Korean J Community Nutr. 2012; 17(6):751–771.

15. Glanz K, Rimer BK, Viswanath K. Health behavior and health education: theory, research, and practice. 4th ed. San Francisco (CA): Joseey-Bass;2008. p. 45–62.

16. Ahn SH, Kim HK, Kim KM, Yoon JS, Kwon JS. Development of nutrition education program for consumers to reduce sodium intake applying the social cognitive theory -based on focus group interviews-. Korean J Community Nutr. 2014; 19(4):342–360.

17. Yim KS. The effects of a nutrition education program for hypertensive female elderly at the public health center. Korean J Community Nutr. 2008; 13(5):640–652.

18. Jung EJ, Son SM, Kwon JS. The effect of sodium reduction education program of a public health center on the blood pressure, blood biochemical profile and sodium intake of hypertensive adults. Korean J Community Nutr. 2012; 17(6):752–771.

19. Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures statistics and strategies for evaluation. Control Clin Trials. 1991; 12:4 Suppl. 142S–158S.

20. Cohen HW, Hailpern SM, Fang J, Alderman MH. Sodium intake and mortality in the NHANES II follow-up study. Am J Med. 2006; 119(3):275.e7–275.e14.

21. Lee KC, Lee JE. Theory and practice of consumer education. 2nd ed. Paju: Kyomunsa;2012. p. 19–25.

22. Kim MK, Lee KG. Consumer awareness and interest toward sodium reduction trends in Korea. J Food Sci. 2014; 79(7):S1416–S1423.

23. Park YS, Son SM, Lim WJ, Kim SB, Chung YS. Comparison of dietary behaviors related to sodium intake by gender and age. Korean J Community Nutr. 2008; 13(1):1–12.

24. Grimes CA, Riddell LJ, Nowson CA. Consumer knowledge and attitudes to salt intake and labelled salt information. Appetite. 2009; 53(2):189–194.

25. Sarmugam R, Worsley A. Current levels of salt knowledge: A review of the literature. Nutrients. 2014; 6(12):5534–5559.

26. Anderson ES, Winett RA, Wojcik JR. Self-regulation, self-efficacy, outcome expectations, and social support: Social cognitive theory and nutrition behavior. Ann Behav Med. 2007; 34(3):304–312.

27. Yon M, Lee Y, Kim D, Lee J, Koh E, Nam E, et al. Major sources of sodium intake of the Korean population at prepared dish level -Based on the KNHANES 2008 & 2009-. Korean J Community Nutr. 2011; 16(4):473–487.

28. Kemm J. Health education and the problem of knowledge. Health Promot Int. 1991; 6(4):291–296.

29. Newson RS, Elmadfa I, Biro G, Cheng Y, Prakash V, Rust P, et al. Barriers for progress in salt reduction in the general population. An international study. Appetite. 2013; 71(1):22–31.

30. Sarmugam R, Worsley A, Flood V. Development and validation of a salt knowledge questionnaire. Public Health Nutr. 2014; 17(5):1061–1068.

31. Zhang J, Xu AQ, Ma JX, Shi XM, Guo XL, Engelgau M, et al. Dietary sodium intake: Knowledge, attitudes and practices in Shandong province, China, 2011. PloS one. 2013; 8(3):e58973.

32. Land MA, Webster J, Christoforou A, Johnson C, Trevena H, Hodgins F, et al. The association of knowledge, attitudes and behaviours related to salt with 24-hour urinary sodium excretion. Int J Behav Nutr Phys Act. 2014; 11(1):47.

33. Kim HY. Activation of nutrition labeling in food and restaurant industry for sodium reduction. Food Sci Ind. 2011; 44(1):28–38.

34. Yim KS. The effects of a nutrition education program for hypertensive female elderly at the public health center. Korean J Community Nutr. 2008; 13(5):640–652.