Abstract:
BACKGROUND: High salt intake is associated with increased blood pressure, the leading dietary risk factor for cardiovascular disease (CVD) mortality in New Zealand (NZ) and globally. Salt reduction programmes are the 'best-buy' to reducing population salt intake and improving health outcomes. Despite the burden of disease, NZ lacks a structured, government-led salt reduction programme. In order to develop an appropriate programme, understanding of population salt consumption patterns are required including consumers' salt-related knowledge, attitudes and behaviours (KAB). AIM: The aim of this thesis research was to assess the knowledge, attitudes and behaviours (KAB) related to dietary salt intake among adults. Objectives were to explore differences in salt-related KAB by demographic characteristics and explore the salt-related KAB among parents/caregivers. METHODS: A systematic literature review was conducted across four scientific databases to examine saltrelated KAB among adults in high-income countries. A web-based cross-sectional survey of adults aged 18-65 years living in NZ was then conducted over a 12-week period using multiple recruitment methods (shopper intercept, Facebook advertising and consumer research panel). Analysis comprised of descriptive statistics, chi-square test for differences by demographic characteristics, and inductive thematic analysis of qualitative responses. RESULTS: Twenty-four studies published between 1950-2018, representing 12 high-income countries were included in the review. The review found there is room for improving consumers' salt-related KAB and identified a need for higher quality KAB surveys, representative of study populations. A sample of n=1131 adults completed the NZ KAB survey. Overall, adults lacked fundamental knowledge of the dietary recommendations of salt, relationship between salt and sodium, and non-CVD health issues associated with high salt intake. Discretionary salt was frequently added to food during cooking. Participants agreed nutrition information on food packaging was difficult to interpret and proved to be a barrier to reducing salt intake. Salt-related KAB gaps were identified among males, Māori, Pacific Island and Asian sub-groups. Parents/caregivers employed strategies during food purchasing and meal preparation to reduce children's salt intake in response to concern about the amount of salt children were consuming. CONCLUSION: Salt-related KAB of NZ adults were similar to those of adults in other high-income countries. Priority areas for improving salt-related KAB were identified indicating the need for awareness raising/education campaigns to be incorporated within structured population salt reduction programmes. Further research is required to better understand salt-related KAB of parents/caregivers in efforts to improve long-term child health outcomes, and continued monitoring of KAB is required to ensure consumers respond to salt reduction programmes.