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Knowledge, attitudes and behaviors towards salt/sodium and use of information in the consumer food environment

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Author(s):
Alícia Tavares da Silva Gomes
Total Authors: 1
Document type: Doctoral Thesis
Press: São Paulo.
Institution: Universidade de São Paulo (USP). Faculdade de Saúde Pública (FSP/CIR)
Defense date:
Examining board members:
Patrícia Constante Jaime; Rafael Moreira Claro; Natalie Marinho Dantas; Ana Paula Bortoletto Martins
Advisor: Patrícia Constante Jaime
Abstract

Introduction: Excessive sodium consumption is prevalent among populations and is associated with negative health outcomes. Understanding individual and environmental factors that influence intake is essential for proposing evidence-based measures. Objective: To explore knowledge, attitudes, and behaviors (KAB) regarding salt/sodium among adults, and the use of available information in the consumer food environment among residents of a medium-sized city in São Paulo state. Methods: A scoping review was conducted to identify the literature on salt/sodium KAB among adults living in the Americas. Searches were performed in six databases and across 64 websites. The search strategies combined relevant terms/keywords related to the concepts of interest and geographical limits. No language, date, or study design limits were applied. The searches were conducted between September-October/2023. A validation study was conducted to develop an instrument for assessing salt/sodium KAB among Brazilians. Experts (n=11) evaluated the representativeness and clarity of the items, generating item and scale content validity indexes (I-CVI and S-CVI). Face validity was analyzed through a focus group (n=8), followed by an operational test (n=36). Using data collected through telephone interviews (probabilistic sample, 20-59 years old, sex-balanced, residents of Jundiaí-SP, n=422), exploratory factor analysis was conducted to assess construct validity, and Cronbachs alpha (&alpha;) was calculated for reliability. Considering the impact on the intake of critical nutrients, the use of information related to nutritional quality and marketing (MKT) in the consumer food environment was described (n=422). Results: After removing duplicates, 1689 references from the databases were screened by title and abstract, and data were extracted from 24 of them. A similar process was conducted for the grey literature (n=54), with seven studies deemed suitable for data extraction. Most studies described salt/sodium KAB among adults in North America (n=16). Knowledge was commonly assessed through the recognition of recommendations and health consequences. Attitudes addressed perceptions and intentions. Behaviors were identified based on the adoption of practices to modulate intake. The developed instrument demonstrated to have representative and clear items (I-CVIs: 0.73-1 and S-CVIs: 0.93; 0.97) and was suitable for application. The final model, with 16 items, sufficiently explained the variance (24%) and showed good reliability (&alpha;=0.81). Advertisements on \"health benefits\" (76%) were the most popular information used, with approximately 40% higher usage compared to the most popular nutritional information (nutrient claims; 35%). Younger consumers, who do not cook at home and frequently consume ultra-processed foods, mainly considered MKT (p<0.05). Conclusion: American literature on salt/sodium KAB is concentrated in the North region, indicating a need for more data from other regions. The studies presented different metrics on dimensions, complementing the understanding of facilitators and barriers to reducing consumption. The instrument developed for assessing salt/sodium KAB among adults in Brazil is ready to be applied and easily reproduced. Purchase decisions are influenced by elements present in the consumer food environment, which can be subjected to regulation to promote healthy choices. (AU)

FAPESP's process: 18/14198-0 - Retail food environment and knowledge, food practices and sodium consumption
Grantee:Alícia Tavares da Silva Gomes
Support Opportunities: Scholarships in Brazil - Doctorate (Direct)