Effectiveness of a Communication for Behavioral Impact (<scp>COMBI</scp>) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples

Do, Ha Thi Phuong; Santos, Joseph Alvin; Trieu, Kathy; Petersen, Kristina S.; Le, Mai Bach; Lai, Duc Truong; Bauman, Adrian; Webster, Jacqui

doi:10.1111/jch.12884

Cited by 43 publications

(75 citation statements)

References 32 publications

(60 reference statements)

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“…13 However, most of these studies were conducted in high-income countries and there is little evidence about the usefulness of spot urine in low-or middle-income countries. 45,47,48 In the recently published SHAKE Package for Salt Reduction, WHO recommends that if resources and capacity permit, countries should collect 24-hour urine samples, but in cases where this is not possible, countries may obtain spot urine samples to measure population salt consumption. 3 The usefulness of spot urine in estimating mean change in population salt intake over time has also been recently explored.…”

Section: Discussionmentioning

confidence: 99%

“…3 The usefulness of spot urine in estimating mean change in population salt intake over time has also been recently explored. 48,49 Future robust research studies on spot urine are still required to strengthen the evidence regarding its application and to better understand which equations to use in different population groups. Furthermore, it is noteworthy that bread was the focus of three out of four included studies.…”

Section: Discussionmentioning

confidence: 99%

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The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Santos

Trieu

Thout

et al. 2017

J of Clinical Hypertension

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This review aims to identify, summarize, and appraise studies reporting on the implementation of salt reduction interventions that were published between March and August 2016. Overall, 40 studies were included: four studies evaluated the impact of salt reduction interventions, while 36 studies were identified as relevant to the design, assessment, and implementation of salt reduction strategies. Detailed appraisal and commentary were undertaken on the four studies that measured the impact of the interventions. Among them, different evaluation approaches were adopted; however, all demonstrated positive health outcomes relating to dietary salt reduction. Three of the four studies measured sodium in breads and provided consistent evidence that sodium reduction in breads is feasible and different intervention options are available.None of the studies were conducted in low-or lower middle-income countries, which stresses the need for more resources and research support for the implementation of salt reduction interventions in these countries. | INTRODUCTIONHigh salt intake is one of the main contributors to premature death from cardiovascular diseases globally. of countries (China, Finland, France, England, and Ireland) had already achieved significant reductions in population salt intake. | METHODOLOGYA detailed description of the search strategy used to identify and screen studies in this review has been previously reported. In the current review, studies evaluating the impact of salt reduction interventions were appraised for risk of bias by two independent reviewers using a modified Cochrane risk of bias tool for nonrandomized trials of intervention studies. 4,7 Detailed appraisal and commentary were also performed on these studies. Other types of studies that provided information pertinent to the design, implementation, and assessment of salt reduction interventions were summarized in a table.These include (1) studies on monitoring and surveillance of salt intake;(2) salt content in foods; (3) consumers' knowledge, attitudes, and behaviors toward salt; (4) economic evaluation or modeling studies of salt reduction strategies; and (5) other studies related to implementation of salt reduction initiatives. | RESULTSThe MEDLINE search identified 3675 citations, of which 85 were considered potentially eligible for full review on the basis of their findings relevant to salt reduction interventions. Ultimately, a total of 40 studies met the inclusion criteria: four studies evaluated the impact of salt reduction interventions, 21 were surveillance or monitoring studies, five were modeling studies relating to salt reduction, and 10 other studies related to the implementation of salt reduction interventions (Figure 1). conducted at a community level, 8,11 one assessed the impact of salt substitution in breads employed at a community level, 10 and one evaluated the changes in sodium levels in foods achieved through voluntary sodium reduction targets implemented at a national level. 9The method for evaluating the impact ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Santos

Trieu

Thout

et al. 2017

J of Clinical Hypertension

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“…The evaluation of sodium excretion from spot urine is feasible in patients who do not have hypertension or do not take medications. In the study by Do and colleagues only 8% of patients were taking hypotensive drugs and only 26% were hypertensive. The change in sodium after the intervention was smaller using spot urine than 24‐hour urine collection .…”

Section: Homeostatic Equilibrium Of Sodium and Watermentioning

confidence: 94%

“…In the study by Do and colleagues only 8% of patients were taking hypotensive drugs and only 26% were hypertensive. The change in sodium after the intervention was smaller using spot urine than 24‐hour urine collection . This is likely because of the different sodium excretion during the day depending on intake and values of aldosterone.…”

Section: Homeostatic Equilibrium Of Sodium and Watermentioning

confidence: 94%

“…The greatest proportion of dietary sodium comes from salt added in home cooking, soy sauce, and commercially processed foods . The results of the study by Do and colleagues show a correlation between reduced sodium intake and sodium excretion using spot urine samples. Moreover, they demonstrated that a community‐based intervention on salt reduction behavior can reduce the risk related to high sodium intake.…”

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confidence: 99%

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Considerations for the Assessment of Salt Intake by Urinary Sodium Excretion in Hypertensive Patients

Armanini

Bordin

Andrisani

et al. 2016

J of Clinical Hypertension

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3Do and colleagues 1 have evaluated the effectiveness of the Eat Less Salt intervention in a Vietnamese population, collecting spot urine samples for estimation of 24-hour sodium excretion before and after informed reduction of sodium intake.It is well-known that hypertension has important implications both on the expense of health and on the future risk of illness. A major factor involved in hypertension is salt intake associated with genetic predisposing factors. Increased dietary sodium intake is a modifiable risk factor for cardiovascular disease. The monitoring of population sodium intake is a key part of any salt reduction intervention. However, the extent and methods used for assessment of sodium intake in Southeast Asia is currently unclear.2 Dietary data suggest that sodium intake in most Southeast Asian countries exceeded the World Health Organization recommendation of 2 g/d, 3 and even healthy patients have frequently lower renin values compared with those in western countries, as a result of different sodium intake. The greatest proportion of dietary sodium comes from salt added in home cooking, soy sauce, and commercially processed foods. 4 The results of the study by Do and colleagues 1 show a correlation between reduced sodium intake and sodium excretion using spot urine samples. Moreover, they demonstrated that a community-based intervention on salt reduction behavior can reduce the risk related to high sodium intake.Collection of 24-hour urine is widely considered the best method for assessment of sodium intake. 5 It is known that about 90% of ingested sodium is excreted in the urine in 24 hours. The remaining 10% is excreted through sweat and feces, which could play an important role in situations of hot climates, increased physical activity, diarrhea, and vomiting. Assessment of completeness of 24-hour urine collection is more precise measuring urinary creatinine or administering paraaminobenzoic acid.6 This latter method may be challenging for patients because it requires administration several times during the 24-hour collection.Recently, many authors have tried to demonstrate that 24-hour sodium excretion can be estimated using spot urine samples, which are easily collected and cannot account for inaccuracy of collection and losses. 7 Sodium concentration in spot urine represents the sodium intake in the short period preceding the collection; for that reason, the sodium excretion can vary during the day depending on sodium intake. Spot urine samples, however, have increased individual variability depending not only on sodium ingestion in the previous hours but also water ingestion and regulation of hormonal and nonhormonal factors involved in sodium concentration. The determination should be standardized by collecting urine samples at the same period of the day to compare the excretion in the same patient.The estimation of sodium intake from measurement of sodium excretion is feasible in the general population, in particular in studies aimed to investigate a sample of patients before and af...

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COMBI : Communication for Behavioral Impact

White¹

2022

The International Encyclopedia of Health Communication

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Communication for Behavioral Impact (COMBI) is a communication planning model for social mobilization and strategic behavior change applied to social or health interventions. The guiding mantras of the approach are: doing nothing until precise behavioral objectives have been set, and doing nothing until a situational market analysis has been undertaken. COMBI adopts its communication planning processes from public relations, community mobilization, sustained appropriate advertising, interpersonal communication, and point‐of‐service promotion. The key steps in the COMBI planning process involve considering the goal, behavioral objective(s), situational market analysis, strategy for achieving the results, plan of action, management and implementation, monitoring, assessment of behavioral impact, and budget. The model is informed by marketing theory that speaks to audience, exchange theory and value, competition, and the four Cs of integrated marketing communication. COMBI also benefits from models used in health behavior change such as the health belief model, the theory of reasoned action or planned behavior, social cognitive theory, and the transtheoretical model. Despite its advantages, some downfalls of COMBI are that on its own it does not always generate development and programs using COMBI often require substantial resources. Nonetheless, COMBI programs aim at an integrated effort with a thoughtful amalgamation and selection of communication actions relevant to achieving desired behavioral outcomes.

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Effectiveness of a Communication for Behavioral Impact (COMBI) Intervention to Reduce Salt Intake in a Vietnamese Province Based on Estimations From Spot Urine Samples

Cited by 43 publications

References 32 publications

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

The Science of Salt: A regularly updated systematic review of the implementation of salt reduction interventions (March–August 2016)

Considerations for the Assessment of Salt Intake by Urinary Sodium Excretion in Hypertensive Patients

COMBI : Communication for Behavioral Impact

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