Barriers, Enablers and Perceptions on Dietary Salt Reduction Among Hypertensive Patients with High Urinary Sodium Excretions in Health Clinics in Batang Padang, Perak, Malaysia 2018

Abstract

Globally, excess of sodium dietary intake attributed an estimated of 1.7 million yearly deaths from cardiovascular causes. Estimated sodium excretion is more strongly associated with increased BP in persons with hypertension than in those without hypertension. A cross-sectional study was conducted among 261 hypertensive patients in six health clinics in the rural district of Batang Padang followed by in depth interviews of 19 hypertensive patients with sodium urine excretion >3 g/day. The mean sodium urine excretion of hypertensive patients was 3.13±0.09 g/day where 66.3% of the hypertensive patients had high sodium urine excretion (≥2.3 g/day). The mean sodium urinary excretions was significantly higher among male patients than in female patients 3.41±1.54 vs. 2.91±1.30 g/day, t= -2.818, p=0.005; higher among <40 years vs 40-60 years (F= 3.255, p = 0.022) and >60 age group (F= 3.255, p = 0.006); higher among no formal education vs. secondary and above group (F= 6.580, p = 0.016) and higher among primary education vs. secondary and above group (F= 6.580, p = 0.008). There were poor correlations between age (r = - 0.182, p = 0.003), years of education (r = 0.182, p = 0.003), Reduction of Salt among Malaysians (ReSAM) health literacy global score (r = - 0.125, p = 0.044), attitude on salt reduction (r = - 0.152, p = 0.014) and practice of salt reduction (r = 0.121, p = 0.050) with the 24 hour urinary sodium excretion levels. The multiple linear regression saw four significant variables which were years of education, ReSAM health literacy global score, other disease knowledge and age. The model explains 15.2% of the variations of the 24-hour sodium urinary excretion levels. Barriers towards achieving salt reduction were (1) eating habits, (2) convenience, (3) comparing with others, (4) lack of knowledge, (5) local culture and traditions, (6) family dynamics and (7) self control and taste. Enablers in achieving salt reduction were (1) knowledge and awareness, (2) aware of health readings, (3) high BP symptoms , (4) family and friends, (5) family dynamics, (6) gardening at home, (7) assertiveness and (8) fruits and vegetables. Perceptions of salt reduction among hypertensive patients with high urine sodium excretion were (1) not disturbed much by high salt level, (2) disturbed by high salt levels, (3) local culture and traditions, (4) myth and misunderstandings, (5) blood pressure control and (6) salt body requirements. As a conclusion, most hypertensive patients still consume high amount of salt in their diet. Salt reduction intervention among hypertensive patients addressing barriers, enablers and perception on dietary salt reduction is important as to compliment dietary education to achieve low salt intake among hypertensive patients and ultimately to acheive better BP control.