Perceptions, barriers and enablers on salt reduction in the out-of-home sectors in five regions of Malaysia from the perspectives of policy makers and food industries

Abstract

Foods consumed outside the home are an increasing source of salt which contributed to the high salt intake, high prevalence of hypertension and CVD death in Malaysia. This study was a qualitative explorative study aimed to identify the perceptions, barriers and enablers on salt reduction among out of home sectors from the perspectives of policy makers and food industries in five regions of Malaysia. A purposive and snowball sampling technique was used which included 40 policy makers and 65 food industries. Questions were constructed from the social ecological model and tested prior to focus group discussion (FGD)/in-depth interview (IDI) sessions as conducted virtually or face to face. Two research team members facilitate interviews and two did transcription of recorded voices. Transcribed data were analysed using NVivo version 12 software by the main researcher using thematic content analysis. The data was coded, sorted into potential themes and subthemes then reviewed, defined and named. Data analysis showed four main perceptions themes emerged namely perceptions on salt intake, salt reduction policy, implementation of current salt reduction policy and industry practice and action. Both stakeholders agreed that salt intake in Malaysia is high. Subthemes emerged for perceptions on salt intake were high salt intake , sources of high salt intake and health risks of high salt intake. In term of implementation of current salt reduction policy, generally both stakeholders agreed that reducing salt intake in the population is feasible though current strategy is not effective and it might reduce the sale or profits of food industry. Ministry of Health should lead the salt reduction with gradual change on voluntary basis first then followed by mandatory salt reduction. Current practice and action showed that food industry has already started initiatives to reduce salt, but high technology and innovation are needed. Motivations and goal’s themes were named as the awareness, health gain, funding, research and technology, knowledge, incentives/recognition and Community Social Responsibility. Barriers and challenges themes were defined as customer acceptance, behavioural change, lack of knowledge, lack of resources, reformulation challenge, salt reduction is not a priority, no guideline and standard, lack of support, increased cost, food stability & shelf life, lack of Research and Development (R&D) and funding, perception on healthy food is pricey, certification issues, cheap price of salt, food analysis issues, lack of enforcement and special requirement by Navy. Enablers and suggestions themes were to prioritize the salt reduction policy, to educate and create awareness on salt, develop guideline/standard/new regulation, enforcement, to have salt target/salt tax, R&D or new technology for the production and application of low salt products, to have premium products together with the marketing and funding support, usage of natural seaweed or spices or herbs, home cooked foods, subsidy for healthy foods, to use influencer for awareness and to have collaboration and engagement with many stakeholders. In conclusion, perceptions, motivations, barriers and enablers by policy makers and food industries were multifaceted and almost similar. Both stakeholders should be involved in strengthening the current and future review or development of any policy of salt reduction in Malaysia.