Evaluation of Consumer Nutrition Education Program to Reduce Sodium Intake Based on Social Cognitive Theory

Article information

Korean J Community Nutr. 2015;20(6):433-446

Publication date (electronic) : 2015 December 31

doi : https://doi.org/10.5720/kjcn.2015.20.6.433

So-Hyun Ahn ¹, Jong Sook Kwon ², Kyung Min Kim ³, Jin-Sook Yoon ⁴, Hye-Kyeong Kim ¹

¹Department of Food Science & Nutrition, The Catholic University of Korea, Bucheon, Korea.

²Department of Food and Nutrition, Shingu College, Songnam, Korea.

³Department of Food and Nutrition, Baewha Women's University, Seoul, Korea.

⁴Department of Food and Nutrition, Keimyung University, Daegu, Korea.

Corresponding author: Hye-Kyeong Kim. Department of Food Science & Nutrition, The Catholic University of Korea, 43 Jibongro, Wonmi-gu, Bucheon-si, Gyeonggi 14662, Korea. Tel: (02) 2164-4314, Fax: (02) 2164-4314, hkyeong@catholic.ac.kr

Received 2015 October 12; Revised 2015 December 13; Accepted 2015 December 13.

Abstract

Objectives

This study was performed to evaluate the consumer education program for reducing sodium intake based on social cognitive theory (SCT) and investigate consumer perceptions of environmental, cognitive and behavioral factors.

Methods

Consumers (n=4,439) were recruited nationwide in Korea to participate in a nutrition education program for reducing sodium intake which was targeted on senior housewives (SH), parents (P), and office workers (OW). Questions regarding main factors of SCT were asked both before and after the education program.

Results

SH and P recognized external social efforts and information to reduce sodium including nutrition labeling more than OW. The main barriers to practice reducing sodium intake were limited choice of low sodium food and menu, interference with social relationship when dining with others, and limited information, knowledge and skills. SH had lower barriers to practice reducing sodium intake and OW perceived 'preference to soup or stew' and 'preference to Kimchi, salted fish and fermented sauces' as barriers more than other groups at the baseline. Less than 50% of participants knew the relationship between sodium and salt, sodium in nutrition labeling, and recommended sodium intake. In addition, OW had little knowledge for capability to reduce sodium intake and lower self-efficacy to practice compared with SH and P. After education, positive outcome expectations such as lowering blood pressure, prevention of cardiovascular disease and osteoporosis were increased and barriers to practice reducing sodium intake were decreased in all groups (p < 0.05). The knowledge for behavioral capability and self-efficacy to reduce sodium intake were also improved but OW had still lower scores compared with other groups.

Conclusions

These results suggested that nutrition education programs could be an effective tool to impact general population by facilitating awareness and increased capability to reduce sodium intake.

Keywords: nutrition education program; reducing sodium intake; consumer; social cognitive theory

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Article information Continued

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Funded by : Korea Food and Drug Adminstration

Award ID : 11162Sobiyeon165

Table 1

Regional distribution of the subjects participated in the educational program

1) N (%): subtotal population of local unit

2) N (%): subtotal education times of local unit

3) N (%): subtotal participated subjects of local unit

Table 2

The demographic characteristics of the study subjects

1) Mean ±SD: Mean values with different letters within a row are significantly different by Duncan's multiple range test after one way ANOVA

2) N (%)

Table 3

Perception of environmental factors related to salt reduction and experience of low sodium product

1) N (%): The response number and rate of 'yes' to each item

Table 4

The change of positive outcome expectation of reducing sodium intake

1) P value from chi-square test by subject group in each category at the baseline

2) P value from chi-square test by subject group in each category after nutrition education

3) Q1: Decrease of blood pressure, Q2: Prevention to stroke and heart diseases, Q3: Weight loss, Q4: Reduction of swelling in body, Q5: Skin enhancement, Q6: Prevention to osteoporosis, Q7: Prevention to cancer

4) N (%): The response number and rate of 'yes' in each item.

5) P value from chi-square test in each item of same subject group (^*: p < 0.05, ^**: p < 0.01, ^***: p < 0.001)

Table 5

The change of negative barriers to practice reducing sodium intake

1) P-value from ANCOVA adjusted by age, sex, height and weight among subject group in each category at the baseline

2) P-value from ANCOVA adjusted by age, sex, height and weight among subject group in each category after nutrition education

3) Q1:Bad taste, Q2:Hard to prepare and cook, Q3:Limitation to choose food, menu and restaurant, Q4:Limited information, knowledge and skills to practice Q5:Interference with to social relationship when dining with family and friends, Q6:Preference to broth dishes (soup, stew), Q7:Preference to Kimchi, salted fish, fermented sauces

4) Mean±SD, Mean values with different superscripts are significantly different among the groups at baseline(before) at α=0.05 as determined by Duncan's multiple range test The lower score means less barriers to practice reducing sodium intake (1=very hard to agree, 2=hard to agree, 3=agree a little, 4=agree, 5=agree a lot)

5) P from paired t-test in each subject group (^*: p < 0.05, ^**: p < 0.01, ^***: p < 0.001)

Table 6

The change of subjects' perceptions and self-efficacy related to reducing sodium intake

1) P-value from ANCOVA adjusted by age, sex, height and weight among subject group in each category at the baseline

2) P-value from ANCOVA adjusted by age, sex, height and weight among subject group in each category after nutrition education

3) Q1:I feel unfulfilled or unsatisfied when eating foods with less salt, Q2:I usually recognize the sodium contents in food or dish, Q3:Practicing low-sodium diet will improve my health status, Q4:I will buy fresh food rather than processed or instant food, Q5:I will request less salty when eating-out, Q6:I will choose dishes with native flavor and taste rather than hot, salty, spicy one, Q7:I will have concern for low-sodium recipe. Q8:I think that influence of consumers' sodium reduction can induce the change of social surroundings.

4) Mean±SD. Mean values with different superscripts and subscripts are significantly different among the groups at baseline (before) and after nutrition education, respectively, at α=0.05 as determined by Duncan's multiple range test. The higher score means better perceptions and self-efficacy (1=very hard to agree, 2=hard to agree, 3=agree a little, 4=agree, 5=agree a lot. The 1'st question was coded conversely)

5) P from paired t-test in each subject group (^*: p < 0.05, ^**: p < 0.01, ^***: p < 0.001)

Table 7

The change of subjects' knowledge for behavioral capability to reduce sodium intake

1) P-value from chi-square test by subject group in each category at the baseline

2) P value from chi-square test by subject group in each category after nutrition education

3) Q1:Excess intake of sodium can increase the risk of osteoporosis, Q2:The amount of sodium and the amount of salt are the same in the same food, Q3:Two tablespoons of salt are the goal intake of salt in a day, Q4:Sodium is necessary to keep the balance and equilibrium of body fluids, Q5:Sodium exists in various food additives such as baking powder and preservatives, Q6:Sufficient intake of vegetables and fruits helps with sodium excretion, Q7:For nutrition labeling, salt content is indicated in the labeling, Q8:Grilled fish with sauce has much more salt than grilled fish itself, Q9:One tablespoon of salt has the same amount of sodium as one tablespoon of soybean paste (miso), Q10:The amount of sodium in the noodle itself is more than that in the broth of Ramen

4) N (%) : the number and rate of correct answer.

5) P value from chi-square test in each item of same subject group (^*: p < 0.05, ^**: p < 0.01, ^***: p < 0.001)

6) Mean±SD : Sum of correct answers out of ten items. Mean values with different superscripts and subscripts are significantly different among the groups at baseline(before) and after nutrition education, respectively, at α=0.05 as determined by Duncan's multiple range test.

Table 8

The evaluation results of education according to target group

1) Mean±SD. Mean values with different subscripts are significantly different among the groups at α=0.05 as determined by Duncan's multiple range test. The higher score means agreement to the questions (1=very hard to agree, 2=hard to agree, 3=agree a little, 4=agree, 5=agree a lot)

2) P-value from ANCOVA adjusted by age, sex, height and weight among subject group in each category