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Randomized Controlled Trial
. 2021 Oct 21;9(10):e26233.
doi: 10.2196/26233.

A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial

Sarah Payne Riches  1 , Carmen Piernas  1 , Paul Aveyard  1   2 , James P Sheppard  1 , Mike Rayner  3 , Charlotte Albury  1 , Susan A Jebb  1   2
Affiliations
Randomized Controlled Trial

A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial

Sarah Payne Riches et al. JMIR Mhealth Uhealth. .

Abstract

Background: A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs.

Objective: The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention's effectiveness.

Methods: This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated.

Results: A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors.

Conclusions: The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted.

Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962.

Keywords: behavior change; mHealth; mobile health; mobile phone; salt reduction; smartphone app.

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Conflict of interest statement

Conflicts of Interest: The University of Oxford is the owner of the SaltSwap app.

Figures

Figure 1
Figure 1
The SaltSwap intervention and included behavior change techniques. BCT: behavior change technique.
Figure 2
Figure 2
The SaltSwap app screenshots.
Figure 3
Figure 3
CONSORT (Consolidated Standards of Reporting Trials) diagram. GP: general practitioner; HCP: health care professional.
Figure 4
Figure 4
Changes in blood pressure from baseline to follow-up. BP: blood pressure.
See this image and copyright information in PMC

References

    1. The top 10 causes of death. World Health Organization. 2020. [2020-05-09]. http://www.who.int/mediacentre/factsheets/fs310/en/
    1. Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, Lim S, Danaei G, Ezzati M, Powles J. Global sodium consumption and death from cardiovascular causes. N Engl J Med. 2014 Aug 14;371(7):624–34. doi: 10.1056/NEJMoa1304127. doi: 10.1056/nejmoa1304127. - DOI - PubMed
    1. Ettehad D, Emdin CA, Kiran A, Anderson SG, Callender T, Emberson J, Chalmers J, Rodgers A, Rahimi K. Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet. 2016 Mar;387(10022):957–67. doi: 10.1016/S0140-6736(15)01225-8. doi: 10.1016/s0140-6736(15)01225-8. - DOI - PubMed
    1. Law MR, Morris JK, Wald NJ. Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies. Br Med J. 2009 May 19;338:b1665. doi: 10.1136/bmj.b1665. http://europepmc.org/abstract/MED/19454737 - DOI - PMC - PubMed
    1. Tackling high blood pressure. From evidence into action. Public Health England. 2014. Nov, [2021-09-02]. https://assets.publishing.service.gov.uk/government/uploads/system/uploa... .

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