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Implementation of a salt substitute intervention using social marketing in resourced-limited communities in Peru: a process evaluation study

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dc.contributor.author Lazo Porras, María de los Ángeles
dc.contributor.author Del Valle, Adela
dc.contributor.author Beran, David
dc.contributor.author Pesantes Villa, María Amalia
dc.contributor.author Pérez León Quinoso, Silvana Patricia
dc.contributor.author Ponce Lucero, Vilarmina
dc.contributor.author Bernabé Ortiz, Antonio
dc.contributor.author Cárdenas García-Santillán, María Kathia
dc.contributor.author Chappuis, François
dc.contributor.author Perel, Pablo
dc.contributor.author Miranda, J. Jaime
dc.contributor.author Diez-Canseco Montero, Francisco
dc.coverage.spatial Tumbes, Perú
dc.date.accessioned 2023-09-06T20:45:09Z
dc.date.available 2023-09-06T20:45:09Z
dc.date.issued 2023
dc.identifier.uri https://hdl.handle.net/20.500.12866/14085
dc.description.abstract Objective: This study aimed to conduct a process evaluation of a salt substitute trial conducted in Peru. Methods: Through semi-structured interviews of intervention participants, we documented and analyzed process evaluation variables as defined by the Medical Research Council Framework. This study was a stepped wedge trial conducted in Tumbes, Peru in 2014. The intervention was a community-wide replacement of regular salt (100% sodium) with “Salt Liz” (75% sodium and 25% potassium) using social marketing strategies to promote the adoption and continued use of the salt substitute in daily life. The components of the social marketing campaign included entertainment educational activities and local product promoters (“Amigas de Liz”). Another component of the intervention was the Salt Liz spoon to help guide the amount of salt that families should consume. The process evaluation variables measured were the context, mechanism of action, and implementation outcomes (acceptability, fidelity and adoption, perceptions, and feedback). Results: In total, 60 women were interviewed, 20 with hypertension and 40 without hypertension. Regarding context, common characteristics across the four villages included residents who primarily ate their meals at home and women who were responsible for household food preparation. As the mechanism of action, most participants did not notice a difference in the flavor between regular salt and Salt Liz; those that did notice a difference took around 2 weeks to become accustomed to the taste of the salt substitute. In terms of implementation outcomes, the Salt Liz was accepted by villagers and factors explaining this acceptability included that it was perceived as a “high quality” salt and as having a positive effect on one's health. Participants recognized that the Salt Liz is healthier than regular salt and that it can help prevent or control hypertension. However, most participants could not accurately recall how the compositions of the Salt Liz and regular salt differed and the role they play in hypertension. Although the use of the Salt Liz was far-reaching at the community level, the use of the Salt Liz spoon was poor. Educational entertainment activities were well-received, and most participants enjoyed them despite not always being active participants but rather sideline observers. Conclusion: This process evaluation identifies key intervention components that enabled a successful trial. Seeking and incorporating feedback from the target population helps deepen the understanding of contextual factors that influence an intervention's success. Furthermore, feedback received can aid the development of the intervention product. Some factors that can be improved for future interventions are acknowledged. en_US
dc.language.iso eng
dc.publisher Frontiers
dc.relation.ispartofseries Frontiers in Public Health
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject Process evaluation en_US
dc.subject Salt replacement en_US
dc.subject Context en_US
dc.subject Acceptability en_US
dc.subject Fidelity en_US
dc.subject Low- and middle-income countries en_US
dc.subject Hypertension en_US
dc.subject.mesh Evaluación de Procesos, Atención de Salud
dc.subject.mesh Sales (Química)
dc.subject.mesh Aceptación de la Atención de Salud
dc.subject.mesh Países en Desarrollo
dc.subject.mesh Hipertensión
dc.title Implementation of a salt substitute intervention using social marketing in resourced-limited communities in Peru: a process evaluation study en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.3389/fpubh.2023.1068624
dc.relation.issn 2296-2565


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