JMIR Publications

ABSTRACT

Background:

Currently, Australian children and adults are eating too much salt, increasing their risk of cardiovascular-related conditions. Web-based programs provide an avenue to engage the parents of primary schoolchildren in salt-specific messages which may positively impact on their own salt-related knowledge, attitudes and behaviors (KABs).

Objective:

The aim of this study was to determine whether parent’s salt-related KABs improved following participation in the Digital Education to LImit Salt in the Home (DELISH) web-based education program.

Methods:

The DELISH program was a 5-week home delivered web-based intervention targeting schoolchildren aged 7-10 years and their parents. This was a single arm study with a pre- and post-test design. Parents received weekly online educational newsletters and text messages. A study website hosted additional resources. Parents completed online pre- and post-program surveys assessing salt-related KABs. Upon completion of the program, all parents were also invited to complete an online evaluation survey. Changes in KABs outcomes were assessed using McNemar’s tests and paired t-tests.

Results:

Eighty parents commenced the program and 73 parents (mean age 41.0 (7.0) (SD) years, 86% females) completed both pre and post surveys. Overall, mean score for salt-related knowledge improved (+3.6±.41 (SE) points), mean behavior score also improved (+4.5±.61 points), indicating a higher frequency of engaging in behaviors to reduce salt in the diet and mean attitudes score decreased (-0.7±.19 points) representing lower importance of using salt to enhance the taste of food (all P<.001). Following participation, the proportion of parents aware of the daily salt intake recommendation increased from 40% to 74% (P<.001) and awareness of bread as the main source of salt increased from 58% to 95% (P<.001). The proportion of parents who agreed that salt should be used in cooking to enhance the flavor of food decreased from 30% to 11% (P=.002) and the proportion who agreed that sodium information displayed on food labels was difficult to understand decreased from 52% to 32% (P=.009). There was a reduction in the proportion of parents who reported adding salt during cooking (55% vs. 41%, P=.03) and at the table (32% vs. 18%, P=.002). Of the 16 parents who completed the evaluation survey, most parents (75%) enjoyed the program and all found the newsletters to be useful. Almost all parents (94%) agreed that the DELISH education program would be useful to other parents.

Conclusions:

The improvement in salt-related knowledge, attitudes and reported behaviors in the DELISH program indicates the potential for online technology, to effectively disseminate simple salt reduction education messages to families with primary school aged children. Future work should explore opportunities to integrate the program within the school setting to enable wider dissemination.