JMIR Publications

ABSTRACT

Background:

High salt consumption has contributed to the rise of non-communicable diseases around the world. The application of mobile health (mHealth) technologies have witnessed rapid growth in recent years. However, evidence to support mHealth interventions to confront the challenge of salt-reduction has not yet been critically reviewed.

Objective:

The purpose of this study is to identify, characterize, and evaluate mHealth interventions aimed at salt-reduction across the world.

Methods:

A systematic search of English or Chinese language literature published from 1 January 1992 to 31 July 2017 was conducted using 4 English literature databases (PubMed, MEDLINE, Global Health, and Cochrane) and 3 Chinese literature databases (Wanfang, CSTJ, and CNKI). All studies directly using mobile technologies in health care with a primary or secondary objective of reducing dietary salt consumption were included.

Results:

A total of 1609 articles were found using the search strategy, with 12 full articles (9 English, 3 Chinese) being included for data extraction, including 11 interventional studies. Overall, few high-quality interventions were identified. Most interventions were limited by small study population sample sizes, lack of control groups, and short follow-up times, all of which were obstacles in generating long-term scalable approaches. Most interventions employed short messaging service (SMS), a more traditional and out-dated platform for mHealth interventions, while some innovative mHealth technologies were also explored. Most interventions had a primary focus of improving awareness of dietary salt consumption. The outcome variables used to measure intervention effectiveness included 24-h urinary sodium excretion, spot urine sampling, dietary records, and indirect behaviour or knowledge indicators targeting salt consumption. Although most interventions displayed positive outcome results, none of them provided reliable evidence to evaluate the effectiveness of salt reduction.

Conclusions:

Salt-reduction as in mHealth initiatives remains relatively unexplored, however studies which did intervene on salt-reduction show the potential of mHealth as an effective intervention method. We provide three recommendations for future mHealth interventions in salt reduction: (1) increased use of new, innovative, and interactive mHealth technologies, (2) development of mHealth interventions with primary prevention measures and goals of salt-reduction, and (3) large-scale, rigorously designed, object-targeted clinical trials of mHealth interventions with appropriate quantitative outcome variables.