Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 2, 2024
Date Accepted: Feb 27, 2025
Date Submitted to PubMed: Feb 28, 2025
Effectiveness of an mHealth and school-based health education programme for salt reduction (EduSaltS) in China: cluster randomized controlled trial within scale-up
ABSTRACT
Background:
Globally, cardiovascular diseases are the leading cause of mortality and disability, with hypertension being a major risk factor. Reducing salt intake and blood pressure is among the most effective and economical health promotion strategies. The effectiveness of school-based and mHealth-based salt reduction interventions has been demonstrated in trial settings; however, the impact of these interventions when scaled up in real-world contexts remains uncertain.
Objective:
This study aims to evaluate the effectiveness of the real-world implementation of such an mHealth and school-based health education scale-up programme for reducing salt intake (EduSaltS).
Methods:
A cluster randomized controlled trial was conducted from April 2022 to July 2023 across 20 schools in two districts and two counties within Ganzhou City. Schools were randomly assigned in a 1:1 ratio to either intervention or control group. The EduSaltS intervention, which spanned over one academic year, incorporated both online health education courses and offline salt reduction activities, with participation being monitored through the backend management system. Changes in salt intake and blood pressure among participants were analyzed by comparing surveys and clinical evaluations of baseline and one year later.
Results:
Of the 524 children (288 (54.96%) boys; mean age 9.16 (SD=0.35) years) and 524 adults (194 (37.02%) men; mean age 40.99 (SD=11.04) years) who participated and completed the baseline assessments in 10 intervention and 10 control schools, the loss to follow-up rate was 2.48% (13/524) for children and 8.97% (47/524) for adults. The participation in online courses and offline activities demonstrated favorable results. For schoolchildren, the measured difference in salt intake, SBP and DBP, between the intervention and the control schools, was -0.24g/day (95%CI:-0.77 to 0.65), -0.66mmHg (95%CI:-2.35 to 1.04), and -1.37mmHg (95%CI:-2.79 to 0.06) respectively. For adults, salt intake in the intervention group decreased from 9.0 (SE=0.2) g/day to 8.3 (SE=0.2) g/day after intervention. Compared with the control group, The adjusted change in the intervention group for salt intake, SBP, and DBP were -1.06g/day (95%CI:-1.81 to -0.30), -2.26mmHg (95%CI:-4.26 to -0.26), and -2.33mmHg (95%CI:-3.84 to -0.82), respectively.
Conclusions:
The EduSaltS comprehensive programme is highly practical and suitable for widespread implementation in Jiangxi province and potentially nationwide. participation in the programme resulted in a significant decrease in salt intake for adults, but not their children. Further optimizations of this programme are imperative to cultivate and reinforce salubrious low-salt dietary habits among children. Clinical Trial: Chinese Clinical Trial Registry ChiCTR2400079893, retrospectively registered on January 15, 2024 (embedded in an prospectively registered scale-up study, ChiCTR2000039767), https://www.chictr.org.cn/showproj.html?proj=199678. Keywords: school-based health education, EduSaltS, mobile health, salt reduction, cluster randomized trial
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