Psychometric testing of the Determinants of Salt-Restriction Behaviour Questionnaire in people of Chinese ancestry: a methodological study

(2022) 21:339 Chan et al. BMC Nursing https://doi.org/10.1186/s12912-022-01124-5 Open Access RESEARCH Psychometric testing of the Determinants of Salt‑Restriction Behaviour Questionnaire in people of Chinese ancestry: a methodological study Alex Chan1,2* , Leigh Kinsman1,3   and Sally Wai‑chi Chan4    Abstract Purpose: Nurses play a key role in educating people about a salt-reduced diet to prevent or manage hypertension or cardiac failure. Assessment tools such as the Chinese Determinants of Salt-Restriction Behaviour Questionnaire (DSRBQ) can provide essential evidence to inform education strategies. This study aimed to translate the DSRBQ into English and evaluate the psychometric properties of the Chinese and English versions for people of Chinese ethnicity in Australia. Methods: A two-phase cross-sectional descriptive study was conducted. Phase 1: The questionnaire was translated into English using the back-translation method. The translation equivalence and content relevance were evaluated by an expert panel. Three items were revised and eight items were removed. Phase 2: Internal consistency and stability of the questionnaires were evaluated by a group of Chinese Australians. Results: Both the English and Chinese versions had satisfactory psychometric properties. In phase 2, 146 participants completed the questionnaire (test), and 49 participants completed the retest. The Cronbach’s alpha scores were 0.638 and 0.584 respectively, and the overall intra-class correlation coefficients were 0.820 and 0.688 respectively for the English and Chinese versions. The Item-Content Validity Index (CVI) ranged from 0.50 to 1.00. The Scale-CVI was 0.94. Conclusion: The DSRBQ has been translated into English. Both English and Chinese versions have acceptable validity and reliability. The tools can be used in people from a Chinese cultural background living in Australia. Further valida‑ tion testing may allow the tools to be adapted for use with other Chinese diaspora groups. The validated DSRBQ will support the development of evidence-based salt reduction nursing assessment tool and interventions for Chinese diasporas who reside in a country where Chinese cultural practices are employed by a minority. Keywords: Diet, Salt, Salt reduction, Chinese, Diasporas, Questionnaire, Psychometric testing, Methodological study *Correspondence: 2 School of Nursing, University of Wollongong, 33 Moore Street, Liverpool, NSW 2170, Australia Full list of author information is available at the end of the article Introduction High dietary salt consumption is a global health issue and the cause of many non-communicable diseases including hypertension and renal disease [1, 2]. Dietary salt restriction is an effective primary and secondary preventive measure for hypertension [3–5]. Currently, the World Health Organization (WHO) recommends a maximum daily salt consumption for healthy adults of 5 g (g) per © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativeco mmons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Chan et al. BMC Nursing (2022) 21:339 day [1]. However, many adults consume higher than the recommended amount in their daily diets [6, 7]. This may be associated with cultural practices and personal food taste preferences. A sociology study in 2011 estimated that more than 40 million individuals of Chinee descent lived in 148 countries around the world [8]. The 2016 Census found that over 5.1% (1.2 million) of Australians reported Chinese ancestry, and of these, only 25% were born in Australia [9]. An Australian study showed that Chinese immigrants who had resided in Australia for a longer period had more cardiovascular risk factors such as hypertension, diabetes and high cholesterol [10]. For example, the prevalence of hypertension among Chinese female immigrants who had lived in Australia for 30 years or longer was greater compared with those who had lived in Australia for less than 10 years (prevalence ratio = 1.47; p < 0.05) [10]. Recent statistics showed that average salt consumption in China was above 10 g/day [11], in Singapore it was 8.5 g/day [12], in Italy it was 9.0 g/day [13] and in Australia it was 9.6 g/day [14]. It is important to note that most salt consumption studies have focused on the main ethnic groups of the countries in which the studies were conducted. The dietary salt practices and related public health issues in minority population groups such as migrants are less explored. Further, the effects of Westernisation on food selections may influence non-Westerners’ dietary selections, leading to an increase in overall salt consumption. In general, dietary practices are often affected by multiple factors including personal preferences and cultural inheritance. Therefore, it is important to study the salt-related knowledge and perceptions of and perceived barriers to following a low-salt diet of the target Chinese population group. Evidence showed that there was a close relationship between salt consumption and blood pressure [15]. With an increase of 2.5 g (1 g of sodium) in daily salt consumption increased the blood pressure by 2.11/0.78 mmHg and this effect was more significant in people who consumed more than 7.5 g of salt per day [15]. A recent literature review in 2022 suggested that salt-related health education might have positive influences on dietary behavioural changes and Chinese diasporas especially the new migrants might experience linguistic and cultural barriers when they seek dietary advice in their host countries [16]. Little is known about the current landscape and effects of the existing salt-related education and the challenges of reducing salt consumption for preventing hypertension among Chinese diasporas. Given more than 1.2 million (5.1%) Australians reported Chinese ancestry and that salt reduction is an effective preventive strategy for hypertension, there is a pressing need Page 2 of 11 to assess the level of daily salt consumption, perceptions and knowledge in this ethnic (...truncated)