Using the health belief model to understand the factors influencing the perceptions of people of Chinese ancestry about reducing salt consumption for hypertension prevention: A cross-sectional study

PLOS ONE RESEARCH ARTICLE Using the health belief model to understand the factors influencing the perceptions of people of Chinese ancestry about reducing salt consumption for hypertension prevention: A cross-sectional study Alex Chan ID1,2☯*, Sally Wai-chi Chan3☯, Leigh Kinsman1,4☯ a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 OPEN ACCESS Citation: Chan A, Wai-chi Chan S, Kinsman L (2023) Using the health belief model to understand the factors influencing the perceptions of people of Chinese ancestry about reducing salt consumption for hypertension prevention: A cross-sectional study. PLoS ONE 18(8): e0289867. https://doi.org/ 10.1371/journal.pone.0289867 Editor: Omnia Samir El Seifi, Zagazig University Faculty of Human Medicine, EGYPT 1 School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia, 2 School of Nursing, University of Wollongong, Wollongong, Australia, 3 Tung Wah College, Hong Kong SAR, China, 4 La Trobe Rural Health School, La Trobe University, Bendigo, Australia ☯ These authors contributed equally to this work. * Abstract Background High-salt diets are linked to hypertension. Chinese people in Australia, are at increased risk of hypertension due to the combination of routine addition of high quantities of salt to food during cooking and high salt levels in processed western foods. There is a scarcity of saltrelated behavioural studies on this population group. This study aimed to explore the habitual salt consumption of Chinese Australians and factors that influence their perceptions about sustaining salt-related behavioural changes for hypertension prevention. Received: February 20, 2023 Accepted: July 27, 2023 Published: August 16, 2023 Copyright: © 2023 Chan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the paper and its Supporting information files. Funding: This study was supported by the Higher Degree by Research Student Support Fund at the University of Newcastle, Australia at which Alex Chan was a student at the time of the study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Method A cross-sectional descriptive study using an adapted Determinants of Salt-Restriction Behaviour Questionnaire was conducted on 188 Chinese Australians. A non-probability sampling method was used to attract participants from different parts of Australia. Statistical analyses such as descriptive analysis, t-tests and Pearson correlation tests were performed in the study. Results Over 97% of participants did not measure the amount of salt added to their meals. Many participants reported that salt was added to their meals based on their experience (39.4%) and food taste (31.9%). Over 80% of participants did not know the recommended level of daily salt consumption. Although salt-related knowledge had no significant correlation with individuals’ salty food taste preferences, there were significant correlations with the perceptions of the severity of disease and health benefits of reducing salt consumption (p = .001 and < .001 respectively). People with stronger salty taste preferences perceived a higher level of health threat than people with lighter salty taste preferences (p = .003). PLOS ONE | https://doi.org/10.1371/journal.pone.0289867 August 16, 2023 1 / 20 PLOS ONE Competing interests: The authors have declared that no competing interests exist. Factors influencing the salt consumption in Chinese Australians Conclusion Findings from this study show that knowledge about salt-reduction alone had no significant effects on salt-related behaviours. Adequate culturally relevant practice-based education in salt-reduction strategies may facilitate salt-related behavioural changes in Chinese Australians. Overall, single young Chinese Australian men with stronger salty taste preferences is the group who needs salt reduction interventions the most. Introduction High dietary salt consumption is a threat to global health, and dietary salt-reduction is an effective measure for lowering the risk of hypertension, a modifiable cardiovascular disease risk factor [1–3]. Dietary salt-reduction is an effective self-management intervention for hypertension prevention and reduces the overall risk of hypertension-related cardiovascular diseases such as heart failure and stroke [4]. Currently, the World Health Organization (WHO) recommends restricting dietary salt consumption to less than 5 grams per day (g/day) for healthy adults [5]. However, previous studies found that many adults around the globe, especially those from some ethnic groups, consumed a significantly higher amount of salt every day. For example, on average, Australians consumed 9.6 g/day in 2015 [6], Italians 9.0 g/ day between 2008 and 2012 [7], Russians 11.35g/day in 2018 [8] and Chinese in Mainland China more than 10 g/day in 2018 [9]. In general, salt intake that is acquired from discretionary sources, with salt added during cooking or at the table, is a growing health concern [10]. A systematic review found that people in China, Japan and India consumed more than half of their total daily salt intake from discretionary sources, compared with less than a quarter of daily salt intake among people in Australia, the United Kingdom (UK) and Denmark [10]. Australia is a popular destination for immigrants. In 2020, over 7.6 million migrants lived in Australia, and 29.8% of Australian residents were born overseas [11]. China has been one of the largest sources of migrants to Australia since 2011 [12]. The 2016 census found that more than 1.2 million people of Chinese ancestry resided in Australia, comprising nearly 5% of the entire Australian population [13]. According to the Australian Bureau of Statistics, Chinese ancestry refers to people who have the similarity of Chinese cultural and ethnic group in terms of social and cultural characteristics [14]. In this study, Chinese Australians refer to residents of Chinese ancestry in Australia. Hypertension is a very serious health problem in China [15]. It was estimated that 1 in 4 Chinese adults suffered from hypertension in 2012–2015 [15]. For Chinese Australians there is a risk of even higher salt intake through the combination of discretionary sources and greater exposure to processed foods in a western country, particularly as 75% of Chinese Australians were first-generation Australian residents [13]. The effects of socialisation and post-migration lifestyle changes may alter migrants’ dietary habits and attitudes, leading to an increase or decrease in their overall salt intake. Health belief model According to the Health Belief Model (HBM), individuals are likely to initiate a health behavi (...truncated)