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      Midterm Evaluation of Malaysia's National Salt Reduction Strategy – Lessons Learned on Adapting Salt Reduction ‘Best Buys’ to the Local Context

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          Abstract

          Objectives

          To evaluate the implementation progress and contextual influences of Malaysia's five-year national salt reduction program at midpoint, with a view to generating lessons on adapting the World Health Organization's salt reduction ‘best buys’ to suit the local context.

          Methods

          The Malaysian Government's multi-faceted strategy includes three of four salt-related ‘best buys’; reduce salt intake through 1) behavior change communication, 2) reformulation of food products to contain less salt and 3) implementation of front-of-pack labeling, as well as a strategy to monitor population salt intake and sodium levels in foods. Based on the UK Medical Research Council's guidance on process evaluation, routinely-collected administrative data, 12 semi-structured interviews and public information were used and synthesized in NVivo to evaluate the reach, dose, adoption, fidelity and contextual influences of implementation. This was supplemented with data from three focus groups (43 participants) conducted using the nominal group technique to understand the priority barriers and facilitators of lowering salt intake in Malaysia.

          Results

          In the first 3 years, there was high progress in accurately monitoring population salt intake and developing culturally-specific education resources. However, a major barrier to implementing the other interventions was the absence of mandatory sodium content declaration on packaged foods. A lack of packaged foods with sodium content labeling hindered the program implementers' ability to identify and engage high-salt food producers in reformulation, identify low-salt foods eligible for the Healthy Choice Logo front-of-pack label, educate consumers to identify high or lower-salt foods and monitor the sodium content of packaged foods. This aligns with the perceived challenges of reducing salt consumption in Malaysia being poor consumer knowledge and attitudes around salt reduction, and the absence of low-salt alternatives.

          Conclusions

          Countries without mandatory sodium or salt labeling on packaged foods should prioritize this regulation to enable effective implementation of the salt reduction ‘best buys’. Interim process evaluations are useful for identifying necessary intervention adaptations.

          Funding Sources

          The World Health Organization.

          Related collections

          Author and article information

          Journal
          Current Developments in Nutrition
          Oxford University Press (OUP)
          2475-2991
          June 2020
          June 01 2020
          June 2020
          June 01 2020
          May 29 2020
          : 4
          : Supplement_2
          : 288
          Affiliations
          [1 ]The George Institute for Global Health
          [2 ]Ministry of Health Malaysia
          [3 ]World Health Organization Office in Malaysia
          Article
          10.1093/cdn/nzaa043_139
          7258005
          0517844b-25fc-4e3d-b3d2-529f91dfe3bc
          © 2020

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