Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, MD, United States.
The George Institute for Global Health, Peking University Health Science Center, Beijing, China.
JMIR Mhealth Uhealth. 2019 Apr 17;7(4):e13250. doi: 10.2196/13250.
High salt consumption has contributed to the rise of noncommunicable diseases around the world. The application of mobile health (mHealth) technologies has 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.
The aim of this study was to identify, characterize, and evaluate mHealth interventions aimed at salt reduction across the world.
A systematic search of studies in English or Chinese language published from January 1, 1992 to July 31, 2017 was conducted using 4 English databases (PubMed, MEDLINE, Global Health, and Cochrane) and 3 Chinese databases (Wanfang, China Science and Technology Journal, and China National Knowledge of Infrastructure). All studies directly using mobile technologies in health care with a primary or secondary objective of reducing dietary salt consumption were included.
A total of 1609 articles were found using the search strategy, with 11 full articles (8 English and 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 message service as a platform for mHealth interventions, whereas 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-hour urinary sodium excretion, spot urine sampling, dietary records, and indirect behavior 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.
Salt reduction in mHealth initiatives remains relatively unexplored; however, studies that did intervene on salt-reduction show the potential of mHealth as an effective intervention method. We provide 3 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, and object-targeted clinical trials of mHealth interventions with appropriate quantitative outcome variables, in particular 24-hour urine sodium.
高盐饮食是导致全球非传染性疾病增加的原因之一。近年来，移动健康（mHealth）技术的应用发展迅速。然而，针对减少盐摄入量的 mHealth 干预措施的证据尚未经过严格审查。
本研究旨在确定、描述和评估全球范围内旨在减少盐摄入量的 mHealth 干预措施。
通过 4 个英文数据库（PubMed、MEDLINE、Global Health 和 Cochrane）和 3 个中文数据库（万方、中国科技期刊数据库和中国国家知识基础设施），从 1992 年 1 月 1 日至 2017 年 7 月 31 日，以英文或中文语言发表的研究进行系统搜索。所有直接使用移动技术进行医疗保健，且主要或次要目标为减少膳食盐摄入量的研究均被纳入。
使用搜索策略共发现 1609 篇文章，其中 11 篇全文（8 篇英文和 3 篇中文）被纳入数据提取，包括 11 项干预研究。总体而言，高质量的干预措施很少。大多数干预措施受到研究人群样本量小、缺乏对照组和随访时间短的限制，这些都是产生长期可扩展方法的障碍。大多数干预措施使用短消息服务作为 mHealth 干预措施的平台，同时也探索了一些创新的 mHealth 技术。大多数干预措施主要侧重于提高对膳食盐摄入量的认识。用于衡量干预效果的结果变量包括 24 小时尿钠排泄量、随机尿样采集、饮食记录以及针对盐摄入量的间接行为或知识指标。虽然大多数干预措施显示出积极的结果，但没有任何一项研究提供可靠的证据来评估减少盐摄入量的效果。
mHealth 倡议中的盐减少仍有待进一步探索；然而，已经进行了干预的研究表明 mHealth 具有作为一种有效的干预方法的潜力。我们为未来的 mHealth 减少盐摄入量干预措施提供了 3 项建议：（1）增加使用新的、创新的和互动的 mHealth 技术；（2）开发以初级预防措施和减少盐摄入量为目标的 mHealth 干预措施；（3）进行大规模、严格设计和以目标为导向的 mHealth 干预措施临床试验，使用适当的定量结果变量，特别是 24 小时尿钠。
