Nutrition and Lifestyle Department, The George Institute for Global Health at Peking University Health Science Center, Beijing, China.
Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Front Public Health. 2022 Mar 14;10:744881. doi: 10.3389/fpubh.2022.744881. eCollection 2022.
Salt reduction is a cost-effective, and rather challenging public health strategy for controlling chronic diseases. The AppSalt program is a school-based multi-component mobile health (mhealth) salt reduction program designed to tackle the high salt intake in China. This mixed-methods process evaluation was conducted to investigate the implementation of this program across sites, identify factors associated with the implementation, and collect evidence to optimize the intervention design for future scale-up.
Mixed methods were used sequentially to collect data regarding five process evaluation dimensions: fidelity, dose delivered, dose received, reach, and context. Quantitative data were collected during the intervention process. Participation rate of intervention activities was calculated and compared across cities. The quantitative data was used for the selection of representative intervention participants for the qualitative interviews. Qualitative data were collected in face-to-face semi-structured interviews with purposively selected students ( = 33), adult family members ( = 33), teachers ( = 9), heads of schools ( = 9), key informants from local health, and education departments ( = 8). Thematic analysis technique was applied to analyze the interview transcripts using NVivo. The qualitative data were triangulated with the quantitative data during the interpretation phase.
The total number of families recruited for the intervention was 1,124. The overall retention rate of the AppSalt program was 97%. The intervention was implemented to a high level of fidelity against the protocol. About 80% of intervention participants completed all the app-based salt reduction courses, with a significant difference across the three cities (Shijiazhuang: 95%; Luzhou: 73%; Yueyang: 64%). The smartphone app in this program was perceived as a feasible and engaging health education tool by most intervention participants and key stakeholders. Through the interviews with participants and key stakeholders, we identified some barriers to implementing this program at primary schools, including the left-behind children who usually live with their grandparents and have limited access of smartphones; perceived adverse effects of smartphones on children (e.g., eyesight damage); and overlooked health education curriculum at Chinese primary schools.
This process evaluation demonstrated the feasibility and acceptability of using smartphone applications delivered through the education system to engage families in China to reduce excessive salt intake.
The AppSalt study was registered at www.chictr.org.cn, identifier: ChiCTR1800017553. The date of registration is August 3, 2018.
减少盐的摄入量是控制慢性病的一种具有成本效益且颇具挑战性的公共卫生策略。AppSalt 项目是一个基于学校的多组分移动健康 (mhealth) 减盐项目，旨在解决中国盐摄入量过高的问题。本混合方法过程评估旨在调查该项目在不同地点的实施情况，确定与实施相关的因素，并收集证据优化干预设计，以便未来推广。
混合方法顺序收集了五个过程评估维度的信息：保真度、提供的剂量、接受的剂量、范围和背景。在干预过程中收集定量数据。计算了干预活动的参与率，并比较了不同城市之间的差异。定量数据用于选择有代表性的干预参与者进行定性访谈。与 33 名学生、33 名成年家庭成员、9 名教师、9 名校长、当地卫生和教育部门的 8 名关键信息提供者进行了面对面的半结构化访谈，收集定性数据。使用 NVivo 对访谈记录进行了主题分析技术分析。在解释阶段，将定性数据与定量数据进行了三角分析。
共招募了 1124 个家庭参与干预。AppSalt 项目的总体保留率为 97%。干预措施按照方案实施，保真度很高。约 80%的干预参与者完成了所有基于应用程序的减盐课程，三个城市之间存在显著差异（石家庄：95%；泸州：73%；岳阳：64%）。该项目中的智能手机应用程序被大多数干预参与者和利益相关者认为是一种可行且引人入胜的健康教育工具。通过对参与者和利益相关者的访谈，我们发现了在小学实施该计划的一些障碍，包括通常与祖父母一起生活、智能手机使用受限的留守儿童；对智能手机对儿童的负面影响的认知（例如，视力损害）；以及中国小学忽视健康教育课程。
本过程评估表明，使用通过教育系统提供的智能手机应用程序使中国家庭参与减少过量盐摄入是可行且可接受的。
AppSalt 研究在中国临床试验注册中心注册，网址为 www.chictr.org.cn，注册号：ChiCTR1800017553。注册日期为 2018 年 8 月 3 日。
