Mapping the Cognitive Architecture of Health Beliefs: A Multivariate Conditional Network of Perceived Salt-Related Disease Risks.

Public beliefs about dietary risks, such as excessive salt intake, are often not isolated misconceptions but part of structured cognitive systems. This study aimed to explore how individuals organize their beliefs and misperceptions regarding salt-related health consequences. Using data from an international online survey, we applied a system of multivariate proportional odds logistic regression (POLR) models to estimate conditional associations among beliefs about salt's links to various diseases-including cardiovascular, metabolic, renal, neuropsychiatric, and mortality outcomes. In addition, exploratory and confirmatory factor analyses (EFA and CFA) were conducted to identify and validate latent constructs underlying the belief items. Beliefs were modeled as interdependent, controlling for latent constructs, sociodemographics, and self-reported health awareness. Statistically significant associations ( < 0.05) were visualized via a heatmap of beta coefficients. Physicians showed almost universal agreement that salt contributes to hypertension (µ = 0.97), compared to non-medical respondents (µ = 0.85; < 0.0001). Beliefs about mortality (µ = 1.55 for MDs vs. 0.99 for non-medical; < 0.0001) emerged as central hubs in the belief network. Strong inter-item associations were observed, such as between hypertension and heart failure (β = -0.39), and between obesity and type 2 diabetes (β = -0.94). Notably, cognitive gaps were found, including a lack of association between atrial fibrillation and stroke, and non-reciprocal links between hypertension and heart failure. Beliefs about the health effects of salt are structured and sometimes asymmetrical, reflecting underlying reasoning patterns rather than isolated ignorance. Understanding these structures provides a systems-level view of health literacy and may inform more effective public health communication and education strategies.