@Article{info:doi/10.2196/12234,
author="Khokhar, Durreajam
and Nowson, Caryl Anne
and Margerison, Claire
and West, Madeline
and Campbell, Karen J
and Booth, Alison Olivia
and Grimes, Carley Ann",
title="The Digital Education to Limit Salt in the Home Program Improved Salt-Related Knowledge, Attitudes, and Behaviors in Parents",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="25",
volume="21",
number="2",
pages="e12234",
keywords="dietary sodium; knowledge; attitude; behavior; parent; internet; family; Australia",
abstract="Background: Currently, Australian children and adults are eating too much salt, increasing their risk of cardiovascular-related conditions. Web-based programs provide an avenue to engage the parents of primary schoolchildren in salt-specific messages, which may positively impact their own salt-related knowledge, attitudes, and behaviors (KABs). Objective: This pilot study aimed to determine whether parents' salt-related KABs improved following participation in the Digital Education to LImit Salt in the Home (DELISH) Web-based education program. Methods: The DELISH program was a 5-week, home-delivered, Web-based intervention, with a pre- and posttest design, targeting schoolchildren aged 7 to 10 years and their parents. Parents received weekly Web-based educational newsletters and text messages and completed online pre- and postprogram surveys assessing salt-related KABs. Upon completion of the program, all parents were also invited to complete an online evaluation survey. Changes in KABs outcomes were assessed using McNemar tests and paired t tests. Results: Of the 80 parents that commenced the program, 73 parents (mean age 41.0, SD 7.0 years; 86{\%} (63/73) females) completed both pre- and postsurveys. Overall, mean score for salt-related knowledge improved (+3.6 [standard error (SE) 0.41] points), and mean behavior score also improved (+4.5 [SE 0.61] points), indicating a higher frequency of engaging in behaviors to reduce salt in the diet, and mean attitude score decreased (−0.7 [SE 0.19] points), representing lower importance of using salt to enhance the taste of food (all P<.001). Following participation, the proportion of parents aware of the daily salt intake recommendation increased from 40{\%} (29/73) to 74{\%} (54/73) (P<.001), and awareness of bread as the main source of salt increased from 58{\%} (42/73) to 95{\%} (69/73) (P<.001). The proportion of parents who agreed that salt should be used in cooking to enhance the flavor of food decreased from 30{\%} (22/73) to 11{\%} (8/73) (P=.002) and the proportion who agreed that sodium information displayed on food labels was difficult to understand decreased from 52{\%} (38/73) to 32{\%} (23/73) (P=.009). There was a reduction in the proportion of parents who reported adding salt during cooking (55{\%} [40/73] vs 41{\%} [30/73]; P=.03) and at the table (32{\%} [23/73] vs 18{\%} [13/73]; P=.002). Of the 16 parents who completed the evaluation survey, 75{\%} (12/16) enjoyed the program, and all parents found the newsletters to be useful. Almost all parents (15/16, 94{\%}) agreed that the DELISH program would be useful to other parents. Conclusions: The improvement in salt-related KABs in the DELISH program indicates the potential for online technology, to disseminate simple salt reduction education messages to families with primary school--aged children. Future work should seek to improve the quality of data collected by including a larger sample size and a control group to integrate the program within the school setting to enable wider dissemination. ",
issn="1438-8871",
doi="10.2196/12234",
url="http://www.jmir.org/2019/2/e12234/",
url="https://doi.org/10.2196/12234",
url="http://www.ncbi.nlm.nih.gov/pubmed/30801255"
}