Conclusions
Stroke, CNM, Diane Wood
BRUCE, CARDIAC EVENT, STROKE, HEART, WRIGHT, EVENTS, RECRUITMENT, SECONDARY, CROSS, BLOOD, FRASER
In summary, our trial found no evidence of the effectiveness of a salt-reduction intervention package comprising a smartphone app and RSS on estimated 24-hour sodium excretion (or any secondary outcome assessed) in adults with high BP. The trial was underpowered because of challenges associated with the implementation of trial technologies and the COVID-19 pandemic, meaning that it is possible that a real effect may have been missed. Furthermore, because of low engagement and recruitment, it was not possible to determine potential effects for Māori whānau or Pacific communities. However, it is also possible that a larger trial in the same study population would produce similar results given the low intervention dose. Nonetheless, further research may be warranted to explore the efficacy of SaltSwitch for secondary prevention in highly motivated clinical populations such as those who have had a recent cardiac event. Further research should also be undertaken to explore the use of RSSs in packaged foods, especially for countries such as NZ, where these foods contribute >50% to population sodium intake, and in specific communities or in settings where most food is cooked in the home or prepared on-site. Finally, the challenges associated with the design and delivery of effective individual-level behavioral interventions highlight the need for comprehensive policies and programs, including improvements to food environments and systems, in addition to supportive tools for behavior change—this is critical if we are to achieve meaningful reductions in population sodium intake.The authors are indebted to their trial participants. They would also like to thank their study project coordinator (Diane Wood) and research assistants (Neela Bhana, Bruce Kidd, and Shistata Shrestha); Nhung Nghiem, who helped with the development of an early plan for economic analysis; Tahu-Pōtiki Te Maro-Doran, who assisted with recruitment in Wellington; Green Cross Health and The Stroke Foundation of New Zealand for support with recruitment; student and staff volunteers who helped with recruitment during the Stroke Foundation “Big Blood Pressure Check” and at Ngāti Whaāua events (Shai Alsaie, Daria Faulconbridge, Bruce Kidd, Xinye Li, Jenny Lin, Magda Rosin, Huang Silver, Summer Wright, and Lina Yousif); Koda Web Design who developed the Salt Alternatives Study smartphone app and database; staff at the National Institute for Health Innovation involved in data management, software, budgets, and contracts (Manoj Alwis, Karen Carter, Sarah Douglas, John Faatui, Michelle Jenkins, Pragya Nandan, Deepak Pandey, Mahfuz Rahman, and Peter Tsai); and Gina Gastrillon and Fraser Taylor, who facilitated the development of the New Zealand version of the SaltSwitch smartphone app. This research was also supported (in part) by the provision of Salt for Life 100 Dietary Alternative Salt free of charge by NuTek. Funding was provided by the Health Research Council of New Zealand program grant (#18/672). HE is funded by a Heart Foundation of New Zealand Senior Fellowship grant (#1843). RND is supported by the Heart Foundation Chair of Heart Health. The funder had no role in the study design; collection, analysis, or interpretation of the data; writing of the report; or decision to submit the manuscript for publication.Authors' Contributions: HE, BN, and CNM contributed to conceptualization. YJ, JG, EU, and RM contributed to data curation. YJ contributed to formal analysis. HE and CNM acquired funding. HE, JG, EU, and LTM contributed to investigation. HE, JG, EU, RM, LTM, BN, AR, RND, and CNM contributed to methodology. JG and EU were responsible for project administration. JG and EU contributed to resources. HE, BN, AR, RND, and CNM supervised the study. YJ and RM validated the data. HE and YJ contributed to visualization. HE wrote the original draft. HE, JG, UM, RM, LTM, BN, AR, RND, and CNM reviewed and edited the manuscript.Conflicts of Interest: None declared.CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) questionnaire V1.6.1.