AUTHOR=Lazo-Porras María , Del Valle Adela , Beran David , Pesantes Maria Amalia , Perez-Leon Silvana , Ponce-Lucero Vilarmina , Bernabe-Ortiz Antonio , Cárdenas María Kathia , Chappuis François , Perel Pablo , Miranda J. Jaime , Diez-Canseco Francisco 

TITLE=Implementation of a salt substitute intervention using social marketing in resourced-limited communities in Peru: a process evaluation study

JOURNAL=Frontiers in Public Health

VOLUME=Volume 11 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2023.1068624

DOI=10.3389/fpubh.2023.1068624

ISSN=2296-2565

ABSTRACT=Objective: To conduct a process evaluation of a salt substitute trial conducted in Peru.
Methods: Through semi-structured interviews of intervention participants, we documented and analyzed process evaluation variables as defined by the Medical Research Council Framework. The study was a stepped wedge trial conducted in Tumbes, Peru. The intervention was a community-wide replacement of the regular salt (100% sodium) with the salt substitute “Salt Liz”using social marketing strategies to promote adoption and continued use of the salt substitute in daily life. The components of the social marketing campaign included entertainment educational activities and local product promoters (“Amigas de Liz”). Also the Salt Liz spoon to help guide the amount of salt that families should consume. The process evaluation variables measured were the context, mechanism of action, and implementation outcomes (acceptability, fidelity and adoption, perceptions and feedback).
Results: Sixty women were interviewed, 20 with hypertension and 40 without hypertension. Common characteristics across the four villages included residents primarily ate their meals at home and women were responsible for household food preparation. Most participants did not notice a difference in the flavour between regular salt and Salt Liz; those that did took around two weeks to become accustomed to the taste of the salt substitute. In general, Salt Liz was accepted by villagers and factors explaining this acceptability included that it was perceived as a “high quality” salt and as having a positive effect on one’s health. Participants recognized that Salt Liz is healthier than regular salt and that it can help prevent or control hypertension. Even when the use of Salt Liz was far-reaching at the community level, the use of the Salt Liz spoon was poor. Educational entertainment activities were well-received, and most participants enjoyed them despite not always being active participants but rather sideline observers. 
Conclusions: This process evaluation identifies key intervention components that enabled a successful trial. Seeking and incorporating feedback from the target population helps deepen understanding of contextual factors that influence an intervention’s success. Some factors that can be improved for future interventions are acknowledged.