Model Development for Reducing Sodium Consumption at the District Level Using a District Health Board Mechanism
Keywords:model, sodium consumption, District Health Board
High levels of dietary sodium are associated with hypertension and non-communicable diseases. We aimed to develop a model for reducing sodium consumption at the district level using a mechanism developed by the District Health Board (DHB). Hankha District in Chai Nat Province was selected as the study area. The study was conducted between June and December 2022. Research methods included the development of a model to reduce sodium consumption, questionnaires and focus group discussions, and measuring the amount of salt in food and blood pressure levels among study participants. The developed model comprised three measures; monitoring people’s sodium consumption; creating a mechanism for driving and managing the environment contributing to behavioral changes; and providing knowledge and promoting behaviors among groups at high risk for hypertension. After model development, the mean knowledge scores among DHB members and their skills in managing plans and projects were significantly higher than those before the process. Mean knowledge scores, health literacy and proper sodium consumption behaviors among at-risk groups were also higher. In addition, the increased knowledge scores significantly correlated with proper sodium consumption behaviors. Our results should encourage authorities at the policy level to apply a DHB mechanism to reduce sodium consumption in communities.
Ministry of Public Health. HDC Dashboard: Non-Communicable diseases reports. [Internet] Nonthaburi: Ministry of Public Health; [cited 2022 Dec 17]. <https://hdcservice.moph.go.th/hdc/reports/page.php?cat_id=6a1fdf282fd28180eed7d1cfe0155e11>. Thai.
Office of the National Economic and Social Development Council. Thailand’s national strategy B.E. 2561–2581 (2018–2037). Royal Thai Government Gazette. Volume 135, part 82 Kor, (Dated 2018 Oct 13):1.
Chailimpamontree W, Kantachuvesiri S, Aekplakorn W, Lappichetpaiboon R, Sripaiboonkij Thokanit N, Vathesatogkit P, et al. Estimated dietary sodium intake in Thailand: A nationwide population survey with 24-hour urine collections. J Clin Hypertens (Greenwich). 2021 Apr;23(4):744–54. [cited 2023 Mar 1]. doi:10.1111/jch.14147.
World Health Organization. Guideline: Sodium intake for adults and children [Internet]. Geneva: World Health Organization; 2012 Dec 25 [cited 2022 Dec 25] <https://www.who.int/publications/i/item/9789241504836>
Moolphate S. Daily salt intake and factors associated with high salt intake in the community, Donkeaw subdistrict, Chiang Mai province, northern Thailand. Chiang Mai: Chiang Mai Rajabhat University; 2015. 125 p. Thai.
Bureau of Non-Communicable, Department of Disease Control. Strategies to reduce salt and sodium consumption in Thailand 2016–2025. 1st ed. Nonthaburi: Bureau of Non-Communicable, Department of Disease Control, Ministry of Public Health (TH); 2016 Oct. 35 p. Thai.
Hfocus. Promoting strategies to reduce salt and sodium set a goal for Thai people to reduce salt consumption 30% by 2025 [Internet]. Udon Thani: Hfocus.org; 2019 [cited 2020 Jul 2020]. <https://www.hfocus.org/content/2019/03/16920>. Thai.
Office of the Prime Minister. Regulations of the office of the prime minister on the development of quality of life at the local level B.E.2561 (2018). Royal Thai Government Gazette. Volume 135, Special part 54 Ngor. (Dated 2018 Mar 9):1–7.
Frechtling J. Logic modeling methods in program evaluation. 8th ed. San Francisco: Jossey-Bass; 2007. 160 p.
Helitzer D, Hollis C, de Hernandez BU, Sanders M, Roybal S, Van Deusen I. Evaluation for community-based programs: the integration of logic models and factor analysis. Eval Program Plann. 2010 Aug;33(3):223–33. doi:10.1016/j.evalprogplan.2009.08.005.
Thammakun T, Thammakun TH, Prompunjai P, Photipim M, Slawongluk T, Bell O, et al. Application of logic model on development of prevention and behavior modification model of alcohol consumption among youth (PABMACY). Interprof. Journal of Health Science. 2018; 27(3):420–31.
Prompunjai P, Thammakun T, Thammakun TH, Pensuk P. Effectiveness of management skill development program for district leaders to prevent dengue hemorrhagic fever in Health Service Network Region 9. Dis Control J. Thailand; 2013;39(3):194–203.
Thailand Health Strategic Management Office, Office of the Permanent Secretary, Ministry of Public Health. Information report on diseases and health threats in the management, prevention and control of diseases and health threats with mechanisms to improve the quality of life at the area level. Nonthaburi: Ministry of Public Health; 2021. 82 p. Thai. Non-communicable disease issues operating in 2021.
Ministry of Public Health. HDC Dashboard: Data on morbidity rates with high blood pressure [Internet]. Nonthaburi: Ministry of Public Health; 2019 [cited 2021 Aug 1]. <https://hdcservice.moph.go.th/hdc/reports/report.php&cat_id=6a1fdf282fd28180eed7d1cfe0155e11&id=e46c73b57c9eeb2f07759a9e9bc50fb3>. Thai.
Hankha District Public Health Office. Situation survey report on sodium and salt consumption of people in Hankha District, Chai Nat Province, 2022. Chai Nat (TH); Hankha District Public Health Office; 2022 May 25. 30 p. Thai. Meeting documents of the District Health Board.
Kaewkungwal J, Singhasivanon P. Sample size in clinical trials. In: Pitisuttithum P, Phichiansunthorn C, editors. Textbook of clinical research. 1st ed. Bangkok: Faculty of Tropical Medicine Mahidol University; 2011. p. 65–72.
Wongsawat Y. Development of salt meter in food and urine for Thai health promotion 2017-2018. Nakhon Pathom (TH): Mahidol University; 2018. 34 p. Thai.
Vijitsoonthornkul K. Guide to surveying sodium content in foods with a salt meter. Nonthaburi: Division of Non-Communicable Diseases, Department of Disease Control (TH); 2022. 14 p.
State Administration Act, B.E. 2534 (1991) (as amended No.8, B.E. 2010) No.108(156). (Dated 1991 Aug 21).
Cohen J, Uphoff N. Rural development participation: concept and measure for project design implementation and evaluation: rural development committee center for international studies. New York: Cornell University Press; 1981.
Malcolm L, Wright L, Barnett P, Hendry C. Clinical leadership and quality in district health boards in New Zealand. [place unknown]: Clinical Leaders Association of New Zealand; 2002 [cited 2021 Aug 1]. <https://www.moh.govt.nz/notebook/nbbooks.nsf/0/82544E2F11F29181CC256D48007CFBF9/$file/DHBsqualrptfinal.pdf>. 94 p.
Vongmanee K, Noosorn N. Lessons learned district health system model for health promotion district in mental health Lomsak District Phetchaboon Province. Journal of Nursing and Health Care. 2017; 35(3):232–41.
Khongsateinpong K, Wanaratwichit C. District quality development committee: challenges and development. Bormarajonani College of Nursing, Uttraradit Journal. 2021 Jul–Dec;13(2):275–86.
Phetchlamul M. Preventive behavior related to knowledge and perception of hypertension among hypertensive patient’s relative. Journal of Public Health Nursing. 2014 Sep–Dec;28(3):175–87.
Luenam A, Ngamkham N, Sangsawang D, Pengpanich W, Rattanasuwannachai K, Sengla W, et al. Predictive factor of self-care behavior for prevention of hypertension among population group at risk. HCU Journal of Health Science. 2019 Jun 26;23(1):93–106.
Laloon P, Madhyamankura N, Malarat A. Self-care behavior of hypertensive patients at out patient department of HRH Princess Maha Chakri Sirindhorn Medical Center. Journal of Medicine and Health Sciences. 2011 Dec;18(3):160–9.
Kareesun K, Malathum P, Sutti N. Relationships among health literacy, Knowledge about hypertension control and health behavior in older person with hypertension. Rama Nurs J. 2019 Sep–Dec;25(3):280–95.
Thongma P. Health literacy and health outcome in hypertensive patients. Thai Red Cross Nursing Journal. 2020 Jan–Jun;13(1):50–62.
Mente A, O’Donnell M, Rangarajan S, McQueen M, Dagenais G, Wielgosz A. et al. Urinary sodium excretion, blood pressure, cardiovascular disease, and mortality: a community-level prospective epidemiological cohort study. Lancet [Internet]. 2018 Aug 11 [cited 2023 March 1];392(10146):496–506. doi:10.1016/S0140-6736(18)31376-X.
How to Cite
Copyright (c) 2023 Outbreak, Surveillance, Investigation & Response (OSIR) Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.