From apps to instant messages: Which tech solutions help cut sodium intake best?

By Dr. Chinta SidharthanReviewed by Lily Ramsey, LLMMar 20 2024

In a recent study published in the journal NPJ Digital Medicine, researchers conducted a review and meta-analysis to determine if behavioral changes through technology-supported interventions could help reduce sodium intake and positively impact health.

Study: Technology-supported behavior change interventions for reducing sodium intake in adults: a systematic review and meta-analysis. Image Credit: itor/Shutterstock.com

Background

Cardiovascular disease is responsible for over 1.5 million deaths each year, and one of the major risk factors for cardiovascular disease and hypertension is an excessive intake of sodium in the diet.

The World Health Organization (WHO) recommends a daily intake of less than 2 gm of sodium for adults, and a salt intake of more than 5 gm a day, or sodium intake of more than the WHO recommended levels is considered excessive.

Studies show that the average sodium consumption among most adults is between 3.5 gm and 5.5 gm a day, significantly increasing the risk of hypertension, cardiovascular disease, disability, and death.

One of the strategies presented by the WHO to reduce sodium intake among adults is behavioral change through education.

While these educational interventions have largely been conducted face-to-face, technology-supported interventions through digital devices, phone calls, mobile applications, and video have become more popular since they can reach a wider audience at lower costs.

However, the effectiveness of such technology-supported interventions in bringing about behavioral change to lower sodium intake remains less understood.

About the study

In the present study, the researchers conducted a systematic review of randomized control trials that evaluated the effectiveness of technology-based interventions in producing behavioral change for lowering sodium intake and changing systolic and diastolic blood pressure.

The study also included a meta-analysis to examine the characteristics of these interventions that effectively lower sodium intake.

Trials included in the review involved participants above the age of 18 years. They evaluated technology-based interventions that aimed to change the sodium intake behavior of the participants either entirely through tools such as digital devices, mobile applications, video, or telephone calls or through a hybrid method of technology-based and face-to-face interventions.

Participants with chronic kidney disease were excluded from the meta-analysis. The examined outcomes were reports of 24-hour urinary sodium.

Data extracted from the studies consisted of sample size, the health status of the participants, the proportion of female participants, the intervention setting, the mean age of the study population, duration of follow-up, type of technology used, delivery mode of intervention, and whether the study was completely or partially technology supported.

The behavior change techniques were also identified using standard methods and verified independently by multiple reviewers.

The meta-analysis used the random-effects model to analyze the systolic and diastolic blood pressure and 24-hour urine sodium.

Subgroup analyses were conducted for characteristics such as normal versus hypertensive participants, technology type used, uni- or multi-disciplinary intervention delivery professional, group-based or individual intervention delivery, involvement of family members, and many more.

Some of the behavior change techniques that were frequently used were also included in the subgroup analyses.

Additionally, continuous variables such as mean age, sample size, number of behavior change techniques in each randomized control trial, and durations of intervention and follow-up were included in the meta-regression analysis.

Results

The results showed that technology-based interventions aimed at producing behavioral changes that helped reduce sodium intake and lower systolic and diastolic blood pressure were effective.

Characteristics such as the frequency of interventions, behavior change techniques such as rehearsal or behavioral practice, and demonstration of behavior were significantly associated with positive reductions in 24-hour urine sodium levels.

The primary type of technology used also effectively changed sodium intake behavior, with instant messaging associated with larger effect sizes. The intervention delivery mode, where the interventions were delivered to a participant-family dyad, was also linked to larger effect sizes.

The reductions in systolic and diastolic blood pressure also indicated that technology-based interventions brought about changes in sodium intake behavior comparable to face-to-face interventions.

Conclusions

Overall, the review and meta-analysis found that interventions using technological communication tools to induce behavioral changes that lower sodium intake and systolic and diastolic blood pressure were just as effective as face-to-face interventions in bringing about positive behavioral changes.

Some technology types and intervention delivery methods were found to be especially effective. Furthermore, characteristics such as the frequency of interventions and some behavior change techniques were also found to be more effective than other interventional characteristics.