MINDTHESALT: An Intervention to Reduce Salt Intake in People of African Descent

Background

Excessive salt consumption remains a major modifiable risk factor in the development of hypertension and cardiovascular diseases (CVDs). People of African Descent (PoAD) bear a disproportionately high burden of hypertension due to factors such as salt sensitivity, cultural dietary patterns, and broader structural inequalities. Although national salt-reduction initiatives in the United Kingdom (UK) have reduced overall intake, evidence suggests that this progress has not been equitably realised across all ethnic groups. This thesis explored the potential of culturally tailored digital initiatives to bridge this gap, culminating in the development and primary testing of MINDTHESALT - a gamified, user-centred web application designed to improve dietary salt literacy and promote behaviour change among PoAD.

Aims and Methods

The thesis utilised a multiphase mixed-methods design, combining qualitative and quantitative approaches to facilitate a comprehensive understanding of the target population and the preliminary impact of MINDTHESALT. Four main aims drove the research: (1) to conduct a systematic review of internet-based interventions (IbIs) for CVD prevention and management, (2) to explore online health-seeking behaviours and barriers to the adoption of digital health resources among PoAD, (3) to investigate the knowledge, attitudes, and practices that shape salt intake within this population, and (4) to develop and conduct primary testing of MINDTHESALT, using a co-design approach informed by the extended Unified Theory of Acceptance and Use of Technology 2 (UTAUT2).

Findings

The findings indicate that despite the high internet usage among PoAD, engagement with mainstream salt reduction efforts was minimal. Challenges in accessing culturally tailored health information and dietary habits, such as the prevalent use of added salt during cooking, contribute to the limited engagement. MINDTHESALT was developed to address these issues by offering culturally relevant content, incorporating tailored recipes, gamification, self-monitoring tools, and behaviour change strategies. Primary testing indicated potential improvement in salt literacy and high engagement. However, concerns regarding privacy and digital accessibility were identified as potential barriers to broader implementation.

Contributions and Future Research

This thesis demonstrates the potential of culturally tailored digital health interventions in promoting dietary behaviour change among ethnic minority populations. The findings underscore the need to complement top-down, industry-led salt reduction strategies with bottom-up, consumer-focused initiatives to achieve equitable health outcomes. Future research should focus on evaluating the long-term efficacy, scalability, and cost-effectiveness of interventions such as MINDTHESALT, particularly in addressing health inequalities.