School-based education programme to reduce salt: Scaling-up in China (EduSaltS)

Background

Cardiovascular disease (CVD) is the leading cause of death and disability worldwide. Raised blood pressure(BP) is a major cause of CVD. Dietary salt intake is the major factor that increases BP. Salt intake in China is very high, more than twice the WHO recommended level of 5 g/d. About 80% of the salt in the Chinese diet is added by the consumer. It is very difficult to reduce salt intake in such settings.

One innovative approach to address this public health challenge has been successfully tested in a MRC-funded project-School-EduSalt, a cluster randomised controlled trial in northern China, in which primary schoolchildren were educated during their usual health education lessons about the harmful effects of salt on health and how to reduce salt consumption. Children then instructed the families to reduce salt intake. After one school term, salt intake decreased by 1.9 g/d in children and 2.9 g/d in adults, accompanied by a significant fall in systolic BP. This approach, if implemented across China, could prevent 200,000 CVD deaths per year, resulting in major cost-savings.

Aims

• Primary aim
  To develop a scale-up health education package to implement the refined education program following WHO’s Conceptual Framework for Scaling Up and evaluate the feasibility, adaptability and effectiveness of the scale-up package in multiple settings for lower salt intake in children and their families.

• Secondary aim
  To identify facilitators, understand and overcome the barriers of implementing the scale-up education programme through process evaluation.

• Other aim(s)
  To achieve sustained policy and program by integrating the scale-up package into the existing school health education system, with the ultimate goal of lowering the risk of developing of hypertension and cardiovascular diseases in the Chinese population.

Project plan

The team will carry out a study with an aim of developing, implementing and evaluating a scale-up package, in order to scale up the School-EduSalt program in multiple settings at regional and eventually national level in China. We will use pre-post design with both qualitative and quantitative methodologies, in a stepwise and structured approach with 4 phases spanning preparation, pilot, scale-up and sustainment in 4 years. Using an implementation science approach, with the application of the key elements and principles from WHO’s Conceptual Framework for Scaling up, we will develop and test an adaptable, feasible and sustainable scale-up package with the core component being the refined School-EduSalt program supported by robust policies and a set of management and evaluation system in 3 large regions covering a population of 3.2 million (1.1 million children and 2.1 million adults) in the north and south, rural and urban areas of China.

The implementation partners are the education/health authorities in the 3 regions, who will take initiative during the research process, with strong technical support from UK and China, including Chinese Centre for Health Education (CCHE, a governmental organisation). Implementation and sustainability will be ensured by integrating the scale-up package into the existing school health education system (education curriculum and Health Promoting School Initiative).

Publications and output

You may visit the project website for more information.

Funding organisations

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