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Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods.

ABSTRACT: BACKGROUND:Corporate decisions affecting the composition of processed foods are a potent factor shaping the nutritional quality of the food supply. The addition of large quantities of salt to foods is incompatible with Australian Dietary Guidelines and the reformulation of processed foods to have less salt is a focus of non-governmental organisations (NGOs). There is evidence that advocacy can influence corporate behaviour but there are few data to define the effects of NGOs working in the food space. The aim of this study is to quantify the effects of advocacy delivered by a local NGO on the salt content of food products produced or marketed by companies in Australia. METHODS/DESIGN:This is a cluster-randomised controlled trial that will be done in Australia from 2013 to 2015 which includes 45 food companies. The 23 companies in the control group will receive no specific intervention whilst the 22 companies in the intervention group will receive an advocacy program based upon an established theory of change model. The primary outcome will be the mean change in sodium content (mg/100 g) of processed foods produced or marketed by intervention compared to control companies assessed at 24 months. Interim outcomes (statements of support, published nutrition policies, level of engagement, knowledge and use of technology to reduce salt, salt reduction plans, and support for national initiatives) will also be assessed and a qualitative evaluation will provide more detailed insight. DISCUSSION:This novel study will provide robust randomised evidence about the effects of advocacy on food company behaviour and the quality of the processed food supply. A finding of improved food company behaviour will highlight the potential for greater investment in advocacy whilst the opposite result will reinforce the importance of government-led initiatives for the improvement of the food supply. TRIAL REGISTRATION:ClinicalTrials.gov: NCT02373423. 26/02/2015.

SUBMITTER: Trevena H

PROVIDER: S-EPMC4727283 | biostudies-literature | 2016 Jan

REPOSITORIES: biostudies-literature

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Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods.

Trevena Helen H Thow Anne Marie AM Dunford Elizabeth E Wu Jason H Y JHY Neal Bruce B

BMC public health 20160125

<h4>Background</h4>Corporate decisions affecting the composition of processed foods are a potent factor shaping the nutritional quality of the food supply. The addition of large quantities of salt to foods is incompatible with Australian Dietary Guidelines and the reformulation of processed foods to have less salt is a focus of non-governmental organisations (NGOs). There is evidence that advocacy can influence corporate behaviour but there are few data to define the effects of NGOs working in t ...[more]

PMID: 26809561

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Project description:BackgroundAustralians are consuming almost double the recommended maximum salt intake. The Victorian Salt Reduction Partnership was established to coordinate efforts to reduce salt intake in the state of Victoria. As part of an intervention strategy, media advocacy strategies were used to raise public awareness and stimulate industry and government action on salt reduction. This study aimed to evaluate the Victorian Salt Reduction Partnership's media advocacy activities by determining the extent to which activities contributed to the overall strategy aims and the effectiveness of the activities in gaining media and industry engagement.MethodsA framework for evaluating media advocacy strategies used in complex public health interventions was used to guide this evaluation. Media advocacy activities were monitored and documented throughout the intervention period. A content analysis of media release press statements was performed. Indicators of media coverage (media items, cumulative audience reach, advertising space rate) and food industry engagement (number of meetings, number and type of follow up actions) were tracked.ResultsSix media releases were issued between March 2017 and November 2018 on different processed food categories including breads, cooking sauces, ready meals, dips and crackers, processed meats and Asian-style sauces. Three main themes were identified in the qualitative analysis of the press statements: general information on salt and health, salt levels in foods, and calls to action for consumers, industry and/or government. These themes were aligned with the overall intervention strategy. Media items (print and online news, radio and TV) generated by each release ranged from 36 to 274, and cumulative audience reach (opportunities to see) ranged from 2.3 to 7.5 million Australians per release. One to three food manufacturers were met with per media release.ConclusionsDisseminating sodium-monitoring data through media releases can be used as a tool to gain access to the media and reach consumers with salt reduction messages, and to engage food manufacturers in discussions about salt reduction. Characteristics of media advocacy activities, including alignment with the overall strategy, and external factors outside the of control of the program implementers, can influence media and industry engagement. When planning future nutrition interventions that include media advocacy activities, internal and external factors impacting outcomes, should be considered, documented and evaluated.

Project description:OBJECTIVE:This paper describes the design and methods of a cluster randomised controlled trial (C-RCT) to determine the effectiveness of a community mobilisation intervention that is designed to reduce the perpetration of violence against women (VAW). METHODS AND ANALYSIS:A C-RCT of nine intervention and nine control clusters is being carried out in a periurban, semiformal settlement near Johannesburg, South Africa, between 2016 and 2018. A community mobilisation and advocacy intervention, called Sonke CHANGE is being implemented over 18 months. It comprises local advocacy and group activities to engage community members to challenge harmful gender norms and reduce VAW. The intervention is hypothesised to improve equitable masculinities, reduce alcohol use and ultimately, to reduce VAW. Intervention effectiveness will be determined through an audio computer-assisted self-interview questionnaire with behavioural measures among 2600 men aged between 18 and 40 years at baseline, 12 months and 24 months. The primary trial outcome is men's use of physical and/or?sexual VAW. Secondary outcomes include harmful alcohol use, gender attitudes, controlling behaviours, transactional sex and social cohesion. The main analysis will be intention-to-treat based on the randomisation of clusters. A qualitative process evaluation is being conducted alongside the C-RCT. Implementers and men participating in the intervention will be interviewed longitudinally over the period of intervention implementation and observations of the workshops and other intervention activities are being carried out. ETHICS AND DISSEMINATION:Ethical approval was obtained from the University of the Witwatersrand Human Research Ethics Committee and procedures comply with ethical recommendations of the United Nations Multi-Country Study on Men and Violence. Dissemination of research findings will take place with local stakeholders and through peer-reviewed publications, with data available on request or after 5 years of trial completion. TRIAL REGISTRATION NUMBER:NCT02823288; Pre-result.

Project description:ObjectiveTo determine whether advocacy targeted at local politicians leads to action to reduce the risk of pedestrian injury in deprived areas.DesignCluster randomised controlled trial.Setting239 electoral wards in 57 local authorities in England and Wales.Participants617 elected local politicians.InterventionsIntervention group politicians were provided with tailored information packs, including maps of casualty sites, numbers injured and a synopsis of effective interventions.Main outcome measures25-30 months post intervention, primary outcomes included: electoral ward level: percentage of road traffic calmed; proportion with new interventions; school level: percentage with 20 mph zones, Safe Routes to School, pedestrian training or road safety education; politician level: percentage lobbying for safety measures. Secondary outcomes included politicians' interest and involvement in injury prevention, and facilitators and barriers to implementation.ResultsPRIMARY OUTCOMES DID NOT SIGNIFICANTLY DIFFER: % difference in traffic calming (0.07, 95%CI: -0.07 to 0.20); proportion of schools with 20 mph zones (RR 1.47, 95%CI: 0.93 to 2.32), Safe Routes to School (RR 1.34, 95%CI: 0.83 to 2.17), pedestrian training (RR 1.23, 95%CI: 0.95 to 1.61) or other safety education (RR 1.16, 95%CI: 0.97 to 1.39). Intervention group politicians reported greater interest in child injury prevention (RR 1.09, 95%CI 1.03 to 1.16), belief in potential to help prevent injuries (RR 1.36, 95%CI 1.16 to 1.61), particularly pedestrian safety (RR 1.55, 95%CI 1.19 to 2.03). 63% of intervention politicians reported supporting new pedestrian safety schemes. The majority found the advocacy information surprising, interesting, effectively presented, and could identify suitable local interventions.ConclusionsThis study demonstrates the feasibility of an innovative approach to translational public health by targeting local politicians in a randomised controlled trial. The intervention package was positively viewed and raised interest but changes in interventions were not statistically significance. Longer term supported advocacy may be needed.Trial registrationCurrent Controlled Trials ISRCTN91381117.

Project description:ObjectivePhosphorus-based food additives increase the total phosphorus content of processed foods. However, the extent to which these additives augment total phosphorus intake per day is unclear.Design and methodsTo examine the contribution of phosphorus-based food additives to the total phosphorus content of processed foods, separate 4-day menus for a low-additive and additive-enhanced diet were developed using Nutrition Data System for Research (NDSR) software. The low-additive diet was designed to conform to U.S. Department of Agriculture guidelines for energy and phosphorus intake (∼2,000 kcal/day and 900 mg of phosphorus per day), and it contained minimally processed foods. The additive-enhanced diet contained the same food items as the low-additive diet except that highly processed foods were substituted for minimally processed foods. Food items from both diets were collected, blended, and sent for measurement of energy and nutrient intake.ResultsThe low-additive and additive-enhanced diet provided approximately 2,200 kcal, 700 mg of calcium, and 3,000 mg of potassium per day on average. Measured sodium and phosphorus content standardized per 100 mg of food was higher each day of the additive-enhanced diet as compared with the low-additive diet. When averaged over the 4 menu days, the measured phosphorus and sodium contents of the additive-enhanced diet were 606 ± 125 and 1,329 ± 642 mg higher than the low-additive diet, respectively, representing a 60% increase in total phosphorus and sodium content on average. When comparing the measured values of the additive-enhanced diet to NDSR-estimated values, there were no statistically significant differences in measured versus estimated phosphorus contents.ConclusionPhosphorus and sodium additives in processed foods can substantially augment phosphorus and sodium intake, even in relatively healthy diets. Current dietary software may provide reasonable estimates of the phosphorus content in processed foods.

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Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods.

Publications

Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods.

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