Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2015 | Study protocol

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

Published in: BMC Public Health | Issue 1/2016

Login to get access

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
Appendix
Available only for authorised users
Literature
1.
Brooks I. Organisational Behaviour, individuals, groups and organisation. 3rd ed. London: Pearson Education Limited; 2006.
2.
Tansey G, Worsley A. The food system: a guide. London: Earthscan publishing; 1995.
3.
4.
Weaver CM, Dwyer J, Fulgoni VL, King JC, Leveille GA, MacDonald RS, et al. Processed foods: contributions to nutrition. Am J Clin Nutr. 2014;99(6):1525–42.CrossRefPubMed
5.
6.
7.
Réquillart V, Soler L-G. Is the reduction of chronic diseases related to food consumption in the hands of the food industry? Eur Rev Agric Econ. 2014;41:375–403.CrossRef
8.
Antman EM, Appel LJ, Balentine D, Johnson RK, Steffen LM, Miller EA et al. Stakeholder Discussion to Reduce Population-Wide Sodium Intake and Decrease Sodium in the Food Supply: A Conference Report From the American Heart Association Sodium Conference 2013 Planning Group. Circulation. 2014;5 May:1–39
9.
Tim L, David B, Martin C. Food Policy; integrating health, environment & society. London: Oxford University Press; 2009.
10.
11.
12.
Land M-A, Webster J, Christoforou A, Praveen D, Jeffery P, Chalmers J, et al. Salt intake assessed by 24 h urinary sodium excretion in a random and opportunistic sample in Australia. BMJ Open. 2014;4:1–8.CrossRef
13.
Keogh JB, Clifton PM. Salt intake and health in the Australian population. Med J Aust. 2008;189:526.PubMed
14.
World health Organization. Guideline: Sodium intake for adults and children. Geneva: WHO; 2012. p. 1–56.
15.
16.
Australian Government. Australia Institute of Health and Welfare. Australia's health 2014. Australia's health series no. 14. Canberra: AIHW; 2014. p. 1–578.
17.
Mente A, O'Donnell MJ, Rangarajan S, McQueen MJ, Poirier P, Wielgosz A, et al. Association of Urinary Sodium and Potassium Excretion with Blood Pressure. N Engl J Med. 2014;371:601–11.CrossRefPubMed
18.
Mozaffarian D, Fahimi S, Singh GM, Micha R, Khatibzadeh S, Engell RE, et al. Global Sodium Consumption and Death from Cardiovascular Causes. N Engl J Med. 2014;371:624–34.CrossRefPubMed
19.
He F, MacGregor GA. A comprehensive review on salt and health current experience of worldwide salt reduction programmes. J Hum Hypertens. 2009;23:363–84.CrossRefPubMed
20.
Brown IJ, Tzoulaki I, Candeias V, Elliott P. Salt intakes around the world: implications for public health. Int J Epidemiol. 2009;38:791–813.CrossRefPubMed
21.
Christoforou AK, Dunford EK, Neal BC. Changes in the sodium content of Australian ready meals between 2008 and 2011. Asia Pac J Clin Nutr. 2013;22:138–43.PubMed
22.
Trevena H, Dunford E, Neal B, Webster J. The Australian Food and Health Dialogue–the implications of the sodium recommendation for pasta sauces. Public Health Nutr. 2014;7:1647–53.CrossRef
23.
Trevena H, Neal B, Dunford E, Wu J. An Evaluation of the Effects of the Australian Food and Health Dialogue Targets on the Sodium Content of Bread. Breakfast Cereals and Processed Meats. Nutrients. 2014;6:3802–17.CrossRefPubMedPubMedCentral
24.
Derek S Pugh ed. Organization Theory. 4th ed. London: Penguin; 1997.
25.
Dawson S. Analysing Organisations. 3rd ed. London: MacMillan Press Ltd; 1996.CrossRef
26.
Robbins SP, Judge TA. Organisational Behaviour. 15th ed. New Jersey: Prentice Hall; 2013.
27.
Porter M, How competitive forces shape strategy. Harv Bus Rev. 1979;57:137–45.
28.
29.
Johnson G, Whittington R, Scholes K, Angwin D, Regner P. Exploring Strategy: text and cases. 10th ed. London,: Pearson Education Limited; 2014.
30.
Kreuter MW. Commentary on Public Health Advocacy to Change Corporate Practices. Health Educ Behaviour. 2005;32:355–62.CrossRef
31.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:1–10.
32.
Coates B, David R. Learning for change: The art of assessing the impact of advocacy work. Development in Practice. 2002;12:530–41.CrossRef
33.
Freudenberg N. Public Health Advocacy to Change Corporate Practices: Implications for Health Education Practice and Research. Health Educ Behaviour. 2005;32:298–319.CrossRef
34.
Freudenberg N, Picard Bradley S, Serrano M. Public Health Campaigns to Change Industry Practices That Damage Health: An Analysis of 12 Case Studies. Health Educ Behaviour. 2009;36:230–49.CrossRef
35.
Spar D, La Mure L. The Power of Activism: Assessing the Impact of NGOs on Global Business. Calif Manage Rev. 2003;45:78–101.CrossRef
36.
Lobstein T, Brinsden H, Landon J, Kraak V, Musicus A, Macmullan J. INFORMAS and advocacy for public health nutrition and obesity prevention. Obes Rev. 2013;14:150–6.CrossRefPubMed
37.
Australian food and Grocery Council. State of the Industry Report. 2014:1–40.
38.
The George Institute for Global Health. Food Composition Database. Sydney, Australia : The George Institute for Global Health. 2014.
39.
40.
College of Law (Sydney NSW) Continuing Professional Education Department. Sydney, Australia: Basics of corporations law; 2004:64.
41.
42.
43.
Michie S, van Stralen M, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011;6(42):1–11.
44.
Minarelli F, Raggi M, Viaggi D. Distinguishing the innovation behaviour of micro, small and medium food enterprises. Journal on Chain and Network Science. 2014;14:95–102.CrossRef
45.
Smith M, Busi M, Ball P, Van Der Meer R. Factors influencing an organisation's ability to manage innovation: a stuctured literature review and conceptual model. International Journal of Innovation Management (IJIM). 2008;12:655–76.CrossRef
46.
Traill W, Meulenberg M. Innovation in the food industry. Agribusiness. 2002;18:1–21.CrossRef
47.
48.
49.
50.
51.
Dunford E, Webster J, Metzler AB, Czernichow S, Mhurchu CN, Wolmarans P, et al. International collaborative project to compare and monitor the nutritional composition of processed foods. Eur J Prev Cardiol. 2012;19:1326–32.CrossRefPubMed
52.
53.
54.
Wong WP, Tseng M-L, Tan KH. A business process management capabilities perspective on organisation performance. Total Qual Manag Bus. 2013;25(5–6):602–17.
55.
Hendriks A-M, Jansen M, Gubbels J, De Vries N, Paulussen T, Kremers S. Proposing a conceptual framework for integrated local public health policy, applied to childhood obesity - the behaviour change ball. Implemt Sci. 2013;8(1):46.CrossRef
56.
Dorfman L, Wallack L, Woodruff K. More Than a Message: Framing Public Health Advocacy to Change Corporate Practices. Health Educ Behaviour. 2005;32:320–36.CrossRef
57.
58.
LW K, Phillips C. The logic model guidebook better strategies for great results. 2nd ed. California: Sage Publications; 2013.
Metadata
Title
Protocol for a cluster-randomised trial to determine the effects of advocacy actions on the salt content of processed foods
Publication date
01-12-2015
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-2743-4

Other articles of this Issue 1/2016

BMC Public Health 1/2016 Go to the issue

Study protocol

Internet-based educational intervention to prevent risky sexual behaviors in Mexican adolescents: study protocol

Research article

Power, fairness and trust: understanding and engaging with vaccine trial participants and communities in the setting up the EBOVAC-Salone vaccine trial in Sierra Leone

Research article

Fish, food security and health in Pacific Island countries and territories: a systematic literature review

Research article

Partnership capacity for community health improvement plan implementation: findings from a social network analysis

Study protocol

Hockey Fans in Training (Hockey FIT) pilot study protocol: a gender-sensitized weight loss and healthy lifestyle program for overweight and obese male hockey fans

Research article

Weekday-weekend patterns of physical activity and screen time in parents and their pre-schoolers