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soltani T, Mazloomy Mahmoodabad S S, Nadjarzadeh A, Fallahzadeh H, Soltani M H, vaezi A A et al . Analysis of the salt consumption situation using SWOT approach and providing solutions related to COMBI strategies. TB 2022; 21 (3) :66-79
URL: http://tbj.ssu.ac.ir/article-1-3273-en.html
URL: http://tbj.ssu.ac.ir/article-1-3273-en.html
Tahere Soltani 
, Seyed Saeed Mazloomy Mahmoodabad * , Azadeh Nadjarzadeh , Hossein Fallahzadeh , Mohammad Hossein Soltani , Ali Akbar Vaezi , Seyedeh Mahdyeh Namayandeh
, Seyed Saeed Mazloomy Mahmoodabad * , Azadeh Nadjarzadeh , Hossein Fallahzadeh , Mohammad Hossein Soltani , Ali Akbar Vaezi , Seyedeh Mahdyeh Namayandeh
School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. , mazloomy.mm@gmail.com
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Received:2021/10/06 Accepted:2022/06/21
Analysis of the salt consumption situation using SWOT approach and providing solutions related to COMBI strategies
Tahere Soltani)Ph.D)1, Seyed Saeed Mazloomy Mahmoodabad(Ph.D)2, Azadeh Nadjarzadeh(Ph.D)3, Mohammad Hossein Soltani(M.D)4, Ali Akbar Vaezi(Ph.D)5, Hossien Fallahzadeh(Ph.D)6, Seyede Mahdieh Namayandeh(Ph.D)7
1.Assistant Professor, Department of Health Education & Health Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
2.Corresponding author: Professor, Social Determinants of Health Research Center, Department of Health Education and Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Email:mazloomy.mm@gmail.com Tel:09131516779
3.Associate Professor, Department of Nutrition Sciences, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
4.Associate Professor, Department of Cardiovascular, Cardiovascular Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
5.Associate Professor, Department of Nursing, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
6.Professor, Department of Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
7.Associate Professor, Department of Epidemiology, Cardiovascular Research Center, Afshar Heart Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Abstract
Introduction: excessive consumption of salt is one of the unhealthy eating habits and is one of the factors in the high prevalence of cardiovascular diseases and the resulting mortality. Using swot tool is one of the effective measures in understanding the society, planning and new solutions for behavior modification. So, the aim of this study was to investigate the factors related to salt consumption in the target society in order to provide solutions to improve the current situation.
Methods: An exploratory study was conducted in hamidia town of yazd city in 2020. Qualitative data were collected using three focus groups and twenty four individual interviews with women and eleven individual interviews with health workers. Quantitative data of knowledge, attitude and performance of women regarding salt consumption were collected using a validated questionnaire regarding salt consumption through a 4-part researcher. The amount of salt consumed was measured through a 24-hour food questionnaire and a urine test. Themes were identified from quantitative and qualitative data and analyzed and were interpreted using a swot matrix and solutions were designed using strategies COMBI.
Results: the results of research showed that the highest priority among the strengths, weaknesses, opportunities and threats of the program are, respectively, trusting the training of doctors and center personnel with the importance coefficient of 0.06, insufficient awareness about the complications of excessive salt consumption with the importance coefficient 0.06, the presence of nutrition experts in health centers and access to health professionals with the importance coefficient of 0.05 and the existence of conflicting information in the society about salt consumption with the importance coefficient of 0.053.
Conclusion:
Our results showed that, the best strategy for the program of reducing salt consumption in the target society was an aggressive strategy. Therefore, the relevant officials can, implement the aggressive strategies presented in this research to reduce the salt consumption
Keywords: SWOT Analyziz, salt consumption situation, strategies COMBI
Conflict of interest: The authors declared that there is no conflict of interest.
References
1-Shidfar MR, Shojaizadeh D, Hosseini M, et al. Knowledge, attitude and lifestyle of patients with unstable angina in mashad, Iran. Journal of School of Public Health and Institute of Public Health Research.2004;2(3):65-82.[Persian]
2- Powles J, Fahimi S, Micha R, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ open.2013;3(12):e003733.
3-Mohammadifard N, Fahimi S, Khosravi A, et al. Advocacy strategies and action plans for reducing salt intake in Iran. Archives of Iranian medicine .2012;15:320-4.[Persian]
4-Motlagh Z, Mazloomy S, MozaffariKhosravi M, et al. Salt intake among women referred tomedical health centers, Yazd, Iran . J ShahidSadoughiUniv Med Sci.2011;19(4):550-60. [Persian]
5- Rahimdel T. design,implementation and evaluation of effect of educational intervention based on the theory 0f planned behavior on salt intake of peple at risk of high blood pressure degree in Health Education and Health Promotion] Shahid sadoughi university of medical science. 2018.[Persian]
6-Soltani T, Mazloomy Mahmoodabad SS, Nadjarzadeh A, et al. A Brief Study of Dietary Salt Intake in an Urban Yazd Population. Critical Comments in Biomedicine. 2021;2(1):100-31.
7-World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020: World Health Organization .2013:7
8-Ibrahim MM, Damasceno A. Hypertension in developing countries. The Lancet 2012;380(9841):611-19.
9- Bertram MY, Steyn K, Wentzel-Viljoen E, et al. Reducing the sodium content of high-salt foods: effect on cardiovascular disease in South Africa. South African Medical Journal 2012;102(9):743-5.
10- Olyaeemanesh A, Behzadifar M, Mousavinejhad N, et al. Iran’s health system transformation plan: a SWOT analysis. Medical journal of the Islamic Republic of Iran. 2018;32:39. [Persian]
11- Topor DR, Dickey C, Stonestreet L, et al. Interprofessional Health Care Education at Academic Medical Centers: Using a SWOT Analysis to Develop and Implement Programming. Mededportal: the journal of teaching and learning resources .2018;14.
12-von Kodolitsch Y, Bernhardt AM, Robinson PN, et al. Analysis of strengths, weaknesses, opportunities, and threats as a tool for translating evidence into individualized medical strategies (I-SWOT). Aorta 2015;3(03):98-107.
13-James F. McKenzie, Brad L. et al. Planning, Implementing, Evaluating Health Promotion Programs: A Primer (7th Edition)7th Edition San Francisco : Pearson/Benjamin Cummings. 2005.
14-DiClemente RJ, Crosby RA, Kegler MC. Emerging theories in health promotion practice and research: Strategies for improving public health. Second ed: John Wiley & Sons.2002.
15- Schiavo R. Health communication: From theory to practice: John Wiley & Sons.2013.
16-Feldon DF, Kafai YB. Mixed methods for mixed reality: Understanding users’ avatar activities in virtual worlds. Educational Technology Research and Development.2008;56(5-6):575-93.
17-Soltani T, Mazloomy Mahmoodabad SS, Vaezi AA, et al. Incentives to Reduce Salt Intake Resulting From Women’s Experiences: A Qualitative Study. Community Health Equity Research & Policy. 2022;42(3):281-9.
18-Mahmoodabad SSM, Vaezi AA, Soltani T, et al. Identifying the inhibitory factors of dietary salt reduction in women: a qualitative study, Yazd, Iran. International Journal of Human Rights in Healthcare .2020 ;13( 5):485-98. https://doi.org/10.1108/IJHRH-01-2020-0003
19-World Health Organization, Unicef. Communication for behavioural impact (COMBI): A toolkit for behavioural and social communication in outbreak response. World Health Organization, 2012. https://apps.who.int/iris/handle/10665/75170
20-van Wijngaarden JD, Scholten GR, van Wijk KP. Strategic analysis for health care organizations: the suitability of the SWOT‐analysis. The International journal of health planning and management.2012;27(1):34-49.
21-McIntosh WA, Fletcher RD, Kubena KS, et al. Factors associated with sources of influence/information in reducing red meat by elderly subjects. Appetite. 1995;24(3):219-30.
22- Kian M. Analysis the Null Curriculum of Nutritional literacy among High School Students. 2016. Journal of Theory & Practice in Curriculum .2016; 6 (3): 101 -20. [Persian]
23-Turrell G, Kavanagh AM. Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. Public health nutrition.2006;9(3):375-83.
24-Rafieifar S, Pouraram H, Djazayery A, et al. Strategies and opportunities ahead to reduce salt intake. Archives of Iranian Medicine .2016;19(10): 729-34.
25-Naghibi SA, Yahyazadeh R, Yazdani Cherati J. Knowledge, attitude referred to health centers on salt intake. Journal of Mazandaran University of Medical Sciences .2012;22(95):99-104. [Persian]
26-Esfandiari Z, Marasi MR, Estaki F, et al. Influence of education on knowledge, attitude and practices of students of Isfahan University of Medical Sciences to traffic light inserted on food labeling. Tehran University Medical Journal TUMS Publications. 2019;77(1):54-62. [Persian]
27-Pourali F, Abdollahi Z, Roufegarinejad L, et al. A Comprehensive Overview on Necessity and Strategies of Salt Intake Reduction in the Population. Depiction of Health.2017;8(1):57-66.[Persian]
28-Namayandeh SM, Lotfi MH, Jafari V, et al. Salt Content in Traditional and Nontraditional Breads in Yazd City, Iran, 2015-2016. Journal of Nutrition and Food Security. 2018;3(4):185-92.
29-Rafiei M, Zaghian N, Rostami A, et al. Principles of nutritional training and counseling for patients in group training sessions based on behavioral change theory. Iranian Journal of Medical Education .2010;10(1): 92-100[Persian]
Analysis of the salt consumption situation using SWOT approach and providing solutions related to COMBI strategies
Tahere Soltani)Ph.D)1, Seyed Saeed Mazloomy Mahmoodabad(Ph.D)2, Azadeh Nadjarzadeh(Ph.D)3, Mohammad Hossein Soltani(M.D)4, Ali Akbar Vaezi(Ph.D)5, Hossien Fallahzadeh(Ph.D)6, Seyede Mahdieh Namayandeh(Ph.D)7
1.Assistant Professor, Department of Health Education & Health Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
2.Corresponding author: Professor, Social Determinants of Health Research Center, Department of Health Education and Promotion, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Email:mazloomy.mm@gmail.com Tel:09131516779
3.Associate Professor, Department of Nutrition Sciences, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
4.Associate Professor, Department of Cardiovascular, Cardiovascular Research Center, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
5.Associate Professor, Department of Nursing, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
6.Professor, Department of Biostatistics, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
7.Associate Professor, Department of Epidemiology, Cardiovascular Research Center, Afshar Heart Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Abstract
Introduction: excessive consumption of salt is one of the unhealthy eating habits and is one of the factors in the high prevalence of cardiovascular diseases and the resulting mortality. Using swot tool is one of the effective measures in understanding the society, planning and new solutions for behavior modification. So, the aim of this study was to investigate the factors related to salt consumption in the target society in order to provide solutions to improve the current situation.
Methods: An exploratory study was conducted in hamidia town of yazd city in 2020. Qualitative data were collected using three focus groups and twenty four individual interviews with women and eleven individual interviews with health workers. Quantitative data of knowledge, attitude and performance of women regarding salt consumption were collected using a validated questionnaire regarding salt consumption through a 4-part researcher. The amount of salt consumed was measured through a 24-hour food questionnaire and a urine test. Themes were identified from quantitative and qualitative data and analyzed and were interpreted using a swot matrix and solutions were designed using strategies COMBI.
Results: the results of research showed that the highest priority among the strengths, weaknesses, opportunities and threats of the program are, respectively, trusting the training of doctors and center personnel with the importance coefficient of 0.06, insufficient awareness about the complications of excessive salt consumption with the importance coefficient 0.06, the presence of nutrition experts in health centers and access to health professionals with the importance coefficient of 0.05 and the existence of conflicting information in the society about salt consumption with the importance coefficient of 0.053.
Conclusion:
Our results showed that, the best strategy for the program of reducing salt consumption in the target society was an aggressive strategy. Therefore, the relevant officials can, implement the aggressive strategies presented in this research to reduce the salt consumption
Keywords: SWOT Analyziz, salt consumption situation, strategies COMBI
Conflict of interest: The authors declared that there is no conflict of interest.
References
1-Shidfar MR, Shojaizadeh D, Hosseini M, et al. Knowledge, attitude and lifestyle of patients with unstable angina in mashad, Iran. Journal of School of Public Health and Institute of Public Health Research.2004;2(3):65-82.[Persian]
2- Powles J, Fahimi S, Micha R, et al. Global, regional and national sodium intakes in 1990 and 2010: a systematic analysis of 24 h urinary sodium excretion and dietary surveys worldwide. BMJ open.2013;3(12):e003733.
3-Mohammadifard N, Fahimi S, Khosravi A, et al. Advocacy strategies and action plans for reducing salt intake in Iran. Archives of Iranian medicine .2012;15:320-4.[Persian]
4-Motlagh Z, Mazloomy S, MozaffariKhosravi M, et al. Salt intake among women referred tomedical health centers, Yazd, Iran . J ShahidSadoughiUniv Med Sci.2011;19(4):550-60. [Persian]
5- Rahimdel T. design,implementation and evaluation of effect of educational intervention based on the theory 0f planned behavior on salt intake of peple at risk of high blood pressure degree in Health Education and Health Promotion] Shahid sadoughi university of medical science. 2018.[Persian]
6-Soltani T, Mazloomy Mahmoodabad SS, Nadjarzadeh A, et al. A Brief Study of Dietary Salt Intake in an Urban Yazd Population. Critical Comments in Biomedicine. 2021;2(1):100-31.
7-World Health Organization. Global action plan for the prevention and control of noncommunicable diseases 2013-2020: World Health Organization .2013:7
8-Ibrahim MM, Damasceno A. Hypertension in developing countries. The Lancet 2012;380(9841):611-19.
9- Bertram MY, Steyn K, Wentzel-Viljoen E, et al. Reducing the sodium content of high-salt foods: effect on cardiovascular disease in South Africa. South African Medical Journal 2012;102(9):743-5.
10- Olyaeemanesh A, Behzadifar M, Mousavinejhad N, et al. Iran’s health system transformation plan: a SWOT analysis. Medical journal of the Islamic Republic of Iran. 2018;32:39. [Persian]
11- Topor DR, Dickey C, Stonestreet L, et al. Interprofessional Health Care Education at Academic Medical Centers: Using a SWOT Analysis to Develop and Implement Programming. Mededportal: the journal of teaching and learning resources .2018;14.
12-von Kodolitsch Y, Bernhardt AM, Robinson PN, et al. Analysis of strengths, weaknesses, opportunities, and threats as a tool for translating evidence into individualized medical strategies (I-SWOT). Aorta 2015;3(03):98-107.
13-James F. McKenzie, Brad L. et al. Planning, Implementing, Evaluating Health Promotion Programs: A Primer (7th Edition)7th Edition San Francisco : Pearson/Benjamin Cummings. 2005.
14-DiClemente RJ, Crosby RA, Kegler MC. Emerging theories in health promotion practice and research: Strategies for improving public health. Second ed: John Wiley & Sons.2002.
15- Schiavo R. Health communication: From theory to practice: John Wiley & Sons.2013.
16-Feldon DF, Kafai YB. Mixed methods for mixed reality: Understanding users’ avatar activities in virtual worlds. Educational Technology Research and Development.2008;56(5-6):575-93.
17-Soltani T, Mazloomy Mahmoodabad SS, Vaezi AA, et al. Incentives to Reduce Salt Intake Resulting From Women’s Experiences: A Qualitative Study. Community Health Equity Research & Policy. 2022;42(3):281-9.
18-Mahmoodabad SSM, Vaezi AA, Soltani T, et al. Identifying the inhibitory factors of dietary salt reduction in women: a qualitative study, Yazd, Iran. International Journal of Human Rights in Healthcare .2020 ;13( 5):485-98. https://doi.org/10.1108/IJHRH-01-2020-0003
19-World Health Organization, Unicef. Communication for behavioural impact (COMBI): A toolkit for behavioural and social communication in outbreak response. World Health Organization, 2012. https://apps.who.int/iris/handle/10665/75170
20-van Wijngaarden JD, Scholten GR, van Wijk KP. Strategic analysis for health care organizations: the suitability of the SWOT‐analysis. The International journal of health planning and management.2012;27(1):34-49.
21-McIntosh WA, Fletcher RD, Kubena KS, et al. Factors associated with sources of influence/information in reducing red meat by elderly subjects. Appetite. 1995;24(3):219-30.
22- Kian M. Analysis the Null Curriculum of Nutritional literacy among High School Students. 2016. Journal of Theory & Practice in Curriculum .2016; 6 (3): 101 -20. [Persian]
23-Turrell G, Kavanagh AM. Socio-economic pathways to diet: modelling the association between socio-economic position and food purchasing behaviour. Public health nutrition.2006;9(3):375-83.
24-Rafieifar S, Pouraram H, Djazayery A, et al. Strategies and opportunities ahead to reduce salt intake. Archives of Iranian Medicine .2016;19(10): 729-34.
25-Naghibi SA, Yahyazadeh R, Yazdani Cherati J. Knowledge, attitude referred to health centers on salt intake. Journal of Mazandaran University of Medical Sciences .2012;22(95):99-104. [Persian]
26-Esfandiari Z, Marasi MR, Estaki F, et al. Influence of education on knowledge, attitude and practices of students of Isfahan University of Medical Sciences to traffic light inserted on food labeling. Tehran University Medical Journal TUMS Publications. 2019;77(1):54-62. [Persian]
27-Pourali F, Abdollahi Z, Roufegarinejad L, et al. A Comprehensive Overview on Necessity and Strategies of Salt Intake Reduction in the Population. Depiction of Health.2017;8(1):57-66.[Persian]
28-Namayandeh SM, Lotfi MH, Jafari V, et al. Salt Content in Traditional and Nontraditional Breads in Yazd City, Iran, 2015-2016. Journal of Nutrition and Food Security. 2018;3(4):185-92.
29-Rafiei M, Zaghian N, Rostami A, et al. Principles of nutritional training and counseling for patients in group training sessions based on behavioral change theory. Iranian Journal of Medical Education .2010;10(1): 92-100[Persian]
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Received: 2021/10/6 | Accepted: 2022/06/21 | Published: 2022/09/1
Received: 2021/10/6 | Accepted: 2022/06/21 | Published: 2022/09/1
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