School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trialBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h770 (Published 18 March 2015) Cite this as: BMJ 2015;350:h770
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Commentary: School based education programme to reduce salt intake in children and their families (School-EduSalt): cluster randomised controlled trial
This research project aimed to demonstrate the link between an educational program for lowering salt intake at home, taught to a 10-year-old child population and the effect on childrens’ households. Researchers decided to produce a randomized control trial to evaluate the impact of the pedagogical sessions. The intervention group’s goal was focusing on the reduction of salt intake while the control group received the regular health programme. The project was conducted over three and a half months and started by measuring the amount of sodium in urine. This 24 hours’ sodium level was then repeated at the end of the project. Blood pressures on children and two adults were also measured at the beginning and the end of the study. The results showed a positive effect in lowering sodium intake in the family members when their children received information as on salt, on a regular basis. They had no significant discordance in blood pressure in children, between before or after the trial. Only a small difference of increased systolic pressure was noticed on both adult research groups. The control group had a slightly higher systolic pressure than the intervention group.
As the authors highlighted in their studies, the pedagogical programmes haven’t been effective, until now. Hence, I found the idea of empowering families by teaching children about health topics is an innovative and instigator way to foster healthy habits. It gives them the opportunity to improve their wellness independently. We should think about the Mobile Theory from Wright and Leahey (2009). It suggests seeing the family as a system rather than independently:
“This concept aids the recognition that any significant event or change in one family member affects all family members to varying degrees as was illustrated in the analogy of the mobile.”
I think that it is important to look at a person as whole, when we provide care. Because they are all influencing each other. This project shows us the positive influence children can have by modifying negative health behaviors in their own family. It will be fascinating, to eventually explore, with quantitative research, the long-term effects of this positive change.
This essential research is important for the development of the program of prevention and promotion in public health, especially because of the optimistic results in reducing salt consumption. As per the Global Strategy on Diet, Physical Activity and Health (WHO, 2016), we can discover many ideas for future studies, using the same familial approach to encourage change. Possible topics for study include: 1) decreasing sugar intake, 2) increasing activity level, 3) decreasing the consumption of processed foods; all can be linked to the promotion of wellness and the prevention of metabolic syndrome, cardiovascular disease and child obesity.
As a nurse, I strongly support both family-centred care and the teaching process to foster positive health changes within family members. If a child can influence his/her family to live healthier than we as healthcare professionals should use this opportunity to teach the younger generation about things like sugar use reduction, increase physical activity and increasing the consumption of fruits and vegetables. Children can then, in turn, pass on their knowledge to improve health for all.
Feng, J. Y.-X.-P. (2015). School-Based Education Programme to reduce salt intake in children and their families (School-EduSalt):clusters randomized controlled trial. THE BMJ , 1-9.
World Health Organization. (2016). Global Strategy on Diet, Physical Activity and Health . Retrieved from the World Health Organization: http://www.who.int/dietphysicalactivity/childhood_why/en/.
Wright, L. and Leahey, M. (2013). Nurses and Families a Guide to Family Assessment and Intervention. Philadelphia: F.A.Davis Company.
Competing interests: No competing interests