Published: 2017-07-26

Knowledge, attitude and behavior toward dietary salt: The nescience among hypertensive patients in Indonesia

Anggi Lukman Wicaksana


Background: Knowledge, attitude and behavior of dietary salt determine sodium intake. Among controlled (CHT) and uncontrolled patients with hypertension (UHT), however, limited information is available. The purpose of the study was to identify knowledge, attitude and behavior toward dietary salt and to define the nescience among hypertensive patients in Indonesia.

Methods: Descriptive cross-sectional study design invited subjects using purposive sampling in a general hospital in Yogyakarta. The inclusion criteria were adult patients with hypertension and able to speak Bahasa Indonesia. The demographic data and knowledge, attitude and behavior toward dietary salt were assessed. Data were collected in cardiac clinics in Indonesia and analyzed using Mann Whitney and chi-squared tests.

Results: A total of 175 participants joined the survey with dominantly males, mature age, married and having basic education level. The CHT group had higher knowledge, attitude and behaviour’s percentage on healthy eating, problems-caused by high salty diet, reducing fat and salt consumption than the UHT group although it was not statistically proved. Both groups reported nescience about recommended amount of salt consumption (84.1% versus 81.1%, CHT and UHT respectively), salt-sodium difference (56.5% versus 59.4%), nutritional information (43.5% versus 48.1%) and food labelling (39.1% versus 40.6%). Limited participants always considered packaged indication (7.2% versus 11.3%) and total salt/sodium per package was more favourable label (42% versus 31.1%).

Conclusions:Results showed no significant differences of knowledge, attitude and behavior between patients with controlled and uncontrolled hypertension. Both groups had problems on concerning recommended amount of salt consumption, nutritional information, and food labelling which should be addressed while teaching patients about hypertension.



Attitude, Behavior, Dietary salt, Knowledge, Nescience

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WHO. Guideline: sodium intake for adults and children. Geneva: World Health Organization, 2012. Available at

WHO. A global brief on hypertension: silent killer, global public health crisis. Geneva: World Health Organization; 2016.

Elliott P, Brown I. Sodium intakes around the world. Geneva: World Health Organization; 2007: 6-15.

Cornelio ME, Gallani MCBJ, Godin G, Rodrigues RCM, Mendes RDR, Nadruz JW. Development and reliability of an instrument to measure psychosocial determinants of salt consumption among hypertensive patients. Latin Am J Nurs. 2009;17(5):701-7.

Powles J, Fahimi S, Micha R, Khatibzadeh S, Shi P, Ezzati M, 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):1-18.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the eighth joint national committee (JNC 8). Jama. 2014;311(5):507-20.

WHO. Strategies to monitor and evaluate population sodium consumption and sources of sodium in the diet. WHO, 2013. Available at 2011/9789241501699_eng. pdf. Accessed 6 June 2016.

Institute of Medicine. Strategies to reduce sodium intake in the United States. Washington, D.C.: IOM; 2010. Available at

Claro RM, Lindersn L, Ricardo CZ, Legetic B, Campbell NRC. Consumer attitudes, knowledge, and behavior related to salt consumption in sentinel countries of the Americas. Rev Panam Salud Publica. 2012;32(4):265-73.

Zhang J, Xu AQ, Ma JX, Shi XM, Guo XL, Xiao-lei, et al. Dietary sodium intake: knowledge, attitudes and practices in Shandong Province, China, 2011. Plos One. 2013;8(3):e58973.

Nasreddine L, Akl C, Al-Shaar L, Almedawar MM, Isma’eel H. Consumer knowledge, attitudes and salt-related behavior in the middle-east: the case of Lebanon. Nutrient. 2014;6:5079-102.

Rahajeng E, Tuminah S. Prevalence of hypertension and its determinants in Indonesia. Indonesian Medical Magazine. 2009;25:580-7.

Australian Division of World Action on Salt and Health. 2007 survey of Australian consumer awareness and practices relating to salt. AWASH; 2007. Available at Accessed 17 November 2016.

Consensus Action on Salt and Health. Salt survey in adults. CASH; 2003. Available at Accessed 12 November 2016.

Public Health Agency of Canada. Canadians’ and health care professionals’ views on sodium commissioned public opinion research to inform the working group about Canadians’ current awareness about sodium. Public Health Agency of Canada; 2009. Available at http:// _agency_canada/2009/11708/report.pdf. Accessed 8 October 2016.

Plichta SB, Kelvin EA, Munro BH. Munro's statistical methods for health care research, 6th Ed. Philadelphia PA: Wolters Kluwer Health/Lippincott Williams and Wilkins; 2013.

Setiati S, Sutrisna B. Prevalence of hypertension without anti-hypertensive medications and its association with social demographic characteristics among 40 years and above adult population in Indonesia. Acta Medica Indonesia. 2005;37:20-5.

Teixeira JF, Goulart MR, Busnello FM, Pellanda LC. Hypertensive’s knowledge about high-sodium food and their behavior. Arq Bras Cardiol. 2016;106:404-10.

Papadakis S, Pipe AL, Moroz IA, Reid RD, Blanchard CM, Cote DF, et al. Knowledge, attitudes and behaviours related to dietary sodium among 35-to 50-years-old Ontario residents. Canadian J Cardiol. 2010;26:e164-9.

WHO. Preventing chronic diseases: a vital investment. Geneva: WHO Global Report; 2005. Available at

WHO and ISH. 2003 World health organization /international society of hypertension statement on management of hypertension. J Hypertension. 2003;21:1983-92.

Smith-Spangler CM, Juusola JL, Enns EA, Owens DK, Garber AM. Population strategies to decrease sodium intake and the burden of cardiovascular disease: cost-effectiveness analysis. Ann Internal Med. 2010;152:481-7.