Table 3 Themes and subthemes for facilitators for and barriers to reducing dietary salt consumption

Facilitators

Perceived health benefits

Individual perceptions

1) “… I ate heavily flavoured foods in the past. Because my skin condition became poor [unwell], then I changed to eat light-flavoured foods. Obviously, my skin condition improved, and I am more used to eating light-flavoured foods. I think it is good, because heavy-flavoured food does not mean the taste is better. Simple food tastes good. I feel better physically and mentally, not that easy to get tired when I started the light-flavoured diet.” (P2)

2) “I found that I felt very uncomfortable, had indigestion or very tired after I eat too much food with MSG or strong taste.” (P4)

Negative health impacts

3) “I expect some intimidating information, let people see the consequences of salt… Or the effects of excessive salt intake on cardiovascular system, will it block the cardiovascular system? It is good to have a picture showing a blood vessel narrowed down to a line.” (P5)

4) “I think it's better to have some harmful side [information] about eating too much salt… the best option is let them [people] know that how bad if they take too much salt …” (P7)

Resources and support

Salt alternatives

5) “The restaurant foods are delicious because they put a lot of salt and seasonings. So homemade meals taste relatively light. If there is a way to make the food taste good without too much salt, then I’d use less salt…I cook for myself; I try to use different herbs instead. Taste good but not too salty.” (P4)

6) “Use vinegar, black pepper instead of salt to enhance the food flavouring.” (P3)

7) “…you can provide some guidance, such as low added salt and condiment recipes. The biggest problem with Chinese cooking is using plenty of condiments. The salt content in condiments is unclear… I do not know the amount of salt [in the paste/sauces]. I don't know whether it has excessive amount of salt.” (P5)

Digital information

8) “Soft copy is easier for me because, you know, my parents are around 60 years old. The info [information] is not only useful for me. If I got such information, I will share it via WeChat with my parents too.” (P7)

9) “Hard copy information maybe you look just for once and then you throw it away. So, like for me, it's better to have digital information. I can put on my computer or somewhere else.” (P8)

Barriers

Perceived health benefits

Physical changes (benefits) are not apparent

10) “Stop eating salt, I won't lose weight. What is the positive reinforcement? A low-salt diet will not improve the skin condition. Stop eating sugar and oil, the body weight is reduced.” (P5)

Resources and support

Inadequate salt-related health education

11) “Yes, not much advertising about salt reduction in Australia. Haven't received any [education] in Australia… I don't think the public has a strong idea of salt reduction as [much as] sugar reduction.” (P1)

12) “My knowledge about the health impacts of salt is just from some random information online and they keep emphasizing that a lot of people currently, taking too much salt… I still believe if I can reduce the amount of salt that I take daily, that should be better for my health.” (P7)

13) “Local GP focuses on secondary prevention. Salt consumption is not a topic that the GP would bring up for discussion.” (P3)

14) “People don’t know the health risk associated with high salt intake. People know that a high sugary diet is a risk for diabetes. A high-salt diet is known to be a cause of hypertension, but hypertension is not perceived as a significant health issue… High blood pressure is not serious enough to die.” (P3)

Wide availability of commercial food products

Hidden salt in food products

15) “I think Asian food may need a lot of different seasonings. There is a lot of salt in different seasonings. Therefore, the food tastes good… For example, stewed chicken with potatoes may contain oyster sauce, and light and dark coloured soy sauces. It is difficult to calculate the amount of salt in these three condiments…” (P2)

16) “I believe that my daily food contains salt, and I am not aware. For example, processed meat, bacon and ham, they have salt. Even if a slice of bread has salt… A lot of opportunities to buy processed meat. And there's a lot of ingredients inside the processed meat that I don't know.” (P5)

17) “The processed food manufacturers, they add salt [to the food products] that it's also a barrier… I would like them [processed foods] to have less salt but it doesn't seem to be a change [over time].” (P6)

Inadequate food literacy (food labelling)

18) “It is difficult to calculate the amount of salt in the condiments… And each brand has different food labels, and the salt content is not the same, so I won't check each time, too much trouble…” (P2)

19) “I don't really know the ingredients. Even they have the ingredients label on the back, but they're sort of medical [chemical] terminology. I don't understand what they are.” (P7)

Affordability and convenience

20) “Foods with high salt content are often cheaper in supermarkets. So, I buy them because the price is lower.” (P4)

21) “If I really want to make homemade sauce, I will make my own chicken broth when I'm free. Then I can be sure that the broth does not contain salt… But I'm not free to make chicken broth every day, so sometimes I need chicken extract.” (P5)

Factors affecting health behavioural change

Individual food taste and cooking habits

22) “Adding a pinch of salt” (P1)

23) “Salt is usually added to the meals last. I try the taste first before I add salt to the meals… when I add a condiment whether is soy sauce or other seasoning to the meals, I don't check the amount of salt that is being added to the meals.” (P2)

24) “I rely on my experience. The dish that I have never cooked, I will try the taste at first. But if I've already cooked the dish before, I add salt to the dish without tasting it.” (P5)

25) “It's sort of depends on my taste…, I sort of tweak that, tweak it [salt] according to my taste… I add a little bit more, little bit more at time for the individual meal.” (P6)

26) “I cook in bulk, so I make a lot at once… I use salt. However, I also use soy sauce, oyster sauce, sometimes chili sauce and yeah, that is quite normal… I used to measure but now I am lazy. Just kind of that should be one spoon. So, myself, I don't measure, but I think I could I have the good sense of how much I put in without that sort of measures or something.” (P7)

Low perceived susceptibility

27) “I don't exactly have heart issues at the moment. So, I know I don't have as much incentive as someone who has heart issues… if I actually have heart issues, then I would probably try a bit harder. But I don't [have heart issues].” (P6)

Barriers and Facilitators

Factors affecting health behavioural change

Peer influence

28) “The barrier is eating out with friends. I do not want others to feel uncomfortable. I won't ask my friends to follow a low salt and sugar diet. If I invite my friends home for dinner, I won't request my friends to eat light-flavoured foods because of my dietary preferences.” (P2)

29) “Eating out is relatively difficult, because gathering with friends and share foods… (P4)

30) “People who I live with enjoy eating highly flavoured foods. I would add extra sugar and salt in cooking.” (P4)

31) “Eating with friends is harder, because I can't just think about myself…” (P5)

32) “I lived with a roommate… she told me if she ate too much salt, she had abdominal pain and discomfort. I realised I need to reduce my salt and sugar intake because of her.” (P2)

Family influence

33) “Family members [parents] instructed not to eat too much salty foods. My family's dietary habits recommend not to eat pickled foods or salty foods. My mother is a renal nurse, so we eat salt as little as possible… My family does not allow us to eat salted fish, fried rice with salted black beans and canned cooked meat products. All canned processed foods are basically not allowed.” (P1)

34) “I cannot be too strict [to my family members]. I have to relax sometimes. If forcing them to eat a low-salt diet every day, it is easy to cause family conflicts.” (P5)

35) “I think it is easier because in Australia. I'm single, so I cook for myself. I can control the flavour in my food…” (P8)