Salt reduction dietary intention and influencing factors in middle-aged and elderly hypertensive patients based on the theory of planned behavior

Abstract Objective This study aims to guide the development of behavioral interventions and promote salt reduction dietary practices. Using the Theory of Planned Behavior (TPB) as the theoretical framework and Structural Equation Modeling (SEM) as the methodological basis, we explored the current status of salt reduction dietary intention and its influencing factors in middle-aged and elderly hypertensive patients. Methods From March to November 2023, convenience sampling was employed to conduct face-to-face surveys by using the Likert scale among 590 middle-aged and elderly hypertensive patients across 38 districts and counties in Chongqing. Structural Equation Model (SEM) was used to analyze the relationship between salt reduction intention (INT) and attitude towards salt reduction (ATT), subjective norms of salt reduction (SN), and perceived behavioral control of salt reduction (PBC). We also evaluated the bivariate correlation among attitude towards salt reduction, subjective norms of salt reduction, and perceived behavioral control of salt reduction in middle-aged and elderly hypertensive patients aged 45 years and above. Result A sample size of 558 respondents was included in the analysis, of which 70.8% had the intention to reduce salt in their diets; 55.2% were female; 48% had junior high school education or higher; 73.5% were married; 44.1% were home cooks; households with home addresses in “Central City(CC),” “Main City New Area (MCNA),” “Northeast Chongqing Three Gorges Reservoir Town Cluster (NCTGRT),” and “Southeast Chongqing Wuling Mountains Town Cluster (SCWMT")” accounted for 29.4%, 27.6%, 29.6%, and 13.4%, respectively; 50.5% had no chronic diseases, except hypertension; and 61.3% were elderly, and 38.7% were middle-aged individuals. Salt-reducing diet attitudes (β = 0.22, P < 0.05) and perceived behavioral control (β = 0.70, P < 0.05) had a positive effect on salt-reducing diet intentions. The effect of perceived behavioral control of salt-reduced diets was pronounced. Subjective scope (β = 0.14, P > 0.05) had a non-significant effect on salt-reducing diet intentions. Conclusion This study highlights the central influence of salt-reducing dietary attitudes and perceived behavioral control in salt-reducing dietary intentions among middle-aged and elderly hypertensive patients. Future nutritional health education should prioritize exploring pragmatic ways of attitude-to-practice.