Applying the extended health belief model to understand salt-reduction behaviors among Saudi adults: a cross-sectional study

Background High sodium intake is a major risk factor for hypertension and cardiovascular disease, with consumption levels in Saudi Arabia far exceeding global recommendations. Understanding the psychosocial determinants of salt-related behaviors is essential for designing effective interventions. Objective This study applied an extended Health Belief Model (HBM) to examine the knowledge, perceptions, and habitual practices related to salt intake among Saudi adults. Methods A cross-sectional study was conducted with 522 Saudi adults using a translated and validated, self-administered questionnaire assessing sociodemographics, salt-related knowledge, HBM constructs (perceived susceptibility/severity, risk, benefits, barriers, cues to action, self-efficacy), and dietary practices. Results While participants demonstrated moderate to high awareness of the health risks of high salt intake (e.g., 85.1% linked it to hypertension), technical knowledge was limited, with only 15.3% correctly identifying the World Health Organization’s daily salt recommendation. Habitual salt use during cooking was high (55.2% always), and consumption of salty snacks and fast food was frequent. Dietary practices were suboptimal across all groups. Significant positive associations were found between dietary practices and behavioral intention ( r = 0.291), self-efficacy ( r = 0.248), and cues to action ( r = 0.234). A persistent awareness-behavior gap was observed, where favorable perceptions did not translate into consistent salt-reduction actions. Conclusion Saudi adults demonstrate moderate to high awareness of salt-related health risks but limited technical knowledge and low adoption of salt-reduction behaviors. The findings suggest that behavioral intention, self-efficacy, and cues to action are associated with more favorable salt-reduction practices. Targeted, multifaceted interventions addressing cognitive, skill-based, and environmental determinants are essential to reduce salt intake, prevent hypertension, and support national and global health objectives.