Factors associated with poor practice of dietary salt intake among patients with hypertension in a primary health care clinic in Malaysia

TL;DR

The study finds that one in three hypertension patients in Malaysia poorly manage their salt intake, with Chinese ethnicity and poor knowledge or attitude being key factors.

Contribution

The study identifies specific demographic and behavioral factors associated with poor dietary salt practice among hypertension patients in Malaysia.

Findings

Chinese ethnicity and poor knowledge or attitude are strongly linked to poor salt intake practices.

One in three participants failed to practice adequate salt restriction despite high knowledge and positive attitudes.

The study suggests the need for targeted dietary counseling and national salt reduction strategies.

Abstract

Excessive consumption of salt had contributed to uncontrolled blood pressure among hypertension patients in Malaysia. This study aims to assess the knowledge, attitude, and practice of dietary salt intake among hypertension patients, as well as identify factors that contribute to poor dietary salt intake habits. A cross-sectional study was carried out among hypertensive patients at Klinik Kesihatan Kampung Simee, Ipoh between January and March 2023. A systematic random sampling method was used to select participants. A self-administered questionnaire adapted from previous study was used. The questionnaire was then scored, and participants were categorized into group of poor and good knowledge, attitude, and practice of dietary salt intake. A total of 396 patients participated in the study, with a response rate of 92.5%. The median age of the study population was 63 years, and 54% of them were female. 49.5% of the participants were Chinese, followed by 32.3% Malay, 15.4% Indian, and 2.8% others. 65.2% had good knowledge on salt, 59.3% had good attitude towards salt reduction, but 31.3% had poor practice of dietary salt intake. According to the results of multiple logistic regression, Chinese ethnicity (AOR 3.055, 95%CI 1.419–6.577, p = 0.004), participants with ischemic heart disease (AOR 2.714, 95% CI 1.115–6.607, p = 0.028), poor knowledge of salt (AOR 1.802, 95%CI 1.114–2.916, p = 0.016), and poor attitude towards reducing salt (AOR 3.960, 95%CI 2.462–6.372, p < 0.001) were significantly associated with poor practice of dietary salt intake among participants. One in three hypertensive patients in this study failed to practise adequate salt restriction. Poor practice of dietary salt intake was significantly higher among Chinese participants, those with ischemic heart disease, individuals with inadequate knowledge or unfavourable attitude towards salt reduction. These findings underscore the importance of a targeted dietary counselling among different ethnicities with different culture and diverse traditional cuisines. The ministry of health should also intensified national salt reduction strategies with a stronger focus on closing knowledge gaps and reshaping attitudes. Future research should evaluate the effectiveness of salt reduction programmes among patients with non-communicable diseases.

The online version contains supplementary material available at 10.1038/s41598-026-40124-2.