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Effects of an Advocacy Trial on Food Industry Salt Reduction Efforts—An Interim Process Evaluation

Food Policy Division, The George Institute for Global Health, The University of New South Wales, P.O. Box 20, Missenden Road, Sydney NSW 2006, Australia
Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney NSW 2006, Australia
Carolina Population Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27516, USA
The School of Public Health, Faculty of Medicine, Epidemiology and Biostatistics, Imperial College of Science, Technology and Medicine, London W2 1PG, UK
Charles Perkins Centre, University of Sydney, Sydney NSW 2006, Australia
The Royal Prince Alfred Hospital, Camperdown, Sydney NSW 2006, Australia
Author to whom correspondence should be addressed.
Nutrients 2017, 9(10), 1128;
Received: 17 July 2017 / Revised: 29 September 2017 / Accepted: 10 October 2017 / Published: 17 October 2017
The decisions made by food companies are a potent factor shaping the nutritional quality of the food supply. A number of non-governmental organizations (NGOs) advocate for corporate action to reduce salt levels in foods, but few data define the effectiveness of advocacy. This present report describes the process evaluation of an advocacy intervention delivered by one Australian NGO directly to food companies to reduce the salt content of processed foods. Food companies were randomly assigned to intervention (n = 22) or control (n = 23) groups. Intervention group companies were exposed to pre-planned and opportunistic communications, and control companies to background activities. Seven pre-defined interim outcome measures provided an indication of the effect of the intervention and were assessed using intention-to-treat analysis. These were supplemented by qualitative data from nine semi-structured interviews. The mean number of public communications supporting healthy food made by intervention companies was 1.5 versus 1.8 for control companies (p = 0.63). Other outcomes, including the mean number of news articles, comments and reports (1.2 vs. 1.4; p = 0.72), a published nutrition policy (23% vs. 44%; p = 0.21), public commitment to the Australian government’s Food and Health Dialogue (FHD) (41% vs. 61%; p = 0.24), evidence of a salt reduction plan (23% vs. 30%; p = 0.56), and mean number of communications with the NGO (15 vs. 11; p = 0.28) were also not significantly different. Qualitative data indicated the advocacy trial had little effect. The absence of detectable effects of the advocacy intervention on the interim markers indicates there may be no impact of the NGO advocacy trial on the primary outcome of salt reduction in processed foods. View Full-Text
Keywords: advocacy; food companies; salt reduction; randomized trial advocacy; food companies; salt reduction; randomized trial
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Trevena, H.; Petersen, K.; Thow, A.M.; Dunford, E.K.; Wu, J.H.Y.; Neal, B. Effects of an Advocacy Trial on Food Industry Salt Reduction Efforts—An Interim Process Evaluation. Nutrients 2017, 9, 1128.

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