Intention to reduce dietary salt and its influencing factors in middle-aged and older hypertensive patients: a theory of planned behavior-based cross-sectional study

Background: Excessive dietary salt intake is a key controllable risk factor for hypertension. Despite the clear clinical benefits of reducing salt intake, overcoming the "knowledge-action" gap among patients with hypertension poses a significant public health challenge. The Theory of Planned Behavior (TPB) is a powerful framework for understanding the psychological factors that influence behavioral intentions. However, studies based on TPB that explore dietary intentions to reduce salt intake in middle-aged and older hypertension patients have not been well described nor well studied in previous literature. Objective: Using the Theory of Planned Behavior (TPB) as the theoretical framework and Structural Equation Modeling (SEM) as the methodological basis, we aimed to examine the status of salt reduction dietary intention and its influencing factors in middle-aged and older hypertensive patients. Methods: From March to November 2023, a total of 558 middle-aged and older hypertensive patients across 38 districts and counties in Chongqing Municipality, China, were interviewed using a face-to-face questionnaire with a Likert scale. SEM was used to explore the relationship between the salt reduction intention (INT) of middle-aged and older hypertensive patients aged 45 years and above and their attitude toward salt reduction (ATT), subjective norms of salt reduction (SN), and perceived behavioral control of salt reduction (PBC), as well as the bidirectional correlation between ATT, SN, and PBC. Results: > 0.05) did not significantly affect intentions to reduce dietary salt. 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 older hypertensive patients. Future nutritional health education should prioritize strategies to strengthen intention and perceived behavioral control.