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An Application-based programme to reinforce and maintain lower salt intake (AppSalt) in schoolchildren and their families in China
  1. Feng J He1,
  2. Puhong Zhang2,3,
  3. Rong Luo2,
  4. Yuan Li2,3,
  5. Fengge Chen4,
  6. Yuhong Zhao5,
  7. Wei Zhao4,
  8. Daoxi Li6,
  9. Hang Chen6,
  10. Tianyong Wu6,
  11. Jianyun Yao7,
  12. Jinbao Li7,
  13. Siyuan Zhou7,
  14. Yu Liu8,
  15. Xian Li2,3,
  16. Changqiong Wang1,
  17. Graham A MacGregor1
  1. 1 Wolfson Institute of Preventive Medicine, Barts and The London Scho ol of Medicine & Dentistry, Queen Mary University of London, London, UK
  2. 2 The George Institute for Global Health at Peking University Health Science Center, Beijing, China
  3. 3 Faculty of Medicine, University of New South Wales, Sydney, Australia
  4. 4 Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang, China
  5. 5 Changan Center for Disease Control and Prevention, Shijiazhuang, China
  6. 6 Luzhou Center for Disease Control and Prevention, Luzhou, China
  7. 7 Yueyang Center for Disease Control and Prevention, Yueyang, China
  8. 8 School of Computing, Beihang University, Beijing, China
  1. Correspondence to Prof Feng J He; f.he{at} and Prof Puhong Zhang; zpuhong{at}


Introduction Salt intake is very high in China, with ≈80% being added by the consumers. It is difficult to reduce salt in such settings. Our previous study (School-based Education programme to reduce Salt(School-EduSalt)) demonstrated that educating schoolchildren, who then instructed their families to reduce the amount of salt used at home, is effective in lowering salt intake in both children and adults. Our team also developed an app called ‘KnowSalt’, which could help individuals to estimate their salt intake and the major sources of salt in the diet. Building on School-EduSalt and KnowSalt, we propose to develop a new app (AppSalt) focusing on salt reduction through education, target setting, monitoring, evaluation, decision support and management to achieve a progressive lower salt intake for long term. To evaluate the effectiveness of the AppSalt programme, we will carry out a cluster randomised controlled trial.

Methods and analysis We will recruit 54 primary schools from urban and rural areas of three provinces in China. A total of 594 children aged 8–9 years and 1188 adult family members will be randomly selected for evaluation. After baseline assessment, schools will be randomly allocated to either the intervention or control group. Children in the intervention group will be taught, with support of AppSalt, about salt reduction and assigned homework to get the whole family involved in the activities to reduce salt consumption. The duration of the intervention is two school terms (ie, 1 year). The primary outcome is the difference between the intervention and control group in the change of salt intake as measured by 24-hour urinary sodium.

Ethics and dissemination The study has been approved by Queen Mary Research Ethics Committee and Peking University Health Science Centre IRB. Results will be disseminated through presentations, publications and social media.

Trial registration number ChiCTR1800017553.

  • salt reduction
  • schoolchildren and families
  • m-health
  • randomised controlled trial

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  • Feng J He and Puhong Zhang are joint first authors

  • FJH and PZ contributed equally.

  • Contributors FJH and PZ conceived the project and contribute equally to the work. FJH, PZ, YLi and RL designed the study and oversaw the conceptualisation and development of the app. PZ, YLi, RL, FC, YZ, WZ, DL, HC, TW, JY, JL and SZ facilitates Patient and Public Involvement and were responsible for setting up the study in each site. YLiu and RL are leading the development and maintenance of the app. XL and CW contributed to sample size calculation and analysis plan. All authors contributed to the development of the intervention and evaluation. FJH wrote the first draft of the manuscript, and PZ, YLi, RL, CW and GAM revised the draft. All authors contributed to the refinement of the study protocol and approved the final manuscript.

  • Funding This work is supported by the National Institute of Health Research using Official Development Assistance (ODA) funding (16/136/77).

  • Disclaimer This research was commissioned by the National Institute for Health Research (NIHR) (NIHR Global Health Research Unit Action on Salt China (ASC) at Queen Mary University of London) using Official Development Assistance (ODA) funding (16/136/77). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Ethics approval The study has been approved by Queen Mary Research Ethics Committee and Peking University Health Science Centre Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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