Vilarmina Ponce - Academia.edu (original) (raw)

Uploads

Papers by Vilarmina Ponce

Frontiers in Public Health

ObjectiveThis study aimed to conduct a process evaluation of a salt substitute trial conducted in... more ObjectiveThis study aimed to conduct a process evaluation of a salt substitute trial conducted in Peru.MethodsThrough semi-structured interviews of intervention participants, we documented and analyzed process evaluation variables as defined by the Medical Research Council Framework. This study was a stepped wedge trial conducted in Tumbes, Peru in 2014. The intervention was a community-wide replacement of regular salt (100% sodium) with “Salt Liz” (75% sodium and 25% potassium) using social marketing strategies to promote the adoption and continued use of the salt substitute in daily life. The components of the social marketing campaign included entertainment educational activities and local product promoters (“Amigas de Liz”). Another component of the intervention was the Salt Liz spoon to help guide the amount of salt that families should consume. The process evaluation variables measured were the context, mechanism of action, and implementation outcomes (acceptability, fidelity ...

International Journal of Environmental Research and Public Health, 2021

Worldwide, salt consumption exceeds the World Health Organization’s recommendation of a daily int... more Worldwide, salt consumption exceeds the World Health Organization’s recommendation of a daily intake of 5 g. Customer journey mapping is a research method used in market research to understand customer behaviors and experiences and could be useful in social marketing as well. This study aimed to explore the potential of customer journey mapping to better understand salt-related behaviors performed during the preparation of household cooking. We tracked the journey of four women in their kitchens for approximately two hours to observe the preparation of lunch. Individual journey maps were created, one for each woman, that were composited into a single journey map. We found that customer journey mapping was a suitable research method to understand how food preparers made decisions around adding salt and artificial seasonings at each stage of the journey. In contrast to the interviewee’ responses, it was observed that the four women added salt and artificial seasonings consistently and...

Nature Medicine

reduction in salt intake has been identified as one of the most cost-effective measures for impro... more reduction in salt intake has been identified as one of the most cost-effective measures for improving health outcomes 1-3. Different studies have reported the benefit of salt-reduction interventions in decreasing blood pressure and cardiovascular events 4-6. Results from a meta-analysis show that modest reductions in salt intake are followed by a decrease in blood pressure levels among both hypertensive and normotensive subjects 7. Nevertheless, the evidence of the effectiveness of population-level, behavior change interventions on reducing salt intake is inconsistent, suggesting that education and awareness-raising interventions alone are not sufficient for reducing population salt intake 8. Salt substitutes, that is, salt enriched with potassium or other similar components such as magnesium or aluminum, have been reported to be effective in reducing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) 9-11. Under controlled conditions, salt-substitution strategies can reduce the SBP up to 5 mm Hg and the DBP up to 1.5 mm Hg, and this effect was larger among individuals with hypertension than among normotensive subjects 12. There is limited evidence, however, from studying the population-level effect of these salt-substitution interventions. A cluster randomized trial conducted in China, evaluating the effect of a community-based sodium reduction program using a salt substitute on salt consumption and blood pressure, found reductions in urinary sodium excretion but not in blood pressure 13. Currently, an increasing number of countries have adopted national salt-reduction strategies 14. Salt-substitution initiatives could aid such strategies in settings where added salt during cooking is the main source of salt intake, particularly in low-and middle-income countries where hypertension rates are increasing at a fast rate 15. The aim of the present study was to assess the efficacy of a pragmatic intervention using a salt-substitution strategy to reduce blood pressure, as well as its impact on the incidence of hypertension, at the population level, using a stepped-wedge cluster trial in Peru. Results Population characteristics. Figure 1 shows the details of participants' enrollment, including dates, number of subjects assessed, those lost to follow-up and those analyzed for each step of the trial. A total of 2,376 (91.2%) out of 2,605 eligible subjects in the 6 villages were enrolled in the study from 2 April to 17 July, 2014: 49.6% females, mean age 43.3 ± 17.2 years. Of note, only 18.9% of the individuals had ≥12 years of education, 68.1% were in the overweight or obesity range with a body mass index (BMI) ≥25 kg m −2 and 18.3% had a diagnosis of hypertension. Table 1 shows the characteristics of the study population at baseline and a comparison between the control and the intervention periods. There were differences among villages in the distribution of age, education, wealth index, BMI, SBP, DBP and hypertension (see Supplementary Table 1). Effect of the salt substitute on blood pressure levels. In the intentto-treat analysis, adjusting only for clustering and time effects, there was an average reduction of 1.23 mm Hg (95% CI (0.38, 2.07); P = 0.004) in SBP and 0.72 mm Hg (95% CI (0.10, 1.34); P = 0.022) in DBP among the participants who received the salt substitute compared with controls. These results remained consistent after further adjustment for sex, age, years of education, wealth index and BMI measured at baseline (Table 2). Variations in SBP and DBP mean levels over the intervention and control periods are shown in Fig. 2. There was no evidence that

Cardiology Clinics, 2017

Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and strok... more Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and stroke, is the leading global risk for mortality. Despite global efforts to combat hypertension, it continues to exert a significant health and economic burden on low-and middle-income country (LMIC) populations, thereby triggering the need to address the problem by way of novel approaches. The Vedanthan et al.

Globalization and health, Jun 2, 2016

Human capital requires opportunities to develop and capacity to overcome challenges, together wit... more Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality…

Nutrients

Background: Salt intakes in Latin America currently double the World Health Organization’s recomm... more Background: Salt intakes in Latin America currently double the World Health Organization’s recommendation of 5 g/day. Various strategies to reduce the population’s salt consumption, such as raising awareness using social marketing, have been recommended. This study identified parents’ perceptions of salt consumption to inform a social marketing strategy focused on urban areas in Peru. Methods: Using a sequential exploratory methods design, parents of pre-school children, of high and low socioeconomic status, provided qualitative data in the form of interviews and focus groups. Following this, quantitative data was obtained via questionnaires, which were sent to all parents. The information was analyzed jointly. Results: 296 people (mean age 35.4, 82% women) participated, 64 in the qualitative and 232 in the quantitative phase of the study. Qualitative data from the first phase revealed that the majority of mothers were in charge of cooking, and female participants expressed that coo...

Nutrients, Jan 5, 2017

Interventions to promote behaviors to reduce sodium intake require messages tailored to local und... more Interventions to promote behaviors to reduce sodium intake require messages tailored to local understandings of the relationship between what we eat and our health. We studied local explanations about hypertension, the relationship between local diet, salt intake, and health status, and participants' opinions about changing food habits. This study provided inputs for a social marketing campaign in Peru promoting the use of a salt substitute containing less sodium than regular salt. Qualitative methods (focus groups and in-depth interviews) were utilized with local populations, people with hypertension, and health personnel in six rural villages. Participants were 18-65 years old, 41% men. Participants established a direct relationship between emotions and hypertension, regardless of age, gender, and hypertension status. Those without hypertension established a connection between eating too much/eating fried food and health status but not between salt consumption and hypertension...

Frontiers in Public Health

ObjectiveThis study aimed to conduct a process evaluation of a salt substitute trial conducted in... more ObjectiveThis study aimed to conduct a process evaluation of a salt substitute trial conducted in Peru.MethodsThrough semi-structured interviews of intervention participants, we documented and analyzed process evaluation variables as defined by the Medical Research Council Framework. This study was a stepped wedge trial conducted in Tumbes, Peru in 2014. The intervention was a community-wide replacement of regular salt (100% sodium) with “Salt Liz” (75% sodium and 25% potassium) using social marketing strategies to promote the adoption and continued use of the salt substitute in daily life. The components of the social marketing campaign included entertainment educational activities and local product promoters (“Amigas de Liz”). Another component of the intervention was the Salt Liz spoon to help guide the amount of salt that families should consume. The process evaluation variables measured were the context, mechanism of action, and implementation outcomes (acceptability, fidelity ...

International Journal of Environmental Research and Public Health, 2021

Worldwide, salt consumption exceeds the World Health Organization’s recommendation of a daily int... more Worldwide, salt consumption exceeds the World Health Organization’s recommendation of a daily intake of 5 g. Customer journey mapping is a research method used in market research to understand customer behaviors and experiences and could be useful in social marketing as well. This study aimed to explore the potential of customer journey mapping to better understand salt-related behaviors performed during the preparation of household cooking. We tracked the journey of four women in their kitchens for approximately two hours to observe the preparation of lunch. Individual journey maps were created, one for each woman, that were composited into a single journey map. We found that customer journey mapping was a suitable research method to understand how food preparers made decisions around adding salt and artificial seasonings at each stage of the journey. In contrast to the interviewee’ responses, it was observed that the four women added salt and artificial seasonings consistently and...

Nature Medicine

reduction in salt intake has been identified as one of the most cost-effective measures for impro... more reduction in salt intake has been identified as one of the most cost-effective measures for improving health outcomes 1-3. Different studies have reported the benefit of salt-reduction interventions in decreasing blood pressure and cardiovascular events 4-6. Results from a meta-analysis show that modest reductions in salt intake are followed by a decrease in blood pressure levels among both hypertensive and normotensive subjects 7. Nevertheless, the evidence of the effectiveness of population-level, behavior change interventions on reducing salt intake is inconsistent, suggesting that education and awareness-raising interventions alone are not sufficient for reducing population salt intake 8. Salt substitutes, that is, salt enriched with potassium or other similar components such as magnesium or aluminum, have been reported to be effective in reducing both systolic blood pressure (SBP) and diastolic blood pressure (DBP) 9-11. Under controlled conditions, salt-substitution strategies can reduce the SBP up to 5 mm Hg and the DBP up to 1.5 mm Hg, and this effect was larger among individuals with hypertension than among normotensive subjects 12. There is limited evidence, however, from studying the population-level effect of these salt-substitution interventions. A cluster randomized trial conducted in China, evaluating the effect of a community-based sodium reduction program using a salt substitute on salt consumption and blood pressure, found reductions in urinary sodium excretion but not in blood pressure 13. Currently, an increasing number of countries have adopted national salt-reduction strategies 14. Salt-substitution initiatives could aid such strategies in settings where added salt during cooking is the main source of salt intake, particularly in low-and middle-income countries where hypertension rates are increasing at a fast rate 15. The aim of the present study was to assess the efficacy of a pragmatic intervention using a salt-substitution strategy to reduce blood pressure, as well as its impact on the incidence of hypertension, at the population level, using a stepped-wedge cluster trial in Peru. Results Population characteristics. Figure 1 shows the details of participants' enrollment, including dates, number of subjects assessed, those lost to follow-up and those analyzed for each step of the trial. A total of 2,376 (91.2%) out of 2,605 eligible subjects in the 6 villages were enrolled in the study from 2 April to 17 July, 2014: 49.6% females, mean age 43.3 ± 17.2 years. Of note, only 18.9% of the individuals had ≥12 years of education, 68.1% were in the overweight or obesity range with a body mass index (BMI) ≥25 kg m −2 and 18.3% had a diagnosis of hypertension. Table 1 shows the characteristics of the study population at baseline and a comparison between the control and the intervention periods. There were differences among villages in the distribution of age, education, wealth index, BMI, SBP, DBP and hypertension (see Supplementary Table 1). Effect of the salt substitute on blood pressure levels. In the intentto-treat analysis, adjusting only for clustering and time effects, there was an average reduction of 1.23 mm Hg (95% CI (0.38, 2.07); P = 0.004) in SBP and 0.72 mm Hg (95% CI (0.10, 1.34); P = 0.022) in DBP among the participants who received the salt substitute compared with controls. These results remained consistent after further adjustment for sex, age, years of education, wealth index and BMI measured at baseline (Table 2). Variations in SBP and DBP mean levels over the intervention and control periods are shown in Fig. 2. There was no evidence that

Cardiology Clinics, 2017

Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and strok... more Elevated blood pressure, a major risk factor for ischemic heart disease, heart failure, and stroke, is the leading global risk for mortality. Despite global efforts to combat hypertension, it continues to exert a significant health and economic burden on low-and middle-income country (LMIC) populations, thereby triggering the need to address the problem by way of novel approaches. The Vedanthan et al.

Globalization and health, Jun 2, 2016

Human capital requires opportunities to develop and capacity to overcome challenges, together wit... more Human capital requires opportunities to develop and capacity to overcome challenges, together with an enabling environment that fosters critical and disruptive innovation. Exploring such features is necessary to establish the foundation of solid long-term partnerships. In this paper we describe the experience of the CRONICAS Centre of Excellence in Chronic Diseases, based at Universidad Peruana Cayetano Heredia in Lima, Peru, as a case study for fostering meaningful and sustainable partnerships for international collaborative research. The CRONICAS Centre of Excellence in Chronic Diseases was established in 2009 with the following Mission: "We support the development of young researchers and collaboration with national and international institutions. Our motivation is to improve population's health through high quality…

Nutrients

Background: Salt intakes in Latin America currently double the World Health Organization’s recomm... more Background: Salt intakes in Latin America currently double the World Health Organization’s recommendation of 5 g/day. Various strategies to reduce the population’s salt consumption, such as raising awareness using social marketing, have been recommended. This study identified parents’ perceptions of salt consumption to inform a social marketing strategy focused on urban areas in Peru. Methods: Using a sequential exploratory methods design, parents of pre-school children, of high and low socioeconomic status, provided qualitative data in the form of interviews and focus groups. Following this, quantitative data was obtained via questionnaires, which were sent to all parents. The information was analyzed jointly. Results: 296 people (mean age 35.4, 82% women) participated, 64 in the qualitative and 232 in the quantitative phase of the study. Qualitative data from the first phase revealed that the majority of mothers were in charge of cooking, and female participants expressed that coo...

Nutrients, Jan 5, 2017

Interventions to promote behaviors to reduce sodium intake require messages tailored to local und... more Interventions to promote behaviors to reduce sodium intake require messages tailored to local understandings of the relationship between what we eat and our health. We studied local explanations about hypertension, the relationship between local diet, salt intake, and health status, and participants' opinions about changing food habits. This study provided inputs for a social marketing campaign in Peru promoting the use of a salt substitute containing less sodium than regular salt. Qualitative methods (focus groups and in-depth interviews) were utilized with local populations, people with hypertension, and health personnel in six rural villages. Participants were 18-65 years old, 41% men. Participants established a direct relationship between emotions and hypertension, regardless of age, gender, and hypertension status. Those without hypertension established a connection between eating too much/eating fried food and health status but not between salt consumption and hypertension...