Systematic Review of Social Marketing as a Behavioral Change Agent in Salt/Sodium Consumption World-Wide

The use of social marketing interventions for salt/sodium reduction has drawn increased attention worldwide. This systematic review investigates the application of social marketing principles to the design, implementation, and evaluation of salt/sodium reduction interventions worldwide and offers recommendations for future public health practice. Using PRISMA, searches were conducted on PubMed, Web of Science, CINAHL and Psych Info with 51 studies abstracted and synthesized using the matrix method. Interventions were heterogeneous in study design, audience segmentation, translation of marketing mix into practice and sustainability. Studies occurring most recently contained a greater quantity of social marketing benchmark criteria (behavioral focus, formative research, segmentation, exchange, competition, marketing mix, community involvement and integration). Studies reporting greater success had a greater quantity of social marketing benchmark criteria than those with self-reported medium to little success. Community-based initiatives using personalized and localized tactics augmented by upstream policy-supported structural supports were the most self-reported effective interventions. Place-based initiatives using management-supported, employee-staffed, hospital, workplace, and school settings were most successful. Future salt/sodium reduction initiatives should consider, applying the full social marketing framework to multilevel interventions designed with community-based processes, and engaging diverse stakeholders and place-based actors and strategies, and focusing on culture and long-term sustainability.