Action on Salt China: Endeavors in the Realm of Capacity Building

The development of capacity remains a fundamental element of the ASC program, dating back to its RCT phase from 2018 to 2019, and continuing through to its expansion phase from 2020 to 2021. A few notable outcomes of the ASC's capacity-building initiatives are outlined as follows:

 

The four RCTs conducted encompassed numerous stages including trial design, intervention development, implementation, monitoring, and evaluation. As part of this process, extensive professional training was carried out for public health workers stationed at local CDCs. These trainings, which primarily benefited the CDC staff located at the 33 study sites across six provinces, encompassed a comprehensive range of topics. This included salt reduction knowledge and practical skills, nuances of RCT implementation and evaluation, project management essentials, and quality control methods among other topics. The public health workforce also received training in the use of mHealth-based intervention and evaluation tools, equipping them to carry out the RCTs effectively.

 

A comprehensive intervention package, designed as a principal educational tool for professional trainings, has been developed. This intervention package includes an all-encompassing array of health education materials such as technical manuals, visual aids, digital and conventional training courses, as well as app-based intervention and evaluation instruments. This package has been incorporated into the national resource repositories of the China CDC and CCHE, and is utilized as instructional material for public health professionals nationwide.

 

Training sessions on measuring dietary salt intake, utilizing the high-accuracy method of 24-hour urinary sodium excretion, have been implemented in field research. The three RCTs namely AIS, HIS, and CIS, have amassed 24-hour urine samples from a total of 6,030 participants. This cohort included 5,436 adults and 594 schoolchildren, consequently making them the most substantial RCTs in China to employ 24-hour urinary sodium in assessing the efficacy of salt reduction interventions. Furthermore, training concerning process evaluation has been executed in these four RCTs.

 

In the scale-up phase, an ASC Scale-up platform was established to facilitate routine public health operations. This platform includes features such as an activity planning and design module, an extensive repository of educational materials, an activity recording module, an impact evaluation system, and a performance-based incentives module. These capabilities were leveraged across six provinces. By the end of 2021, over 1,000 salt reduction initiatives were executed, with 350 of these activities gaining recognition for their excellence across these provinces.

 

In the broader context of capacity enhancement, numerous engagement initiatives have taken place with multi-sectoral government leaders and policymakers, particularly within the education and health sectors, to facilitate the implementation of salt reduction interventions across various sectors at a policy level. These initiatives have been instrumental in disseminating research findings and advocating for the integration of salt reduction policies into the operations of non-health sectors.

 

Training workshops have been conducted targeting a variety of stakeholders, including schoolteachers, restaurant chefs, community workers, and members of the media. These individuals play an instrumental role in assisting public health professionals in the implementation of salt reduction interventions in key environments such as schools and restaurants. For instance, within the context of the AIS, training was initially provided to schoolteachers regarding the delivery of interventions, followed up by educational courses for students and salt reduction activities engaging entire families. Likewise, in the RIS, restaurant personnel, such as waiters and chefs, received training on salt reduction knowledge and techniques.

 

Partners of ASC have collaboratively developed a cloud-based information system. A variety of WeChat applications, including AppSalt, KnowSalt, FoodSwitch, and the Salt and Health WeChat official account, as well as a mobile phone-based data collection system, have been integrated into this system. These digital resources facilitate capacity building activities, health education, intervention implementation, and project management.

 

Research training opportunities have been given to public health investigators and researchers in order to enhance their capacities in areas such as data management, analysis, process evaluation, implementation science, and health economic evaluation. Throughout the project timeline, research conducted by ASC has facilitated the academic completion of two doctoral and four master's students.

 

A series of training activities in finance and project management have been implemented for local CDC staff to enhance their competencies. The focus of these activities includes project planning, budget control, due diligence checks, among other related subjects.