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Background: In 2016, the World Health Organization recommended salt reduction strategies. In most low- and middle-income countries, little is known about what causes people to reduce their salt intake. Aim: In rural West Java, Indonesia, we conducted a cross-sectional survey to describe self-reported salt reduction practices among middle-aged Muslims with hypertension (n = 447) and to identify correlates of salt reduction. Methods: We developed a questionnaire with Likert scales to measure self-reported frequency of efforts to reduce salt intake, and degree of agreement/disagreement with 51 statements about variables hypothesized to influence salt reduction practices. We compared groups using t-tests and one-way ANOVAs. Through one-factor confirmatory factor analysis and structural equation modeling, we identified correlates of salt reduction practices. Results: About 45% of participants reported regularly reducing their salt intake; only 12.8% reported never attempting. Men reported higher social barriers, while women reported higher family support and spiritual support. Overall, we found that participants' frequency of effort to reduce their salt intake was associated with a constellation of six correlates. Salt reduction practices were directly positively associated with prior health/illness experiences (β = 0.25), and by seeking health information (β = 0.24). Seeking health information was in turn positively associated with prior health/illness experiences (β = 0.34), receiving support from health professionals (β = 0.23) and Islamic spiritual practice (β = 0.24). Salt reduction practices were negatively associated with environmental barriers to healthful eating practices (β = -0.14). Conclusion: In this population, reinforcing positive correlates identified in this study and mitigating against negative correlates may foster salt reduction practices.

Background: In Indonesia, as in many low and middle-income countries, hypertension is a significant health issue. Community health nurses need to identify those with early onset of hypertension by promoting frequent blood pressure (BP) checks, even among those with normal BP. Positive deviance approaches focus on identifying people who undertake uncommon preventive actions. Among middle-aged women in rural West Java, Indonesia, we aimed to identify covariates of the positive deviant practice of having one's BP checked at least once every three months even when having normal BP.  Methods: We conducted a cross-sectional survey recruiting participants at health centers. Our structured questionnaire measured socio-demographic characteristics, frequency of BP checks, BMI, beliefs and practices. We used binomial logistic regression to identify covariates., Results: Among 520 participants, 265 had normal BP, and of those 156 had obtained frequent BP checks, making them positive deviants. For women with normal BP, significant covariates of obtaining frequent BP checks were: 1) having BMI ≥25.0 (adjusted odds ratio (AOR)  =2.57, 95% confidence interval (CI)=1.39-4.78), 2) greater tendency to seek health information (AOR=1.13, 95% CI=1.03-1.24), 3) receiving less support from family members (AOR=0.87, 95% CI=0.77-0.97), and 4) receiving greater support from health volunteers (AOR=1.12, 95% CI=1.01-1.23)., Conclusion: Positive deviants were more likely to be proactive because of the convergence of their own individual-level tendencies to learn about  their health, family-level conditions that allowed for greater autonomy, and community-level capacity of health volunteers to provide them with support. Community health nurses should focus simultaneously on activating individual-level, family-level, and community-level capacity to prevent hypertension.

Hypertension is a significant health issue in Indonesia. Health professionals in a rural district of West Java identified hypertension as a priority health issue. In this study, we describe healthy-lifestyle behaviors as perceived by the district's middle-aged Muslims with hypertension. A qualitative case-study design was used. Twelve married couples, directly or indirectly impacted by hypertension, and who visited community health centers, were purposively recruited. Semistructured interviews provided data that were systematically analyzed for categories and subcategories. Categories of healthy-lifestyle behaviors currently practiced were eating behavior, physical activity, resting, not smoking, managing stress, seeking health information, seeking health care, caring other people, and fulfilling an obligation to God. Categories of reasons for practicing healthy-lifestyle behaviors were behavioral beliefs, competence, religious support, prior experience, social support, and health system support. Categories for not practicing healthy-lifestyle behaviors were personal, social, and environmental barriers. To achieve healthy-lifestyle behavior changes, it is essential for rural middle-aged Muslim individuals to be supported by reinforcing their positive reasons and to address their negative reasons to practice healthy-lifestyle behaviors., (© 2015 Wiley Publishing Asia Pty Ltd.)