Long-Term Reduction in Sodium Intake After Online and In-Person Group Nutrition Education in WIC Participants


      Excess sodium intake is associated with increased blood pressure and heart disease, with low-income populations at increased risk. The purpose of this study was to examine the long-term impacts of online and in-person group nutrition education on changes in knowledge, self-efficacy, and behaviors related to sodium reduction in a diverse sample of low-income women enrolled in the Women, Infants, and Children (WIC) Program.

      Design, Setting, and Participants

      Randomized trial of 514 WIC participants held in 3 Los Angeles, CA WIC clinics between November 2014-October 2015. Traditional in-person group and online nutrition education on sodium reduction was conducted.

      Outcome Measures and Analysis

      Knowledge, self-efficacy and behaviors related to sodium reduction with two nutrition education modalities were assessed at baseline, 2-4 months and 9 months following the intervention. ANCOVA and GEE were used to compare changes between groups in knowledge, self-efficacy, and behavior outcomes.


      Positive changes in knowledge and self-efficacy improved between pre-questionnaire and was retained 9 months later for both groups (P<0.05). Both groups reported significant improvements in behaviors related to using less salt in cooking, adding less salt to foods at the table, and eating less fast-food and restaurant foods at 2-4 months (P<0.01) and 9-months later (P<0.01).

      Conclusions and Implications

      Both online and in-person group education resulted in long-term improvements in knowledge, self-efficacy, and behaviors related to reducing sodium intake in a low-income population. Making nutrition education available for WIC participants in multiple modalities could broaden the reach of nutrition education and lead to long-term positive dietary changes, which could improve cardiovascular health.



      Supplementary data