Table 3.
Perceptions, barriers and enablers regarding salt reduction in Malaysia’s out-of-home sectors identified by consumers
| Consumers perceptions regarding salt intake in Malaysia’s out-of-home sectors | |
|---|---|
| Theme/sub-theme | Example of quotes |
| Salt intake in Malaysia | |
| High-salt intake and health complications | ‘I also think that salt intake among Malaysians is high. We can’t even control how much salt we consume in our daily lives.’ (C6/S/Male) ‘..associated with heart disease… Hypertension, heart disease, blockage…’ (C2/N/Male) |
| Factors influencing salt intake in out-of-home food | |
| Various sources of high-salt food | ‘…so, whether we eat at home or outside we tend to take processed foods which are salty…’ (C2/W/Male) ‘…I admit that I rather like my food a bit salty and sometimes we eat junk foods which actually are salty…’ (C4/EC/Female) ‘Fast food, because it has a lot of salt…’ (C3/N/Male) |
| Convenience of out-of-home food options | ‘Usually when working, during lunch, I have to eat outside. When coming off from work, it is tiring, so I have to eat outside too.’ (C3/EM/Male) ‘It’s easy to order. There are many delivery services nowadays. So it’s easy to order (C2/EM/Male) and thus making harder to control salt intake daily…’ (C6/W/Female) ‘For me, the circumstances force me to eat outside. I have no one to cook at home. So, I have no other options but to eat outside. Similar to what C3 said previously, I am the type to hang out and eat.’ (C2/EM/Male) |
| Incorporation of salt, seasonings and sauces by food operators | ‘…if we eating outside, when they cook fried rice, they will put in maggi (seasoning), ajinomoto (seasoning), salt and also soy sauce and whatnot.’. (C2/EC/Female) ‘…lots of MSG is added into the keropok lekor (fish sausage). Food bought from night market, RM 1 fried chicken also salty…’(C2/EC/Female) ‘Foods that are sold at side roads. Fish sauce. and also lots of MSG.’(C1/EC/Female) |
| Consumers’ out-of-home food practices | ‘First, if I go to restaurants or any eateries, I choose food that has less salt. Or if not, we demand, request for noodles - noodles with less salt. Such as less salt mi kolok.’ (C7/EM/Male) ‘Yeah, if I buy food from mamak (Indian Muslim Restaurant), I will alter the food back when at home. I add more water into it…” (C6/W/Female) … if it tastes salty, I will adjust the taste when at home.’ (C5/W/Female) ‘The first time eating less salty fried rice. It was definitely not salty. I needed to add salt into it.’ (C1/EM/Male) |
| The practice of reading nutritional content labels on packaged foods among consumers | ‘We look at products that we use every day. Did not look at the nutrition content. We only look at the price. That is the problem. This product is expensive, this product is not.’ (C6/W/Female) ‘Ingredients is the most important thing.’ (C3/EM/Male) ‘Meaning that I do not care that much on the nutritional content. What is important is the halal logo and MeSTI logo, that’s all.’ (C1/EM/Male) ‘Usually, I inspect the expiry date. For salt, I do not focus on it that much.’ (C5/W/Female) ‘Probably because we do not understand much on the nutrition content label. So, I do not look at it that much.’ (C3/EC/Female) |
| Barriers encountered by consumers regarding salt reduction in Malaysia’s out-of-home sectors | |
| Theme/sub-theme | Example of quotes |
| Awareness and knowledge among consumers | |
| Inefficient salt-related messaging | ‘Yes, felt that the messages did not really deliver to us. The messages did not have a wide coverage compared to sugar messages…so I do not see why I should eat less salt when eat home or outside.’ C5/W/Female) |
| Challenges from food operators’ practices | |
| Limited knowledge and awareness to reduce salt in food | ‘…sometimes we already tell them to use less salt, don’t make it salty. But, it was still salty.’ (C4/N/Female) ‘…yes it is probably because they do not care…or don’t know how to (use less salt).’ (C5/N/Female) |
| Food operator autonomy in food preparation | ‘Sometimes it’s because we are not the cook, so when the cook tends to cook salty food, we as customers just eat it…’ (C1/N/Female) ‘Regarding salt usage, it depends on the cook, we just eat whatever they cook…’ (C4/N/Female) |
| Food quality | |
| Effect on taste, flavour and mouthfeel of reduced-salt foods and beverages | ‘It is hard not to put salt in certain dishes, because sometimes the salt enhances the taste.’ (C4/EC/Female) ‘If salt is not added, the creaminess and mouthfeel of the food won’t be enhanced.’ (C7/EM/Male) |
| Price of regular salt | ‘…for eating, sometimes people are more concern on the cost rather than the nutrient contents. And…salt is a cheap thing…’ (C2/EC/Female) ‘The salt reduction campaign…salt itself is not that pricey.’ (C1/EC/Male) |
| Availability and affordability of low and high-salt food products in the market | |
| Lack of low-salt food products | ‘I think low salt products are not that many in the market. Even if there are a few, probably we didn’t notice that.’ (C3/EM/Male) ‘Low salt food products are really only a few that we can see. Usually, we would see low sugar products, not the low salt ones.’ (C1/EM/Female) ‘No, I don’t think I have seen low salt products in the market. Are there any?’ (C1/W/Female); (C2/W/Female); (C5/W/Female); (C6/W/Female) |
| Price of low-salt food products | ‘Because the healthier versions are always pricier than the regular versions.’ (C1/W/Female) |
| Enablers identified by consumers regarding salt reduction in Malaysia’s out-of-home sectors | |
| Theme/sub-theme | Example of quotes |
| Raising awareness among consumers | |
| Promoting health as the ultimate goal | ‘Means that I can see our enthusiasm to take care of our health. So this campaign is good so that we can be given good health.’ (C1/EM/Male) ‘To me, I am willing to join in the campaign because I want prevent high blood pressure.’ (C2/EM/Male) |
| Dissemination of knowledge on salt reduction | ‘Have to educate through self-awareness. For example, advertise the health effects like high blood pressure. That is one effective way to do it.’ (C2/EM/Male) ‘Maybe the media can teach people how to read labels, salt content, something like that.’ (C4/W/Female) ‘Then have to inform on the salt substitute.’ (C6/W/Female) ‘So that Malaysians know how to read label. Then, they will also know how and how much salt that can be taken daily and used in cooking.’ (C5/W/Female) |
| Effective communication channels | ‘Except for the way to deliver…(C2/EC/Female) The delivery needs to be in a way that is easy to be understood.’ (C1/EC/Female) ‘We can disseminate through Facebook, WhatsApp, Instagram and many more. I think if it’s frequently played in mass media, probably the society can accept it. Like the case of covid now.’ (C5/W/Female) ‘But maybe for salt usage, maybe posters on heart attacks and all. Can be displayed to everyone. So that they can straight away see that high usage of salt can cause heart attack etc.’ (C1/EM/Male) ‘Or someone giving talks to the crowds.’ (C4/W/Female) ‘Programs like food selling. Because if there are food festivals, maybe we will be more interested.’ (C2/EC/Female) |
| Targeting younger consumers | ‘For me, I think there need to be an exposure from school. Lots of campaigns on salt in food. That is one way of it.’ (C2/EM/Male) ‘Can do those kinds of programs, like awareness campaign. If it can be start early, through the school curriculum, that would be good. MOH can visit schools and do a session with the Education Division of every area.’ (C3/EM/Female) ‘To me, need early education. For example, in primary schools, high schools, kindergartens…we inform the children about salt. So, they can tell their parents when at home like “Mom, this food is salty. The teacher said that it is not good,” for example.’ (C2/N/Female) |
| Promotion and recognition of health-conscious food premises | ‘Maybe the government can organise a program that is specifically for the stalls that take care of their salt usage in each of the food. So, if they do it, probably through advertisements, we could know that this and that stall is good, healthy. So, maybe we as customers will become interested to visit the stall.’ (C2/S/Female) ‘One program that can introduce those kinds of stalls.’ (C1/S/Female) ‘The government and vendors can promote their food and healthy stalls…Or the health ministry can issue a certification for the healthy stalls…’ (C2/N/Female); (C4/N/Male) |
| Regulation measures for manufactured food products | |
| Control over regular salt distribution | ‘But the government doesn’t do any control (on the salt content in food products). There have to be an explanation, or an act that controls the sales of salt…’ (C7/EM/Male) ‘Please reduce the selling of salt in the market. Then there would not be too many salt manufacturers anymore.’ (C4/EM/Male) |
| Enforcement of mandatory salt limits | ‘Next, for the industry, there must be an enforcement. We legislate law to limit the salt usage in the food. That’s one way of it.’ (C2/EM/Male) ‘To me, for food industries and manufacturers, we can set the requirements, such as the percentage of salt that is allowed in the products. So, they will proceed to produce products that follow the requirement.’ (C2/N/Female) ‘Set a maximum limit for each product. To limit the salt usage.’ (C10/N/Male) |
| Integration of salt substitutes in food products | ‘Because if we want to reduce or use no salt at all for pickled products and other high salt products, then what will happen to the manufacturers? So, the government must have a product that can substitute salt. Just like how stevia can replace sugar. Because previously for sugar campaign, it’s because we already have the substitute for it. So, what is the alternative for salt?’ (C9/EM/Female) |
| Enhancement of food packaging labels | ‘That is important as well (to put a warning sign on the salt packaging).’ (C2/S/Female) ‘Yes, in terms of the nutrition information.’ (C7/N/Female) ‘…I suggest that the products in the market to be put some colours on it. For example, put red for salted fish that has the most salt. Maybe we can put green for the one with lowest salt. The colour system can help even the people who can’t read. Like “Oh, this one is red, so this must have been the highest in salt.’ (C7/EM/Male) |
| Affordability of low-salt food products | ‘We will choose the ones that are cheaper (C6/W/Female) …right, because the healthier versions are always pricier than the regular versions.’ (C1/W/Female) ‘Reducing the price (of the food products) can attract Malaysians to buy. When it became cheap, we will buy it. We will support.’ (C5/W/Female) |
| Price adjustment and taxation of regular salt | ‘Increase the price of salt.’ (C2/EM/Male); (C8/EM/Female) ‘Maybe taxation should be introduced to the industries as well.’ (C9/N/Male) ‘Due to everyone use salt, maybe the taxation needs to be a mandatory.’ (C5/N/Male) |
| Regulation of street food vendors | |
| Monitoring and enforcement of salt content | ‘Maybe the health division can do monitoring on the stalls to limit the salt usage in every food. If there are stalls or restaurants that use a lot of salt, maybe MOH or other agency can give exposure to them on reducing the salt in food.’ (C1/S/Female) |
*C, Consumer; W, West; N, North; S, South; EC, East Coast; EM, East Malaysia.