Table 4.
Perceptions, barriers and enablers regarding salt intake and salt reduction in Malaysia’s out-of-home sectors identified by food operators
| Food operators perceptions regarding salt intake and salt reduction in Malaysia’s out-of-home sectors | |
|---|---|
| Theme/sub-theme | Example of quotes |
| Salt intake in Malaysia | |
| High-salt intake and health complications | ‘In my view, the salt intake in Malaysia is quite high. Because if we look at the nutrition aspect, we can know that the salt intake is high.’ (CO1/EM/Male); (SFV16/W/Male) |
| Factors influencing salt intake in out-of-home food | |
| Various sources of high-salt food | ‘Sometimes there are food that are added with salt, sugar, and monosodium glutamate to get viral. But try sending the food for analysis, the salt must be high.’ (CO1/W/Male) ‘Salt intake is high especially traditional food that definitely uses a lot of salt.’ (SFV5/EC/Male) ‘…as you can see, shrimp paste, anchovies are high in salt content…’ (C7/C/Male) |
| Incorporation of salt, seasonings and sauces by food operators | ‘Yes, I do add a little bit of seasonings because that gives the flavour.’ (SFV19/EM/Female)…some vendors replace salt with seasonings.’ (SFV9/N/Male) ‘…when we cook, we put in multiple sources of salt.’ (SFV18/EM/Male) ‘Like I said just now, chicken stock, monosodium glutamate, chicken broth. We use all these.’ (Caterer 3/West/Male) ‘Yes, I add salt into our mango float menu in order to enhance its taste.’ (SFV14/W/Male) ‘Like milk tea, they (the vendors) will add salt into it to add the creaminess.’ (SFV7/N/Female) ‘There are some people that buy soft drinks and ask to add in salt.’ (CO5/W/Male) |
| The practice of reading nutritional content labels on packaged foods among food operators | ‘We only take the products that we usually use. If we compare with other brands, we usually compare the price, halal logo, MeSTI logo, and ingredients. Not really on the nutrition label.’ (SFV21/EM/Male) ‘Have never looked at the nutrition label.’ (Caterer 5/East Malaysia/Female) |
| Salt reduction policy | |
| Inclusive engagement | ‘To reduce salt, I think all parties should be involved in the policy… the food providers, consumers, government… (CO1/W/Male)… all parties, then the citizens will support as well.’ (SFV4/EC/Male) ‘The food manufacturers for high salt processed food should take part in the policy.’ (SFV6/N/Male) ‘…salt usage among vendors is not that extreme compared to the big industries. Big industries use a lot of salt especially in fast food and in junk food. These contribute to the high salt intake compared to the small vendors that sell traditional food.’ (SFV4/EC/Male) |
| Policy implementation approaches | ‘To start, the policy should be on a voluntary basis first. Maybe for the first two years.’ (SFV18/W/Male) ‘…volunteer first…’ (CO7/W/Male) ‘The policy should be done voluntarily. If it is done mandatory, it will be like the smoking campaign. People still smoke.’ (SFV13/S/Female) ‘For me, it needs to be mandatory. Maybe need to have a policy.’ (CO3/S/Male) ‘…when it is not mandatory, like viral food, supposed the salt cannot be high. So, need to have a law and regulations.’ (CO1/W/Male) |
| Barriers encountered by food operators regarding salt reduction in Malaysia’s out-of-home sectors | |
| Theme/sub-theme | Example of quotes |
| Lack of a standard guideline | ‘Yes, so far for catering, there is not standard operating procedure for the food preparation. So, we just cook accordingly.’ (CO1/EM/M) ‘Just like we said earlier, we don’t see the guideline to reduce salt usage.’ (SFV4/EC/Male) ‘In terms of awareness, they do not know the ingredients that they can use to substitute the salt or reduce the salt.’ (SFV14/W/Male) ‘Because they do not know how to change the formulation of their recipes and still taste good.’ (Street Vendor 24/South/Male) |
| Challenges from consumer practices | |
| Awareness of the importance of salt reduction | To me the most important thing is knowledge. How we are going to tell the society or customers that this salt reduction is very important. That for me is a challenge…” (CO3/S/Male) ‘To be honest, as far as I know, I have never meet customer that request less salt for their dishes. It’s because they don’t have the awareness.’ (CO1/W/Male) ‘The parents sometimes asked for salty soy sauce for their kids at our restaurants. They insisted on it even after I said that the food is already salty. So, this habit is a problem…’ (CO3/C/M). |
| Consumer acceptance | ‘Usually, my customers will complain if my food is not salty.’ (SFV7/N/Female) ‘They definitely will complain that the food tasted bland…not tasty.’ (CO5/W/Male) ‘If we change the formulation of the recipes, customers might not like it.’ (SFV24/S/Male) ‘We cannot sell food that is cooked according to our preference. It must follow the preference of our customers.’ (SFV19/EM/Female) ‘…maybe the number of customers will reduce, they will say it’s better for them took at home rather than buying from us.’ (CO1/EM/Male) |
| Lack of consumers request for reduced salt | ‘To be honest, as far as I know, I have never meet customer that request less salt for their dishes.’ (CO1/W/Male) ‘My customers don’t really ask for less salt.’ (SFV7/N/Female) |
| Food quality | |
| Effect on taste, flavour and mouthfeel of reduced-salt foods and beverages | ‘Cannot be reduced (salt) as it will give effects to the taste and quality of the food.’ (SFV5/EC/Male) ‘Usually, we add salt into creamy dishes to enhance the flavour and creaminess. So if we reduce the salt, it would not be creamy or tasty enough for the consumers.’ (SFV25/S/Female) |
| Effect on the taste of traditional or heritage recipes | ‘It’s not easy to change recipes for traditional food because that is where the “tradition” sits. If customers eat, then they will complain that it doesn’t taste like how it should.’ (SFV5/EC/Male) ‘It’s because these recipes are passed down from our ancestors, so we are used to follow the recipes.’ (SFV6/N/Male) |
| Price of regular salt | |
| Comparison of regular salt prices with natural flavour enhancers and salt substitutes | ‘If the cost is too expensive, I think vendors would not use KCl.’ (SFV24/S/Male) ‘…but for cost wise, we cannot replace the cheap salt with all these wet spices in high volume. Lemongrass, bird’s eye chili is RM 15 per kg.’ (CO1/W/Male) |
| Regulation of street food vendors | |
| Lack of regulatory authority | ‘For vendors, they do not have any regulations or rules to follow to prepare healthy food, except for cleanliness and license. So, they prepare the food in their own way because they do not have any regulatory body.’ (SFV24/S/Male) |
| The tedious license registration process | ‘We would not attend the course (preparing less salt food) because most of us do not have license. So I think only those who have license will attend the course.’ (SFV/21/EM/Male) ‘It’s like this, the procedure to get the license is too long and complicated… so, that is why I don’t have the license yet.’ (SFA/20/EM/Male) |
| Enablers identified by food operators regarding salt reduction in Malaysia’s out-of-home sectors | |
| Theme/sub-theme | Example of quotes |
| Enhancing knowledge among food operators | |
| Establishing a standard guideline for salt reduction in food | ‘To me, the first thing is the guideline. What I mean is, how much salt that we are supposed to use. The small vendors want to know that.’ (SFV4/EC/Male) ‘I think for caterers, their own standard operating procedures need to be made first.’ (CO1/EM/Female) |
| Implementation of mandatory courses or trainings | ‘How can we practice using less salt in food? Maybe through classes conducted by the authorities…’ (SFV5/EC/Male) ‘So maybe, part of the food handling courses also, can also talk about eating healthy. Not only clean in the kitchen…’ (CO3/N/Male) ‘Because we already have the food preparation course right, so just include this one in this course.’ (CO1/EC/Female) ‘We try to make it (attending healthy food preparation course) as a mandatory for those that want to get business licence from the city council, they need to attend the healthy food preparation course.’ (CO1/W/Male) |
| Leveraging guidance from research agencies | ‘We can ask support from MARDI to do our R&D such as how to cook the food without salt or with less salt, and then can also be applied to ready-to-eat food.’ (SFV5/EC/Male) ‘How much to reduce… based on the standardised recipe. Let say in the recipe, stated 100 g and we reduce to 50 g. So, what is the difference? That means we need a professional to do the research.’ (CO2/W/Male) |
| Raising awareness among consumers and food operators | |
| Promoting health and managing healthcare expenses as the ultimate goals | ‘I would join in the policy if it’s for the health of the public.’ (SFV9/N/Male) ‘We support the salt reduction for our health.’ (CO1/W/Male) ‘I think this is let it become, actually this is a very good calling, these calling, it is a hard calling, you know not only that the action very root, the effective will be helping people, reduce the medical spending, and always saving money.’ (CO7/W/Male) ‘I have high blood pressure, so it costs so much every time I have to get medications even from government hospitals. So that is why I join this discussion session.’ (SFV18/W/Male) |
| Educating consumers on the importance and methods of salt reduction in food | ‘Creating awareness among the consumers is important. Creating awareness among the food sectors is also important.’ (C1/W/Male) ‘We need awareness among the customers as well.’ (SFV13/S/Female) ‘Yes, customers’ request is the most important thing.’ (SFV19/EM/Female) ‘We follow the request from customers when preparing food.’ (SFV13/S/Female) ‘Other than that, for things like how to eat balance, diagram of food pyramid, MOH can turn that into visual and make them in a form of sticker or any printing materials. Like us, we have trucks or stalls, we can paste them everywhere, so people can read when they are waiting for their order.’ (SFV17W/Female) |
| Targeting younger consumers | ‘Another thing is, we must educate on salt intake and salt in food starting from school level. We could design a subject especially for it.’ (SFV18/W/Male) ‘For me, school is the most effective. Teachers need to play their vital role because they can teach a culture. Less salt food culture. The students need to be given awareness to avoid instant food.’ (CO1/EC/Female) |
| Strategies for gaining consumers acceptance | |
| Progressive salt reduction and separate salt presentation | ‘I think it depends on customer, if the food providers sell less salty food for example the salty fish is not salt anymore, it will ruin the business because customer want their dish to be delicious. When you implement drastically, the reputation suddenly…’ (CO2/W/Male) ‘They do not have to mention. If we want to reduce, we just reduce.’ (CO4/W/Male) ‘We can prepare salt on the table, and the customers can add salt themselves.’ (SFV6/N/Male) |
| Introduction of reduced-salt menus | ‘Those that come to buy can have a taste of the reduced-salt food. They can have a new kind of flavour.’ (SFV12/S/Male) ‘As you can say, the benefit is that you might get additional customer. You might lose a few, but you can still have new customer that is keen in eating healthy. So, you will not lose them. I don’t think you will lose 100 % of them.’ (CO3/N/Male) ‘We can do food festival consisting of programs with vendors demonstrating their food using original recipes and reduced-salt food.’ (SFV2/EC/Male); (SFV17/W/Female) |
| Promotion and recognition of health-conscious food premises | ‘…for example, we give a recognition to hotels or restaurants through invoice prove. Let say last month they bought 3 kg but this month 2 kg, so we give them the recognition…if we put rating like 5-star rating for example, will catch their attention. This is their perception.’ (CO1/W/Male) |
| Food quality | |
| Salt reduction through the freezing method | ‘When the product is in a frozen form, customers will be fine with it. I have tried with my traditional food menu.’ (SFV5/EC/Male) ‘Salt can be reduced in traditional food, but it needs to be frozen because the customers will already expect that the food will not have 100 % of its original taste. So, from that aspect, we could reduce the salt usage. But cannot for ready-to-eat food.’ (SFV5/EC/Male) |
| Salt reduction in spices-infused dishes | ‘I think dishes like curries are suitable if we want to add more spices and lower the salt.’ (SFV19/EM/Female) ‘We got our own traditional style (for Indian Muslim dishes). So salt is not so important in our cooking. If we put lots of onions, it got all the taste. Normally spices and onions. The onions enhance the taste.’ (CO6/W/Male) ‘In Indian foods…when we put all these wet spices, we fry them well, we cook them well, sometimes we do not need salt. That has been implemented in the industry.’ (CO1/West/Male) ‘I only use spices for my burger patties. And maybe the smoke already gives the flavour to the patties, so I do not add salt to it.’ (SFV2/EC/Male) |
| Regulation measures for manufactured food products | |
| Enhancement of food packaging labels | ‘The picture on the food packaging. Let say, if lots of salt, maybe can show maggots or stomach cancer, high blood pressure.’ (CO3/W/Male) |
| Control over regular salt and high-salt products distribution | ‘…There are lots of salt, lots of sauces. So, if the display is reduced. They will finally disappear from the industry.’ (CO5/W/Male) |
| Price adjustment and taxation of regular salt | ‘I suggest we increase the salt price.’ (CO1/W/Male) ‘Tax would be helpful. It will help us in controlling the salt usage.’ (CO2/EM/Male) ‘Imposing taxation would be a great suggestion.’ (CO/EM/Male) |
| Price adjustment of natural flavour enhancers and salt substitute | ‘…for me, maybe can reduce the price of herbs, spices.’ (CO3/S/Male) ‘Like I said, pricing point of KCl is very important. If the cost is too expensive, I think vendors would not use KCl.’ (SFV 24/S/Male) ‘Yes, most importantly, the government should take care of the price of KCl first, then there would not be any problem for the industry players to accept the salt reduction initiative.’ (SFV24/S/Male) |
| Regulation of street food vendors | |
| Collaborative partnership between MOH and local authorities | ‘Now, vendors are only tied to the local authorities for their business license. I think MOH can collaborate with them to extend the information on the salt reduction policy…including making sure they use less salt in food.’ (SFV24/S/Male) ‘Yes, the local authority need to make the procedure easier for us to get our license.’ (SFV24/S/Male) |
*SFV, Street Food Vendor; CO, Catering Operator; W, West; N, North; S, South; EC, East Coast; EM, East Malaysia.