
































Microsoft Word - 2205 - PB.docx


Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

61 

 
Research Article 
 
Health education to improve the compliance of low salt 
diets in patients with hypertension 
 
Beti Kristinawati1*, Siti Rahmawati2, Riska Nurul Khasanah3 

1 Medical-Surgical Nursing, School of Nursing, Faculty of Health Sciences, Universitas 
Muhammadiyah Surakarta, Indonesia 

2,3 Professional Program Education, School of Nursing, Faculty of Health Sciences, 
Universitas Muhammadiyah Surakarta, Indonesia. 

*Correspondence: bk115@ums.ac.id.  Phone: +6282137266023 
  

ABSTRACT 

Background: The level of knowledge of hypertensive people can influence obedience in 
running a low-salt diet. Low levels of public awareness about low-salt diets can be at risk of 
complications due to hypertension and death. Health education activities in this community 
aim to increase the understanding of patients with hypertension on the importance of low-salt 
diets to improve adherence to the exercise of the diet 
Methods: Educational methods used in the form of teaches and demonstrations in groups of 
people with hypertension in Drono village, Ngawen Sub-District, Klaten Regency. 
Results: Knowledge of the hypertension diet increased between before and after educational 
activities. Success demonstrated with increased knowledge scores before educational 
activities of 3.46 and after education score rose to 85.02.  
Conclusions: Devotion to the community in health education provides increased knowledge 
in the group of hypertension sufferers. This activity is expected to continue, programmatic, 
and developed with specialized training in cadres to improve the degree of public health. 

Keywords: Health education, Low salt diet, Hypertension 

 

INTRODUCTION 
 
Hypertension is one of the non-infectious diseases with high mortality and morbidity figures. 
Hypertension is a condition in which there is an increase in systolic blood pressure above 149 
mmHg and diastolic pressure above 90 mmHg. It causes heart work to become increasingly 
severe in fulfilling oxygen and nutrients throughout the body (1). The World Health 
Organisation (WHO) in 2015 states that around  1,13 billion people in the world suffer from 
hypertension, with 9,4 million deaths annually (2). 
 
Southeast Asia is an area with a hypertensive sufferer of 36% and predicted to continue to 
increase to 65% in 2025 (3). The prevalence of Indonesian national hypertension was 34, 
1%(4). In Central Java province in the year 2016, the highest case of the non-infectious 
disease was hypertension, which is 61% (5). The health profile of Klaten district shows that 
the first sequence of the five significant not contagious diseases is hypertension. In 2018 there 



Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

62 

was an increase in the number of hypertension sufferers in Klaten District as many as 53.362 
people (6). 
 
Hypertension treatment can be conducted through two approaches: pharmacological and non-
pharmacological therapy (6). The pharmacological approach through antihypertensive drugs. 
Non-pharmacological can be done by behavioral action: stopping smoking, avoiding alcoholic 
beverages, limiting salt intake, avoiding preserved and preserved food, exercising and 
physical activity, or doing proper self-management (7) such as restrict of salt intake (6). Low 
salt diet compliance in hypertensive sufferers is indispensable to achieve success in their diet 
therapy, thus helping to lower blood pressure and prevent complications (8). A low-salt diet in 
daily foods was sufficient to reduce blood pressure in patients with hypertension (9). A low-
salt diet and dietary compliance can lower systolic and diastolic blood pressure and help 
maintain the blood pressure of patients with hypertension (10). One factor that affects the 
ability to restrict salt intake is the knowledge of hypertension among the sufferers. Health 
education activities can enhance an individual's level of expertise. 
 
Health education in the community is one capital to empower people and the community. The 
activity is not only able to improve knowledge but also can change the attitude and practice of 
an individual in maintaining its health independently (11). Continuing health education can 
lead people to participate in managing their health actively. Data from Ngawen Health Center 
in Drono village in 2018 recorded as many as 190 people suffering from essential hypertension 
(12). Our preliminary assessment of patients with hypertension in Drono village obtained 9 out 
of 10 sufferers have not known about the importance of low-salt diets, and the restriction of 
salt intake in diets consumed was also not routine. Besides, patients with hypertension still 
often consume instant foods high rated and foods preserved with preservatives derived from 
salt. Other data was found only some 40 hypertension that actively follows routine health 
screening activities in an integrated service post for the elderly. Research conducted by 
Sulistiorini about the compliance of low-salt diets in hypertensive sufferers' research locations 
found that people with hypertension were not obedient in choosing low-salt foods, sodium-
based herbs, and foods containing sodium preservatives (12). This study aims to understand 
the level of knowledge on low salt-diet compliance in hypertensive sufferers in Drono village 
after education. Expected with increased awareness and adherence to the exercise of the diet 
can help shape the positive attitude of society and improve the quality of their life.  
 
METHODS 
 
Study design and intervention course 
The experimental, one-group pre-post-test design was applied in this study. Health education 
in the communities was conducted by lecture and demonstration techniques. The 
implementation of the activities consists of several phases: pre-test, intervention, and post-
test. Three team members held the education and a demonstration on how to quantify salt 
consumption daily. The activity also involves a village midwife who serves as the head of 
health care and as a key person who provides information about the public health status of 
Drono village, Ngawen Sub-District, Klaten Regency.   
 
Settings and participant 
This research was conducted in Drono village, Ngawen Sub-District, Klaten Regency. The 
population was people with hypertension in Drono village. Data were obtained from Ngawen 
Public Health Center in 2018 as many as 190 patients. We took 40 samples for this research 
by considering purposive sampling using criteria, including people with hypertension who 
actively participated in the integrated service center for the elderly (Posyandu Lansia). 
 
 



Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

63 

Data collection and Pre and post-assessment 
Data collection was conducted in the monthly meeting of the integrated service center for the 
elderly (Posyandu Lansia). Pre and post-tests were delivered before and after the intervention, 
respectively, using similar questionnaires consisting of seven questions to measure the 
change of hypertension knowledge before and after the intervention (Table 2).  
 

Table 2. Inquiry List Pre and Post-Test Education 

 
Analysis  
Pre and post data were administered and presented descriptively using table and chart. 
 
Ethical Approval 
The implementation of this research activity is done after the activity proposal. Memorandum 
of Understanding (MOU) is approved and signed by the head of Ngawen Public health center 
and researchers. The research team also asks for approval to respondents after being 
explained the intent, purpose, and permit to photograph process activities for documentation 
purposes by signing informed Consent. 

 
RESULTS 
Respondents were involved in this study as much as 40 people, with characteristics shown in 
table 1. 
 

Table 1. Characteristics of the study subjects (N = 40) 
 

Variable  Frequency 
 Number Proportion (%) 

Gender    Male 11 27.5 
 Female 29 72.5 

Age (years) 45-59 22 55 
 60-74 16 40 

 75-90 2 5 
Education Elementary School 29 72.5 
   Junior High School 7 17.5 
 Senior High School 2 5 
 College 2 5 

 
 
 
 
 
 
 
 

No Questions 
1 What is the purpose of the restriction of salt consumption for patients with hypertension? 
2 Mention a variety of low-salt diets! 
3 Are instant foods and foods preserved mostly high in salt content? 
4 What is the safe limit of salt content in instant foods and foods preserved for people 

with hypertension? 
5 How many sizes of salt consumption recommended for people with hypertension? 
6 How do I limit salt intake if the hypertension is eating at the restaurant? 
7 What is the risk if people with hypertension do not limit salt consumption? 



Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

64 

 
Participants' total score pre-post-test presents in Figure 1. In the pre-test, the lowest and the 
highest score of respondents were 28.58 and 42.87, respectively. Subsequently, in the post-
test, the respondent got a better score with the lowest score of 71.45 and the highest score of 
85.74. 
 
 

 
 

Figure 1. Total score pre and post-test for each participant 
 

 
DISCUSSIONS 
 
Non-infectious disease risk factors (NCDs) such as hypertension are categorized in a risk 
factor that can be modified and cannot be modified. Unmodifiable risk factors are individual 
characteristics that cannot be altered and cannot be controlled. These factors include age, 
gender, race, family history, genetics, etc. Besides, the risk factors that can be controlled are 
characteristics of individuals that can be adjusted or can be changed to prevent disease 
progression. Risk factors that can be modified Included; Obesity, high intake of salt, inactive 
or lack of exercise, a diet high in fat, smoking, alcohol consumption, etc. (13,14). 
 
The results of the study gained that patients with hypertension were dominated by women 
(72.5%). Most sufferers (55%) are in the 45-59 age group. In young women, hypertension is 
rarely found; this condition is associated with endogenous estrogen content. Hypertension is 
common in women when entering the age of the elderly (65 years or more) than women 
(15,16). Women who have entered the age of menopause are more susceptible to having 

0

10

20

30

40

50

60

70

80

90

100

Score

Score Pre Test Score Post Test



Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

65 

problems with cardiovascular one of them is hypertension because the levels of HDL patients 
have decreased, thereby causing atherosclerosis. Hypertension experienced by women is 
associated with a unique condition that is only experienced, namely related to pregnancy, 
menopause, and the use of oral contraceptive drugs (16,17) 
 
Our result shows, based on the pre and post assessment, we found the change of knowledge 
among participants after the intervention. Education is part of non-pharmacological action to 
control blood pressure and prevent the risk of complications from hypertension (15). The 
possible complications for hypertension are stroke, heart attack, and kidney disease. 
Accordingly, proper management is required to avoid complications (14). 
 
Education level, most elementary schools are 72.5%. Low level of education affects the level 
of knowledge of sufferers on compliance with medication, conducting medical examinations, 
and maintaining a proper diet in hypertensive patients (18). Previous research obtained data 
that self-management by limiting salt intake to one way to control blood pressure (19). Low 
salt diet compliance in hypertensive sufferers is indispensable to achieve success in therapy. 
The knowledge assessment of a diet low in salt on research includes a variety of low-salt diets, 
sodium levels in the instant foods that are safe for people with hypertension, and the amount 
of daily sodium consumption. We also included the strategy of reducing sodium intake when 
eating at the restaurant as well as the purpose of limiting sodium consumption and risks that 
can arise when not adhered to the hypertension diet. The results of the evaluation showed 
that there was a significant change in educational pre-post knowledge levels. 
 
The results of previous studies were found that there was a close connection between 
increasing blood pressure for hypertension and sodium intake. High sodium intake will 
increased blood pressure associated with the occurrence of water retention, increased 
peripheral resistance, changes in endothelial function, changes in structures and features of 
the elasticity of large blood vessels, modifications in sympathetic activity, and autonomic nerve 
modulation of the cardiovascular system (20). 
 
Besides limiting salt intake, hypertensive diets limit the consumption of saturated fats and high 
cholesterol foods. Hypertension sufferers can use the Dietary Approaches to Stop 
Hypertension/DASH method in regulating food intake. DASH focuses on structuring the 
patient's diet with the restriction of sodium, fat, and cholesterol intake. Patients are 
recommended to consume a lot of foods that contain a lot of protein, calcium, potassium, and 
fiber to encounter the daily needs of the body (21). The study showed that the respondents' 
level of knowledge about the high content of sodium in low food. Healthy subjects consume 
fast food 3 to 4 times a week, while the fact 74% sodium content is in prepared food or fast 
food (22). Patients with hypertension need to reduce salt per day to a maximum of 6 grams 
and not more than 2400 milligrams. Patients with adherent hypertension who maintain a diet 
low in salt proved to lower blood pressure at 3.4 systole mmHg and diastolic blood pressure 
1.5 mmHg (23). 
 
 
CONCLUSIONS 
 
Education with the method of lectures and demonstrations can improve society's knowledge, 
especially patients with hypertension. Furthermore, increasing awareness is expected to 
increase adherence to low salt diets that impact the quality of life and lower the risk of 
complications and deaths from hypertension. Health care personnel are expected to make 
education a promotive and preventive effort to prevent hypertension complications. For the 
stakeholder, such results can be primary data to be followed up with behavioral change 
assessment activities in running a low-salt diet. Besides, it is expected to motivate patients 



Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

66 

with hypertension who have not been actively involved in activities in the integrated service 
center for the elderly (Posyandu Lansia) to be active. For further researchers, these results 
are expected to be primary data for subsequent studies. 
 

Authors' Contribution 

Each author has contributions to the process of research and the preparation of this article. 
BK, as the head of the team and the speaker in education activities, RN assists in the process 
of research activities, and SR roled in the process of evaluating and compiling the reports of 
events that have conducted. 

Funding 

This research was funded by Universitas Muhammadiyah Surakarta, Indonesia.  

Conflict of Interest  

The is no conflict of interest. 

 
 
REFERENCES 
 
1. The Ministry of Health of Indonesia. Indonesian Health Profile Data and Information 2018. 

Jakarta: The Ministry of Health of Indonesia; 2019. Available from: 
https://pusdatin.kemkes.go.id/resources/download/pusdatin/profil-kesehatan-
indonesia/Data-dan-Informasi_Profil-Kesehatan-Indonesia-2018.pdf. (in Indonesian) 

2. WHO. World Health Statistic Report 2015. Geneva; 2015. 
https://apps.who.int/iris/bitstream/handle/10665/170250/9789240694439_eng.pdf;jsessi
onid=4D55F1759CB2B1311B6315914AC5A560?sequence=1 

3. Banik KK. Save lives: Make hospitals safe for emergencies. J Indian Med Assoc. 
2009;107(4):206–7. 

4. The Ministry of Health of Indonesia. Main Finding of Basic Heath Research of Indonesia 
(RISKESDAS) 2018. Jakarta: The Ministry of Health of Indonesia; 2019. 
http://kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-
2018_1274.pdf. (in Indonesian) 

5. Klaten District Health Office. Health Profile 2018. Klaten: Klaten District Health Office. 
https://www.kemkes.go.id/resources/download/profil/PROFIL_KAB_KOTA_2018/3310_J
ateng_Kab_Klaten_2018.pdf. (in Indonesian) 

6. Ainurrafiq A, Risnah R, Ulfa Azhar M. Non-pharmacological therapy in controlling blood 
pressure in hypertensive patients: Systematic Review. MPPKI (Media Publ Promosi 
Kesehat Indones Indones J Heal Promot. 2019;2(3):192–9. (in Indonesian) 

7. Burnier M, Vuignier Y, Wuerzner G. State-of-the-art treatment of hypertension: 
Established and new drugs. Eur Heart J. 2014;35(9):557–62.  

8. Tarigan AR, Lubis Z, Syarifah S. The influence of knowledge, attitudes and family support 
for hypertension diets in Hulu Village, Pancur Batu Sub-District in 2016. J Kesehat. 
2018;11(1):9–17. (in Indonesian) 

9. Kiha RR, Palimbong S, Kurniasari MD. The effectiveness of a low-salt diet in ordinary and 
soft foods for the duration of recovery of hypertensive patients. J Keperawatan 
Muhammadiyah. 2018;3(1). (in Indonesian) 



Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

67 

10. Hayati A. Evaluation of Treatment Compliance among Patients with Lung Tuberculosis 
year 2010-2011 in Pancoran Mas Health Center, Depok. Universitas Indonesia; 2011. (in 
Indonesian) 

11. Bisallah CI, Rampal L, Lye MS, Sidik SM, Ibrahim N, Iliyasu Z, et al. Effectiveness of 
health education intervention in improving knowledge, attitude, and practices regarding 
Tuberculosis among HIV patients in General Hospital Minna, Nigeria – A randomized 
control trial. PLoS One. 2018;13(2):1–14.  

12. Sulistiorini H. Kepatuhan Diet Rendah Garam Pada Penderita. Universitas 
Muhammadiyah Surakarta; 2019. (in Indonesian) 

13. Mayega RW, Makumbi F, Rutebemberwa E, Peterson S, Östenson CG, Tomson G, et al. 
Modifiable socio-behavioural factors associated with overweight and hypertension among 
persons aged 35 to 60 years in Eastern Uganda. PLoS One. 2012;7(10). 

14. Ahmed N, Rahman M, Islam M, Ali S, Hossain A, Fatema K, et al. Socio-demographic, 
clinical characteristics and status of hypertension control among rural hypertensive 
patients. Faridpur Med Coll J. 1970;6(1):5–9.  

15. Nuraini B. Risk factors of hypertension. J Major. 2015;4(5):10–9. 
16. Ahmad A, Oparil S. Hypertension in women: recent advances and lingering questions. 

Hypertension. 2017;70(1):19–26.  
17. Rahmatika D. The relationship between emotional support and adherence to the diet of 

elderly people with hypertension. The Indonesian Journal of Public Health. 2019; 
14(2):252-262. (in Indonesian) 

18. Pramestutie HR, Silviana N. The knowledge level of hypertension patients for drug 
therapy in the primary health care of Malang. Indones J Clin Pharm. 2016;5(1):26–34.  

19. Welviana I, Waliyo E. General description of food scraps and nutritional status in 
hypertensive patients who receive a low salt diet at Sultan Syarif Mohamad Alkadrie 
Hospital Pontianak. Pontianak Nutr J. 2018;1(1):40. (in Indonesian) 

20. Grillo A, Salvi L, Coruzzi P, Salvi P, Parati G. Sodium intake and hypertension. Nutrients. 
2019;11(9):1–16.  

21. Apriana R, Rohana N, Simorangkir Y. The relationship between the application of the 
DASH (Dietary Approach to Stop Hypertension) method with the level of hypertension. 
Medisains. 2017;15(3):179–84. (in Indonesian) 

22. Prihatini S, Permaesih D, Julianti ED. Sodium intake of Indonesians: Analysis of 2014 
individual food consumption survey (SKMI) data. Gizi Indones. 2017;39(1):15. (in 
Indonesian) 

23. Fauziah NY, Bintanah S, Handarsari E. The pattern of consumption of sodium food 
ingredients in outpatient hypertension patients at Tugurejo Hospital Semarang. J Gizi 
Univ Muhammadiyah Semarang. 2013;2(1):1-9. (in Indonesian) 

 

 

 

 

 

 

 



Epidemiology and Society Health Review| ESHR 
 

Vol 2, No 2 (2020) 
 

68 

 

 

 

 


