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Online and In‐Person Nutrition Education Reduces Sodium Intake: A Randomized Trial to Assess Knowledge, Self‐Efficacy and Behaviors in WIC Participants

High blood pressure is one of the leading causes of preventable morbidity and mortality in the U.S., and low‐income populations are at increased risk. The purpose of this randomized controlled trial was to examine the 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 Women, Infants, and Children (WIC) between November 2014‐May 2015. The content of the lesson focused on ways to reduce sodium intake and promoted healthy low‐salt cooking options. 580 WIC participants from 3 Los Angeles, CA WIC clinics were randomly assigned to receive in‐person group education (n=294) or online education (n=286). Questionnaires assessing knowledge, self‐efficacy, and behaviors related to sodium reduction were administered before and after education, and 2 to 4 months later. T‐tests and x 2 tests were used to compare changes within and between in‐person and online groups. ANCOVA and GEE were used to assess differences in change between groups. Positive changes in knowledge and self‐efficacy improved between pre‐ and post‐questionnaire and were retained 2–4 months later for both groups (P<0.05). Both groups reported significant improvements in behaviors related to using less salt in cooking, and eating less salt, processed foods, fast‐food, and restaurant foods (all P<0.001). Overall, this study demonstrates that both online and in‐person group education can result in improvements in knowledge, self‐efficacy, and behaviors related to reducing sodium intake in a low‐income population. Findings support the use of innovative and effective nutrition education to low‐income populations to improve long‐term dietary behaviors.