Contextual factors and implementation strategies for a multi-level community-based sodium reduction intervention in Chicago's South Side: a qualitative study.

Background: Excessive sodium intake exacerbates rates of hypertension. African American adults have higher rates of hypertension in part due to a higher-sodium diet. The multi-level Communication for Behavioral Impact for Sodium Reduction (COMBI-SR) community-based intervention effectively reduces sodium intake in international settings, but it has not yet been implemented and tested in the U.S. This study explored the contextual factors (barriers/facilitators) and implementation strategies for COMBI-SR in Chicago's South Side neighborhood-an area with high rates of hypertension.

Methods: Between May and November 2023, we conducted qualitative interviews with potential intervention recipients (n = 8), Research Ministry Ambassadors (n = 5) and healthcare professionals (n = 2), 1 focus group with potential intervention recipients (n = 9) and 3 focus groups with healthcare professionals (n = 10). The Consolidated Framework for Implementation Research (CFIR) 2.0 guided the development of semi-structured interview guides. Thematic analysis was performed using CFIR 2.0 constructs to identify barriers and facilitators to implementation, and the Expert Recommendations for Implementing Change (ERIC) compilation to identify implementation strategies.

Results: Key barriers included a lack of awareness of sodium content in foods, socioeconomic disparities limiting access to healthy options, and cultural dietary traditions. Facilitators included strong community partnerships, engaged faith-based organizations, and openness to integrating technology, such as a mobile app, to help monitor and reduce sodium intake. Specific strategies to support sodium reduction involved simplifying public health messages, offering low sodium cooking demonstrations, promoting healthier food options through community outreach, and providing personalized education on reading nutrition labels and managing sodium intake.

Conclusions: Successful implementation of COMBI-SR in Chicago's South Side requires addressing financial, educational, and cultural barriers while leveraging trusted community structures to promote sustainable sodium reduction. These findings will guide future efforts to implement COMBI-SR in the U.S., emphasizing culturally tailored messaging and ongoing community engagement to improve cardiovascular health.