Most participants knew that high sodium is unhealthy, yet many did not know the recommended intake, struggled to read food labels, and still faced practical barriers to cutting back. This study asks why awareness alone was not enough. High sodium intake, largely through salt, is associated with high blood pressure, a key risk factor for cardiovascular disease.

High sodium intake is also associated with kidney diseases, osteoporosis and stomach cancers, while increasing deaths and disability have been attributed in part to high sodium intake. The WHO recommends that adults consume less than two grams of sodium, equivalent to five grams of salt, per day, but salt consumption has remained consistently higher than that recommendation in many countries.

Understanding knowledge, attitudes and behaviours toward dietary sodium can inform effective salt-reduction interventions. Research in high-income Western populations has identified poor knowledge of sodium and salt recommendations, misconceptions about salt, limited use of food labels, and limited willingness to use low-salt products.

Those findings may have limited generalisability to Singapore because cultural context and dietary habits differ: sodium in Asian cuisine comes largely from sauces, seasonings and table salt. The understanding of dietary sodium knowledge, attitudes and behaviours in the Singapore population was lacking.

These data are valuable as a needs assessment before sodium-reduction initiatives and can provide an opportunity to evaluate their impact and effectiveness. The study therefore aimed to fill this gap among Singapore residents. A cross-sectional online survey was conducted in Singapore between October and December twenty twenty.

Participants came from the Singapore Population Health Study Online Panel and were Singapore citizens or permanent residents aged twenty-one years and above who used the internet, had personal email, and could read English. One participant was randomly selected from each household, and invitations were sent to one thousand two hundred and forty participants after multiple participants per household were excluded.

Those who consented completed a questionnaire on REDCap, using a desktop, laptop, tablet or mobile phone, and received ten dollars after an average completion time of fifteen point seven minutes. Existing Asian questionnaires tended to focus on salt intake and did not ask about other sodium sources, such as sauces and seasonings.

A questionnaire consisting of fifty-nine items was developed to assess Singapore residents’ knowledge, attitudes and behaviours toward dietary sodium intake. The questions were adapted from questionnaires used in the United States, United Kingdom, Australia, China, Hong Kong and India, then modified for local context and ethnic cooking methods.

The questionnaire was pilot tested for face validity among internal staff before administration. Data were extracted from REDCap and imported to STATA slash se version fourteen point zero for analysis. The data were weighted by gender, age, ethnicity and education level to represent the Singapore resident population.

Descriptive statistics used means and standard deviations, or counts and proportions, to describe participant characteristics and responses. Agreement responses were grouped into agree, neither, and disagree, while frequency responses were grouped into never or rarely, sometimes, and often or always.

A total of nine hundred and fifty-five participants completed the survey, with a seventy-seven point zero percent response rate. The mean age was forty-six point six years, and females made up fifty-eight point zero percent of participants. The sample was mostly Chinese, at eighty-two point one percent, with ten point five percent Indian and four point five percent Malay participants.

Almost half had attained a university degree or higher, and just over half were overweight or obese. Most participants were aware of the health impact of high sodium consumption. However, sixty-eight percent were unaware of the recommended intake for salt, eighty-three percent were unaware of the recommended sodium intake, and sixty-nine percent were unable to correctly use food labels to assess sodium content.

The findings also indicated knowledge gaps about the sources of sodium in participants’ diets. Thirty-four percent of participants thought canned or processed foods contributed the most sodium, while only twenty-nine percent identified sauces and seasonings added during cooking and thirteen percent identified sauces and seasonings added while eating.

When participants compared their personal sodium intake with their perceived recommended amount, the proportions were quite evenly distributed among those who felt they ate more, less, about the right amount, or were unsure. Fifty-eight percent reported knowing how to monitor sodium intake using information on the nutrition information panel, but only thirty-two percent correctly identified foods with higher sodium when labels showed different serving weights.

Fifty-five percent reported using per-serving values rather than per-one-hundred-gram values when making comparisons, suggesting misplaced knowledge in reading food labels. Table one compares knowledge and behaviour scores across participant characteristics, using means, standard deviations, and significance values.

Knowledge differed by age, ethnicity, education, BMI category, and whether a medical professional recommended reducing sodium intake, while behaviour differed by age, ethnicity, BMI, medical history and treatment, and household responsibilities. These results matter because they show that knowledge and reported behaviour are associated with different participant profiles, helping identify groups and contexts relevant to dietary sodium education.

About half of participants reported frequently using salt, sauces or condiments when cooking, at fifty-one percent, while thirteen percent used them frequently at the table. The most common sodium-reduction practice was minimising preserved foods, at fifty-one percent, followed by minimising fast foods, processed foods and savoury snacks, and using spices or herbs instead of salt and condiments.

Requesting no or less salt when eating out was the least frequently practiced strategy, at nineteen percent. Although ninety-four percent noticed the nutrition information panel and eighty-eight percent noticed the lower-sodium Healthier Choice Symbol, only twenty-eight percent used food labels to check sodium content.

Fifty-nine percent of participants reported limiting their sodium consumption, but many reported barriers such as not knowing how to limit their intake. Participants also felt there were limited low-sodium food options when eating out and lacked awareness of low-sodium products.

The conclusions highlighted substantial gaps in participants’ knowledge and skills for managing sodium consumption. Figure one shows where participants preferred to receive information about dietary sodium. This matters because the authors identify healthcare professionals, labels, and online platforms as potentially important channels for communicating sodium-reduction guidance.

The study describes itself as the first study exploring dietary sodium knowledge, attitudes and behaviours among Singapore residents, but it also identifies several limitations. Participants aged sixty years and above, males and Malay participants were underrepresented, so the weighted responses may limit generalisation to the whole population.

The questionnaire was self-developed and adapted from existing questionnaires; although it had face validity testing, it had not been tested for construct or criterion validity. The survey relied on self-reported responses and could not quantify or validate actual sodium-related behaviours.

Future research could use twenty-four-hour urine collection and multiple twenty-four-hour diet recalls. The study suggests the need for more public education and improvements in the food environment. The study found substantial gaps between knowing that sodium matters and knowing how to manage it.

Better public education and a food environment with more low-sodium choices may be needed.