Disseminating sodium-monitoring data of the Australian food supply through periodic media releases enabled the VSRP to raise public awareness of the salt content of different foods through mass media and engage food manufacturers in meetings to discuss product reformulation. A total of 759 media items were generated through radio, newspaper, online news, and television across six media releases. This is much greater than the 58 media items that were generated by six media releases about tobacco control in New South Wales , and implies the VSRP strategy was more effective in gaining access to the media . The media coverage reached over 5.6 million Australians on average, approximately 20% of the population .
This reach is comparable to a salt reduction public awareness campaign Give Your Head a Shake in the Champlain region of Canada, which reached 5.7 million Canadians through more than 70 media items in the first year of the campaign . However, the number of Australians reached varied by product category from around 2 million to over 7 million, which could suggest that there were characteristics of certain media releases that attracted greater attention than others . In addition, about one-quarter of manufacturers contacted by the were directly engaged, with between one and three manufacturers being engaged per report. This may suggest that media publicity can be used by public health advocates to engage the food industry in discussions about food reformulation, and could possibly influence food industry action, as seen in the UK . Therefore, our results show that media releases are a useful tool for reaching consumers with salt reduction messages and engaging food manufacturers in discussions about salt reduction reformulation.
The variations in the media coverage between product categories may be due to characteristics of the media releases  or external factors outside the VSRPs control. The processed meats release had the highest number of media items, cumulative audience reach, ASR, and social media engagement. This may reflect factors within the press statement , including the media angle chosen (“Aussie BBQ classic proving a snag to good health” ), the leading message or framing of the findings (e.g. “a sausage in a slice white bread with sauce contains nearly half the recommended daily maximum salt intake” ), other key findings (e.g. reduction in the salt content of bacon, but not sausages, over time) or that all themes identified in the qualitative analysis were present. It could also reflect external factors, such as: the timing of the media release (Salt Awareness Week 2018 [43, 44]), a planned media event in Melbourne with a local chef , perceived newsworthiness , general public or media interest in the category, or other factors.
Contrastingly, the dips and crackers release performed the poorest across all media coverage indicators. Based on our analysis of the press statement , showing almost all qualitative themes were present and similar messaging to other product categories, the potential reasons for lower media uptake are likely external. The timing of the media release was likely a major factor, specifically other events occurring in the world at the time, with the Aztec High School shooting in America occurring on the same day . Other timing factors, including the lead up to Christmas, other health or nutrition related stories in the week, and the short space of time since the previous media release could have also contributed to the lower media pick-up . The perception from the media that because dips and crackers are discretionary or occasional foods  the salt content is a lesser a priority, may also be a factor.
Due to data limitations, we were unable to compare the media indicators for bread with other product categories, however possible factors influencing outcomes include the focus on general salt information rather than the key findings of the product category report, and the release date, which was before the Unpack the Salt campaign launch . While levels of media engagement may be unpredictable, both internal and external factors should be considered more closely for future strategies as the impact on media coverage was substantial.
Levels of engagement with food manufacturers also differed between reports, which could be due to the VSRP approach to engagement, manufacturer-specific factors, or product category-specific factors. The number of manufacturers contacted by the VSRP per report varied depending on how many were named in the release as having the highest salt products [31–36], however, the number of manufacturers engaged per report did not reflect this. Both manufacturers contacted in relation to the processed meat report met with the VSRP compared to only one of 11 manufacturers of dips/crackers.
Whether the press releases included a call for industry to act did not seem to influence the likelihood of manufacturers to engage with the VSRP. These findings imply that factors affecting industry engagement are likely external. Manufacturer-specific factors, such as company philosophy, size and location (overseas, Australia-based), capacity and available resources for reformulation, and receptivity to the industry engagement approach (naming manufacturers and products in the media) may have influenced manufacturers’ decisions to engage with the VSRP. Another factor to consider is the feasibility of reformulation for specific product categories. Some foods are harder to reformulate than others due to technical and functional roles of salt, such as its use as a preservative in many products, role in the control of yeast growth and fermentation in bread, and role in sensory and textural properties in processed meats ; and manufacturers of these product types may be more likely to be looking for support. Media advocacy can be used as a tool to engage manufacturers in conversations about salt reduction reformulation, however future interventions should consider factors that may affect levels of engagement from the outset.
The idea of utilising product category reports to advocate for salt reduction through mass media stemmed from a similar strategy in the UK, whereby regular surveys were undertaken by Action on Salt, and used to raise public awareness and put pressure on the food industry to reformulate in line with the UK’s salt targets . Between 2006 and 2011, the UK salt reduction strategy reduced population salt intake by 15% and salt levels in foods were reduced by up to 57% in some food categories . Building on concepts from the UK strategy, the VSRP utilised mass media to call consumers, industry and government to act to reduce population salt consumption.
Consumer messages in the press statements were based on evidence about salt levels in different food categories from the product category reports [14–19, 49] and were centred around concepts such as: raising awareness of the salt content of different foods, swapping to a reduced salt variety, replacing processed foods with fresh foods, and trying homemade options. Although the key messages are based on a successful strategy and media coverage indicators seem promising, it is currently unknown whether these messages were enough to trigger changes in consumer behaviour to reduce the salt intake . Media advocacy strategies were used to stimulate industry action to reformulate processed foods and government action to set sodium targets, as well as increase public demand for these actions, in line with the aim to reduce salt in the food supply. In four of six press statements, industry was called to act, with messages highlighting that reformulation is feasible within these product categories, and in three of six press statements, the federal government was also called to act, specifically to set targets for sodium levels in foods.
Worldwide, 61 countries have reported working with the food industry to reformulate products to include less salt . At least 23 countries have reported engaging in industry meetings as part of their national salt reduction strategy , the approach undertaken by the VSRP. However only two of these countries, France and Italy, have reported a reduction in the salt levels of selected food categories, and these countries also had voluntary sodium targets . In total, 36 countries have established sodium targets, and 19 countries reported a reduction in salt levels in foods and meals . This emphasises the importance of nutrient reformulation targets for reducing salt levels in the food supply, and consequently decreasing population salt intake and the burden of disease associated with excess salt consumption.
This study is a novel assessment of the outcomes of a media and advocacy strategy in Australia. It provides insight into media coverage and industry engagement outcomes from six media releases based on salt levels in different processed food categories. It provides an in-depth understanding of the factors influencing the effectiveness of using media as a tool for engaging media and industry, which is a key element of a larger salt reduction intervention strategy. The methodology for assessing the media and advocacy strategy, both quantitatively and qualitatively, was based on items from a public health framework for evaluating complex public health interventions . A limitation of the study is that the indicators of media coverage for the bread release were unable to be compared to other media releases. For this report, average audience reach was recorded by The George Institute for Global Health, whereas cumulative audience reach, media items and ASR were collected by the Heart Foundation for the other reports.