The Behavioral Architecture of Dietary Salt Reduction Among Hypertensive Population in Sabah, Malaysia: A Descriptive Qualitative Inquiry

Abstract

Dietary patterns, not medical adherence, make it dif8icult to  reduce salt  in the population. This  is due to the complex structure of  the  house.  Hypertensive  residents  living  in  communities  in  Sabah,  Malaysia, have dif8iculty adhering to a low-salt diet due to factors such  as  family  kitchen  dynamics,  barriers  in  multi-level  behavior,  and  barriers in the local food environment. Using a descriptive qualitative  investigative  framework  compatible  with  COREQ  principles,  we  conducted semi-structured face-to-face and telephone interviews with  a purposive sample of N=10 individuals diagnosed with home-cooked  hypertension.  Thomas  and  Harden's  three-stage  inductive  theme  framework  has  been  used  to  process  the  transcript  verbatim.  These  transcripts  have  also  been mapped to  external  settings  of  the  Socio Ecological  Model  and  CFIR  2.0.  Four  main  themes  of  non-compliant  architecture  are  shown  in  inductive  thematic  analysis:  Interpersonal  Friction  and  the  Stress  of  Collective  Family  Food  Sharing,  in  which  family  tastes  override  medical  needs;  The  Socioeconomic  Gap  and  Architectural Barriers of Retail Choices, which emphasises that ultra processed high-salt products are cheaper and more readily available in  Sabah's  retail  market  than  fresh  low-salt  products.  Dietary  non compliance  is  structural  design,  not  motivation.  Public  health  and  clinical  nurse  leaders  must  transition  from  didactic  counseling  to  supporting family choice-architecture interventions and regional food  policy changes to ease the cognitive and economic constraints of salt  restriction.  Finally,  this  study  supports  a  tactical  shift  towards  community-based support systems that consider local eating habits for  better health outcomes in the long run.