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.