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Table 2 Stakeholder quotes illustrating key themes for each process element, by action area

From: Stakeholder perspectives on the effectiveness of the Victorian Salt Reduction Partnership: a qualitative study

Action area, aim and approach Process element Theme Quotes
Establishing a Strategic Partnership
Aim: to create a Strategic Partnership and develop a collaborative approach to salt reduction with stakeholders
Approach: VicHealth invited stakeholder organisations to join the Partnership and develop a joint action plan for salt reduction in Victoria.
Perspectives on achieving aims Learning how to work together It’s a true partnership where every organisation brings strengths to the table... the real success of this project is that, learning how to collaborate and work with others and recognise each of the strengths that they bring is really important. (Member 9: SP, R)
Achieving collaborative action I think the partnership had achieved what it set out to achieve in terms of collaborative action and setting of action plan that is about us working together for salt reduction specific to the state. (Member 11: SP, I, R)
Achieving capacity building I think there has been good ongoing discussion, collaboration, I think there’s been a bunch of capacity building. (Member 4: SP, R)
Enablers to intervention delivery The “right” Partners I think you had the right organisations, strong leadership within those organisations and good expertise. (Member 2: SP, I, R)
Commitment from Partners I think that’s been critical in having all of those people with a common interest around the table because it’s been such a long time, the working group period, and you need a range of players committed to that to keep momentum going through. (Member 1: SP, R)
Regular strategic meetings The ability to have a meeting every three months, same people coming together, who heard the conversation last meeting, at that partnership level – it usually makes it much easier and it’s kind of an enabler. (Member 11: SP, I, R)
The regular meetings were really good opportunities, they were well-run and focused and so I think they were fantastic opportunities to build momentum in the salt space and the hypertension space, we really hadn’t had something like that for a really long time, so that was terrific. (Member 8: SP)
Diverse skills and expertise (capacity building) I think those core groups brought a really good mix of skills and expertise, which I think we all learnt from. In my early days on the partnership when we’re establishing the agenda, it was really useful and great because we all learned from one another and you know we had some pretty fiery kind of debates and discussions, which were great. (Member 7: SP)
Developing a shared action plan Looking at the evidence, engaging with the key stakeholders around it, appraising options for action, feasibility, political acceptability a whole host of different domains to then draw-up a shared plan, on what the consensus for action on that would be that everyone could co-commit to. (Member 13: SP)
Barriers to intervention delivery Less active involvement from some partners I think we’ve had some who haven’t actively contributed in the same way as others... they share our messages and our campaign, but it wouldn’t always feel like they had a stake. (Member 11: SP, I, R)
Too many people / organisations You do have to get a lot of people involved and a lot of people across things or signed off by people. (Member 5: SP, I)
Slow start-up It might have been a good year before it was quite clear what they were planning to do to me … trying to design implementation strategies… looking at getting other stakeholders involved and it is quite a slow process, but it took a while for me to clearly understand what the implementation strategies were going to be. (Member 3: R)
Transfer of knowledge and skills to new members We could have done more in terms of really making sure the new people who came in were fully aware of what the precise goals of the partnership, the ways of working and that we did everything we could to ensure that the capacity was transferred for the relevant people…I think sometimes you just underestimate the benefits or stopping, taking stock, making sure that absolutely everybody in the partnership is on the same page and has all the relevant background information and knowledge and skills in order to ensure that the project continues on the same track, and I think potentially we could have spent some more time doing that. (Member 2: SP, I, R)
Barriers to achieving outcomes The “right” intervention I think the Heart Foundation to the extent that it delivered an intervention, did deliver an intervention pretty effectively, but whether the intervention was the intervention that needed delivering I think is a key question. (Member 4: SP, R)
Everyone’s passionate who was around the table on this issue and of course you’re going to have some heat, and that’s part of it, it shouldn’t all just be smooth sailing, you need people to question, challenge whether you need the consumer piece or do you just focus on the food reformulation or do you do the debate and the policies? (Member 7: SP)
Perspectives on the fidelity of the intervention Changes to Partnership members A number of other players have come on as it’s deemed relevant that they can contribute, and obviously they have an interest in this area. (Member 1: SP, R)
Perspectives on utility/ quality of the intervention Effective Partnership It’s been really effective to have these different organisations with different skillsets working so closely together. (Member 21: SP, I)
Enabler to intervention delivery The Partnership’s a background enabler. (Member 12: SP)
Raising Consumer Awareness
Aim: to increase public awareness of salt intakes, salt and health, dietary sources of salt and steps to reduce salt intake.
Approach: a three-phase digital campaign that targeted primary food providers within families with primary school-aged children.
Perspectives on achieving aims Positive achievements, given limitations With the campaign, they’ve done well, given the budget and all the other factors, that was always going to make that a tough task. (Member 10: SP)
Good reach and recall within the target audience Nearly 50% of the target markets were reached with this campaign across the three years that we did an intervention, which is huge, and then of that, 82% of that are recalling one of our top key messages about that there’s processed food is high salt, that they need to be reading labels and looking for lower salt options, and eating fresh is best. So, there’s some really good positive outcomes and they were achievements against objectives. (Member 21: SP, I)
Limited impact on general population The metrics we’ve got on awareness-raising were promising and that’s great but Deakin’s research would say we’re not changing knowledge, attitudes and behaviours on a general public level but potentially with that target market of campaign we have raised awareness. (Member 11: SP, I, R)
Concerted campaign We were able to run a concerted campaign for four years around getting Victorians to reduce their salt intake - I think that was a huge achievement. (Member 9: SP, R)
Enablers to intervention delivery Utilising earnt media to increase reach Whilst all our paid advertising focused on Victoria, all of our organic social and earnt media was all national, so we reached far beyond that. (Member 21: SP, I)
Barriers to intervention delivery Limited mediums Look I think [the reach] is limited to some degree because it’s only social media… there’s no broader brush...we haven’t got a diversity of mediums. (Member 7: SP)
Weak messaging Our call to action in our consumer awareness has perhaps not been as strong as it could’ve been. (Member 7: SP)
Barriers to achieving outcomes Inability to cut-through other nutrition messages I think the target audience that we were targeting was problematic in that they’re being bombarded by all sorts of messages around what to feed their kids and how to feed their kids and how to get them exercising or how to maintain their health. So, I think there were some challenges in perhaps the target audience that we selected. (Member 9: SP, R)
Target audience did not see the relevance I think we’ve had problems with the target audience for the consumer group and I don’t know whether they were the best place to start...You can often find salt and that issue with the older age group because they see it as relevant to them and we’ve seen that through the consumer awareness that the people that were the biggest uptake are those that are older because they see the relevance. (Member 7: SP)
Short intervention timeframe All credit to the partners and the Partnership in that we were able to do this for four years but shifting consumer behaviour and changing an entire food supply is a real long-term commitment and you’re not going to see significant shifts in the space of four years. (Member 9: SP, R)
Perspectives on the fidelity of the intervention Decision to try and move the target audience along the Stages of Change At first, we sort of wanted to make them aware and say, “look there is a lot of salt in these packaged products, so we want you to be aware of that”. And then they were like “okay, maybe we are making them aware, we have done a few different campaign bursts, can we get them to consider this a bit more, consider doing something about this”. So then that was introduced, more of like potentially a swap message, and then by the time I came to it last year when I started, through discussions with the general working group and the Partnership group, it was sort of like, “look, why don’t we see if we can push people towards that behaviour change so can we actually get them to act, can we actually get them to do something about reducing their salt”. (Member 5: SP, I)
Reverted to awareness and consideration due to cost-efficiencies We decided to cut that action and acquisition part and just focus on awareness and consideration, because we knew with the budget we had, we could still retain and get good numbers and healthy traffic and cost-efficiencies in educating people at that stage (Member 5: SP, I)
Limited mediums after first campaign round The first round of the campaign, for “Unpack the Salt”, we did outdoor advertising, which performed well. We didn’t have quite as much money the second time we ran it, so it was then more just digital and online... When you change because of finances, you might lose a little bit of your impact. (Member 11: SP, I, R)
Perspectives on utility / quality of the intervention Not effective in increasing public demand What we were hoping was that the campaign originally would generate some of the community awareness and action to help elevate [salt] as a conversation, a bit like it has with family violence and is starting to happen with obesity. That hasn’t really happened and so the politicians have been able to kind of ignore it for want of another. (Member 10: SP)
Not effective at population salt reduction With the small number of people that that impacted then that was a good response, but it was a small number of people so at a population level I would say it was ineffective (Member 10: SP)
Generating Public Debate
Aim: to generate public discourse and debate around salt reduction
Approach: media releases disseminating product category reports that highlighted salt levels in processed foods throughout the intervention period.
Perspectives on achieving aims Salt in the public domain I think we’ve had salt talked about in the public domain, pretty consistently, and I think that’s a really competitive environment for nutrition, so I think that’s a pretty great achievement. (Member 11: SP, I, R)
Shaping public debate I think the research has been particularly powerful and productive. It’s been a major part of the partnership and I think the quality of the research coming out, and the way in that’s being used to try and shape public debate, has been highly effective. (Member 13: SP)
Enablers to intervention delivery Naming companies Those research reports, the way that they were designed to actually name companies and brands, meant we got great media pick-up, that meant we got great reach. (Member 11: SP, I, R)
Barriers to intervention delivery Alignment of organisational and Partnership views The Heart Foundation is, as are most organisations are now, shifting away from the nutrients focus… to a more whole-food approach. So, we certainly yes felt some tensions there… when we’re looking at food categories (Member 21: SP, I)
Some of the food categories that VicHealth and the George Institute would have liked to go out with didn’t sit well with the Heart Foundation’s philosophy, so [the Partnership] couldn’t pursue those opportunities. (Member 21: SP, I, R)
Barriers to achieving outcomes Crowded nutrition space The newspapers are full of debates about ‘clean eating,’ and caffeine will give you this and your processed fats will give you that, we used to talk about fats and now we’re talking about sugars. In that context, talking about salt it was always going to struggle to get cut through. (Member 13: SP)
Perspectives on the fidelity of the intervention Changes in the design of the intervention If we now went into designing this, we’d go in with the intention of implementation looking like it ended up... It took a while to get to that... this idea if you benchmark industry around a nutrient or around the healthiness of their products, you can leverage them for public awareness and food industry engagement and potentially government policy engagement depending on what the political landscape is. That’s a key lesson. (Member 11: SP, I, R)
Perspectives on utility/ quality of the intervention Engaging media, industry and policy makers What’s been really effective has been the product category reports, which the George Institute has done. These regular reports, which basically look at salt levels of certain foods, we use those for strategic advocacy to get media attention... it raises awareness of the public and our policy makers, but it also enables us to liaise directly with the food companies to raise their awareness... and invite them to the table, and to develop strategies to try and reduce salt ... that’s worked relatively well. (Member 2: SP, I, R)
Scalability This concept of doing these surveys on food groups and resurveying every few years and that naming and shaming of individual products, brilliant, absolutely critical and I reckon that was something that would be scaled up and a really valuable piece of work. I thought that approach was very important. (Member 8: SP)
Innovative approaches with food industry
Aim: To reduce salt levels in packaged and processed foods by supporting food manufacturers to reformulate.
Approach: Engage food industry through events and meetings, develop resources, services and grants, and produce case studies.
Perspectives on achieving aims Establishing relationships We’ve been successful in developing really strong relationships with some of Australia’s major food manufacturers (Member 6: I)
Understanding reformulation practices We set out to engage with top manufacturers and understand what’s happening within these businesses and then to showcase their practice, where it was available and try and help those who aren’t, and I think we have definitely achieved all of those things (Member 21: SP, I)
Developing supportive resources and services And we also were able to, as a result of working with [the food industry], develop a guide to support particularly the Victorian-based objectives that we originally had at the outset of the project. So that guide was something we could develop for these smaller to medium manufacturers based in Victoria and that’s been shared with them through various networks. So yes, I think we’ve definitely achieved those outcomes. (Member 21: SP, I)
Changes to the food supply How effective will activity that has kind of sped up in the last year or two be in actually getting salt levels down in the time that we’re measuring?... If you looked at it right now, I’m not sure if we could see that the food supply has already shifted. (Member 1: SP, R)
Enablers to intervention delivery Building positive relationships Your overall aim was to really support manufacturers and you wanted to provide us with the reformulation guide, you had an event that was really, really supportive of companies who were doing things well and that really helped us to get involved. (Industry 15)
Barriers to intervention delivery Uncertainty of roles and authority This is happening at Federal level and therefore what is our role and what is our authority in terms of industry engagement. So, I think it was that lack of clarity of roles, and where do we fit and what’s our authority, I think that was probably one of the barriers. (Member 2: SP, I, R)
Slow start to implementation Engaging with food industry at the start may have been a bit slow but I personally don’t have experience engaging with food industry. Other people at the table have some, but I think it’s taken a while to probably come up with the working plan of what is the best approach to engage with that target group. (Member 1: SP, R)
Perspectives on the fidelity of the intervention Changes to the plans due to new knowledge and innovation Overall the Partnership has been so open to trial and error and the level of innovation in terms of let’s try this and let’s try that. The resources that have been developed by the partnership for industry, we never envisaged that at the beginning. Who would have envisaged two years ago that we would have finished this project with a how to guide, benchmarking reports and grants? (Member 6: I)
Changes to the target audience to effect more change We changed half-way through in regards to our thinking around who we should target.... If we had been thinking at the start around how can we effect the most change and target the big ones with these food category reports and then how do we effect the most change in Victoria by providing tools and resources and contacts for small to medium, that would have been a nice round brand from the start. (Member 21: SP, I)
Perspectives on utility/ quality of the intervention ‘Reformulation Readiness’ Guide The reformulation readiness guide... I think that is a great resource that was put out... We had a lot of good feedback from different areas of our supply chain and food technologists around that guide, so just really helpful. (Industry 17)
Industry-centred events It’s probably the first time we have seen a public health organisation run an industry event and be supportive... you understand the work we are doing, and you’re willing to support it and highlight where companies are doing well (Industry 15)
Case studies Smaller businesses... they need to see what we’re doing and they need to learn from us and if they see case studies from us, that can really help them shape their nutrition strategy, so I think it’s a positive for those other industry players and also consumers to see what we’re doing and obviously government to see what we’re doing (Industry 17)
Benchmarking service The George Institute was offering those reports which could take one companies’ products and compare it to the entire category... I think that’s really valuable as well because you know, all companies are going to be interested to know what their competitors are doing. (Industry 16)
Reformulation grants The salt reduction grants, I think that’s showing really strong leadership and showing food manufacturers that there is support and there are resources available to do this. (Member 6: I)
One-to-one meetings We’ve been able to undertake over 20 one on one engagement meetings which have revealed a lot of insight and information around the drivers for reformulation and the current obstacles and issues that food manufacturers are still facing. (Member 6: I)
Advocacy and policy strengthening
Aim: to “strengthen healthy policies” to improve the food environment, including food reformulation programs and institutional nutrition policies.
Approach: Engaging government stakeholders, creating a policy position statement and influencing government initiatives.
Perspectives on achieving aims Did not achieve policy change I reckon if we’d just gone, “You know what, to make an impact in Victoria what we need to do is we need to change things nationally,” we just spent all of our time and effort just focusing on bringing the Victorian State government, regulators, power and influence to bear on Canberra and indeed on the other states, to actually change things for the whole country, maybe that would have been more successful. (Member 4: SP, R)
Whilst we might not have seen policy change, we’ve definitely continued the conversation and put support behind it. (Member 21: SP, I)
Supported already planned activities I feel like the advocacy activities probably have just added a strong supporter base around things that were in-train. (Member 11: SP, I, R)
Enablers to intervention delivery Developing a blueprint We developed the call to action document. I think was a great output and a deliverable... it’s probably the first-time organisations have got together to actually get some form of consensus, a blueprint on what we need going forward. (Member 7: SP)
Barriers to intervention delivery Lack of allocation of roles and responsibilities We developed a clear statement, which outlines what the key asks of the strategic partnership were, but then we didn’t identify peer roles or allocate specific responsibilities to the different partnership members in terms of who was going to take that forward. (Member 2: SP, I, R)
Uncertainty around ownership and leadership I think one of the challenges of the Partnership, when you’ve got multiple organisations, a lot of strengths, but then you’ve got a certain degree of who’s owning it, leading, driving it, and who’s going to make those calls and who’s going to get the credit for it. Which is unfortunately the politics working anywhere and I think that’s probably held some of the progress back in that policy advocacy space because mixed in with all that political context. (Member 10: SP)
Barriers to achieving outcomes Political climate There’s been some good work but as a whole it probably hasn’t quite had the impact at the state and federal level as we would have wanted. That’s not necessarily because of the fault of any of the partners, it’s partly because of the political conversations and agendas out where salt is and you can’t make an issue popular with politicians if they don’t want it to be and there’s not a public push. (Member 10: SP)
Perspectives on the fidelity of the intervention Shift from targeting state government to federal government Up until probably June 2018, we were advocating at a state level, and then we shifted, we thought it was more of a national, a federal issue... so we wrote a new plan (Member 21: SP, I)
At the very beginning of the project, it was very Victoria focused… but along the way the decision was made… it’s a national thing, if they’re going to make that policy, it’s going to be Federal policy. (Member 5: SP, I, R)
Perspectives on utility / quality of the intervention Joint advocacy There are lots of benefits to a partnership working together on strategic advocacy and I think we’ve utilised that quite well on some occasions, but perhaps not as well as we could throughout the whole project, and I think this is probably a challenge for these sorts of partnerships in general. (Member 2: SP, I, R)
Advocacy asks document Some people might say well that’s the statement of the obvious but to have it as a document there, to hand-out to governments and to use as and advocacy tool was a milestone. (Member 8: SP)