PROJECT ABSTRACT
The Nigerian Agency for Food and Drug Administration and Control (NAFDAC) is leading implementation
and scale-up of a national sodium reduction program with other national, state, and international agencies
using the WHO’s “Best Buy” SHAKE package (Surveillance of salt intake, Harness industry, Adopt standards
for labelling and marketing, Knowledge to empower consumers, and Environments to promote healthy eating).
SHAKE provides evidence-based recommendations for population-wide sodium reduction interventions for
hypertension prevention and control. Our research will support and embed in this program’s implementation
and scale-up for late-stage implementation research for hypertension prevention and control by evaluating the
extent to which the program is implemented using a type III hybrid, mixed methods study design through
repeated: 1) stakeholder interviews, 2) populations surveys, and 3) retail surveys. We will use
implementation research methods during adaptation, planning, and initial implementation for baseline (Years 1-
2, UG3 phase) and of follow-up (Years 3-4 and Years 5-6, UH3 phase) assessments. A much-needed dietary
sources of sodium study will also be performed at baseline and Years 5-6 follow-up to target/track sodium
reduction efforts according to local context and culture. The retails surveys over the study period will capture
novel data on packaged, unpackaged, and informal restaurant/hawker food through the international
FoodSwitch program, which combines a consumer facing tool with crowdsourcing to better define Nigeria’s
food supply. We will use the Exploration, Preparation, Implementation and Sustainment (EPIS) framework
throughout both phases. The formative research period will include Exploration and Preparation, when we will
perform quantitative and qualitative measures of key process indicators, relevant contextual factors informed
by CFIR, and relevant Proctor implementation outcomes, acceptability, feasibility and appropriateness. As
implementation is started, we will use the Reach, Effectiveness, Adoption, Implementation and Maintenance
(RE-AIM) framework, including implementation outcomes (feasibility, fidelity, adoption, acceptability, and cost)
and contextual factors associated with the Implementation and Sustainment phases. We will disseminate our
finding via mass media advocacy campaigns and will extend our existing implementation research training
program to stakeholders for knowledge translation through evidence-informed policymaking to optimize
sustainability. We will host multisectoral stakeholder meetings to facilitate cross-sectoral collaboration,
dissemination, and multi-level policy coherence among sectors include food, health, trade, and law, among
others. The proposal builds on the team’s existing NHLBI-funded large-scale hypertension control program
with team members from University of Abuja, Northwestern University, and The George Institute for Global
Health, the latter which is performing a parallel, GACD-funded assessment in China with similar methods.