Studies on dietary sodium knowledge, attitudes and behaviours in the Americas: a scoping review.

Objective: To characterise the literature on dietary sodium knowledge, attitudes and behaviours (KAB) among adults in the Americas. Design: A scoping review conducted between September 2023 and August 2024, with an updated search in March 2025. Data sources: Ovid MEDLINE, Ovid EMBASE, Web of Science Core Collection, ProQuest Dissertation & Theses Global, Latin American and Caribbean Health Sciences Literature, Scientific Electronic Library Online, and other grey literature sources. Inclusion criteria: Studies with adults (≥ 18 years) residing in the Americas that assessed sodium-KAB were included. Screening and data extraction: Two reviewers independently screened titles, abstracts and full texts. Data charting was conducted by one polyglot reviewer and validated by another. Results: Thirty-two studies were included, mostly from North America (n=17; USA=11), followed by South America (n=13; Argentina and Chile=4) and Central America and the Caribbean (n=7; Costa Rica=5). Only one US study monitored sodium KAB over time, and three assessed differences by intake level. Most used quantitative methods (n=26), convenience samples (n=22), and had predominantly female participants (n=20). Rural populations were interviewed in only two studies, and just one used questions that underwent content validity testing with published results. Knowledge assessments focused on health outcomes (72%), food sources (47%) and intake recommendations (44%). Attitudes centred on concern about intake (53%), perceived intake (41%) and intention to change (28%). Behaviours commonly assessed included actions to reduce intake (72%), use of added salt (53%) and food practices (50%). Conclusions: Significant gaps exist in dietary sodium KAB monitoring across the Americas, particularly in lower-income countries with several under-represented populations. Future research should prioritise equity-focused surveillance using validated tools and behaviour change theories and frameworks to generate actionable data to advance public health policies and WHO sodium reduction targets.