General practitioners' willingness and perceived barriers and facilitators to 'prescribing' potassium-enriched salt in China: an explanatory sequential mixed methods study.

Introduction: Replacing regular salt with potassium-enriched salt has been identified as a promising strategy to reduce blood pressure and prevent cardiovascular diseases. However, its implementation in clinical practice remains limited. To address this implementation gap, this study aimed to examine general practitioners' (GPs) self-reported awareness, perceptions, personal use and willingness to 'prescribe' potassium-enriched salt and to identify perceived barriers and facilitators to its future implementation in routine primary care. Methods: This explanatory sequential mixed methods study combined a cross-sectional survey of GPs across mainland China with semi-structured qualitative interviews with GPs and patients. Key results: A total of 7134 survey responses were received, of which 7116 were included in the quantitative analysis after 18 internally inconsistent responses were excluded. The qualitative phase included 51 participants (19 GPs and 32 patients). Among the 7116 GPs included in the quantitative analysis, 82.6% reported having heard of potassium-enriched salt, 48.6% reported currently using it, 78.7% perceived it to be safe and 79.5% expressed willingness to 'prescribe' it. Among those unwilling to 'prescribe' it (n=1456), the most frequently reported reason was perceived low patient awareness (44.7%). Qualitative findings indicated that willingness was influenced by uncertainty about appropriate use, concerns about potential safety risks, the lack of clinical guidelines and perceived gaps in understanding of long-term benefits and risks. Consumer adoption was influenced by taste preferences, cost and limited awareness of potential health benefits. Strong GP-patient trust emerged as a key facilitator. Conclusions: This study highlights the potential role of GPs in recommending potassium-enriched salt. Future implementation will require addressing gaps in awareness and understanding, providing formal training and developing standardised guidelines to support safer and more consistent implementation in routine primary care.