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Using the socio-ecological model (SEM), we qualitatively examine stakeholder perspectives to gain a comprehensive understanding of the influences contributing to these unhealthy consumption patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and methods<\/jats:title>\n                    <jats:p>A qualitative study was conducted using semi-structured interviews. Transcripts were analysed thematically, with identified drivers mapped onto the corresponding levels of influence within the SEM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>The study included 21 purposively sampled stakeholders from government and academic institutions in Ghana, including policymakers, practitioners and researchers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Drivers of excessive salt and alcohol consumption were identified across all five levels of the SEM. At the intrapersonal level, disregard for health risks was a key factor. Community-level drivers included easy access to unhealthy foods and cultural norms promoting alcohol use at social events and salt in traditional dishes. At the societal and policy levels, inadequate regulation of the alcohol and food industries was found to reinforce lower-level drivers, further encouraging unhealthy consumption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study highlights the multilevel influences on alcohol and salt consumption, emphasising the interactions across SEM levels. It highlights that addressing unhealthy consumption is not solely a matter of personal responsibility, demonstrating that societal and policy factors play a significant role in shaping health and dietary behaviours. The findings underscore the need for comprehensive public health strategies that address influences at multiple levels to effectively reduce excessive alcohol and salt intake.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-100490","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T08:56:24Z","timestamp":1761209784000},"page":"e100490","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Application of the socio-ecological model to understand the drivers of excessive alcohol and salt consumption: a qualitative study in Ghana"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7664-8458","authenticated-orcid":false,"given":"Joseph Prince","family":"Mensah","sequence":"first","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Akparibo","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8704-3262","authenticated-orcid":false,"given":"Chloe","family":"Thomas","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richmond","family":"Aryeetey","sequence":"additional","affiliation":[{"name":"School of Public Health, University of Ghana, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1025-312X","authenticated-orcid":false,"given":"Alan","family":"Brennan","sequence":"additional","affiliation":[{"name":"School of Medicine and Population Health, The University of Sheffield, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,23]]},"reference":[{"key":"2025120415085443000_15.10.e100490.1","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1080\/14779072.2021.1850266","article-title":"The role of dietary salt and alcohol use reduction in the management of hypertension","volume":"19","author":"Wake","year":"2021","journal-title":"Expert Rev Cardiovasc Ther"},{"key":"2025120415085443000_15.10.e100490.2","doi-asserted-by":"crossref","DOI":"10.1186\/s13011-016-0081-2","article-title":"A narrative review of alcohol consumption as a risk factor for global burden of disease","volume":"11","author":"Rehm","year":"2016","journal-title":"Subst Abuse Treat Prev Policy"},{"key":"2025120415085443000_15.10.e100490.3","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1038\/kisup.2013.65","article-title":"Cardiovascular and other effects of salt consumption","volume":"3","author":"Cappuccio","year":"2013","journal-title":"Kidney Int Suppl (2011)"},{"key":"2025120415085443000_15.10.e100490.4","unstructured":"WHO . 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