Date of Award
5-10-2026
Date Published
June 2026
Degree Type
Thesis
Degree Name
Master of Science (MS)
Department
Nutrition Science and Dietetics
Advisor(s)
Maryam Yuhas
Second Advisor
Katie Kidwell
Keywords
caregivers;consumption;parents;preschoolers;sugar;text message
Subject Categories
Life Sciences | Nutrition
Abstract
Abstract Introduction: As early childhood represents a crucial window for establishing lifelong dietary patterns, excessive intake of sugary foods and beverages during this period may result in long-term adverse health outcomes. Intake levels continue to exceed recommended guidelines, and disparities within and across race and low-income population groups persist. Given these disparities, targeted interventions developed to consider the unique needs, preferences, and cultural differences in diverse population groups are essential to enhance health and well-being. The purpose of this research was to develop the content of the "SweetTexts", a text-message-based intervention to reduce the intake of free sugar among preschool-aged children from low-income families in Syracuse. Objectives: The study specifically assessed message comprehension and cultural fit, engagement metrics, and the perceived impact on caregivers’ behaviors. Additionally, strategies for effectively engaging communities in intervention development to ensure relevance and feasibility were examined in this study. Approach: An iterative participatory approach was used to develop the content of the SweetTexts messages. In the first iteration, an expert group (child nutrition, health communication and implementation science, parenting interventions) worked together, and reviewed Theory of Planned Behavior (TPB) mapped messages for relevance, clarity, and theoretical alignment; items were revised for reading level, behavioral specificity, and tone. 18 Caregivers participated in focus groups guided by the Self-Determination Theory; data underwent rapid matrix and reflective thematic analysis to inform cultural/linguistic tailoring, barriers and enablers, and cadence. Results: Caregivers identified key barriers (busy schedules, picky eating, cost, difficulty setting limits, feeling judged, grandparent influence) and enablers (school support, buying in bulk, portion reduction). Message perceptions emphasized practicality, non-judgmental tone, and autonomy support, with cautions about repetition; preferred cadence was ~2 texts/week during eating occasions. Requested enhancements included context-specific swaps (birthdays, school snacks, family involvement), lower-cost examples, and light multimedia (short videos/audio). Findings directly informed micro-tailoring rules linking intake patterns to message sequencing and personalized strategy selections (e.g., caregiver report of increased consumption prompts personalized feedback, followed by selection of strategy tailored to barrier), message edits, and culturally responsive examples. Conclusion: The findings of this study provide compelling evidence that the “SweetTexts” intervention is perceived as educational, culturally resonant, and motivating by caregivers of preschool-aged children from low-income families enrolled in Head Start. The immediate next step for this research is a 4-week usability pilot trial, in which a subset of focus group participants will engage with the refined “SweetTexts” content and provide structured feedback on its usability, accessibility, and perceived impact.
Access
Open Access
Recommended Citation
Addo, Bervelyn Asantewaah, "Co-Designing SweetTexts: An Intake-Driven SMS Intervention to Reduce Free-Sugar Consumption in Preschoolers" (2026). Theses - ALL. 1004.
https://surface.syr.edu/thesis/1004
