Photo-enhanced messaging to address dietary sugars as a common risk factor for chronic disease

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Dental caries is highly prevalent among people from underserved population groups and added sugar consumption is one of the most prominent and consistent risk factors for this disease. Interventions to modify behavior and minimize sugar intake among those most affected by dental caries are challenging and, to date, attempts to develop effective interventions have been largely unsuccessful. This may be due in part to the lack of theoretically-based messaging that is tailored to population-specific barriers and facilitators. We propose to use theoretically-based innovative strategies to develop messages that are tailored to the barriers and facilitators of our underserved study population – residents of public housing. We will draw upon Social Cognitive Theory which highlights interplay among individuals, their behavior, and their environment, in order to ensure that messages we develop are theoretically grounded. PhotoVoice uses photographs taken by participants to capture the social and environmental conditions in settings not typically available to researchers (e.g., homes). It allows for an in-depth examination of behavioral barriers and facilitators. Messages designed using PhotoVoice are particularly well adapted to documenting multiple influences across community, consumer, and organizational nutrition environments (e.g., store shelves, neighborhood parties, etc.). Our scientific premise is that by tailoring messages to population-specific barriers, it will increase attention given to the message, improve efforts to process the message, result in fewer counterarguments and increase the perceived credibility of the message. Our goal is to develop intervention-ready messages and delivery protocols for use in new areas of intervention science, such as social networks. Our Specific Aims are: (1) Using PhotoVoice and focus group methodology, to identify the environmental-level and individual-level barriers and facilitators to reducing consumption of sugar-sweetened beverages and foods among adult residents of Boston public housing (n=40); (2) Using the information gained in Aim 1, to develop photo-enhanced theory-based health promotion messages that target reduction of dietary sugar in a public housing population (n=60); (3) Assess the acceptability of the developed messages and message delivery preferences across three different delivery channels – SMS/App-based text, social media, print media – in a population of adult public housing residents (n=100). Public housing residents represent a high impact, high-reward population for interventions addressing health disparities as they are particularly disadvantaged by the high-density spatial clustering of poverty and poor health and by the associated stigma that burdens them more than many other disadvantaged communities. Effective tailoring of interventions that target the urban poor require innovative techniques to achieve the goals of behavior change, risk reduction and improved oral health outcomes.