Mobilising Young Singaporeans for Household Sodium Reduction: A Digital Mixed-Methods Pilot Study

Year Submitted: 2025
Published Date: 05 January 2026

Tags: Applied/Translational Research, Mixed-Methods, Chronic Care, Self Care, Social Care, Population Health, Preventive Care, Community Health, Health Promotion, Patient Education, Public Awareness, Digital Health, Mobile Health, Caregiver, Community Engagement

About this Content

Aims

Pilot-test a sodium-reduction education intervention for young adults aimed at 1) reducing their sodium intake, and 2) empowering them to reduce their family members sodium intake.

Background

High sodium intake is a major contributor to hypertension and cardiovascular disease globally and in Singapore, where dietary salt consumption remains well above recommended levels. Traditional population-level salt reduction strategies have had limited success, in part because dietary practices are socially embedded and shaped within households. Family members play a central role in influencing food choices, yet are rarely positioned as active agents of change in prevention efforts. Young adults in multigenerational households may be particularly well suited to lead household dietary change given their digital fluency, openness to behavior change, and regular interaction with family decision-makers. This study builds on these insights to pilot a family-led, digitally delivered sodium reduction intervention in Singapore.

Methods

Design & Participants: Pre-post, single- group pilot with 35 young adults (21-35 y) and 79 family members in Singapore. Intervention: The Supporting Household heAlth through familY-led Promotion (SHAYP) program consisted of a 2-week online course (nine short video lessons, interactive assignments, tailored WhatsApp feedback) followed by a 4-week action plan phase, where young adults implemented personal and family-oriented sodium-reduction goals within their households. Development: SHAYP was co-created using a standardized 21-item co-creation checklist (Leask et al., 2019) by young adults and academic experts in nutrition and family dynamics. It was theory-driven, guided by the Theory of Planned Behavior and Family Systems Theory to ensure cultural and household relevance. Data collection: Pre/post surveys (knowledge, behaviors, TPB constructs), weekly reflections, course engagement metrics, and a photovoice component where young adults and family members reflected on experiences and household change dynamics. Analysis: Mixed-methods approach combining quantitative analyses (descriptive, paired t-tests, multivariable linear mixed models) with qualitative thematic analysis of photovoice narratives.

Results

Participant Demographics: 114 participants (35 young adults, 79 family members incl. parents, siblings, grandparents, aunts/uncles, cousins, partners). Young adults: mean age 24.7 y, 45% female, 9% with NCDs. Family members: mean age 41.2 y, 73% female, 36% with NCDs. Photovoice: 11 households (22 participants; 45% of YAs, 73% of FMs female). Engagement & Feasibility: Young adults completed the course in ~7.7 days; most goals targeted eating out, with high action plan completion and satisfaction. Post-Intervention Changes: Sodium knowledge (+1.15) and behaviors (+1.23) improved significantly, with young adults showing the largest gains. Perceived behavioral control (PBC) improved most (+2.07 overall; +2.64 YA vs. +1.82 FM). Subjective norms and behavioral intentions also increased, while attitudes showed no significant change. Strategies (Photovoice): Young adults promoted sodium reduction through light-touch nudges (mealtime conversations, verbal encouragement, portion control, and purchasing low-sodium products) tailored to elders, siblings, or partners. Barriers & Sustainability (Photovoice): Change was constrained by taste preferences, skepticism of substitutes, cultural traditions, and elders authority . Flexible, low- burden nudges embedded in daily routines proved most sustainable.

Conclusion

This pilot suggests young adults may serve as promising family health ambassadors for sodium reduction, using light-touch strategies within households. Next steps are to scale up and assess effectiveness via a controlled trial, tailor content for hypertension management, target healthcare and social systems for delivery, and leverage digital innovations (e.g., AI) to support implementation.

Lessons Learnt

Household sodium reduction is most likely to stick when it is designed as a low-burden, digitally supported, family-led process, where one motivated young adult can translate skills into everyday household routines through goal-setting plus light-touch follow-up (WhatsApp/Zoom). Change appears to be driven most by building perceived control and practical skills, alongside gains in knowledge and behaviors, rather than relying on large attitude shifts. Interventions should prioritize eating out and grocery decisions as high-leverage, flexible contexts where young adults can participate directly, while recognizing that cooking-related change can be constrained by time and by family hierarchies and respect for elders culinary authority. Finally, feasibility depends on the environment: clear labeling and vendor willingness to accommodate customization can enable strategies, while their absence limits what families can implement when dining out.

Additional Information

Funding: NUS SSHSPH Seed Fund for Ground-up Research 2023.

Keywords

sodium reduction, young adults, family-led intervention, digital health, hypertension prevention

Innovators' Details

Connect with this contributor!

Shahmir Hassan Ali - sali@nus.edu.sg

Project Attachment

shayp_isbnpa_slides_v3.pdf