Table 6 Qualitative findings and analysis

Feedback on the campaign and app

Sugar cubes were an appropriate quantitative measure for target audience.

“Yes, even though [children] actually don’t know how much is in a cube, but some of the things in cans in the shops they have like 36 cubes and she goes, “36!” and then it’s really worked wonders for us.” (Parent1)

The app was useful, fun and hands on for children to use.

“This app is a really good idea because the younger generation are all obsessed with all these iPads and smartphones, so I guess that’s a good way for them to get a bit of new knowledge in their head” (Parent2)

Campaign messages and impact on sugars intake

Parents engaged with the message to limit amount of sugars.

“Look at what you’re eating. Look at how much added sugar is in the food that you’re buying and replace it with lower sugar” (Parent3)

The app helped parents make purchasing decisions when shopping.

“I knew that fruit juices were high in their own sugars, but for him to see the amount of sugar in the carton of fruit juice, it made him go, “Oh, actually, yes”.” (Parent3)

The app prompted family discussions around food.

“It helped springboard the conversation with them, and it helped as well to get the core message home about healthier eating and about managing sugar in your diet” (Parent4)

“They were quite interested in going round the house to scan the foods, to see all the different sugars in the juices that they ask for and things like that that we always say, “There’s too much sugar.” They didn’t understand, so by seeing it on there it was quite interesting for them to see.” (Parent12)

The campaign instigated dietary changes through reducing portion size, changes to purchasing habits or substitution with healthier options.

“The Sugar Smart App, that’s helped a lot, because my daughter likes cereal bars, but she’s gone off them now because of that App” (Parent1)

“we found out about the [Brandname] yoghurt thing, because we picked that up and put that in the trolley and when it was scanned, it was like, “Yes, that can go back.” …. Yes, we didn’t even buy it in the end.” (Parent5)

“There was the chocolate milk that had quite a lot of sugar in it. You’d go, “Okay, well, I thought it wouldn’t have been that good anyway because it’s chocolate milk but, okay, we’ll still buy it occasionally. Then, we’ll make sure that instead of you finishing the bottle, we’ll just put it in the glass and you have this much.” It’s about limiting and about being portion control aware” (Parent3)

“The desserts have changed; actually, they have, yes. Whereas they used to go and want cake and custard all the time, then they do like fruit, so they tend to have more fruit for dessert and puddings, so that’s changed” (Parent6)

The campaign raised children’s awareness and dietary changes were made.

“[My daughter] will sometimes say to me, ‘I’d best not have that; I’ve had too much sugar today already.’” (Parent7)

“When he was eating his chocolate, he asked me, “How many sugar cubes in this chocolate?” (Parent2)

Some parents were critical of substitution with sweeteners.

“That was one thing about the campaign, it does say that you can have sugar free drinks. I’m not sure that that’s necessarily right […] letting them develop a taste for something very sweet is not the way.” (Parent8)

Reported barriers to reducing sugar intake

Parents criticised schools for promoting a ‘pudding culture’.

“It seems silly. They should just offer a piece of fruit or nothing. I don’t know why there’s this thing about having pudding is still there, really […] it’s bizarre. It’s a very old fashioned kind of thing” (Parent8)

“I am quite sure they are offered cake in school now. It is apple crumble and custard. This idea that you have to have a sweet thing after your dinner, it is like you have to have something.” (Parent9)

Parents described the existence of a ‘treat culture’: sugars-rich treats are easily available and are used to ‘bribe’ children to eat.

“If we go to a shop they think they can just have a treat. Every time we are at a shop they are like, “Mum can we have a treat?”” (Parent9)

“As a parent it’s really easy to end up giving in to your kids, to reward your kids or pacify them with treats” (Parent7)

Misleading food marketing: Parents commented on misleading food marketing; in particular, dried fruit based snacks (also milkshakes, chocolate spreads, cereals, pasta sauces, cheese sticks, cordials and cereal bars).

“Even those [snack bars] are really bad, because they’re just processed, and they just stick to your teeth like [sweet candies] which is the other problem, obviously, the tooth decay. So, even those, even though they count as one of your five a day and they’re marketed as healthy, they count as a sweet in our house …” (Parent10)

“I had a habit of just buying those [processed fruit product], the presumption was, it’s only natural ingredients, it’s fruit-based, it’s fine, but then you scan it with the app and you think, “Wow, it’s got that much sugar in there,” (Parent11)

Parent’s busy lifestyle led to leniency with regard permitting sugar-rich treats.

“You get tired and sometimes you go, “oh, just eat it then” (Parent8)

Parents expressed a reticence to deny children sugar-rich treats.

“I like to think that we give the children a balanced diet anyway, so I think, especially with young children, you can’t get away from sugar, they absolutely love it, but who doesn’t? It’s just about having things in moderation, at least that’s what I’m trying to do” (Parent4)

Parents struggled with pressure from peers.

It’s very hard when you’ve got friends of the family or friends of the children who go, “[name] is allowed a bottle of Coke at school,” or, “[name] takes a bottle of Coke.” … It’s hard to compare to other people”. (Parent12)

Parents exhibited unrealistic optimism regarding the relevance of the campaign to their child.

“I haven’t made any changes, because I think, overall, our diet is pretty good” (Parent13)

“she’s a very active child so I haven’t necessarily got any concerns over her diet” (Parent14)

Confusion which sugars to avoid and how to explain to their child the distinction between these sugars and those that are not considered bad for health (i.e. those sugars naturally present in whole fruits and vegetables and milk).

“We scanned one of the Greek plain yoghurts and the machine said it had no added sugar, but, actually, on the label of that can, it said it had sugar.” (Parent2)

“[The children] thought because they couldn’t have sugar, they couldn’t have fruit and it was saying that sugar was bad, so we had to sort of explain that it’s not all bad; it’s just different types.” (Parent6)

“I used to do Weight Watchers so I’m savvy enough to know what vegetables have a higher concentration of sugar and to limit those and to have a mixture of vegetables … only have one piece of fruit a day and to have the other four vegetables to keep sugar down. So yes, that’s it” (Parent15)