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Colorado's Text2LiveHealthy - Culturally Responsive Programming

| Colorado

Oct 24, 2023

Text2LiveHealthy is a nutrition and physical activity text message outreach program funded by USDA, SNAP-Ed. The focus of the program is to provide nutrition and physical activity education to SNAP eligible communities. Those who are signed up receive recurring text messages with recipes, tips, and resources to help eat more fruits and vegetables, drink fewer sugar-sweetened beverages, and be more physically active. Subscribers also receive messages that connect them to local community events and resources.  


Refugee communities have a higher rate of chronic disease than other immigrant groups and individuals born in the United States (Kumar et. al, 2021, Wang et al., 2016). After resettlement, refugees face a variety of economic and environmental challenges that make it difficult for them to eat enough fruits and vegetables and get enough physical activity. Few programs have been designed to address the unique needs of refugee communities to support positive health behavior change. 

Example of a text message on phone: T2LH: Give yourself the confidence to drink more water and fewer sugary drinks. Challenge: This week replace your favorite sugary drink with water. Don't forget you can add fruit to your water to improve the flavor. 2nd image: mother and daughter read text message on their phone.


The Text2LiveHealthy program was originally implemented as part of the Rocky Mountain Prevention Research Center’s (RMPRC) School Wellness Program at the Colorado School of Public Health. The program supports parents in making healthy dietary and physical activity choices for their families. Parents at participating schools can enroll to receive 2-3 messages per week in English or Spanish. Messages complement nutrition and physical activity lessons being delivered at school. 

To better serve the needs of the refugee community in Colorado, a partnership was formed with a local non-profit organization iNOW (integration: Navigation, Outreach, and Wealth-Building). Together, iNOW and RMPRC adapted the Text2LiveHealthy program to a standalone intervention for adult, English-speaking refugees in Colorado. Refugee community navigators, representing seven of the largest refugee groups in the Denver metro area, were involved in reviewing and adapting the program. Messages and resources were modified to address dietary restrictions, cultural preferences and traditions, English language skills, and to be more broadly applicable for adults. Community navigators then recruited eligible individuals within their communities. 

example of how messages were adapted: Target Audience: removed family and video associated wording; Media Preferences: incorporated emojis and short, clear videos; Cultural Factors: provided indoor exercise options for those uncomfortable or unable to exercise outside the home

Sustaining Success  

Since the program was launched in the summer of 2021, about 425 refugees from 7 different communities joined the program with only 10% of individuals opting out. Text message evaluation questions sent out as part of the program revealed that most respondents reported that they ate more fruits and vegetables (82.8 %), drank fewer sugary drinks (81.3 %), and were more physically active (100 %) because of the program.  Additional interviews conducted with program subscribers demonstrated how the program had provided subscribers with the tools they needed to make healthier choices: 

“When I substituted [sodas] with fruit water it was a little more helpful… it tastes way better than regular water so that helps me drink a lot more water than I used to drink and cut back on caffeine drinks.” – Sudanese Subscriber 

“[Text2LiveHealthy is] a reminder to eat more fruits and veggies so it really helps me personally because I'm like, oh, yeah, I need more vitamins in my body. That's like the best source.” – Burmese Subscriber 

“We just totally stopped … shopping [for] some sugary drinks. And my son used to drink a lot of soda, but I just make him to drink lots of water instead of soda…” – Nepali Subscriber 

“Before I used to just eat whatever was in front of me like I would eat a lot, but now not as much as before.” – Sudanese subscriber 

“[the messages] helped me a lot because they tell me exactly why I have to give my kid…I have to give my kid a lot of water and have to give to him the fruit and vegetable.” – Nepali Subscriber

Text2LiveHealthy and refugee community navigators are currently working to further adapt the program based on insights from these interviews. Over the next year, Text2LiveHealthy plans to work with local communities to investigate translating the program to allow refugees with limited English proficiency to participate in the program. 

Rocky Mountain Prevention Research Center Colorado School of Public Health Text2LiveHealthy fun tips to keep your family healthy and images of Refugee community navigators who helped to adapt the Test2LiveHealthy program