Ta'am Mustadam Intervention to Promote Sustainable Food Choices

BAACKGROUND \&RATIONAL:

Suboptimal diets are a major contributor to non-communicable diseases (NCDs) and premature mortality in the United Arab Emirates (UAE). NCDs-including diabetes, cancer, chronic respiratory conditions, and cardiovascular diseases-account for 77% of all deaths and 17% of premature deaths (ages 30-70) in the country. Obesity rates have doubled since 1989, reaching 31.7% among adults by 2017, reflecting an increasing burden of diet-related chronic diseases.

At the same time, the UAE faces significant environmental pressures. Water scarcity, poor soil quality, and harsh climate conditions threaten domestic food production. Rapid population growth has intensified the demand for food and water, further straining natural resources. The UAE's dependence on food imports heightens risks to food security, dietary adequacy, and environmental sustainability.

To address these interlinked issues, the UAE has launched several policy initiatives, such as the National Food Security Strategy 2051 and the UAE National Action Plan in Nutrition, aligned with regional and international frameworks. These initiatives aim to enhance health and food system resilience while supporting environmental goals.

A key proposed solution to the interlinked challenges of diet, health, and the environment is the adoption of sustainable diets. These diets aim to promote individual health while minimizing environmental impact. The EAT-Lancet Commission introduced the "planetary health diet," a mostly plant-based model that could nourish 10 billion people by 2050 without exceeding environmental limits. Reduced meat consumption is also associated with lower risks of heart disease, cancer, and premature mortality.

The limited success of existing sustainability interventions is often due to a lack of theoretical grounding. The Behaviour Change Wheel (BCW), underpinned by the COM-B model (Capability, Opportunity, Motivation - Behaviour), provides a structured framework for designing effective interventions. It incorporates 93 behavior change techniques (BCTs) and links them with policy strategies for sustainable implementation.

To evaluate such interventions, this study applies the RE-AIM framework, which examines Reach, Effectiveness, Adoption, Implementation, and Maintenance. This model offers insights into real-world feasibility and long-term impact. Unlike purely efficacy-driven studies, RE-AIM supports practical, scalable approaches to public health challenges and contributes to implementation science aimed at bridging research and practice.

OBJECTIVES:

Primary Objectives:

• To evaluate whether the intervention promotes sustainable food choices- specifically greater consumption of fruits and vegetables, plant-based foods (e.g., legumes \&nuts), and reduced intake of red and processed meats-at post-intervention and 4-week follow-up.
• To assess changes in food choice motives at post-intervention and 4-week follow-up.

Secondary Objectives:

• To examine improvements in knowledge, intentions, and practices related to sustainable diets at post-intervention and 4- week follow-up.
• To assess changes in energy and nutrient intakes at post-intervention and 4- week follow-up.
• To evaluate the intervention's real-world impact using the RE-AIM framework.

STUDY DESIGN:

This 6-week pilot intervention will use a quasi-experimental pre-post design with a 4-week follow-up, targeting 80 participants at College of Medicine and Health Sciences (CMHS). The Ta'am Mustadam intervention will be designed using BCW, will consist of three core components: 1) sending educational materials \&recipes through WhatsApp group, 2) behavioral practice through activities, and 3) regular reminders and nudges delivered through WhatsApp group. The intervention focuses on increasing the consumption of fruits, vegetables, and plant-based foods (e.g., legumes \&nuts), and reducing the consumption of red/processed meat intake.

ETHICAL CONSIDERATION:

Ethical approval for the study was obtained from the United Arab Emirates University Human Research Ethics (ERSC_2025_6704), and permissions were obtained from relevant university authorities. The study adheres to the Declaration of Helsinki. Participants will be informed about study procedures, data collection, and their right to withdraw at any time. Informed consent will be obtained before data collection. University email addresses will be used to match questionnaires across 3 time-points, with all data kept anonymous. Participants will receive discount vouchers at the end of the intervention

DATA COLLECTION:

Data will be collected at 3 time-points: pre-intervention (1-week before the start of intervention period), post-intervention (at intervention end) and follow-up (4-week after intervention end)

ASSESSMENT TOOLS:

• General information including participants' sociodemographic data, self- reported height and weight, and details on prior nutrition education or consultation with a dietitian.
• Food choice motives using a validated Food Choice questionnaire adapted to UAE population.
• Sustainable diet-related knowledge, intentions, practices, and self-reported behaviors will be assessed using tailored, validated tools.
• Dietary intake will be evaluated via a culturally adapted Food Frequency Questionnaire (FFQ).