Understanding foodscapes for sustainable diets in rural localities in Tunisia: Integrating multiple methods and tools in a mixed-methods design.

Background Understanding foodscapes is essential for developing effective interventions to support nutritional health. However, resource limitations often hinder comprehensive foodscape assessments linked to dietary outcomes. This study aimed to examine the foodscapes in the context of sustainable diets within a food systems framework in rural farming communities in Tunisia.Methods A mixed-methods approach using the following tools and methods, was employed in a sample of four rural communities in Tunisia to explore food beliefs and dietary influencers: market observation combined with a food costing survey, a household survey including dietary data collection using Diet Quality Questionnaire, distance from market, meal decision influencers, anthropometric and demographics data, and focus group discussions.Results The participants' (n = 692) dietary quality and BMI were significantly associated with gender, age, distance from fresh markets, and education. Food price was significantly positively associated with dietary diversity and with both health-protective and health-risking food groups' consumption. Focus group discussions revealed religion and culture's embeddedness in food beliefs and behaviors. Participants placed animal-sourced foods and grain-based products among the top highly praised foods for health, with significantly more men than women believing meat was necessary for good health. Few respondents considered legumes as meat-alternatives.Conclusion This foodscapes study presented the application of farming household survey, food market and costing, and restaurant observation data, and focus group discussion in a convergent parallel mixed methods design to efficiently assess foodscapes in rural Tunisia. The tools enabled the identification of eco-socio-cultural factors that can guide the designing of interventions for sustainable diets.