A mixed-methods study of food environment and consumer perception in Catalonia

The rise of ultra-processed foods has led to unhealthy food environments in Southern Europe, including Catalonia, where Mediterranean diets are being replaced by Western eating habits. This shift is contributing to obesity and diet-related diseases. While food policies often focus on consumer choices, they overlook broader environmental factors. The aim of this study was to investigate the food environment and consumer perceptions and how these influence dietary choices. This study used a mixed-methods design to examine food environment perceptions among adults aged 40 and over in Catalonia, Spain. Quantitative data were collected using the modified NEMS-P-MED survey, which assessed perceptions of the food environment and sustainability. Qualitative data were gathered through Photovoice and focus groups, allowing participants to share their experiences. Statistical analyses were performed using descriptive methods, and qualitative data were analysed using content analysis. Participants generally perceived their environment as supportive of healthy eating, with easy access to fresh fruits and vegetables. While food shopping focused on quality and variety, sustainability and cost were also considered. Convenience often outweighed health considerations, especially when eating out. Healthy food availability in stores and restaurants was positively viewed, but convenience frequently influenced decisions. Despite the availability of healthy foods, a gap remains between actual eating habits and dietary guidelines, driven by cost and taste preferences. Food choices are shaped by factors such as health, affordability, culture, and sustainability. Interventions should focus on improving the affordability and accessibility of healthy foods, but structural changes and multi-sector collaboration are essential to promote sustainable diets.