SALSA (Health, Nutrition and Sociability): Community networks for healthy eating, autonomy, and social interaction: Study protocol for a clinical randomized trial

Loneliness is a highly relevant social determinant of health associated with depression, anxiety, reduced quality of life, malnutrition, cognitive decline, and increased morbidity and mortality. Social prescribing initiatives that connect individuals with community-based activities show potential to improve emotional and social wellbeing, although evidence, particularly regarding shared-meal programs, remains limited and inconsistent. This study aims to evaluate a community-based intervention consisting of group meals in restaurants, complemented by monthly healthy eating workshops, to improve emotional, nutritional, and social outcomes among adults experiencing loneliness and symptoms of anxiety and/or depression. We hypothesize that participation in restaurant-based group meals will significantly enhance emotional wellbeing, social support, and diet quality compared with usual care. A randomized controlled trial will be conducted with 2 groups, intervention and control, and a total of 98 participants aged ≥18 years who report loneliness and mild-to-moderate anxiety and/or depression. The intervention group will attend group lunches twice weekly for 4 months in local restaurants, accompanied by a facilitator and supported by monthly healthy eating workshops. The control group will receive usual care. Data collected will include sociodemographic, clinical, and emotional variables (BDI-II, GAD-7), social support (DUKE-UNC-11), quality of life (EQ-5D), adherence to the Mediterranean diet, and healthcare resource use. Analyses will compare pre-post and between-group changes, with logistic regression used to identify predictors of clinical remission. This innovative intervention leverages existing community infrastructure, namely restaurants, as spaces for social and nutritional support, strengthening local networks while promoting equity and sustainability. It may enhance emotional wellbeing, diet quality, and social connectedness and potentially reduce healthcare utilization. Implementation challenges include adherence, restaurant adaptation, financial sustainability, and interinstitutional coordination. The SALSA (Health, Nutrition and Sociability) trial will provide rigorous evidence on the effectiveness of a social prescribing model based on shared meals. Its results could inform scalable and sustainable strategies to reduce loneliness, improve wellbeing, and promote healthier, more connected communities.