A multi-country mixed-methods protocol to assess and improve sugar-sweetened beverage packaging and labelling policies in South Asia

Abstract Background Sugar-sweetened beverages (SSBs) are a major dietary risk factor contributing to the rising burden of non-communicable diseases (NCDs) globally, including in South Asia. Although several countries in the region have introduced fiscal and regulatory measures, implementation remains fragmented, with limited evidence on policy effectiveness, regulatory compliance, and consumer response. This study aims to address these gaps by generating integrated, context-specific evidence on SSB packaging and labelling systems. Methods We will adopt a multiphase sequential mixed-methods design involving five South Asian countries: three implementation countries (Bangladesh, Nepal and Pakistan) and two knowledge-partner countries (India and Sri Lanka). The study comprises three interlinked phases. First, a policy landscape analysis (Work Package 1; WP1) will systematically assess national nutrient profiling and labelling regulations against international standards to identify policy gaps. Second, empirical assessment (WP2) will include a cross-sectional audit of SSB packaging using unique pack sampling and consumer surveys following country-specific sampling designs, including household-based surveys in Bangladesh and Nepal and a school-based adolescent survey in Pakistan. Packaging data will be analysed using two composite measures: a Compliance Index and an SSB Packaging Risk Score. Third, stakeholder engagement and co-creation (WP3), guided by the Consolidated Framework for Implementation Research (CFIR), will be used to develop contextually appropriate front-of-pack nutrition labelling strategies. Findings will be integrated using a Theory of Change framework. Expected outcomes The study will generate a comparative policy gap matrix, country-level evidence on packaging compliance and consumer behaviour, and co-designed labelling prototypes. These outputs are expected to strengthen the regional evidence base, support policy dialogue, and enhance readiness for effective nutrient profiling and labelling reforms. Conclusions By integrating regulatory, market, and behavioural perspectives, this study provides a comprehensive framework to inform SSB labelling policies in South Asia. The approach offers a contextually grounded and scalable model for improving food environments and reducing diet-related NCDs in low- and middle-income countries.