Perceptions and Attitudes Toward Plant-Based Meat Alternatives: A Systematic Meta-Ethnography Review

Abstract Context Plant-based meat alternatives (PBMAs) can support the transition toward healthier and more sustainable dietary patterns. However, PBMA adoption remains limited despite availability and awareness of health and environmental benefits, highlighting a gap between potential and practice. Objective This review sought to synthesize evidence on perceptions and attitudes toward PBMAs across populations and to examine how sociodemographic factors shape consumer perspectives. Data sources A comprehensive search was conducted across MEDLINE, CINAHL, Web of Science, Greenfile, and Cochrane from inception to August 2025. Data extraction This systematic review was informed by meta-ethnographic principles (4 to 6), while qualitative data were synthesized using thematic synthesis. Qualitative data from eligible studies were analyzed using a thematic synthesis assisted by ATLAS.ti software and an inductive and iterative approach for coding. Quality assessment employed the Critical Appraisal Skills Programme (CASP) checklist, and confidence in findings was evaluated using the GRADE-CERQual (Confidence in Evidence from Reviews of Qualitative Research) approach. Data analysis This review included 31 studies with a total of 2425 participants (aged 9 to > 65 years) from the Asia-Pacific (n = 14), Europe (n = 14), the United States (n = 1), and the United Kingdom (n = 4). Analysis of 914 quotations identified 6 themes (12 subthemes): with moderate GRADE-CERQual confidence, including dietary options, food ethics, dietary perceptions, food openness, food preferences, and dietary drivers; high confidence for dietary alternatives and substitutes; and low confidence for animal ethics. Younger participants (aged <18 years) linked PBMAs with identity and experimentation, while middle-aged adults showed both critical evaluation and resistance. Women demonstrated greater awareness and culinary engagement; men expressed stronger reluctance tied to masculinity. High-income countries exhibited culinary narratives linked to sociocultural values, whereas low- and middle-income countries emphasized affordability and access barriers. Conclusions Acceptance of PBMAs is shaped by intersecting sociodemographic factors that reflect broader social identities, moral values, and structural inequities. Future research should adopt intersectional and gender-informed approaches while prioritizing underrepresented low- and middle-income country contexts. PROSPERO registration CRD420251114306