Development and Evaluation of a Community Meat-Reduction Meal Plan Program

Thesis Abstract

The food system in many communities is characterized by high animal-sourced-diet exposure, with associated environmental, health, and economic implications, prompting a need for scalable dietary interventions that reduce meat consumption without compromising nutrient adequacy. This study aims to develop, implement, and evaluate a community-based meat-reduction meal plan program designed to improve dietary quality, reduce meat intake, and assess feasibility and acceptability for long-term adoption. Specific objectives are to (1) determine baseline meat consumption patterns and nutrient adequacy among adults aged 18–65 in the target community; (2) co-create a culturally appropriate 12-week meat-reduction meal plan aligned with local food resources and dietary guidelines; (3) implement a randomized controlled pilot comparing the meal plan to usual dietary practices, assessing changes in total meat intake, dietary quality (Healthy Eating Index-2015), and micronutrient status; (4) evaluate behavioral determinants—knowledge, attitudes, perceived barriers, and self-efficacy—using the Theory of Planned Behavior and the Health Belief Model; (5) examine viability, acceptability, and scalability through process evaluation and cost analysis; and (6) generate policy-relevant recommendations for community nutrition programs. The study adopts a mixed-methods, parallel convergent design underpinned by the Social Ecological Model and the Theory of Planned Behavior. A multi-stage sampling frame will recruit 320 adults across four neighborhoods, with 160 randomized to the intervention arm and 160 to control, ensuring adequate power to detect a minimum 15% reduction in weekly meat servings and a 3-point improvement in Healthy Eating Index scores (? = 0.05, power = 0. Eighty participants will complete qualitative interviews at baseline, mid-intervention, and post-intervention to elucidate contextual factors and acceptability. Data collection instruments include 3-day dietary recalls administered by trained dietitians, validated food frequency questionnaires focused on meat subtypes, nutrient biomarker panels (serum ferritin, 25-hydroxyvitamin D, and ferritin for iron status), a process-tracking checklist, and structured questionnaires assessing TPB constructs and perceived barriers. The primary outcomes are change in weekly meat servings and change in overall dietary quality; secondary outcomes include nutrient adequacy indicators, physical activity levels, and anthropometric measures. Quantitative data will be analyzed using mixed-effects linear models to account for clustering by neighborhood and repeated measures, with intention-to-treat and per-protocol analyses. Mediation analyses will test whether changes in attitudes and self-efficacy mediate dietary outcomes, and subgroup analyses will explore differential effects by gender, age group, and baseline meat consumption. Qualitative data will undergo thematic analysis guided by Braun and Clarke’s approach, with triangulation to expand understanding of adherence determinants, cultural acceptability, and perceived benefits and barriers. A process evaluation will document fidelity, reach, dose, and context, while an economic evaluation will estimate incremental cost per quality-adjusted life year gained and cost per additional meat serving avoided, informing scalability. Anticipated findings include a statistically significant reduction in weekly meat servings by 20–25% in the intervention group, modest but meaningful improvements in dietary quality without compromising nutrient adequacy, and enhanced knowledge and positive attitudes toward plant-forward eating. The study will contribute to knowledge by providing empirical evidence on the effectiveness, mechanisms, and costs of a community-tailored meat-reduction meal plan, integrating behavioral theories with practical implementation insights for broader adoption. Conclusions are expected to underscore the viability of structured meal-plans as a feasible public health strategy to promote healthier, more sustainable diets, with recommendations for refining meal-plan components, policy integration, and pathways for scale-up in diverse community settings.