Knowledge and attitudes surrounding the ecological sustainability of healthy eating in the adult population of Malta : a cross-sectional study

Abstract

This dissertation, titled 'Knowledge and Attitudes Surrounding the Ecological Sustainability of Healthy Eating in the Adult Population of Malta: A Cross-Sectional Study', explores the general adult population’s understanding and perceptions of the ecological sustainability of food choices and their relationship to healthy eating. The research addresses a notable gap in local studies by examining public awareness of sustainable diets within Malta’s cultural and socio-economic context. The study stems from growing international concern over the environmental unsustainability of current food systems, which contribute substantially to greenhouse gas emissions (GHGs), biodiversity loss and the depletion of natural resources such as water. Global frameworks including the Sustainable Development Goals (SDGs) and the EAT-Lancet Commission emphasise the urgent need for dietary transitions that benefit both human and planetary health. This study aimed to assess and compare knowledge and attitudes on food sustainability and environmental impacts across demographic factors, and to explore public perceptions of the connection between sustainable and healthy diets. The outcomes are intended to inform national policy and education initiatives promoting sustainable and healthy eating practices. An exploratory descriptive cross-sectional study design was adopted, employing a structured online questionnaire distributed via social media, Whatsapp and via internal Governmental emails. The validated tool, adapted from García-González et al. (2020) and translated into Maltese, collected demographic data along with measures of knowledge, attitudes and perceptions related to food sustainability. Convenience and Snowball sampling yielded 443 valid responses from adults aged 18 years and above residing in Malta, guaranteeing a maximum margin of error of 4.65%, assuming a 95% confidence level. Data were analysed using Statistical Package for the Social Sciences (SPSS) and Microsoft Excel, applying descriptive and inferential statistical tests (Chisquare and Kruskal–Wallis) with a significance threshold of p ≤ 0.05. The sample was predominantly made of women (68.4%), Maltese (95.5%) and highly educated, with more than two-thirds holding tertiary qualifications. Overall, participants demonstrated moderate awareness of sustainability-related terms, with approximately half reporting familiarity with key concepts such as 'ecological footprint' and 'sustainable diet'. Significant differences were found across gender and educational level, with women and highly educated participants showing greater knowledge and more favourable attitudes toward sustainable diets. Attributes such as local production, affordability and low environmental impact were rated as most important features of a sustainable diet, with female respondents assigning consistently significantly higher importance than males (p < 0.05). Age, employment status and monthly income levels also influenced perceptions and attitudes, with older, retired and those falling under ‘other’ employment status and higher-income participants expressing greater willingness to pay for sustainably produced foods. Most respondents (63.9%) perceived 'sustainable diet' and 'healthy diet' as similar but not identical concepts, indicating satisfactory understanding of their interconnection. Promisingly, the overall attitudes reflected positive awareness of the importance of sustainable consumption and a general openness to behavioural change. The findings suggest that while Maltese adults display encouraging levels of awareness and positive attitudes, gaps remain in comprehensive understanding and practical application of sustainable dietary principles. The study recommends targeted educational campaigns and policy measures to strengthen public food sustainability literacy, particularly among younger and less-educated groups. This research provides a valuable evidence base for designing interventions that advance sustainable healthy diets aligned with global sustainability and public health priorities.