Taxation of sugar-sweetened beverages: Perspectives of adults and nursing practitioners in Makhanda, Eastern Cape, South Africa.

Background: High sugar-sweetened beverage (SSB) consumption has been linked to the rising prevalence of obesity and non-communicable diseases (NCDs) in South Africa. In April 2018, the country introduced an SSB tax-known as the Health Promotion Levy (HPL)-as a fiscal measure to reduce excessive sugar consumption and curb the rise of overweight, obesity, and NCDs. Although national evidence indicates product reformulation, community-level awareness and perceptions, particularly in low-socioeconomic settings, remain unclear. Objectives: To assess adults' awareness, beliefs, and self-reported behaviour changes related to the SSB tax, and to explore nursing practitioners' understanding, perceptions of its impact on consumer behaviour, and views on their educational role at primary health care (PHC) facilities in Makhanda, Eastern Cape. Design and methods: A multi-method, cross-sectional design was used. Quantitative data were collected from adults (n = 275) at seven PHC facilities through an interviewer-administered questionnaire. Qualitative data were obtained from semi-structured interviews with nursing practitioners (n = 10) at the same facilities. Data were analysed using descriptive statistics and thematic analysis, and the results were integrated for interpretation. Results: Ninety-six percent of adults (n = 264), based on the interviewer-administered questionnaire, were unaware of the SSB tax, while 98% (n = 269) reported no change in consumption since implementation. Nursing practitioners displayed limited awareness of the tax's rationale and timing but supported taxation as a public health strategy. Conclusions: The SSB tax demonstrates limited perceived impact in this setting. Strengthened community education, awareness campaigns, and improved policy implementation are required to enhance effectiveness.