Integrating macro- and meso-level perspectives on school nutrition programs in Dubai: a joint display mixed methods integration study.

Background: School Nutrition Programs (SNPs) are increasingly recognized as essential public health interventions that influence children's health, educational attainment, wellbeing, and future non-communicable disease risk. While previous studies in Dubai explored stakeholders' macro-level perceptions regarding the upscaling of SNPs and quantitatively characterized SNPs implementation across schools, the integrated understanding of how policy-level aspirations align with school-level realities remains limited. Generating such an integrated understanding is essential for informing implementation strategies that are effective, efficient, equitable, and contextually responsive. Objective: This study aimed to integrate the primary inferences generated from two complementary studies investigating SNPs in Dubai, United Arab Emirates. Methods: This study represents the third integrative phase of a multi-staged mixed methods research program. The first study qualitatively explored perceptions of key opinion leaders involved in planning, implementation, and evaluation of SNPs in Dubai. The second study quantitatively examined the status quo and characteristics of SNPs across public and private schools in Dubai. In the current study, findings from both studies were merged through a structured joint display analysis process informed by mixed methods integration approaches. Primary inferences from both datasets were iteratively compared, connected, and synthesized to generate integrated meta-inferences. Results: The integration process revealed five major meta-inferences: (1) strong policy-level commitment coexists with implementation heterogeneity across schools; (2) awareness of nutritional guidelines does not necessarily translate into comprehensive SNPs implementation; (3) implementation capacity and governance structures are key determinants of SNPs effectiveness; (4) public-private variation reflects differences in operational flexibility, resources, and institutional priorities; and (5) sustainable SNPs advancement in Dubai requires a unified systems-oriented implementation framework integrating governance, accountability, capacity building, and continuous evaluation mechanisms. Joint display analysis demonstrated convergence between stakeholder aspirations and school-level realities while also exposing critical implementation gaps. Conclusion: This integrative mixed methods analysis advances understanding of SNPs in Dubai by moving beyond triangulation toward explicit integration and meta-inference generation. Findings suggest that future SNPs advancement in Dubai should prioritize coordinated implementation governance, school-level capacity strengthening, standardized monitoring systems, and adaptive policy translation mechanisms. The generated meta-inferences provide a foundation for future policy-oriented implementation research and action.