Drivers of fruit and vegetable intake among Buddhist monks in Bangkok: A mixed-methods study

Low fruit and vegetable intake remains a significant public health issue worldwide. Theravada Buddhist monks in Thailand rely on food offered by laypeople during daily alms rounds. Previous reports have indicated that this food often fails to meet healthy eating standards, being low in fresh fruits and vegetables and high in fat, salt, and sugar. This study analyzed factors influencing fruit and vegetable intake among monks in urban Bangkok. It uses a mixed methods approach, combining descriptive analysis of 203 questionnaire-based interviews and thematic analysis of nine in-depth interviews. Monks consumed an average of 279 grams of fruits and vegetables per day, well below the WHO recommendation of 400 grams and the EAT-Lancet recommendation of 500 grams. A comparison of means showed that the availability of healthier food options ( p <.05), dietary self-efficacy ( p <.001), intention ( p <.001), and social support ( p <.10) were positively associated with fruit and vegetable intake, whereas nutritional knowledge was not statistically significant. Qualitative findings explained these associations by revealing the structural dependence on food offerings, laypeople’s desire for convenience, the role of personal preferences and health concerns in selective eating, and reduced practice of food sharing among monks. The findings show a triangular system of influence in which religious offerings establish the baseline of availability, individual preferences and health concerns filter acceptance, and practical enablers such as preparation, hygiene, and social organization condition actual intake. There is a need for local governments, civil society organizations, and temple abbots to promote healthier eating among the monastic population and laypeople.