Where traditions meet change: a qualitative evidence synthesis and meta-aggregation exploring healthy eating perceptions among Asian populations living in high-income Western countries

Background Asian populations in Western, high-income countries (WHICs) face growing diet-related health disparities. Prior work highlights dietary acculturation as a contributing factor, yet an in-depth understanding of Asian populations’ perspectives on healthy eating with traditional cuisines blended with Western practices and environments remains limited. This qualitative evidence synthesis systematically examined definitions and cultural influences on healthy eating perceived by diverse Asian ethnic groups in WHICs to inform tailored interventions to improve nutrition and health. Methods A systematic search was conducted in six databases (PubMed, CINAHL, EMBASE, Web of Science, Scopus, PsycINFO), focusing on qualitative studies examining healthy eating perceptions among Asian populations in WHICs. Data extraction used an adapted Joanna Briggs Institute (JBI) Qualitative Data Extraction Form, followed by quality assessment using the JBI Critical Appraisal Checklist. The meta-aggregation approach guided finding synthesis, with cumulative confidence evaluated through the ConQual approach. Results From 8,117 records screened, 25 qualitative papers were included in the synthesis, representing eight Asian ethnic groups across seven Western countries. The synthesis revealed both pan-Asian patterns and ethnicity-specific phenomena. Four synthesized findings emerged: (1) culturally grounded definitions of healthy eating that prioritize freshness, balance, and traditions, with notable variations in perceptions between ethnic groups; (2) dual nutrition knowledge systems that blend Western dietary guidelines with traditional medicine frameworks; (3) migration-driven changes including a critical gap where improved food security coincides with poorer nutrition security; and (4) socio-cultural meanings of foods as expressions of cultural identity that are frequently prioritized over health considerations. All synthesized findings were rated as moderate level in confidence. Conclusions This is the first qualitative evidence synthesis to summarize the healthy eating perceptions of Asian ethnic groups in WHICs. Study findings reveal the complexity and nuances of their dietary knowledge and perceptions, which were often intertwined with cultural traditions and migration experiences. The coexistence of pan-Asian patterns and ethnic-specific variations warrants the need for targeted nutrition environment interventions to accommodate both the shared values and the unique needs across diverse Asian populations in WHICs.