{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T10:48:24Z","timestamp":1789123704084,"version":"build-2803163510"},"reference-count":59,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","award":["5131924"],"award-info":[{"award-number":["5131924"]}],"id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100015283","name":"Bloomberg Philanthropies","doi-asserted-by":"publisher","award":["2019-71181"],"award-info":[{"award-number":["2019-71181"]}],"id":[{"id":"10.13039\/100015283","id-type":"DOI","asserted-by":"publisher"}]},{"award":["5131924"],"award-info":[{"award-number":["5131924"]}],"id":[{"id":"https:\/\/ror.org\/01sv5vd96","id-type":"ROR","asserted-by":"publisher"}]},{"award":["2019-71181"],"award-info":[{"award-number":["2019-71181"]}],"id":[{"id":"https:\/\/ror.org\/01sv5vd96","id-type":"ROR","asserted-by":"publisher"}]},{"name":"University of North Carolina (UNC) at Chapel Hill"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: In May 2023, Ghana implemented a 20% ad valorem tax on bottled water and sweet beverages (SBs), replacing a 17.5% tax; sachet water remained untaxed. The effect on low-income consumers\u2019 purchasing decisions and consumption patterns remains poorly understood. Objective: We aimed to explore factors influencing water and SB purchasing behaviours among low-income households in four peri-urban Accra communities. Methods: This study employed a convergent parallel mixed-methods design. Four focus group discussions (n = 36) and a cross-sectional survey (n = 43) were conducted among purposively sampled household primary shoppers in early 2025 across Oyarifa, Teiman, Kweiman, and Danfa. Data were analysed thematically and descriptively. Results: Of 43 participants, 67% were female and 65% had junior high school education. Water insecurity was common (60%), and sachet water was the main drinking source (77%). SB purchasing was driven by taste and convenience, while sachet water choices were linked to perceived safety, price, and availability. Tax awareness was moderate (56%); many perceived bottled water taxation as unfair and reported intentions to switch to cheaper local alternatives. Conclusions: Limited tax awareness and perceived inequities suggest the need for policy refinements to better align fiscal measures with public health objectives.<\/jats:p>","DOI":"10.3390\/ijerph23060799","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T10:19:53Z","timestamp":1781691593000},"page":"799","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors Influencing Water and Sweet Beverage Purchasing Decisions and Behaviours Among Low-Income Households in Four Peri-Urban Communities in Accra: An Exploratory Study"],"prefix":"10.3390","volume":"23","author":[{"given":"Christopher Delali","family":"Amegah","sequence":"first","affiliation":[{"name":"Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Accra P.O. Box LG 134, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5004-3701","authenticated-orcid":false,"given":"Gloria Adobea","family":"Odei Obeng-Amoako","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Accra P.O. Box LG 134, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0582-110X","authenticated-orcid":false,"given":"Shu Wen","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Lambon-Quayefio","sequence":"additional","affiliation":[{"name":"School of Economics, College of Humanities, University of Ghana, Legon, Accra P.O. Box LG 59, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Adu-Afarwuah","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Food Science, School of Biological Sciences, College of Basic and Applied Sciences, University of Ghana, Legon, Accra P.O. Box LG 134, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2477","DOI":"10.2337\/dc10-1079","article-title":"Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A meta-analysis","volume":"33","author":"Malik","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e077310","DOI":"10.1136\/bmj-2023-077310","article-title":"Ultra-processed food exposure and adverse health outcomes: Umbrella review of epidemiological meta-analyses","volume":"384","author":"Lane","year":"2024","journal-title":"BMJ"},{"key":"ref_3","unstructured":"World Health Organization Regional Office for Africa (2026, May 03). Noncommunicable Diseases Factsheet. Available online: https:\/\/www.afro.who.int\/health-topics\/noncommunicable-diseases."},{"key":"ref_4","unstructured":"WHO African Region (2024, August 27). Country Disease Outlook Ghana. Available online: https:\/\/www.afro.who.int\/sites\/default\/files\/2023-08\/Ghana.pdf."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"5957","DOI":"10.1038\/s41467-023-41269-8","article-title":"Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries","volume":"14","author":"Micha","year":"2023","journal-title":"Nat. Commun."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2568283","DOI":"10.1080\/16549716.2025.2568283","article-title":"Trends in sales of sugar-sweetened beverages and associated type 2 diabetes burden in nine African countries: An ecological time-series analysis","volume":"18","author":"Karugu","year":"2025","journal-title":"Glob. Health Action"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1093\/inthealth\/ihy067","article-title":"Prevalence and risk factors for diabetes mellitus among adults in Ghana: A systematic review and meta-analysis","volume":"11","author":"Tuffour","year":"2019","journal-title":"Int. Health"},{"key":"ref_8","unstructured":"Ghana Statistical Service (GSS) and ICF (2022). Ghana Demographic and Health Survey."},{"key":"ref_9","unstructured":"World Health Organization (2016). Fiscal Policies for DIET and Prevention of Noncommunicable Diseases: Technical Meeting Report, World Health Organization."},{"key":"ref_10","unstructured":"World Health Organization (2022). WHO Manual on Sugar-Sweetened Beverage Taxation Policies to Promote Healthy Diets, World Health Organization. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789240056299."},{"key":"ref_11","unstructured":"Republic of Ghana (2026, April 23). Excise Duty Act, 2014 (Act 878), Available online: https:\/\/ghalii.org\/akn\/gh\/act\/2014\/878\/eng@2014-11-12\/publication."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"International Monetary Fund (2014). Ghana: Staff Report for the 2014 Article IV Consultation. IMF Country Report No. 14\/129, International Monetary Fund. Available online: https:\/\/www.imf.org\/external\/pubs\/ft\/scr\/2014\/cr14129.pdf.","DOI":"10.5089\/9781616355609.002"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1017\/S136898001800321X","article-title":"Did high sugar-sweetened beverage purchasers respond differently to the excise tax on sugar-sweetened beverages in Mexico?","volume":"22","author":"Ng","year":"2019","journal-title":"Public Health Nutr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1377\/hlthaff.2016.1231","article-title":"In Mexico, Evidence of Sustained Consumer Response Two Years After Implementing A Sugar-Sweetened Beverage Tax","volume":"36","author":"Colchero","year":"2017","journal-title":"Health Aff."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Essman, M., Taillie, L.S., Frank, T., Ng, S.W., Popkin, B.M., and Swart, E.C. (2021). Taxed and untaxed beverage intake by South African young adults after a national sugar-sweetened beverage tax: A before-and-after study. PLoS Med., 18.","DOI":"10.1371\/journal.pmed.1003574"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2900","DOI":"10.1017\/S1368980020005078","article-title":"Assessing sugar-sweetened beverage intakes, added sugar intakes and BMI before and after the implementation of a sugar-sweetened beverage tax in South Africa","volume":"24","author":"Wrottesley","year":"2021","journal-title":"Public Health Nutr."},{"key":"ref_17","unstructured":"Ghana Statistical Service (2026, April 23). Ghana 2021 Population and Housing Census, General Report, Available online: https:\/\/census2021.statsghana.gov.gh\/gssmain\/fileUpload\/reportthemelist\/Volume%203%20Highlights.pdf."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1071\/PY21119","article-title":"Availability of drinking water in rural and remote communities in New South Wales, Australia","volume":"28","author":"Perry","year":"2022","journal-title":"Aust. J. Prim. Health"},{"key":"ref_19","unstructured":"Engel, J.F., Kollat, D.T., and Blackwell, R.D. (1973). Consumer Behavior, Holt, Rinehart & Winston. [2nd ed.]."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1080\/08870446.2011.613995","article-title":"The theory of planned behaviour: Reactions and reflections","volume":"26","author":"Ajzen","year":"2011","journal-title":"Psychol. Health"},{"key":"ref_21","unstructured":"Creswell, J.W., and Clark, V.L.P. (2017). Designing and Conducting Mixed Methods Research, SAGE Publications."},{"key":"ref_22","first-page":"81","article-title":"Urban growth and livelihood transformations on the fringes of African cities: A case study of changing livelihoods in peri-urban Accra","volume":"5","author":"Oduro","year":"2015","journal-title":"Environ. Nat. Resour. Res."},{"key":"ref_23","first-page":"98","article-title":"A simplified general method for cluster-sample surveys of health in developing countries","volume":"44","author":"Bennett","year":"1991","journal-title":"World Health Stat. Q."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/ije\/dyh096","article-title":"Comparison of two cluster sampling methods for health surveys in developing countries","volume":"33","author":"Milligan","year":"2004","journal-title":"Int. J. Epidemiol."},{"key":"ref_25","unstructured":"UN-HABITAT (2024). Ghana Housing Profile. United Nations Human Settlements Programme (UN-HABITAT), UN-HABITAT. Available online: https:\/\/unhabitat.org\/ghana-housing-profile."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"155","DOI":"10.2307\/2648118","article-title":"Measuring living standards with proxy variables","volume":"37","author":"Montgomery","year":"2000","journal-title":"Demography"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1080\/09603120500105935","article-title":"Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana","volume":"15","author":"Boadi","year":"2005","journal-title":"Int. J. Environ. Health Res."},{"key":"ref_28","unstructured":"UN-Habitat (2026, April 23). The Challenge of Slums: Global Report on Human Settlements Programme. Available online: https:\/\/unhabitat.org\/the-challenge-of-slums-global-report-on-human-settlements-2003."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e001750","DOI":"10.1136\/bmjgh-2019-001750","article-title":"The Household Water InSecurity Experiences (HWISE) Scale: Development and validation of a household water insecurity measure for low-income and middle-income countries","volume":"4","author":"Young","year":"2019","journal-title":"BMJ Glob. Health"},{"key":"ref_30","unstructured":"Rutstein, S.O., and Staveteig, S. (2014). Making the Demographic and Health Surveys Wealth Index Comparable, ICF International."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.jpubeco.2010.11.006","article-title":"Counting and multidimensional poverty measurement","volume":"95","author":"Alkire","year":"2011","journal-title":"J. Public Econ."},{"key":"ref_32","unstructured":"Young, S.L., Bose, I., Miller, J.D., Pascavis, K., Alzarez, K., Barstow, C., and Yeye, V. (2024). The Water Insecurity Experiences (WISE) Scales: A Manual for Implementation and Analysis of People\u2019s Experiences with Water, Institute for Policy Research, Northwestern University."},{"key":"ref_33","unstructured":"Moc\u0103na\u0219u, D.R. (2020). Determining the sample size in qualitative research. Proceedings of the International Multidisciplinary Scientific Conference on the Dialogue between Sciences & Arts, Religion & Education, T\u00e2rgovi\u0219te, Romania, 26\u201327 October 2020, Ideas Forum International Academic and Scientific Association."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: A systematic review of empirical tests","volume":"292","author":"Hennink","year":"2022","journal-title":"Soc. Sci. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1177\/160940690600500107","article-title":"Demonstrating rigor using thematic analysis: A hybrid approach of inductive and deductive coding and theme development","volume":"5","author":"Fereday","year":"2006","journal-title":"Int. J. Qual. Methods"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s12966-019-0781-x","article-title":"Responses to the Chilean law of food labeling and advertising: Exploring knowledge, perceptions and behaviors of mothers of young children","volume":"16","author":"Correa","year":"2019","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process","volume":"62","author":"Elo","year":"2008","journal-title":"J. Adv. Nurs."},{"key":"ref_38","first-page":"140","article-title":"\u2018Chasing for Water\u2019: Everyday Practices of Water Access in Peri-Urban Ashaiman, Ghana","volume":"7","author":"Peloso","year":"2014","journal-title":"Water Altern."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1080\/07900627.2021.1921708","article-title":"Service differentiation as an improvement strategy for access to water in urban low-income areas: Evidence from three Kenyan cities","volume":"38","author":"Schwartz","year":"2022","journal-title":"Int. J. Water Resour. Dev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1080\/09603129773913","article-title":"A survey of microbial pollution of rural domestic water supply in Ghana","volume":"7","author":"Ampofo","year":"1997","journal-title":"Int. J. Environ. Health Res."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Moulds, S., Chan, A.C., Tetteh, J.D., Bixby, H., Owusu, G., Agyei-Mensah, S., Ezzati, M., Buytaert, W., and Templeton, M.R. (2022). Sachet water in Ghana: A spatiotemporal analysis of the recent upward trend in consumption and its relationship with changing household characteristics, 2010\u20132017. PLoS ONE, 17.","DOI":"10.1371\/journal.pone.0265167"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"3865895","DOI":"10.1155\/2020\/3865895","article-title":"Consumer preference and quality of sachet water sold and consumed in the Sunyani Municipality of Ghana","volume":"2020","author":"Addo","year":"2020","journal-title":"BioMed Res. Int."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"526","DOI":"10.4269\/ajtmh.17-0804","article-title":"An evolving choice in a diverse water market: A quality comparison of sachet water with community and household water sources in Ghana","volume":"99","author":"Stoler","year":"2018","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.habitatint.2015.01.009","article-title":"Piped water flows but sachet consumption grows: The paradoxical drinking water landscape of an urban slum in Ashaiman, Ghana","volume":"47","author":"Stoler","year":"2015","journal-title":"Habitat Int."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"h6704","DOI":"10.1136\/bmj.h6704","article-title":"Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: Observational study","volume":"352","author":"Colchero","year":"2016","journal-title":"BMJ"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"216","DOI":"10.2105\/AJPH.2008.151415","article-title":"The impact of food prices on consumption: A systematic review of research on the price elasticity of demand for food","volume":"100","author":"Andreyeva","year":"2010","journal-title":"Am. J. Public Health"},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Dipalma, G., Inchingolo, A.M., Fiore, A., Chieppa, S., Carone, C., Tartaglia, F.C., Palermo, A., Inchingolo, A.D., and Inchingolo, F. (2026). Role of nutrition in prevention of dental caries in children and adolescents: A systematic review. BMC Oral Health, 26.","DOI":"10.1186\/s12903-026-07839-0"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Urugo, M.M., Kidane, B., Firew, S., Hunde, W., Endere, S.D., Semu, A., Getachew, S., and Yirga, Y. (2026). Comprehensive review of carbonated soft drink consumption rates and their public health importance. BMC Public Health, 26.","DOI":"10.1186\/s12889-025-26141-2"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"100725","DOI":"10.1016\/j.ajpc.2024.100725","article-title":"Phenotyping lipid profiles in type 2 diabetes: Risk association and outcomes from the Cardiovascular Health Study","volume":"19","author":"Bleich","year":"2024","journal-title":"Am. J. Prev. Cardiol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"32","DOI":"10.4093\/dmj.2025.0848","article-title":"Health effects of sugar-sweetened and artificially sweetened beverages: Umbrella review and evidence-based consensus statement of the Korean Diabetes Association and the Korean Nutrition Society","volume":"50","author":"Choi","year":"2026","journal-title":"Diabetes Metab. J."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e2215276","DOI":"10.1001\/jamanetworkopen.2022.15276","article-title":"Outcomes Following Taxation of Sugar-Sweetened Beverages: A Systematic Review and Meta-analysis","volume":"5","author":"Andreyeva","year":"2022","journal-title":"JAMA Netw. Open"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e012154","DOI":"10.1136\/bmjgh-2023-012154","article-title":"Making food-related health taxes palatable in sub-Saharan Africa: Lessons from Ghana","volume":"8","author":"Laar","year":"2023","journal-title":"BMJ Glob. Health"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1080\/20954816.2022.2117676","article-title":"Using behavioural economics to understand tax compliance","volume":"11","author":"Alm","year":"2022","journal-title":"Econ. Political Stud."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1017\/S1368980017002695","article-title":"Exploring perceptions of the Mexican sugar-sweetened beverage tax among adolescents in north-west Mexico: A qualitative study","volume":"21","author":"Papadaki","year":"2018","journal-title":"Public Health Nutr."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"331","DOI":"10.14505\/tpref.v16.2(34).05","article-title":"Tax Reform and Investment Decision Effects in an Emerging Economy: Insights from Ghana","volume":"16","author":"Yeboah","year":"2025","journal-title":"Theor. Pract. Res. Econ. Fields"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e13144","DOI":"10.1111\/obr.13144","article-title":"Differential exposure to, and potential impact of, unhealthy advertising to children by socio-economic and ethnic groups: A systematic review of the evidence","volume":"22","author":"Backholer","year":"2020","journal-title":"Obes. Rev."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e200","DOI":"10.1016\/S2542-5196(20)30304-1","article-title":"Changes in beverage purchases following the announcement and implementation of South Africa\u2019s Health Promotion Levy: An observational study","volume":"5","author":"Stacey","year":"2021","journal-title":"Lancet. Planet. Health"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/0749-5978(91)90020-T","article-title":"The theory of planned behavior","volume":"50","author":"Ajzen","year":"1991","journal-title":"Organ. Behav. Hum. Decis. Process."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1002\/hbe2.195","article-title":"The theory of planned behavior: Frequently asked questions","volume":"2","author":"Ajzen","year":"2020","journal-title":"Hum. Behav. Emerg. Technol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/799\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T10:27:13Z","timestamp":1781692033000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/6\/799"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,15]]},"references-count":59,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["ijerph23060799"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23060799","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,15]]}}}