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 a SSB tax—known as the Health Promotion Levy (HPL)—as a fiscal measure to reduce excessive sugar consumption. National data reported changes in reformulation. Yet, evidence on community-level awareness and perceptions, particularly in low-socioeconomic settings, remains limited. This study aimed to explore both the public and professional understanding of the SSB tax in a rural South African context, i.e. Makhanda, Eastern Cape, South Africa.

METHODS:
The research employed a multi-method, cross-sectional design. 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) employed at the same facilities. Data were analysed using descriptive statistics and thematic analysis, then integrated for interpretation.

RESULTS:
Most adults (96%) were unaware of the SSB tax, while 97.8% reported no change in consumption since its introduction. Although nursing practitioners displayed limited awareness of the tax’s rationale and timing, they supported taxation as a public health strategy. Both groups identified affordability, entrenched consumption habits, and insufficient health education as key barriers to the SSB tax’s effectiveness.

CONCLUSIONS:
Perspectives from adults and nursing practitioners in Makhanda highlight that the SSB tax, in its current form, has limited perceived impact. Complementary strategies—including stronger community education, awareness campaigns, and policy enforcement—are necessary to enhance its effectiveness.