{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T08:45:22Z","timestamp":1792053922235,"version":"4.4.0"},"reference-count":45,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004916","name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Estado do Amazonas","doi-asserted-by":"publisher","award":["FAPEAM\u2013FAP\/CnPQ003\/2022"],"award-info":[{"award-number":["FAPEAM\u2013FAP\/CnPQ003\/2022"]}],"id":[{"id":"10.13039\/501100004916","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002322","name":"Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To investigate the barriers and facilitators to adopting healthy lifestyle habits among patients with type 2 diabetes mellitus (T2DM) in the Brazilian Amazon, using the Environmental Factors domain of the International Classification of Functioning, Disability and Health (ICF) as a conceptual framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative study was conducted with 47 patients with T2DM and 17 community health workers (CHWs) from primary health care services in the Brazilian Amazon. Data were collected through two World Caf\u00e9 group discussion sessions (one involving patients and one involving CHWs) and 15 semi\u2010structured interviews conducted in patients\u2019 homes. Data were analysed using thematic analysis supported by Atlas.ti 24 software.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three major categories emerged: attitudinal, social and physical factors. Attitudinal barriers included resistance to behaviour change, denial of disease severity and physical limitations, whereas fear of complications and valuing life motivated healthier behaviours. Social barriers comprised lack of family support, insecurity and transportation difficulties, while family involvement, professional guidance and trust in CHWs facilitated treatment adherence and lifestyle modification. Physical barriers included inadequate infrastructure, adverse weather conditions and the absence of safe public spaces for physical activity. Conversely, proximity to local markets and fairs facilitated access to healthy foods and supported dietary improvements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Barriers and facilitators to healthy lifestyle adoption among people with T2DM in the Brazilian Amazon are strongly influenced by attitudinal, social and environmental factors. Effective diabetes management in this context requires culturally sensitive interventions, improved urban infrastructure, strengthened community support networks and continued engagement of multidisciplinary healthcare teams, particularly CHWs. These findings provide important insights for developing context\u2010specific strategies to promote sustainable lifestyle changes, enhance patient autonomy and improve quality of life in remote Amazonian communities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70381","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:39:28Z","timestamp":1784176768000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Living with diabetes in the Brazilian Amazon: Exploring barriers and supports for healthy lifestyle practices"],"prefix":"10.1111","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3991-7022","authenticated-orcid":false,"given":"Thalyta Mariany R\u00eago Lopes","family":"Ueno","sequence":"first","affiliation":[{"name":"Programa de P\u00f3s\u2010gradua\u00e7\u00e3o em Enfermagem em Sa\u00fade P\u00fablica, Escola de Ci\u00eancias da Sa\u00fade Universidade Do Estado Do Amazonas (UEA)  Manaus Amazonas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-834X","authenticated-orcid":false,"given":"Tiago Assun\u00e7\u00e3o dos Santos","family":"Farias","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s\u2010gradua\u00e7\u00e3o em Ci\u00eancias Do Movimento Humano (PPGCiMH), Faculdade de Educa\u00e7\u00e3o F\u00edsica e Fisioterapia (FEFF) Universidade Federal do Amazonas (UFAM)  Manaus Amazonas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3303-3031","authenticated-orcid":false,"given":"Wagner Ferreira","family":"Monteiro","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s\u2010gradua\u00e7\u00e3o em Enfermagem em Sa\u00fade P\u00fablica, Escola de Ci\u00eancias da Sa\u00fade Universidade Do Estado Do Amazonas (UEA)  Manaus Amazonas Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2182-9841","authenticated-orcid":false,"given":"Maria Paula dos","family":"Santos","sequence":"additional","affiliation":[{"name":"Faculdade de Desporto \u2013 Universidade do Porto (FADEUP)  Porto Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6919-8161","authenticated-orcid":false,"given":"H\u00e9rcules L\u00e1zaro Morais","family":"Campos","sequence":"additional","affiliation":[{"name":"Programa de P\u00f3s\u2010gradua\u00e7\u00e3o em Ci\u00eancias Do Movimento Humano (PPGCiMH), Faculdade de Educa\u00e7\u00e3o F\u00edsica e Fisioterapia (FEFF) Universidade Federal do Amazonas (UFAM)  Manaus Amazonas Brazil"},{"name":"Instituto de Sa\u00fade e Biotecnologia (ISB) Universidade Federal do Amazonas (UFAM)  Coari Amazonas Brazil"},{"name":"Programa de P\u00f3s\u2010gradua\u00e7\u00e3o Interdisciplinar em Estudos Rurais 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