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Sa\u00fade P\u00fablica"],"abstract":"<jats:p>Abstract: This study aimed to explore perceived barriers and facilitators to healthy eating among individuals with type 2 diabetes mellitus and community health workers (CHWs) in primary health care in the Brazilian Amazon. This qualitative study used a participatory approach. Data were collected by World Caf\u00e9 discussion groups and semi-structured interviews with type 2 diabetes mellitus patients and CHWs. Thematic network analysis was used to find intrapersonal, interpersonal, and environmental factors influencing dietary behaviors. This study included 64 participants - 47 type 2 diabetes mellitus patients and 17 CHWs in the Brazilian Amazon. Key barriers to healthy eating included financial constraints, lack of family support, and limited access to qualified health professionals such as nutritionists. Additional environmental challenges included seasonal food shortages and poor access to markets. Facilitators included personal motivation, dietary awareness, family support, and local food cultivation. Although the Amazon has a rich biodiversity conducive to healthy eating, socioeconomic and environmental conditions often prevent people with diabetes from accessing healthy food. The findings underscore the need for culturally appropriate, community-based strategies involving multidisciplinary teams to improve dietary adherence in low-resource settings.<\/jats:p>","DOI":"10.1590\/0102-311xen175125","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T12:59:56Z","timestamp":1787317196000},"source":"Crossref","is-referenced-by-count":1,"title":["Healthy eating among people with type 2 diabetes in the Brazilian Amazon: a qualitative study in primary health care"],"prefix":"10.1590","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6269-834X","authenticated-orcid":false,"given":"Tiago Assun\u00e7\u00e3o dos Santos","family":"Farias","sequence":"first","affiliation":[{"name":"Universidade Federal do Amazonas,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3991-7022","authenticated-orcid":false,"given":"Thalyta Mariany R\u00eago Lopes","family":"Ueno","sequence":"additional","affiliation":[{"name":"Universidade do Estado do 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":"Universidade do Estado do Amazonas,  Brazil"}],"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":"Universidade Federal do Amazonas,  Brazil; Universidade Federal do Amazonas,  Brazil; Universidade Federal dos Vales do Jequitinhonha e Mucuri,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2559-6897","authenticated-orcid":false,"given":"Elisa Brosina de","family":"Leon","sequence":"additional","affiliation":[{"name":"Universidade Federal do Amazonas,  Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2026]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.15406\/hij.2020.04.00155","article-title":"Fruits of the Amazon a window of opportunity","volume":"4","author":"Aguiar JPL","year":"2020","journal-title":"Horticulture International Journal"},{"key":"ref2","doi-asserted-by":"crossref","DOI":"10.33448\/rsd-v11i15.37494","article-title":"Dieta saud\u00e1vel na Amaz\u00f4nia com nutrientes e subst\u00e2ncias bioativas partir dos frutos tropicais","volume":"11","author":"Rolim CC","year":"2022","journal-title":"Res Soc Dev"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"2609","DOI":"10.1590\/1413-81232022277.20362021","article-title":"Padr\u00f5es de consumo alimentar nas comunidades ribeirinhas da regi\u00e3o do m\u00e9dio 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In: IV Seven International Congress of Health.","author":"Passos LM"},{"key":"ref37","article-title":"Barriers and facilitators that influence on adopting healthy lifestyles in people with cardiovascular disease","volume":"39","author":"Espinosa JNS","year":"2021","journal-title":"Invest Educ Enferm"},{"key":"ref38","first-page":"146502","article-title":"Understanding barriers and facilitators to healthy eating and active living in rural communities","volume":"14","author":"Seguin R","year":"2014","journal-title":"J Nutr Metab"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1590\/S0034-71672008000200007","article-title":"O cuidado \u00e0 pessoa diab\u00e9tica e as repercuss\u00f5es na fam\u00edlia","volume":"61","author":"Zanetti ML","year":"2008","journal-title":"Rev Bras Enferm"},{"key":"ref40","first-page":"543","article-title":"As dificuldades de ades\u00e3o ao tratamento dietoter\u00e1pico em pacientes idosos diab\u00e9ticos","volume":"14","author":"Almeida LRS","year":"2022","journal-title":"Rev Sa\u00fade Foco"},{"key":"ref41","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1007\/s10668-016-9783-x","article-title":"Factors influencing the food transition in riverine communities in the Brazilian Amazon","volume":"19","author":"Silva RJ","year":"2017","journal-title":"Environ Dev Sustain"},{"key":"ref42","doi-asserted-by":"crossref","first-page":"177","DOI":"10.30810\/rcs.v4i7.1406","article-title":"Alimenta\u00e7\u00e3o na v\u00e1rzea amaz\u00f4nica estudo dos h\u00e1bitos alimentares de fam\u00edlias ribeirinhas no munic\u00edpio de Alenquer-PA","volume":"4","author":"Silva LS","year":"2020","journal-title":"Revista Ci\u00eancias da Sociedade"},{"key":"ref43","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1590\/0001-3765201520140250","article-title":"Food consumption as an indicator of the conservation of natural resources in riverine communities of the Brazilian 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