Healthy eating among people with type 2 diabetes in the Brazilian Amazon: a qualitative study in primary health care.

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 Café 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.