Living with diabetes in the Brazilian Amazon: Exploring barriers and supports for healthy lifestyle practices

IF 3.3 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Diabetic Medicine Pub Date : 2026-10-15 Epub Date: 2026-07-15 DOI:10.1111/dme.70381

Thalyta Mariany Rêgo Lopes Ueno, Tiago Assunção dos Santos Farias, Wagner Ferreira Monteiro, Maria Paula dos Santos, Hércules Lázaro Morais Campos, Elisa Brosina de Leon

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引用次数: 0

Abstract

Aims

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.

Methods

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 Café group discussion sessions (one involving patients and one involving CHWs) and 15 semi-structured interviews conducted in patients’ homes. Data were analysed using thematic analysis supported by Atlas.ti 24 software.

Results

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.

Conclusions

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-specific strategies to promote sustainable lifestyle changes, enhance patient autonomy and improve quality of life in remote Amazonian communities.

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巴西亚马逊地区的糖尿病患者：探索健康生活方式的障碍和支持。

目的：利用国际功能、残疾和健康分类（ICF）的环境因素领域作为概念框架，研究巴西亚马逊地区2型糖尿病（T2DM）患者采用健康生活习惯的障碍和促进因素。方法：对巴西亚马逊地区47名T2DM患者和17名社区卫生工作者（CHWs）进行定性研究。通过两次世界咖啡馆小组讨论（一次涉及患者，一次涉及卫生保健员）和在患者家中进行的15次半结构化访谈收集数据。使用Atlas支持的专题分析对数据进行分析。Ti 24软件。结果：出现了态度因素、社会因素和身体因素三大类。态度障碍包括抗拒行为改变、否认疾病严重程度和身体限制，而对并发症的恐惧和对生命的重视促使人们做出更健康的行为。社会障碍包括缺乏家庭支持、不安全感和交通困难，而家庭参与、专业指导和对卫生工作者的信任促进了治疗依从性和生活方式的改变。物理障碍包括基础设施不足、恶劣的天气条件和缺乏安全的公共空间进行体育活动。相反，靠近当地市场和集市有助于获得健康食品，并有助于改善饮食。结论：巴西亚马逊地区T2DM患者采用健康生活方式的障碍和促进因素受到态度、社会和环境因素的强烈影响。在这种情况下，有效的糖尿病管理需要具有文化敏感性的干预措施、改善城市基础设施、加强社区支持网络以及多学科医疗保健团队，特别是保健护士的持续参与。这些发现为制定特定环境的策略提供了重要的见解，以促进可持续的生活方式改变，增强患者的自主权，提高偏远亚马逊社区的生活质量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetic Medicine 医学-内分泌学与代谢

CiteScore

7.20

自引率

5.70%

发文量

229

审稿时长

3-6 weeks

期刊介绍： Diabetic Medicine, the official journal of Diabetes UK, is published monthly simultaneously, in print and online editions. The journal publishes a range of key information on all clinical aspects of diabetes mellitus, ranging from human genetic studies through clinical physiology and trials to diabetes epidemiology. We do not publish original animal or cell culture studies unless they are part of a study of clinical diabetes involving humans. Categories of publication include research articles, reviews, editorials, commentaries, and correspondence. All material is peer-reviewed. We aim to disseminate knowledge about diabetes research with the goal of improving the management of people with diabetes. The journal therefore seeks to provide a forum for the exchange of ideas between clinicians and researchers worldwide. Topics covered are of importance to all healthcare professionals working with people with diabetes, whether in primary care or specialist services. Surplus generated from the sale of Diabetic Medicine is used by Diabetes UK to know diabetes better and fight diabetes more effectively on behalf of all people affected by and at risk of diabetes as well as their families and carers.”