ArticleDiabetic medicine : a journal of the British Diabetic Association2026
Living with diabetes in the Brazilian Amazon: Exploring barriers and supports for healthy lifestyle practices.
Article in Diabetic medicine : a journal of the British Diabetic Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
aimsTo 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.
methodsA 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.
resultsThree 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.
conclusionsBarriers 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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