Barriers and facilitators to nutritional recommendations identified by participants of a cardiovascular rehabilitation program in a low resource context in Brazil

Objective Nutritional recommendations, a core component of cardiovascular rehabilitation (CVR), play a vital role in managing cardiovascular diseases. However, adherence to these recommendations is complex, particularly in low-resource settings. This study explored the barriers and facilitators influencing adherence to nutritional recommendations among participants in a low-resource CVR program in Brazil. Methods A mixed-methods approach was employed. Sociodemographic data, the Mediterranean Diet Score (MDS-P), Scale for Assessing Nutrition (SAN), and open-ended questions on adherence were collected. Those who completed the questionnaires (phase 1) were invited to participate in one focus group session (phase 2). The participants were characterized according to the responses provided in phase 1 (MDS-P and SAN) in low adherence or high adherence to dietary practice. Descriptive statistics and thematic content analysis within the context of the theory of planned behavior were employed. Results Seventy-four participants completed phase 1, with 41.9% classified into low adherence and 27.0% in high adherence; of those, 17 participated in phase 2. Focus group findings revealed 9 themes/29 subthemes. Barriers included food prices, income, knowledge, routine, food access, family patterns, disease, work, anxiety, eating habits, and food planning. Facilitators included affordable food, health considerations, taste preferences, knowledge, family/professional support, government assistance, personal willpower, income stability, easy food access, media influence, and a quiet eating place. Conclusion The study findings underscore the need for targeted interventions, including individualized meal planning, community engagement, and enhanced access to healthcare professionals, to optimize dietary adherence and improve cardiovascular outcomes.