Barriers and facilitators to nutritional recommendations identified by participants of a cardiovascular rehabilitation program in a low resource context in Brazil
Bibliographic record
Abstract
OBJECTIVES: Nutritional recommendations, a core component of cardiovascular rehabilitation, 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 cardiovascular rehabilitation program in Brazil. METHODS: A mixed-methods approach was employed. Sociodemographic data, the Mediterranean diet score, scale for assessing nutrition, 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 (Mediterranean diet score and scale for assessing nutrition) 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. CONCLUSIONS: 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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".