Other Titles

Culturally Inclusive and Emotionally Supportive Nutrition Interventions: Lessons form the Pro-HEART Trial [Title Slide]

Abstract

Altering the dietary habits of individuals with obesity, heart failure, and cardiometabolic comorbidities can enhance their health outcomes (Gjermeni et al., 2025). Adhering to these interventions remains challenging, leading to higher dropout and lower retention rates in clinical nutrition trials (Chao et al., 2021). To develop enduring, patient-focused interventions, it is essential to understand participants' experiences. Therefore, this qualitative sub-study explored participant-reported barriers to dietary adherence within the Pro-HEART randomized controlled trial, which evaluated the effects of high-protein versus standard-protein diets in individuals with heart failure and metabolic syndrome or Type 2 diabetes mellitus. The intervention in the Pro-HEART trial was a 12-week calorie-restricted program. Participants were enrolled in either the high-protein or standard-protein diet. They also received nutrition counseling from licensed dieticians at 2, 4, 8, and 12 weeks. They also received reminders to attend an appointment through phone calls, text messages, or emails. Finally, participants kept manually written daily food logs, which were reviewed during nutritional counseling visits. A total of 24 participants who completed the intervention (n=12 from the standard-protein diet; n=12 from the high-protein diet) were interviewed for the qualitative section of the Pro-HEART trial. We conducted semi-structured interviews to explore participants' challenges and barriers to adhering to the intervention. Six key themes emerged from the thematic analysis: (1) psychological stress from strict intervention guidelines, (2) tracking burden from weighing, food logging, and portion tracking, (3) technological stress from digital tracking tools, (4) cultural incompatibility from lack of culturally relevant prescribed diet, (5) social pressures from family meals and peer expectations, and (6) diminishing motivation over time. These concerns aggravated one another, affecting their overall satisfaction and adherence to the intervention. The findings highlight the importance of creating nutrition programs that are culturally inclusive, emotionally supportive, and behaviorally sustainable. Addressing participant concerns can increase retention in clinical nutrition research and reduce attrition rates. Future trials should adopt patient-centered, adaptive strategies that account for the social and psychological effects of dietary changes.

Notes

References:

Chao, A. M., Quigley, K. M., & Wadden, T. A. (2021). Dietary interventions for obesity: Clinical and mechanistic findings. The Journal of Clinical Investigation, 131(1), e140065. https://doi.org/10.1172/JCI140065

Gjermeni, E., Fiebiger, R., Bundalian, L., Garten, A., Schöneberg, T., Le Duc, D., & Blüher, M. (2025). The impact of dietary interventions on cardiometabolic health. Cardiovascular Diabetology, 24(1), 234. https://doi.org/10.1186/s12933-025-02766-w

This work was supported by funding from the National Heart, Lung, and Blood Institute (1R01HL093466). The project described was also supported by the National Institutes of Health/National Center for Research Resources and the National Center for Advancing Translational Sciences (NIH/NCRR/NCATS), through the University of California Irvine Institute for Clinical and Translational Science Grant Number UL1TR000153 and by NIH/NCRR/NCATS, University of California, Los Angeles Clinical and Translational Science Institute Grant Number UL1TR000124.

Description

This study reports the qualitative results of the Pro-HEART trial, a 12-week high- or standard-protein dietary program with nutritional counseling support. A total of 24 individuals with obesity, heart failure, type 2 diabetes mellitus, and metabolic syndrome were interviewed. Results highlight the cultural and emotional barriers to adherence to nutritional interventions, including psychological stress, tracking burden, diminishing motivation, cultural incompatibility, and social pressures.

Author Details

 Andrew Thomas Reyes, PhD, RN; Angelina Nguyen, PhD; Alona D. Angosta, PhD; Rebecca Meraz, PhD; Kelly L. Wierenga, PhD; Jennifer Kawi, PhD; Lorraine S. Evangelista, PhD

Sigma Membership

Zeta Kappa at-Large

Lead Author Affiliation

University of Nevada, Las Vegas, Nevada, USA

Type

Presentation

Format Type

Text-based Document

Study Design/Type

Other

Research Approach

Qualitative Research

Keywords:

Stress and Coping, Public and Community Health, Primary Care, Nutrition, Nursing Interventions

Conference Name

37th International Nursing Research Congress

Conference Host

Sigma Theta Tau International

Conference Location

Toronto, Ontario, Canada

Conference Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

Abstract Review Only: Reviewed by Event Host

Acquisition

Proxy-submission

Date of Issue

2026-07-29

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Exploring Adherence Barriers to Nutrition Intervention: A Qualitative Study of the Pro-HEART Trial

Toronto, Ontario, Canada

Altering the dietary habits of individuals with obesity, heart failure, and cardiometabolic comorbidities can enhance their health outcomes (Gjermeni et al., 2025). Adhering to these interventions remains challenging, leading to higher dropout and lower retention rates in clinical nutrition trials (Chao et al., 2021). To develop enduring, patient-focused interventions, it is essential to understand participants' experiences. Therefore, this qualitative sub-study explored participant-reported barriers to dietary adherence within the Pro-HEART randomized controlled trial, which evaluated the effects of high-protein versus standard-protein diets in individuals with heart failure and metabolic syndrome or Type 2 diabetes mellitus. The intervention in the Pro-HEART trial was a 12-week calorie-restricted program. Participants were enrolled in either the high-protein or standard-protein diet. They also received nutrition counseling from licensed dieticians at 2, 4, 8, and 12 weeks. They also received reminders to attend an appointment through phone calls, text messages, or emails. Finally, participants kept manually written daily food logs, which were reviewed during nutritional counseling visits. A total of 24 participants who completed the intervention (n=12 from the standard-protein diet; n=12 from the high-protein diet) were interviewed for the qualitative section of the Pro-HEART trial. We conducted semi-structured interviews to explore participants' challenges and barriers to adhering to the intervention. Six key themes emerged from the thematic analysis: (1) psychological stress from strict intervention guidelines, (2) tracking burden from weighing, food logging, and portion tracking, (3) technological stress from digital tracking tools, (4) cultural incompatibility from lack of culturally relevant prescribed diet, (5) social pressures from family meals and peer expectations, and (6) diminishing motivation over time. These concerns aggravated one another, affecting their overall satisfaction and adherence to the intervention. The findings highlight the importance of creating nutrition programs that are culturally inclusive, emotionally supportive, and behaviorally sustainable. Addressing participant concerns can increase retention in clinical nutrition research and reduce attrition rates. Future trials should adopt patient-centered, adaptive strategies that account for the social and psychological effects of dietary changes.