This qualitative study was embedded within the KETO-HF pilot randomised controlled trial, in which participants with heart failure with reduced ejection fraction followed a ketogenic diet for 4 months. Fifteen participants completed semi-structured interviews that were analysed by thematic analysis. Facilitators of adherence were personal motivation and self-regulation, improved well-being, interpersonal support, and adaptive strategies with improved nutritional literacy. Barriers were early-phase physiological and psychological challenges, social and cultural friction, competing family and work demands, and limited availability of suitable foods.
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