Intervention for Women in Costa Rica
Condition: Obesity; Food Habits; Mental Depression
MeSH terms: Depression
Study type: Interventional

Summary: 
      The study develops, implements, and evaluates an intervention focused on alleviating
      discouragement, food insecurity, and excess weight in women,targeted at the individual,
      family, and community levels in the Canton Central of the province of Alajuela, Costa Rica.
    

Detailed description: 
      Food insecurity is defined as "limited or uncertain availability of nutritionally adequate
      and safe foods or limited or uncertain ability to acquire acceptable foods in socially
      acceptable ways." The coexistence of excess body weight and food insecurity is recognized by
      researchers and increasingly by the broader public. Poverty and household food insecurity are
      priority topics for the global community because of their negative impacts in physical and
      mental health. In Costa Rica, there are no specific data about how many households are
      affected by food insecurity, but it is well-known that the poverty level has stood at about
      20% for the past five years and that food insecurity has an economic component through
      material deprivation. Thus, even though food insecurity is not the same as poverty, the
      conditions often coexist.

      Multiple studies have concluded that poverty and household food insecurity are often
      associated with excess body weight in women, but not men. Excess body weight, as defined as
      Body Mass Index ≥25, is a global health problem and the major public health problem in Costa
      Rican women. In 2008-2009, 59.7% of women between 20 and 44 years of age have excess body
      weight, reaching 77.3% in women who are 45 to 64 years of age. Excess body weight also has
      multiple consequences for physical and mental health. Thus, women with excess body weight and
      food insecurity have compromised their physical and mental health in multiple ways.

      This project builds on a productive partnership between the School of Nutrition of the
      University of Costa Rica, the association Agenda de Mujeres, the Hospital of Alajuela, and
      the Women´s Office of the Municipality of Alajuela. For the last eight years, these
      organizations have been working together to implement health promotion interventions in
      low-income women with excess weight. For this project, we have the support of the University
      of South Carolina.

      The conceptual framework that guides the intervention is based on the investigators' previous
      work in Costa Rica that found that discouragement - or in other words, "feeling depressed" -
      is the primary link in the coexistence of food insecurity and excess body weight among Costa
      Rican women.

      The study is a 6-month intervention targeted at the individual, family, and community levels
      in the Canton Central of the province of Alajuela, Costa Rica. The specific aims are:

      Specific Aim 1: To determine the impact of an intervention to alleviate discouragement
      feelings among food-insecure, excess-weight women. Hypothesis 1: After the intervention, the
      participants in the intervention group, as compared with the control group, will reduce their
      household food security status, increase their psychological and economic empowerment level,
      decrease their depression and anxiety levels, increase perceived social support, and decrease
      their body mass index and waist circumference. Qualitative methods, specifically group
      interviews and semi-structured in-depth interviews, also are used to assess the intervention
      Specific Aim 2: To qualitatively examine the impact of the intervention on gender norms,
      including co-responsibility in the household (i.e., joint decision-making, sharing
      responsibilities in the household, including taking care of children and the disabled and
      contributing to household support), and self-care, including healthy nutrition.

      To address these aims, we designed a cluster-randomized controlled trial design at the
      health-center level, the first level of care in Costa Rica. Investigators randomize 15
      matched pairs of health centers in a 1:1 ratio to intervention and control arms, and enroll 7
      participants per health center (total n=210).

      For specific aim #2 the investigators will use qualitative methods, such as group interviews,
      semi-structured in-depth interviews, and non-participant observation This study is
      significant because there are no interventions in Costa Rica or other countries that aim to
      improve both food security and health, including mental health and excess body weight, in
      food-insecure women with excess body weight. Therefore, studies are needed to develop,
      implement, and evaluate the efficacy and effectiveness of interventions targeting these
      women.
    

Intervention name(s): Intensive Intervention; Non-Intensive Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): an intervention focused on alleviating discouragement, food insecurity, and excess weight in women and targeted at the individual, family, and community levels; Group sessions for healthy lifestyle
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: obesity; food insecurity; depressive symptoms; empowerment