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Assessing food security in the Monteverde Zone: a multi-method approach

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Title:
Assessing food security in the Monteverde Zone: a multi-method approach
Translated Title:
Valorando la seguridad alimenticia en la zona de Monteverde: un acercamiento del método múltiple ( )
Physical Description:
Book
Language:
English
Creator:
Andia, Jennifer
Publication Date:
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normalized irregular

Subjects

Subjects / Keywords:
Food supply--Costa Rica--Puntarenas--Monteverde
Nutrition and health--Costa Rica--Puntarenas--Monteverde
Public health--Costa Rica--Puntarenas--Monteverde
Nutrition surveys--Costa Rica--Puntarenas--Monteverde
Community Health 2002
Genre:
Books/Reports/Directories
Books/Reports/Directories

Notes

Summary:
A multi-method assessment on food security in the Monteverde Zone.
Summary:
Un método de evaluación multiple en la seguridad alimenticia en la Zona de Monteverde.
Abstract:
Our research focused on food insecurity and perceptions of nutrition and food resources in the Monteverde Zone. Information was collected through various methods, including an anthropometric assessment of nutritional status in San Luis, semi-structured interviews with mothers regarding what foods are considered healthy and what they feed their children, sixty-seven returned Radimer/Cornell Measure of Hunger and Food Insecurity Scales, and a focus group with seven mothers of young children concerning the idea of a community garden. A priority of the research was exploring solutions to improving nutrition and access to food resources. Food insecurity was an issue in all of the communities, with Adult Food Insecurity being the most prevalent. Adult Food Insecurity is characterized by “compromises in the quality and quantity of food eaten by adults” (Himmelgreen et al. 2000: 336). The semi-structured interviews revealed a high degree of nutritional knowledge, yet a lack of quality nutrition because of economic limitations. The community garden idea was well accepted by the focus group. The women felt that the garden would be a solution to the lack of nutritious foods by providing better quality and more affordable produce.
Abstract:
Nuestra investigación esta enfocada en la inseguridad alimenticia y percepciones de la nutrición y los recursos alimenticios en la Zona de Monteverde. Se colecto información a traves de varios métodos, incluyendo una evaluación antropométrica del estado nutricional en San Luis, entrevistas semi-estructuradas con madres con respecto a cuales alimentos se consideran saludables y que les dan a sus niños, 67 devolvieron el Radimer/Cornell medida de hambre y scalas de inseguridad alimentaria, y un grupo de enfoque con siete madres de niños pequeños sobre la idea de un jardin comunitario. Una prioridad de la investigación era explorar soluciones para mejorar la nutrición y el acceso a los recursos de alimentos. Inseguridad alimenticia era un tema en las comunidades, con inseguridad alimentaria de adultos siendo el más prevalente. La inseguridad alimenticia de adultos es caracterizado por "compromisos en la calidad y cantidad de alimentos consumidos por adultos" (Himmelgreen et al. 2000: 336). Las entrevistas semi-estructuradas revelaron un grado alto de conocimiento nutricional, pero la falta de calidad nutricional por las limitaciones económicas. La idea del jardin comunitario fue aceptado por el grupo de enfoque. Las mujeres sintieron que el jardin sería una solución a la falta de alimentos nutritivos en proveer mejor calidad y mas producto accesible.
Language:
EN

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University of South Florida Library
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University of South Florida
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All applicable rights reserved by the source institution and holding location.
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usfldc doi - M38-00012
usfldc handle - m38.12
System ID:
SFS0000206:00001


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Our research focused on food insecurity and perceptions of nutrition and food resources in the Monteverde Zone. Information was collected through various methods, including an anthropometric assessment of nutritional status in San Luis, semi-structured interviews with mothers regarding what foods are considered healthy and what they feed their children, sixty-seven returned Radimer/Cornell Measure of Hunger and Food Insecurity Scales, and a focus group with seven mothers of young children concerning the idea of a community garden. A priority of the research was exploring solutions to improving nutrition and access to food resources. Food insecurity was an issue in all of the communities, with Adult Food Insecurity being the most prevalent. Adult Food Insecurity is characterized by compromises in the quality and quantity of food eaten by adults (Himmelgreen et al. 2000: 336). The semi-structured interviews revealed a high degree of nutritional knowledge, yet a lack of quality nutrition because of economic limitations. The community garden idea was well accepted by the focus group. The women felt that the garden would be a solution to the lack of nutritious foods by providing better quality and more affordable produce.
Nuestra investigacin esta enfocada en la inseguridad alimenticia y percepciones de la nutricin y los recursos alimenticios en la Zona de Monteverde. Se colecto informacin a traves de varios mtodos, incluyendo una evaluacin antropomtrica del estado nutricional en San Luis, entrevistas semi-estructuradas con madres con respecto a cuales alimentos se consideran saludables y que les dan a sus nios, 67 devolvieron el Radimer/Cornell medida de hambre y scalas de inseguridad alimentaria, y un grupo de enfoque con siete madres de nios pequeos sobre la idea de un jardin comunitario. Una prioridad de la investigacin era explorar soluciones para mejorar la nutricin y el acceso a los recursos de alimentos. Inseguridad alimenticia era un tema en las comunidades, con inseguridad alimentaria de adultos siendo el ms prevalente. La inseguridad alimenticia de adultos es caracterizado por "compromisos en la calidad y cantidad de alimentos consumidos por adultos" (Himmelgreen et al. 2000: 336). Las entrevistas semi-estructuradas revelaron un grado alto de conocimiento nutricional, pero la falta de calidad nutricional por las limitaciones econmicas. La idea del jardin comunitario fue aceptado por el grupo de enfoque. Las mujeres sintieron que el jardin sera una solucin a la falta de alimentos nutritivos en proveer mejor calidad y mas producto accesible.
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Food supply--Costa Rica--Puntarenas--Monteverde
Nutrition and health--Costa Rica--Puntarenas--Monteverde
Public health--Costa Rica--Puntarenas--Monteverde
Nutrition surveys--Costa Rica--Puntarenas--Monteverde
Community Health 2002
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Klein, Rebecca
Wirsing, Elisabeth
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Assessing Food Security in the Monteverde Zone: A Multi Method Approach Jennifer Andia Emilie Davis Rebecca Klein Elisabeth Wirsing Globalization and Health Monteverde Institute June 23 to August 4, 2002

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Abstract Our research focused on food insecurity and perceptions of nutrition and food resources in the Monteverde Zone. Information was collected through various methods, including an anthropometric assessment of nutritional status in San Luis, semi structured interviews with mothers regardin g what foods are considered healthy and what they feed their children, sixty seven returned Radimer/Cornell Measure of Hunger and Food Insecurity Scales, and a focus group with seven mothers of young children concerning the ide a of a community garden. A pr iority of the research was exploring solutions to improving nutrition and access to food resources. Food insecurity was an issue in all of the communities, with Adult Food Insecurity being the most prevalent. (Himmelgreen et al. 2000: 336). The semi structured interviews revealed a high degree of nutritional knowledge, yet a lack of quality nutrition because of economic limitations. The community gard en idea was well accepted by the focus group. The women felt that the garden would be a solution to the lack of nutritious foods by providing better quality and more affordable produce. Research Team Biography Our research team consisted of four members fr om similar backgrounds: Emilie Davis, who graduated from University of Kansas in 2001 with a degree in Community Health from the School of Education. This fall she will begin her second year at University of North Carolina Chapel Hill, working toward her Masters in Public Health with an emphasis on nutrition; Jennifer Andia, who graduated from Albright College in 2000 with a dual degree in Biology and Spanish, and is currently at Tufts University in Boston, MA completing a dual MS/MPH degree in Internation al Nutrition and Public Health; Rebecca Klein who graduated from Hampshire College in 2001 with a concentration in Nutritional Anthropology. She is planning to do graduate work in International Public Health and Nutrition; and Elisabeth Wirsing who is ente ring her final year at Mount Holyoke College, focusing on Medical Anthropology and Public Health. Introduction While severe over and under nutrition are not problems in the Monteverde Zone, there are still nutritional concerns. Many people are not getting all nutrients that they need (Bretnall et al. 2001). Most often, poor nutrition is related to economic factors and food security is a major issue in much of the world. Our research team chose to investigate the level of food security in the Monteverde Zone To gain a broad understanding of this issue we used a range of quantitative and qualitative methods, including surveys, semi structured interviews and a focus group. The information gathered through each of these methods is presented in its own section i n chronological order. Therefore, each section builds on the previous. For example, we began by assessing whether food insecurity is an issue in the Monteverde Zone. Through semi structured interviews, we gained information about factors contributing to fo od insecurity, and began to explore solutions for this issue. With a focus group, we explored one solution in particular and gained in depth information about the interest level and feasibility for such a project.

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Food Insecurity In the past, in order to measure the prevalence of hunger among populations, the percentage of those living in poverty was used as a proxy measure (Himmelgreen, 2000). Anthropometric, biochemical and dietary measurements have also been used to assess the e xistence of hunger, however, they do not address the issue of causality. It has been suggested that food insecurity may be a more sensitive measurement of the food issues experienced by low income families than household income alone (Matheson et al 2002). An increasing interest in examining food security and insecurity in the last 10 years has helped develop concepts to describe adequacy and reliability of food resources for both individuals and households (Himmelgreen et al. 2000). Food insecurity can be 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 (Matheson et al. 2002: 210). Therefore, food security can be defined as the: Acc ess by all people at all times to enough food for an active, healthy life, and includes at a minimum: a) the ready availability of nutritionally adequate and safe foods, and b) the assured ability to acquire acceptable foods in socially acceptable ways (An derson 1990; cited in Himmelgreen et al. 2000: 335). so a necessary component in classifying a household as food secure. requirements of its population (Lorenzana and Sanjur 1999). The focus of food securi ty later shifted from the national to the household perspective, primarily those countries that have acquired macroeconomic adjustment programs had adverse effects on the poor. Within Latin America, macroeconomic adjustment programs and economic recessions have caused a decrease among national food supplies, thus inhibiting access to food by the poor. Decreased food security among these countries has been attributed to rising food prices, high unemployment rates, real income loss and the eradication of gene ralized food subsidies. Radimer/Cornell Measure of Hunger and Food Insecurity There are several food insecurity scales used to measure the presence and severity of food insecurity among households, including the Radimer/Cornell Measure of Hunger and Food I nsecurity. This survey is a sensitive instrument that classifies the severity of food insecurity according to the responses for 10 questions (see Appendix 1). This survey examines food security from 3 components: a food anxiety component, a quantitative an d qualitative component. For our use, the head of the household was asked to choose the response that best represented her perception of food access in the household; the choices of response were are three levels of food insecurity. Household Food Insecurity is a general concern about runn ing out of food or not having enough money to buy food. It can include anxiety and is the least severe level of food insecurity.

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(Himmelgreen et al. 2000: 3 inquire about Household Food Insecurity, questions 5 8 refe r to Adult Food Insecurity, and the remaining two questions examine Child Hunger at the quantitative level. Food Insecurity and Nutrition Malnutrition and hunger among individuals can arise because of food insecurity within households, due to insufficient access to the appropriate quantity or quality of food necessary for an active, healthy life. When food insecurity is most severe, hunger is often likely to occur. Within Costa Rica, according to the 1996 National Nutrition Survey, only 2% of children ages 1 6 were considered by Waterlow classification to be suffering from acute malnutrition and 5.7% suffered from chronic malnutrition ( http://165.158.1.110/english/sha/prflcor.html ). In addition, 16. 3% of girls and 13.6% of boys were considered to have excess weight. Recently, there has been increased interest in the possible link between food insecurity and obesity (Matheson et al 2002). Research has suggested a positive relationship between food ins ecurity and obesity, among both adults and children, thus, suggesting obesity as a consequence of food insecurity rather than food security. See diagram below (Matheson et al. 2002). Food Insecurity in the Monteverde Zone With the increase in globalization within the Monteverde Zone, over nutrition, rather than undernutrition has become more of a health problem in recent years. A larger percentage of the population in this area is becoming overweight or obese with increased stores of adiposity, especially a mong women (Bretnall et al. 2001). Another factor related to globalization is tourism. Many of the stores in the area have prices that are aimed at the tourists and therefore limit the purchasing capacity of local residents. As the Monteverde Zone continue s to become popular among foreigners, the particular types of foods sold in the Santa Elena supermarket may be tailored towards their needs and preferences, without taking into account the needs and preferences of the local community. Prices have and will popularity; the higher prices will make it more difficult for local individuals to access the necessary foods to maintain a healthy and active life. Therefore, our goal was to determine the level of food security within the Monteverde Zone, including households in Santa Elena and Cerro Plano, as well as the region of San Luis. Using the information gathered from both areas, we compared the results to determine whether there was a difference between the two areas, in term s of their ability to access and acquires a sufficient quantity and quality of food. Food Insecurity of San Luis: Analysis of Surveys During the anthropometric assessment in San Luis on July 11, 2002, data on food security were collected from eighteen fami lies among the forty individuals evaluated. Of these eighteen families, five did not currently have children living in their homes; therefore information from questions eight through ten on the Radimer/Cornell Questionnaire was not applicable (1). Only one household was considered to be food secure according to the (1) hosting families versus non hosting families could not be carried out. This c omparison was performed on the data collected from Santa Elena and Cerro Plano.

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Scale and one household were considered to have household level food insecurity. A total of twelve households were considered to be food insecure at the adult level. It is important to note that all of the households without children were classified as food insecure at the adult level. Of the thirteen families who currently had children living in their households four households answered positively to questions nine and ten concerning child hunger. This is the most severe level of food insecurity becau se most households buffer the children from the effects of food scarcity and therefore they are usually the last individuals in the household to be affected by the lack of food. See Tables I and II below for further detail.

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Food Security in Monteverde Cerro Plano and Santa Elena Methods for Assessing Food Insecurity Approximately one hundred and fifty Radimer/Cornell Hunger and Food Insecurity Questionnaires were distributed to families living in the towns of Monteverde, Cerro Plano, and Santa Elena. Eighty five questionnaires were distributed to the children attending the one of the primary schools in the Monteverde Zone. Sixty five questionnaires were also distributed throughout the community through the help of students attending the Monteverde Inst itute in the Globalization and Health course, as well as the Sustainable Futures course. Students were asked to take questionnaires home and ask the head of the household to complete the questionnaire; host families in the Globalization and Health course w ere also asked to distribute an additional questionnaire to another family who was not currently hosting an international student. A total of twenty four questionnaires were returned from the families of the primary school, and an additional twenty five qu estionnaires from the families of the Monteverde Institute. The response rate for each cluster of questionnaires from the primary school and the Monteverde Institute were 28% and 38%, respectively. This response rate is rather low; several factors may have contributed to this. For example, it is impossible to determine how many students actually followed through in giving the survey to their families. Some families may have chosen not to respond because of the sensitive nature of the material. Usually this survey is orally given by an interviewer and not sent to an individual to complete by herself. Although the questionnaire is relatively self explanatory, some people may not have understood the survey and therefore not responded. Had the research period be en longer we would have conducted the surveys orally with individuals. There may have been an overlap in respondents because questionnaires were sent home to families who may have both a child attending the primary school, and were also hosting a student from the Institute. Because of the sensitive nature of the questionnaire, we asked the respondents not to identify themselves on the form and therefore, we were unable to control for a possible overlap in respondents. It is reasonable to assume that respon dents would not complete the questionnaire twice, however, we were unable to verify this and time permitting we would recommend a more precise sampling frame. Also, we were not able to verify that the heads of households were the respondents to the questio nnaires. Again, with additional time, one should take precautions to verify that only the heads of households completed the surveys. In addition to the Radimer/Cornell Hunger and Food Security Scale, the respondents were asked to answer 4 demographic quest ions concerning their households: how many persons live in the house, from these how many persons were under 20 years of age, how many were under 5 years of age, and if there was a foreign student(s) living in the house. The Radimer/Cornell Hunger and Food Security Scale was analyzed according to the composition of the household specifically, if the family currently had a foreign student in the house or not (see Table IV). Based on these responses, the households were separated into 2 categories: (A) repr esenting households currently hosting a student, and B) households without a student. We made this separation because we hypothesized that the added income of hosting a foreign student may affect the There were 21 f amilies placed into category (A), and the 26 families not currently hosting students designated as category (B). Due to the voluntary nature of the questionnaire, there were two surveys that could not be

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classified because no information was provided conce rning the presence of students in the households; according to the responses given, and grouped according to the most severe degree of food insecurit y indicated. The different levels of food insecurity can be described from most secure to least secure as: Food Secure, Household Food Insecure, Adult Food Insecure, and Child Hunger. It should be noted that households classified as food insecure at the hi gher degrees most likely possess many of the characteristics of food insecurity at the lower degrees. Therefore, households classified as having Child Hunger are likely to be food insecure at the adult level and the household level as well. This is assumed because when there is a food shortage, children usually receive food before adults do (Himmelgreen, personal communication July 2002). In our analysis, the households are grouped according to their greatest degree of food insecurity, but the underlying le vels should be taken into account. Results: Analysis of Food Security Of the Radimer/Cornell questionnaires distributed in the Santa Elena, Monteverde, and Cerro Plano regions, forty nine were returned. Based on the returned surveys, households were categorized according to their highest degree of food insecurity (Food Secure, Household Food Insecurity, Adult Food Insecurity, or the severest degree of Child Hunger) (see Table III). Eight of the forty nine (16%) households were Food Secure. From these regions, two (4%) families expressed Household Food Insecurity only. Twenty of the forty nine (41%) households fit into the overall Adult Food Insecurity category. The remaining nineteen households of the sample (39%) showed characteristics of the severes t degree of food insecurity, Child Hunger, answering positively to the quantitative questions 8 10 concerning children Once again, it should be noted that households expressing high levels of food insecurity, such as Child Hunger, are also considered to b e Adult and Household Insecure as well.

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From category (A) of households with students, twelve out of twenty one showed Adult Food Insecurity (57%), this was the largest percentage. Child Hunger was present in only four of the (A) households (19%). Thre e households in category A (14% ) were Food Secure, and two (9%) had food insecurity at the Household level only (see Table V). Of the families without students (B), the most frequent classification was Child Hunger. Fifteen out of twenty six households (58%) answered positively to one or both of questions 8 foods. Six households (23%) were Adult Food Insecure. Similarly, five families (19%) were Food Secure, answering negatively to all of the questions presented. Intere stingly, none of the households without students (B) fit into the Household Food Insecurity only category, although it can be assumed that families with Child y fit into the Adult Food Insecurity category (see Table VI). When using the Radimer/Cornell Scale to compare households hosting students to those who are not currently hosting students, discrepancies can be noted. Households without students had larger percentages of Child Hunger than those with students with 19% to 58% shown respectively. Households hosting students had a higher percentage of Adult Food Insecurity (57%) than households without students (23%). Child Hunger is the most severe form of foo d insecurity and may be a sign of a greater lack of economic resources than Adult Food Insecurity alone. This points to the possible impact of students in the household, for increased economic resources and therefore access to food. However, it is not cert ain whether the relationship between hosting students and increased food security is direct. Further investigation on this association is suggested. In addition, we only questioned whether the family currently was hosting a student; in the future more deta ils about how many students, how often, and for how many years would be useful.

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The Radimer/Cornell Questionnaires were answered by community members in two regions; one community being San Luis, and the other being the combination of Monteverde, Cerro Plano, and Santa Elena. It is difficult to compare the survey results from these communities, because the sample sizes are different. Representatives from eighteen households filled out surveys in San Luis, while forty nine completed the same questionnaire in the combined region of Monteverde, Cerro Plano, and Santa Elena (MVI/CP/SE). For this reason it is problematic to make conclusions about communities based on such small sample sizes. Information about students living in households was collected in the MV/CP/SE region, however this information was not gathered for San Luis, since these additional questions were not a part of the anthropometric assessment, and hosting students is not as common. It should also be noticed that five of the eighteen household s (28%) in San Luis were without children; therefore having Child Hunger was not possible for these families. This is important, since there is a larger presence of Child Hunger in the MV/CP/SE region (39%). When looking at the Food Insecurity graphs for t he two regions, both have significant percentages of Adult Food Insecurity; San Luis showing twelve out of eighteen households (67%), and MV/CP/SE having twenty out of forty nine families (41%) with Adult Food Insecurity. Five of these San Luis households with Adult Food Insecurity were the families without children. A difference in the composition of the two regions is that nineteen out of forty nine households (39%) in MV/CP/SE were categorized as having Child Hunger, compared to four out of eighteen fami lies (22%) in San Luis. The distribution of food insecurity in San Luis is concentrated in the area of Adult Food Insecurity. Food insecurity in the MV/CP/SE region, however, is characterized by similar percentages of both Adult Food Insecurity and Child H unger. Qualitative Data The Radimer/Cornell Measure of Hunger and Food Insecurity provided a brief quantitative and qualitative assessment of food insecurity in the Monteverde Zone. To gain a deeper, more qualitative understanding of issues related to food insecurity we conducted a number of interviews as well as a focus group with mothers living in the Zone. Interviews Methods for Semi Structured Interviews Semi structured interviews were conducted on July 15 th 2002, with five mothers living within the Monteverde Zone (Santa Elena, Cerro Plano and Monteverde). Another three interviews were conducted at the Santa Elena Clinic on July 24 th 2002. The women were asked a set of questions related to nutrition; body size perception, health status, and food security (see Appendix 2). Three of the five women interviewed on July 15 th were also given the Radimer/Cornell Measure of Hunger and Food Insecurity survey. The information gathered through the surveys was analyzed with the food security surveys distribut ed to families in the Monteverde, Cerro Plano and Santa Elena areas, as previously mentioned. Four of the July 15 th interviews were conducted in Spanish, and one in English. It is important to note that a large portion of the qualitative data was collected after the initial interview. Once the questions were asked and the pen was put down, the women seemed more comfortable and willing to divulge personal information. The July 24 th interviews were conducted in Spanish by two researchers, one to ask questions and the other to

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take notes. The interview format was essentially the same; however, several questions were added to the interviews on July 24 th These changes are noted in Appendix 2. Each of the eight women was read an explanation of the study, includin g the goal of the study and the potential benefits to the community. They were also assured that anything discussed during the interview would be completely anonymous. Each of the informants was told they could stop the interview for any reason, at any tim e. They were also invited to ask questions if they needed clarification. The women gave their verbal consent before the interview proceeded. Results of Semi Structured Interviews s represent a healthy child. A healthy child was described as one who is energetic, playful, intelligent, happy, and rarely becomes ill. Six of the eight mothers admitted that there are foods they would like to provide for their children, but because of insufficient funds, they are rarely able to purchase such foods. The foods listed ranged from nuts and grains to meats. High biological value protein foods, which primarily expensive foods such as the standard diet of beans, rice, tortillas, fried plantains, potatoes, and cornmeal products, are all that many larger families can afford. It is important to note that rice an d beans are a traditional part of the diet in Costa Rica, as in much of Latin America. These staple foods have an intimate tie to culture and therefore may be consumed with such frequency for this reason and not merely because of economic ones. Foods of th is nature, however, contribute to a starch laden diet, lacking in protein, vitamins, minerals, and essential fatty acids. It is necessary to consume a balanced diet, especially during the growing years. The women also spoke about the poor selection and qua lity of the produce. There is only one supermarket in Santa Elena which also serves other outlying areas. Because this particular store has no competition, the prices are considerably higher than those in communities where one store does not hold the mark et on essential nutrients needed to balance a healthy diet. Discussion/Conclusion Based on Semi Structured Interviews One initial hypothesis and interest that provoked this study was the assumption that problems with malnutrition in the Monteverde Zone are due to a lack of nutrition knowledge among mothers, other caregivers and the population in general. There is very little media about nutrition, specifically about what foods are essential and why the body needs them. Considering the absence of media atten tion, the mothers demonstrate a substantial nutritional knowledge base. Average daily intakes were reported and the women were questioned about healthy foods and their short and long term effects on body size and overall well being. Every one of the mother s listed a variety of healthy foods and explained their role in a healthy diet. Therefore, the hypothesis was disproved and the focus of the study turned to the more blatant issue of economic stability, relative to food insecurity.

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Recommendations Based o n Semi Structured Interviews While the preliminary results are not final, the trend is clear. Many families living within the Monteverde Zone are not financially capable of providing the foods they feel are necessary to create a nutritionally sound diet. W ith regard to community efforts, it is recommended that educational efforts and community support combine to form a coalition with the goal of assisting families in need. Nutrition education could focus on ways to create nutritious meals with limited resou rces. A cooperative garden project could also be planned for and implemented. Fruits, vegetables, and herbs that are grown could be rationed out to families depending on their level of food insecurity. A cooperative garden project would be of assistance to people living in the Monteverde Zone and would also generate community collaboration. The economic impact would also be In addition, future research should include an anal ysis of available food assistance programs. For example, what resources are available for people who are not financially able to provide adequate quantity or quality foods for their family? Focus group Despite time constraints, our research team felt that it was important to ascertain and document recommendations for improving the nutritional status of the community, rather than exclusively focusing on collecting data. It is necessary that these recommendations and interventions be feasible for and desired by those at whom they are aimed. Therefore, it is imperative that one solicits advice, input and thoughts from community members concerning these recommendations and interventions As mentioned above, a community garden could be an excellent way to provide essential foods at a lower cost. In order to explore the feasibility of this idea our team conducted a focus group of local women living in the Monteverde Zone. Methods for Focus Group Due to limited time, our sampling frame for participants for the focus group was a list of host families from the Monteverde Institute. From this list, we chose families who were known to have young children. The sample may have been biased as families hosting students may have a different economic status than those who do n ot host students. In addition, those who chose to come to the discussion may have a stronger interest in nutrition and/or being involved in community techniques for future work. Approximately six women were called and were told that we would have a discuss ion about the nutrition and health in general of children in the community. They were asked to bring a friend to the meeting and were informed that the discussion would last an hour to an hour and a half and that transportation would be provided. Seven wom en came to the discussion. Initially, we collected general information from the they have hosted foreign students, and for how long. After a brief in troduction and explanation of our study we asked a series of prepared questions (see Appendix 3).

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Results of Focus Group The discussion was extremely informative. We asked a variety of questions ranging from opinions about whether or not people in the com munity have trouble buying the food that they need, to specific questions about having a community garden. The women agreed that people have problems buying all of the food that they would like, need or know is good for them and their family. The major exp lanation for this problem was that there is only one grocery store in the area, which was an issue also raised in individual interviews. Solo un supermercado no hay opciones de supermercado The Women stated that food is ver y expensive due to the lack of competitive prices because there is only one supermarket, thus generating higher priced foods that are often are of po o r quality. When asked what people do not buy if they do not have enough money the first foods mentioned w ere meats and canned goods. The women said that these are expensive foods in addition to fresh vegetables, legumes, and fruits. Despite complaining of the high costs, they reported that they personally buy food even if it is expensive because they need it. During this discussion some women raised the issue of Monteverde being a tourist town and therefore, many prices are set for tourists and that store owners need to learn that there are local people living who do not have the income to afford these prices. When questioned about what can be done to help people afford the food they need, the first response was petition to get another store in the area, but t hat not everyone had signed it. She was not positive that this had actually taken place; it would be interesting to investigate this further as well as the plausibility of opening a second store. Most of the women were excited about the idea, but the gener al consensus was that it would be impossible to open another store. When probed for more ideas about how to help the situation another woman suggested a garden. The group seemed interested in this idea and got more and more animated as we asked detailed qu estions. All of the women expressed a willingness to help with a community garden. Some older women commented that they did not have much to do and would enjoy getting out of the house. The women who had young children said that they would help as well. Th ey did not think the children would hinder them, and it would be good to teach the kids how to grow food. Many of the women talked about how old traditions have been lost and how most of the children today are not taught and do not know how to plant and gr ow food. One woman spoke of cultivaban mas, no tenan que comprar there was never a shortage. ofreca comida a todos habra ma Someone also commented about life being harder now because chemicals that are contaminating foods. They were emphatic that if there were to be a community garden it would have to be organic. There were various ideas about how the garden should be. Some people thought that it should start small. Another thought it would be good to create a greenhouse because of the varied and often severe weather in Monteverde. Other women argued that this woul d be too expensive. All of the women agreed that precaution against the weather were necessary. They also talked about fences and gates for the garden. Several of the

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women told stories of people who they knew who had food stolen from their gardens. There was also a discussion of what should be done with the products of the garden. One woman suggested driving around the Zone selling the produce. There was also talk of having a market in which to sell the goods. The general consensus, however, was that the y ield would be divided among everyone working in the garden. They did not have a preference about where to put the garden. They said that they would be willing to go wherever it was. When we raised the question of location the women immediately started tal king about people that they knew who had land. One woman mentioned that she had land that might be able to be used. She said that she would have to talk to her husband about it; she also said that she was not sure if it was the best and there might be bett er land in the area. When asked who they thought should be in charge of the garden their response was a pause in the conversation and then someone suggested the woman who had mentioned that she had land. There was some laughter and the women seemed uncomfo rtable saying who should be in charge. The general consensus was whoever owned the land. One of us suggested that the responsibility could be shared, and some of the women seemed to like this idea. We asked who should do what job within the garden and the response was everyone should do a little of everything. There was a horas a la Overall the women were very interested in the community that they would need help however, especially with funding, and mentioned that if an organization li ke the Monteverde Institute would back them their project would be taken more seriously. Discussion/Conclusion Based on Focus Group The enthusiasm that was generated by the focus is encouraging. A community garden has the potential to be transformative i social and political status, and improve their sense of self 2001: 2). The garden could foster confidence and sk ill building. This is important for many reasons, the most Dick 2001: 1). Though the garden women would have the opportunity to work actively toward changin g factors that limit their ability to feed their families. The capacity to work around the system to acquire needs (i.e. growing food rather than buying it) is a powerful tool. Once one learns that there are other options for solving a problem that had see med impossible, one starts to apply the same mindset to other challenging situations. Thus, the garden will create learning, not only about food, but also about problem solving. The socializing that will result from working on this project will provide add itional opportunities for people to share experiences and advice; thus, furthering the learning process. Tourism is widespread and growing in the Monteverde Zone. As some of the women in the focus group stated, the stores are catering to the needs of the tourists not the needs of the community The garden has the rather than catering to tourists. On the other hand, the garden could also take advan tage of the tourist market

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and become a place to visit and buy locally grown organic produce. It is important that the food go to those that need it first; however, visiting the community garden and learning why it was formed could raise awareness of touri sts about how their presence affects a community. Recommendations Based on Focus Group Based on what we were told during some interviews and the focus group there is a definite interest in creating a community garden in the Monteverde Zone. We recommend that additional meetings take place. A community meeting to assess the broader interest may be the next step. Once it is determined who is interested in the project, smaller committees should be formed. We recommend spreading the responsibilities throughou t the community so that the project is not overwhelming for any one person. Trainings on how to garden as well as how to organize and run the community garden should be provided. It is also important to explore various options, such as having several small er gardens throughout the Zone, or a neighborhood garden that would be the collaboration of several families. Nothing is set in stone, and therefore this project can develop however large or small the community desires. Final Conclusions/Recommendations Although the sample size was small the research revealed that there are potential issues with food insecurity in the Monteverde Zone. The Radi mer/Cornell Measure of Hunger and Food Insecurity was a good tool for an initial assessment; however, we recommend more in depth research with culturally sensitive measures. Our semi structured interviews showed a strong presence of nutritional knowledge, however a clear lack of sufficient economic resources. Women in the zone have many ideas about how to address this issue. One strong possibility is the creation of a community garden; this would provide quality food at a lower cost as well as the potential for community collaboration and shared learning. We en courage the Monteverde Institute and other community organizations to assume supportive roles in the development of a community garden; however, the community members should feel ownership of this proj ect.

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Appendix 1 MONTEVERDE FOOD CONSUMPTION PATTERNS AND OBESITY STUDY 3. FOOD INSECURITY QUESTIONNAIRE (Caretaker) CORNELL/RAMIMER FOOD INSECURITY QUESTIONS (All information in this questionnaire is confidential) Instructions: I am going to ask you some questions about the availability of food in your household. Some of these questions may be sensitive; however your answers will help us to determine if there is a problem with food availability in your community. Please, remember that your an swers to these questions will remain anonymous. Of course, if you feel uncomfortable with any of the questions, you may choose not to answer them. 1. I worry that I might run out of food before I get money to buy more. 01. This happens frequently. 02. This happens sometimes 03. This never happens. 2. 01. This happens frequently. 02. This happens sometimes 03. This never happens. 3. buy more. 01. This happens frequently. 02. This happens sometimes 03. This never happens. 4. money to buy more food. 01. This happens frequently. 02. This happens sometimes 03. This neve r happens. 5. 01. This happens frequently. 02. This happens sometimes 03. This never happens. 6. 01. This happens frequently. 02. This happens sometimes

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03. This never happens. 7. 01. This happens frequently. 02. This happens sometimes 03. This never happens. 8. nough money. 01. This happens frequently. 02. This happens sometimes 03. This never happens. 9. 01. This happens frequently. 02. This happens sometimes 03. This never happens. 10. I know my children 01. This happens frequently. 02. This happens sometimes 03. This never happens.

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Appendix 2 Semi Structured Interview Date: Time: Place: Informant: Other (atmosphere, demeanor, etc): Note (if/how mother attends to children): Introduction: Somos estudiantes del programa Globalizaci n y Salud en el Instituto Monteverde. Estamos haciendo un proyecto sobre la nutricin y comida en su casa. Recuerde que usted no tiene que hacer nada ni responder a ninguna pregunta que le hace sentirse incomoda. Puede terminar su participacin en cualquier momento. Por favor, si tiene preguntas con este proyecto pregntame. Esta bien? Quiere seguir con la entrevista? Preguntas : Cuantos nios tien e? Cuantos aos tienen? Por favor, descrbame la comida tpica que les da sus nios en un da tpico. a. El desayuno b. El almuerzo c. La cena En su opinin, describa un nio sano. (Por ejemplo, el cuerpo) Piensa que el tamao del cuerpo afecta la salud general de un nio? Piensa que el tamao del cuerpo del nio ahora en su vida va a afectarle cuando ser adulto? Piensa que hay tipos de comida que sean mejores para alimentar a sus nios? Y por que? a. Si________________________________________ b. No_____________ _________________________ Piensa que hay tipos de comida que no sean mejores para alimentar a sus nios? Y porqu? a. Si________________________________________ b. No________________________________________ Como define comida saludable y las que no son saludables? Y por qu? Alimenta a sus nios y a sus nias la misma comida? a. Si___________________________________ b. No__________________________________ Hay comidas que le quisiera dar a sus nios, pero no puede? (Porque hay razones como no tiene tiempo, o al supermercado no las tiene, o no tiene bastante dinero, o no tiene transporte para comprarlas)? Si hay veces en que no puede comprar todos los alimentos que quisiera, cuales no compra? Told interviewee about idea of a community garden and asked about f easibility, location preference and interest level.

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Appendix 3 Focus Group Questions Introduccin: Somos estudiantes del programa de Globalizaci n y Salud en el Instituto Monteverde. Estamos haciendo un proyecto sobre la nutricin y la comida en la zona de Monteverde. Primero, (lo ms importante J) tenemos algunos refrigerios, pueden pasarse en cualquier momento para tomar o comer algo. Tenemos algunas preguntas sobre la alimentacin en la comunidad, pero vamos a empezar con algunos datos sobre ustedes. Por favor escriban dnde viven, cuntas personas viven en sus casa, las edades de usted y sus nios, y tambin si tiene o ha teni do estudiantes extranjeros viviendo con ustedes y por cuantos aos. Ahorita vamos a empezar con las preguntas, querem os or de todas, es muy importante que todas hablen, no importa si no estn de acuerdo, solamente queremos or sus opiniones y sugerencias. No hay respuestas correctas o incorrectas, todas su s opiniones son muy importantes para nosotros. Preguntas: Como parte de nuestro proyecto hemos hablado con muchas personas de la comunidad sobre nutricin y salud. La mayora de la gente sabe bastante sobre la buena nutricin, pero alguna gente dice que a veces no pueden darle a la familia lo que saben que deben darle s a. Ustedes creen que este es un problema en su comunidad? b. Cuales serian las razones que alguna gente no pueda darle a su familia lo que quisiera? c. (PROBE A LOT HERE) Si hay veces en que uno no puede comprar todos los alimentos que quisiera, cuales no comp ra? a. (PROBE FOR PRICE, ETC. b Que puede hacer la comunidad para resolver estos problemas? a. (PROBE A LOT HERE) Algunas de las personas con las que hablamos sugirieron tener una huerta comunitaria a. Primero que todo, para ustedes, qu significa ese trmino? Ustedes creen que sea posible tener una huerta comunitaria aqu? a. Porque o porque no? Donde debera estar? a. Otras posibilidades? Quienes trabajaran? Quin hara cual trabajo? Quin estara encargado? Cual sera la mejor manera de distribuir las verduras y frutas que se cultiven? Habra alguna desventaja de tener una huerta comunitaria? (This part and the details after we will do if there is time) Tambin, hemos pensado que si no es po sible para todos trabajar, es po sibl e tener un Mercado donde se vendan esas verduras y frutas a un precio m a. Ustedes creen que sea posible tener un mercado as aqu?

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a. Porqu o porqu no? Quines trabajaran en el mercado? Quien hara cada trabajo? Quin estara encargado? Habra alguna desventaja de tener mercado para vender los productos de la huerta? (These are ONLY if there is a lot of time left) En su opinin, describa a un ni o sano, por ejemplo, su cuerpo? Alguna gente piensa que el tamao del cuerpo afecta la salud general de un nio. Usted que cree? Porque? Alguna gente piensa que el tamao del cuerpo del nio va a afectarle cuando sea adulto. Usted que cree? Porque? Cules creen ustedes que s ean las mejores comidas para los nio s ? Porque? Cules comidas no deber as drsele a los nios? Porque? Como define comida saludable y la que no es saludable? Y porque? Alimenta a sus nios y sus nias con la misma comida? References Cited Blumberg Stephen J. PhD; Bialostosky, Karil MS; Hamilton, William L. PhD; Briefel, Ronette R. DrPH, RD 1999 The Effectiveness of a Short Form of the Household Food Security Scale American Journal of Public Health 89 (8) August 1999: 1231 1234. Bretnall, Ann, Sca rlett Hutchison, Scarlett Hutchison, Lourdes Rodrguez, Claudia Sanchez Castillo and Ann Smyntek 2001 Anthropometric and Nutritional Assessment of the Community of San Luis, Monteverde. Globalization, Nutrition and Health Course Monteverde Institute. Crow ley, Eve 2001 Land Rights in Empowering Women to Achieve Food Security, eds. Agnes R. Quisumbing and Ruth S. Meinzen Dick http://www.ifpri.cgiar.org/2020/focus/focus06.htm Himmelgreen, David A., Rafael Prez Escamilla, Sofia Segura Milln, Yu Singer, and Ann Ferris Food Security Among Low Income Hispanics in Hartford, Connecticut: Implications for Public Health Policy. Human Organization 59 (3): 334 342. Lore nzana, Paulina A and Diva Sanjur 1999 Abbreviated Measures of Food Sufficiency Validly Estimate the Food Security Level of Poor Households: Measuring Household Food Security. Journal of Nutrition 129: 687 692. Matheson, Donna M., et al. Household Food Sec urity and Nutritional Status of Hispanic Children in the Fifth Grade. American Journal of Clinical Nutrition 76 (1): 210 217. http://165.158.1.110/english/sha/prflcor.html June 8, 1995 Country Health Profile for Costa Rica. Health Analysis. Quisumbing, Agnes R. and Ruth S. Meinzen Dick 2001 Overview in Empowering Women to Achieve Food Security, eds. Agnes R. Quisumbing and Ruth S. Meinzen Dick http://www.ifpri.cgiar.org/2020/focus/focus06.htm