¿Lo que no mata, engorda? : an exploratory profile of elderly nutrition in the Monteverde Region

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¿Lo que no mata, engorda? : an exploratory profile of elderly nutrition in the Monteverde Region

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¿Lo que no mata, engorda? : an exploratory profile of elderly nutrition in the Monteverde Region
Translated Title:
¿Lo que no mata, engorda? : Un perfil exploratorio de la nutrición en personas mayores de la región de Monteverde
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Subjects / Keywords:
Older people--Nutrition ( lcsh )
Adultos mayores--Nutricion ( lcsh )
Food preferences ( lcsh )
Preferencias de alimentos ( lcsh )
Costa Rica--Puntarenas--Monteverde Zone
Costa Rica--Puntarenas--Zona de Monteverde
Community Health 2010
Salud Comunitaria 2010


This research seeks to explore the nutritional profile of older generations living in and around Santa Elena and San Luis, Monteverde Region, Costa Rica as impacted by increased globalization. An additional goal of this study is to determine a baseline of factors that contribute to food selections among older generations. This research further seeks to understand generational changes in perceptions of food and to explore nutritional knowledge among older people in the region. ( ,, )
Esta investigación tiene como objetivo explorar el perfil nutricional de las generaciones mayores que viven en los alrededores de Santa Elena y San Luis, Region de Monteverde, Costa Rica impactado por la creciente globalizacion. Un objetivo adicional de este estudio es determinar una linea base de los factores que contribuyen a la selección de alimentos entre las generaciones mayores. Esta investigación busca entender los cambios generacionales en la percepción de los alimentos y explorar el conocimiento nutricional entre las personas mayores en la region.
Student affiliation : University of South Florida
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Banks, Tarika Baxter, Joshua Cox, Austin Gordon, Linda Robinson, Deborah
Lo Que No mata, engorda? : Un perfil exploratorio de la nutricin en personas mayores de la regin de Monteverde
Lo que no mata, engorda? : an exploratory profile of elderly nutrition in the Monteverde Region
c 2010-08
Born Digital
3 520
This research seeks to explore the nutritional profile of older generations living in and around Santa Elena and San Luis, Monteverde Region, Costa Rica as impacted by increased globalization. An additional goal of this study is to determine a baseline of factors that contribute to food selections among older generations. This research further seeks to understand generational changes in perceptions of food and to explore nutritional knowledge among older people in the region.
Esta investigacin tiene como objetivo explorar el perfil nutricional de las generaciones mayores que viven en los alrededores de Santa Elena y San Luis, Region de Monteverde, Costa Rica impactado por la creciente globalizacion. Un objetivo adicional de este estudio es determinar una linea base de los factores que contribuyen a la seleccin de alimentos entre las generaciones mayores. Esta investigacin busca entender los cambios generacionales en la percepcin de los alimentos y explorar el conocimiento nutricional entre las personas mayores en la region.
Text in English.
Older people--Nutrition--Psychological aspects
Food preferences
Costa Rica--Puntarenas--Monteverde Zone
Adultos mayores--Nutricin--Aspectos psicolgicos
Preferencias alimenticias
Costa Rica--Puntarenas--Zona de Monteverde
Community Health 2010
Food selection
Salud Comunitaria 2010
Seleccin de alimentos
t Monteverde Institute : Community Health
M38-00027, ¡Comer bien, estar bien! Calendario de nutricin y salud; M38-00029, Nutricin de los Adultos Mayores; M39-00055, Lo que no mata, engorda? An Exploratory Profile of Elderly Nutrition in the Monteverde Region [ppt]
i Related document;
u http://digital.lib.usf.edu/?m38.28


¿Lo que no mata, engorda? An Exploratory Profile of Elderly Nutrition in the Monteverde Region University of South Florida Globalization and Community Health Field School 2010 Tarika Banks B.S. Oregon State University Joshua Baxter, M.P.H. University of South Florida Austin Cox, A.A. University of South Florida Linda Gordon, M.S. Michigan State University Deborah Robinson B.S., R.D. University of South Florida


Title 2 The research group for elderly nutrition is comprised of Linda Gordon, Tarika Banks, Joshua Baxter, Deborah Robinson, and Austin Cox. Linda Gordon is a Ph.D. student in medical anthropology at Michigan State University; Linda is also obtaining her master degree in public health. Linda has a include health disparities, immigrant health, nutritional health, and food in security. Tarika Banks is currently getti ng her masters in applied medical anthropology at Oregon State University. Tarika has a background interests include nutritional health, globalization, food commoditization, and health disparities. Joshua Baxter will in public health and global health practices from the University of South Florida this August. Joshua has a background i n pre disaster management and relief and clinical work. Deborah Robinson is currently a public health pr at the University of South Florida. Deborah is a re gistered dietitian and has a background in dietetics and health include nutrition and wellness. Austin Cox is an undergraduate in law and human rights. Austin plans on applying to law school in October 2010. Introduction Nutritional profiles are integral to understanding individual and population health worldwide. Increased globalization has le d to changing health and nutrition profiles. The introduction of commodity foods in many countries has contributed to dietary delocalization and a loss of local food production practices (Himmelgreen, 2006). In Costa Rica, specifically in the Monteverde region where tourism and globalization greatly impact the local economy, little information is known about the nutritional changes among certain subsets of the population. This research seeks to explore the nutritional profile of older generations living in and around Santa Elena and San Luis, Monteverde Region, Costa Rica. Social, cultural and economic factors, as well as access to food and nutritional knowledge, influence food selection and consumption (Pérez Lizaur, 2008) . A goal of this study is to determine a baseline of factors that contrib ute to food selections among older generations. This research further seeks to understand generational changes in perceptions of food and to explore nutritional knowledge among older people in the region. Background on Area Santa Elena and San Luis are small rural communities in the north central region of Costa Rica ( Hemmelgreen, Romero Daza, & Vega, 2006 ). Santa Elena has been impacted by the tourism industry, which in turn has affected the diets of the local population. Tourism has benefited the community by bringing jobs, but in return takes away from the local food production in the area. When local farmers take jobs in tourism it takes away from their participation in the local food cooperative, which contribute s to food insecurity within the area ( Himmelgreen et al., 2006 ). When the tourism season slows and jobs related to tourism dissipate, many families struggle and must rely on food staples. As a result, t hese families consume lower priced, processed foods thereby decreasing the overall n utritional composition of the population ( Himmelgreen et al., 2006 ). Social Roles Costa Ricans report using food as a sign of appreciation and hospitality. Women are traditionally the cooks of the household and often times draw pride, self esteem, and respect through their cooking skills. According to Preston Werner (2008 ) Costa Rican women tend to cater to the desires of their children and other family members who want non traditional dishes such as spaghetti and hamburgers, although the mother may p refer to cook traditional meals . Whi le this may be uniqu e , however it may transcribe to other families as well whe re elderly people cook and must cater to their younger family members to be accepted, hence changing their diets. Literature on adolescents show that


Title 3 they inherit their eating habits from their parents, and that they have few healthier choices when it comes to school foods( Mendez Chaco, Santamaria Ulloa, & Rosero Bixby, 2008 ). Hypertension In the elderly population there is a h igh prevalence of hypertension with a diagnosis of 69% of females and 60% of males in Costa Rica . Research shows that m ales have a higher percentage of being unaware that they have high blood pressure and are therefore less likely to be diagnosed indicating that the aforementioned statistic for the male popul ation may be an underestimation . A majority of the elderly population that know s they have hypertension is being treated, primarily with medications used to prevent stroke, heart attacks, and other hear t diseases ( Mendez Chaco et al., 2008) . Methods This project employed a multi methods approach to exploring the nutrition and consumption patterns of the elderly community in the Monteverde region of Costa Rica. The project consisted of three phases incl uding both quantitative and qualitative measures. The first phase of our research was conducted at a health fair in the San Luis community . We conducted a survey ( Appendix B ) in which the questions address ed an array of consumption topics ranging from foo d purchasing patterns in the household to dietary changes linked to diagnoses of nutrition related chronic diseases such as hypertension and diabetes. In addition, we collected blood pressure and glucose measures for all participants, a 24 hour food recall ( Appendix B ) for participants over 50 years of age and anthropometric data ( Appendix B ) including, height, weight, elbow breadth, mid arm circumference, waist circumference, and skinfolds for suprailliac and tricep s . From this data, body mass index ( BMI ) , frame size and disease risk were calculated for each participant. The second phase consisted of a pile sort activity ( Appendix A & A.1 ) and a focus group comprised of participants from the Santa Elena area; due to limitations in time and resources a conveni en ce sample was used to conduct the research. A total of s even people completed the pile sort activity and five people participated in the focus group. The pile sort was designed to identify the ways that commonly consumed foods are categorized; i .e. participants were shown a ser ies of photographs with common and traditional foods and asked to c ategorize them into either The focus group consisted of questions ( Appendix C ) aimed to explore potential changes in cons umption patterns the elderly population may have experienced over time in general and specifically in relation to their nutritional/health needs . Further, questions were designed to explore their perceptions of generational changes in food and eating habit s in the area. Th e third and final phase of data collection took place at the Fería Agricultura (Agriculture Fair) in Santa Elena . The Feria Agricultura is a weekly fair where independent vendors congregate to sell predominantly fresh fruits and vegetables ; a prime location for recruiting members of the local community. At the fair, we administered a quantitative survey ( Appendix D ) to any consenting patrons of the Feria; the only exclusion criterion was if the person was under the age of 50. The survey was designed to identify the frequency with which fruits and vegetables are consumed, where participants shop for their food, what they consider most important when determining where to buy their food, whether they have diabete s or hypertension, and if so whether they follow special food recommendations. Results During phase one and two we were able to recruit a total of 33 participants. At the health fair we had 6 men and 11 women, while at the agriculture fair we had 10 men and 6 women. Figure one su mmarizes the results of the surveys administered. In our sample, o n average women had a higher BMI and larger waist circumference than the ir male counterparts . The women were also more likely to be overweight and obese compared to men , with a ratio of 36 % compared to 16% of men. The data indicate that disk risk among the women is high er when compared to the men where 63% of our female participants had an increased risk (disease risk is a composite score based on anthropometric data) when c ompared to 33% of men . The data from the b lood pressure measurements indicate that both men and


Title 4 women fall within the normal range, although it is important to note that on average women have a slightly higher blood pressure . Further, the implications of the data are l imited because the majority of the women (n=7) indicated that they are currently taking medications specifically for hypertension. There were insignificant differences in their glucose readings with an average 105 among women and 119 among men. Figure 2 represents the prevalence of hypertension and diabetes that was found among the 16 participants at the agriculture fair. The results show that within this sample, men had a higher rate of hy pertension and diabetes. Two male participants had both hypertension and diabetes. The frequency of men having one or both of the diseases was higher than that of the women , with 40% compared to 33% respectively. Figure 3 shows that the two most popular places where our interviewees from the agriculture fair buy their food are the fair the data were collected at and the Super Compro ; a local supermarket that offers some fresh foods but has a much wider variety of prepackaged goods. Following these, were the Cultiva , which is a smaller store that sells mostly vegetables; the Pulperia, which is a smaller convenience store located outside of the do wntown district in Santa Elena; and finall y, one person mentioned exchanging foods . Figure 1 Feria Salud ( Health Fair ) Data Measurement (cm) Men (n=6) Women (n=11) Both Average BMI 24.1 29.4 27 Waist Circumference 85.3 95.23 90.27 Over Weight 1 4 5 Obese 1 4 5 O.W. & Obese Compared to Normal 2:4 8:3 10:7 Increase Disease Risk 2 7 9 Average Blood Pressure 125/69 127/75 126/72 Average Glucose 119 105 112 Taking HBP Pills 0 7 7 Figure 2 La Feria Agricultural Data Disease Men (n=10) Women (n=6) Both Hypertension Diabetes Both Diseases 1 1 2 2 0 0 3 1 2


Title 5 Figure 5 Where do you live? Where N Santa Elena Sero Plano La Cruz Guacimal Casen 8 3 2 2 1 Figure 6 24 hour Food Recall Snacks (19) Breakfast (51) Lunch (50) Dinner (61) Cookies (6) Gallo Pinto(3) Rice (11) Rice (9) Fruits (7) Coffee (15) Beans (7) Beans (6) Fresco (3) Bread (3) Eggs (3) Bread (5) Other (3) Eggs (1) Tortillas (6) Tortillas (6) Tortilla s (8) Chicken (2) Eggs (2) Fruit (5) Fresco (7) Fresco (5) Cookies (2) Soup (2) Soup (1) Cheese (3) Fruits & Vegetables (3) Salad (3) Sour Cream (2) Other (9) Fruits (6) Fresco (2) Chayote (1) Other (7) Chicken (2) Other (15) (# of responses) n=16 Figure 4 What do you consider when buying your food? Why N Price Family Other Nutrition Convenience Tradition Moda 10 5 5 4 3 2 1 Figure 3 Where do you obtain your food? Place N Feria Super Compro Cultiva Pulperia Intecambia Other 10 10 6 5 1 1 Figures 3, 4, and 5 represent the results from three survey questions administered at the agriculture fair . Further, we found that when people shop for food price was the most commonly endorsed factor affecting their decision regarding where to shop. From the pile sort data ( Appendix A and A.1 ) , we found that a majority of the foods included in the activity ewer of of f ruits and vegetables in a ddition to chicken and bee f. The sugar drinks, caffeinated beverages, oil, butter, condiments, and fried foods. Many participants classified the processed foods as


Title 6 Figure 6 represents the 24 ho ur food recall that was collected from the health fair. It was split into four categories of meals: snacks, breakfast, lunch, and dinner. Under category were mentioned most frequently (n= 7 ) , followed by cookies with (n= 6 ) . There were a total of 51 responses for breakfast, and coffee was the most listed beverage with a total of 15 responses. The food item that was most commonly listed was tortillas with a total of 8. Fresco was the most commonly listed drink item under l unch, with a total of 7 responses. The most common food item for lunc h was rice with resco was the beverage with the most responses with a total of 5. The food item with the most responses was rice with a total of 9. Focus Group Results The focus group with five individuals from the Santa Elena area was vital in providing depth to the mostly quantitative data gathered at the health fair and agricultural fair. The goal of the focus group was to explore food perceptions of the participants as members of older generations in the area. We were also interested in how the group described generational changes in food production and consumption, as well as changes in their own consumption over time as a resul t of changes in health or illness status. Several themes emerged during the focus group, including generational changes in cultivation of food, preparation time and use of pre prepared foods. The group further expanded this theme by discussing the need fo r nutritional education among today's youth. One 77 year old woman described the younger Compran los sacos de cornflakes, que parece comida para animales, para no tener que hacer desayuno, para no tener que hacer un pintico o tener que hacer unas tortillitas para darle a los chiquitos don't have to make breakfast, so they don't have to, so they don't have to make gallo pinto or make tortillas to giv e to the children). The participants described that more elderly individuals who must depend on others for their foods are in little control over their diet s. They described the helpers cooking with an excess amount of oil, or frying certain foods. Once participant believed that control over their diets could be gained with talking to the helpers with respect and trying to convey a healthier way of food pre paration rather than criticism. Perceptions of a healthy body type was a theme the group did not agree on. One woman described a man who had lost a great deal of weight as looking ill and further commented, " No me gusta la gente flaca, ni las vacas se v en bonitas flacas " (I don't like the thin people, not even thin cows look pretty). Another participant said that she was very skinny as a young married woman and tried to gain weight so that people would not comment to her husband about her weight. Howev er, yet another participant commented that she thinks people should not be really skinny or really fat, but that thin people look healthier and their clothes fit better. Another woman agreed and we observed that these women were also the ones who reported having changed their diets for health reasons. Discussion The impact that globalization has on health, specifically nutritional health, has been well documented, particularly in regions where tourism is increasing ( Himmelgreen et al., 2006 ). Although research aimed at exploring the impacts tourism has on nutritional health has been conducted, there is an absence of work that explores how subsets of such populations are differentially affected. For example, in their research on tourism and f ood insecurity in two rural Costa Rican communities, Himmelgreen and colleagues discuss findings that body mass index is positively correlated with food insecurity; where research of this nature provides important insight into the relationship between cons umption patterns, food insecurity and ultimately nutritional health, the implications of their findings are constrained by demographic factors such as age and gender. (Himmelgreen et al., 2006). As such, the aforementioned research speaks to the constraint s of previously conducted research by focusing on an understudied subset of Costa Ricans; older adults (both male and female) aged 50 years or older. Evidence indicates a change in the general health of Costa Ricans where there is a marked epidemiological transition in which the prevalence of chronic degenerative conditions is incr easing .


Title 7 (Himmelgreen et al., 2006) . It is precisely because of this change that the inclusion of older adults in research exploring the impacts of tourism on community health is particularly relevant; by focusing on the specific health profile of older adults, cross generational comparisons can be drawn and multidimensional depictions of the impacts of tourism over time can be constructed. Consistent with findings from previous research, the exploratory work discussed here highlights a multitude of topics that should be considered for future work. For example, the data showing gender differences in overweight and obesity rates indicate potential variations in consumption pattern s and/or physical activity. These disparities at least partially, may be linked to the documented gender differences in occupation s among Costa Ricans, where men, in comparison to women, more commonly work outside of the home in physically demanding settin gs. Further, there is evidence to suggest that women, particularly those who work in relatively isolated settings (e.g. at home) may be at an increased risk for mental illness ( Kessler et al., 1982 ). With consideration of such an increased risk, local info rmants have speculated that a possible factor affecting gender differences in overweight and obesity are linked to gender differences in coping strategies; i.e. increased consumption among women in response to distress. Further, if this relationship is exp lored in more depth, focusing on an older population has the potential to not only substantiate the claim but also provide insight into how this trend may be changing in light of transitions in traditional occupational roles linked to increased tourism. F inally, an important aspect of nutritional health that needs to be considered is how changing trends in body ideals interacts with consumption choices. For example, research shows that changes in perceptions of attractive and/or healthy body types have bee n linked to expanding globalization ( Becker et al., 2005 ). Costa Rica, particularly the Monteverde Zone, is susceptible to such changes as it is increasingly becoming an area with contact from non indigenous communities and their potentially inconsistent i deals. The data from this research supports the potential for a shift in current body ideals, not only between genders but within them, away from more traditional ideals as evidenced by the aforementioned excerpt from the focus group regarding s Although the implications of these quotes are limited, they certainly provide a justification for further inquiry. In addition to gender differences in nutritional health among older populations, the data from this research supports an increasing focus on generational differences. These differences include not only consumption habits but encompass both preparation and community aspects of eating. The following quote from the focus group depicts a general sentiment f d preparation and food choices: Compran los sacos de cornflakes, que parece comida para animales, para no tener que hacer desayuno, para no tener que hacer un pintico o tener que hacer unas tortilli tas para darle a los chiquitos. Una mujer tiene 77 años The participants continued to discuss what their eating habits were like when they were younger; they described a greater sense of community involved in their food preparation and unanimously agreed that styles and cuisine and attempt to fully engage in their eating practices by taking time to prepare fresh meals. Alth ough limited, this supports a need to explore more intricately how the older population interacts with food purchasing, preparation, and consumption. This is a particularly rich topic with consideration of the influx of processed foods and changing communi ty values regarding eating habits linked to increased globalization. Further, the data showing that price and convenience continue to be prioritized when making decisions about what foods to purchase points to a potential conflict between ues surrounding consumption habits and the increasing access to lower priced , processed foods where tradition based choices may be sacrificed for economic preservation.


Title 8 Conclusion The impacts of globalization are becoming more prominent as more and mor e time elapses between contemporary cultural practices and what is considered traditional. As such, it is imperative to design research efforts with the aim of identifying the nature of such impacts on subsets of the population. This research provides a so und starting point for future work by identifying a variety of themes relevant to globalization and health among older populations. As the discussion above implies, it is not entirely clear how and through what variables individual s relationships with food (including consumption, purchasing, and preparation) are mediated; however, the data presented here justify future work among older populations with a particular focus on within and between gender and generational differences. Finally, it is importan t to note that careful attention should be given to the differing perspectives on health needs of older populations in the Monteverde region. Although not an original aim of this study, feedback received from local experts regarding the profile of the heal th and needs of older populations was often times conflicting. This indicates that there is not only a need for clarification regarding what the needs of the population are but also perhaps a clarification of how different institutional and/or national lev should be prioritized certainly all of the information from each informant should be valued and treated as relevant data; however, focusing research speci fically on how and why there is a disconnect among health care workers has the potential to enhance future efforts aimed at lessening the disease burden of the older Costa Rican population. A combination of an institutional exploration and a local level in vestigation , promise to move research efforts away from the theoretical towards more sustainable and culturally informed application s .


Title 9 R eferences Becker, A.E., Gilman, S.E., & Burwell, R.A. (200 5). Changes in Prevalence in Overweight and in Body Image among Fijak Women between. Obesity Research, 13(1). Himmelgreen, D.A., Romero Daza, N., & Vega, M. (2006). The Tourist Seaso n Goes Down But Not The Prices. Tourism And Food Insecurity In Rural Cost a Rica. Ecology of Food and Nutrition, 45. Retrieved from http://www.informaworld.com/smpp/content~db=all~content=a756747060 . Instituto Nacional De Estadistica y C e nsos. (2007 ). Encuesta de Hogares de Propositos Mulitples Cifras Basicas Sobre Fuerza de Trabajo. INEC. Retrieved from http://www.inec.go.cr. Kessler, R.C., & McRae, J.A. (1982). The Effect of Wives' Employment on the Mental Health of Married Men and Women. American Sociological Review , 47(2). Mendez Chacon, E., Santamaria Ulloa, C., & Rosero Bixby, L. (2008). Factors associated with hypertension prevalence, unawareness and treatment among Costa Rican elderly. BMC Public Health. Retrieved from http://www.biomedcentral.com/1471 2458/8/275 . Monge Rojas, R., Garita, C., Sanchez, M., & Munoz, L. (2005). Barriers to and Motivators for Healthful Eating as Perceived by Rural and Urban Costa Rica Adolescents. Journal of Nutrition Education Behavior, 37. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15745654 . Pérez Lizaur, A. B., Kaufer Horwitz, M., & Plazas, M. (2008). Environmental and personal correlates of fruit and vegetable consumption in low income, urban Mexican children. Journal of Human Nutrition & Dietetics, 21(1). Preston Werner, T. (2008). In the Kitchen: Negotiating Changing Family Roles in Costa Rica. Journal of Folklore Research, 4 5(3). Retrieved from http://muse.jhu.edu/login?uri=/journals/journal_of_folklore_research/v045/45.3.preston werner.html .


Title 10 Appendix A Pile Sort Data Foods N Healthy N Unhealthy % Healthy : Unhealthy Coffee with milk 4 5 44 : 56 Tang 1 8 11 : 89 Lemon 8 1 89 : 11 Papaya 8 1 89 : 11 Watermelon 9 0 100 : 0 Pork 3 6 33 : 67 Chicken 7 2 78 : 22 Beef 5 4 56 : 44 Soup 7 2 78 : 22 Chicharron 2 7 22 : 78 Empanadas 3 6 33 : 67 Soda Crackers 6 3 67 : 33 Corn tortilla 5 4 56 : 44 Wheat Bread 8 1 89 : 11 Pastas 5 4 56 : 44 Fresh Cheese 7 2 78 : 22 Onion 7 2 78 : 22 Fried plantains 4 5 44 : 56 Beans 8 1 89 : 11 Lettuce 9 0 100 : 0 Tomatoes 9 0 100 : 0 Yucca 7 2 78 : 22 Coca C ola 1 8 11 : 89 Milk 7 2 78 : 22 Marmalade 5 4 56 : 44 Tuna 5 4 56 : 44 Tortilla Chips 3 6 33 : 67 White sugar 2 7 22 : 78 Vegetable oil 5 4 56 : 44 White rice 6 3 67 : 33 Consume 1 8 11 : 89


Title 11 Appendix A.1 Pile Sort Data Food N Healthy N Unhealthy % Healthy : Unhealthy Granola 7 2 78 : 22 Butter 3 6 33 : 67 Bananas 9 0 100 : 0 Mangos 9 0 100 : 0 Pineapple 8 1 89 : 11 Eggs 8 1 89 : 11 Plantains 8 1 89 : 11 Chayote 9 0 100 : 0 Potatoes 6 3 67 : 33 Avena 8 1 89 :11 Mayonaise 4 5 44 : 56 Sour Cream 3 6 33 : 67 Water 9 0 100 : 0 Salchichon 3 6 33 : 67 Salsa Liz ano 0 9 0 : 100


Title 12 Health Fair Survey Appendix B Nutrition Group 1 Code: _______ Interviewer: _____________ Direcciones: Le vamos a hacer algunas preguntas sobre su alimentación. 1. ¿ En su hogar, quien decide que comida se .compra ? ( Who decides what food to purchase?) 2. ¿ Q uien cocina en su casa? ( Who cooks in your household? ) 3. ¿ Cuantas veces al dí a come Usted ? ( How many times a day do you eat?) 4. ¿Ud. usualmente que comida come? ( What are typical foods you eat? ) 5. ¿Ud. come meriendas durante el dí a? ( Do you eat snacks during the day?) 6. ¿ Q ue tipo meriendas? ( What types of snacks?) 7. ¿ Ud. q ue tipo de bebida toma durante la comida? ( What do you normally drink with meals?) 8. ¿ Bebe alg una otra cosa . durante el dí a? ( Do you normally drink something throughout the day?) 9. Ud. tiene: diabétes hiperten s ión 10. Ud . recibe tratamiento o medicina para la diabetes ? SI _____ NO _____ 11. Si , SI _De qui en? _____________________________________________________ 12. Que tratamiento recibe? .


Title 13 13. Recibe tratamiento para la hiperten s ión? SI _____ NO _____ 14. Si , SI _De quien? _____________________________________________________ 15. Que tratamiento recibe? 16. Hace algo m á s para controlar la diabetes? 17. Para la hipertensión? 18. Le han dado recomendaciones especial es de alimentación para controlar la diabetes o la hiperten s ión? 19. Ha podido .seguir esas recomendaciones ? Nunca Casi nunca Alguna veces Casi siempre siempre 20. Porque ?


Title 14 Focus Group Discussion Question Appendix C PREGUNTAS DE DISCUSION DE GRUPO Welcome : Consent forms, pile sort, and ice breaker (question #1) 1 . Cúal es su comida favorita? 2 . Dis cuss results of pile sorts. 3 . Estamos interesados en saber como es la nutricion de los adultos mayores. Como describirian Ustedes la nutricion de una persona mayor comparada con la de una persona mas jove n? (Probe for reasons for any differences mentioned) Cambios: Salud, sabor, economicos 4 . Ha habido cambios en la comida que ustedes comen porque de cambios en salud? Probe: Por ejem plo diabetes o problemas con dientes ? 5. Hay cambios en la preparacion de la comida de los adultos mayores porque de salud? Probes for #4 Salud Sabor Dientes Familia 6. Uds. piensan que habia adultos mayores en la comunidad quien recibian un regimen alimientaci on por diabetes o hipertension? 7. Creen que estas personas siguen algún régimen de alimentacion para la diabetes o hipertension? Por que


Title 15 Agricultural Fair Survey Appendix D ENCUESTA PARA LA LA FERIA DE AGRICULTORES NUTRICION EN ADULTOS MAYORES) Buenos días, somos estudiantes del Instituto Monteverde y queremos hacerle unas preguntas rápidas sobre su alimentación Cual es su fecha de nacimiento? _____________ Edad: 1 . Donde vive? 2 . ¿Ud. cómo dirí a que son sus hábitos de alimentación? ___ Malos ____Mas o menos ____Buenos ____ Excelentes 3 . Cuantas veces come frutas en un día? ___ 0 ___ 1 2 ___ 3 4 ___ 5+ 4 . Cuantas veces come verduras en un día? ___ 0 ____ 1 2 ___ 3 4 ___ 5+ 5 . De donde obtiene su comida? ___ La feria ___ la cultiva ___ Super Compro/Super Mercado ___ Puntarenas ___ Pulperia ___ Intercambia con vecinos o familiares Otro _______________________ 6 . Si la compra, por que la compra en (el supermercado, la pulperia, erc.)____________? 7 . Que cosas tiene en cuenta al comprar la comida?


Title 16 ___ Precio ___ Conveniencia ___ Tradición ___ Nutrición __ Los gustos de su familia ___ Factores S ocial ___ Otro ________________ ___ Lo que esta de moda? 8 . Algun doctor le ha dicho que tiene: ___ Diabetes ___ Hipertensión (presion alta) 9 . Ud. sigue algún régimen de alimentacion para la diabetes? ___ Nunca ___ Casi nunca ___ Algunas ve ces ___ Casi siempre ___ Siempre Que hace? Por que?: 10 . Ud. sigue algún régimen de alimentacion para la hipertensión? ___ Nunca ___ Casi nunca ___ Algunas veces ___ Casi siempre ___ Siempre Que hace? Por que?:


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Nunc fringilla dolor ut dictum placerat. Proin ac neque rutrum, consectetur ligula id, laoreet ligula. Nulla lorem massa, consectetur vitae consequat in, lobortis at dolor. Nunc sed leo odio.