Cardiovascular

Community-based social connection intervention programme to improve cardiovascular and brain health in older adults in rural Ecuador: study protocol for a quasi-experimental trial.

TL;DR

This paper describes a protocol for a quasi-experimental matched-control trial to determine whether a 12-month multi-component social connection intervention programme (SCIP) can reduce loneliness and social isolation and improve cardiovascular, cognitive and psychosocial outcomes among older adults in rural Ecuador.

Key Findings

Loneliness and social isolation are recognised as determinants of cardiovascular and brain health in older adults, with evidence from high-income settings linking social disconnection to higher risk of coronary heart disease, stroke, cognitive decline and mortality.

  • The authors note that few interventions have been adapted for rural, resource-limited environments.
  • The study is motivated by a gap between evidence generated in high-income settings and the needs of underserved rural populations.
  • The intervention is grounded in Social Cognitive Theory to ensure cultural relevance.

The study will be conducted in three rural coastal villages in Ecuador, using Atahualpa as the intervention site and El Tambo and Prosperidad as matched control sites.

  • The rural coastal Ecuador setting was selected because of its demographic stability, low migration rates, and strong community engagement.
  • These villages are part of an existing population-based cohort.
  • The quasi-experimental matched-control design was chosen to evaluate a culturally grounded intervention in a resource-limited environment.

Eligible participants are adults aged 60 years or older without disability, dementia, or major psychiatric illness, matched to controls using variable-ratio propensity score methods.

  • Participants must be residents of the study villages and free of disability, dementia, and major psychiatric illness.
  • Intervention participants will be matched to control participants using variable-ratio propensity score matching to reduce selection bias.
  • Control village participants will receive usual community and primary care services without exposure to SCIP activities.

The 12-month Social Connection Intervention Programme (SCIP) is a multi-component intervention including monthly community educational activities, peer-support group sessions, and individualised coaching twice per month.

  • Individualised coaching is focused on skill-building, goal-setting and cognitive-behavioural strategies.
  • The programme runs for 12 months.
  • Coaching sessions occur two times per month, with monthly community educational activities and peer-support group sessions as additional components.

Baseline and 12-month assessments will measure a comprehensive range of outcomes including social isolation, loneliness, cardiovascular health, sleep quality, cognitive performance, depressive symptoms, and quality of life.

  • Incident stroke, cardiovascular disease, and mortality will be monitored quarterly throughout the study period.
  • Analyses will use mixed-effects models for continuous and categorical outcomes.
  • Cox proportional hazards models will be used for incident events, adjusting for relevant confounders.

The authors anticipate that findings may inform scalable strategies to enhance psychosocial well-being and reduce cardiovascular and cognitive risk in underserved rural populations.

  • Results will be disseminated through peer-reviewed publications, conference presentations, and community reports.
  • The protocol was approved by the Ethics Committee of Hospital-Clinica Kennedy, Guayaquil.
  • All participants will provide written informed consent.
  • The trial is registered under NCT07319663.

What This Means

This research describes the design of a study testing whether a structured social connection programme can improve the health of older adults living in rural villages in Ecuador. The programme, called SCIP, runs for 12 months and includes group educational sessions, peer support meetings, and one-on-one coaching twice a month focused on building social skills, setting personal goals, and using mental health strategies. One village receives the programme while two neighbouring villages serve as comparison groups, and researchers will track changes in loneliness, social isolation, heart health, sleep, memory, mood, and quality of life before and after the programme. This research suggests that social disconnection — feeling lonely or cut off from others — may be an important but underappreciated risk factor for serious health problems like heart disease, stroke, and memory loss in older people, especially in rural or low-resource settings. Most previous studies on this topic have been conducted in wealthy, urban countries, so this trial aims to fill a critical gap by testing whether a community-based approach can work in a rural Latin American context where resources are limited but community ties are strong. If the intervention proves effective, it could provide a practical model for other rural and resource-limited communities around the world to address the health consequences of social isolation among older populations. The study also highlights that health is shaped not just by medical factors but by social ones, and that community-level programmes designed with local culture in mind may offer a scalable way to improve wellbeing in underserved areas.

Have a question about this study?

Citation

Del Brutto V, Leal G, Mera R, Rumbea D, Abad M, Del Brutto O. (2026). Community-based social connection intervention programme to improve cardiovascular and brain health in older adults in rural Ecuador: study protocol for a quasi-experimental trial.. BMJ open. https://doi.org/10.1136/bmjopen-2026-118544