{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:13:52Z","timestamp":1788444832609,"version":"build-2803163510"},"reference-count":47,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100017418","name":"Universidad de Especialidades Esp\u00edritu Santo","doi-asserted-by":"publisher","award":["n\/a"],"award-info":[{"award-number":["n\/a"]}],"id":[{"id":"10.13039\/100017418","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Loneliness and social isolation are increasingly recognised as determinants of cardiovascular and brain health, particularly among older adults. Evidence from high-income settings links social disconnection to higher risk of coronary heart disease, stroke, cognitive decline and mortality, yet few interventions have been adapted for rural, resource-limited environments. In rural coastal Ecuador, demographic stability, low migration and strong community engagement provide a unique context to evaluate a culturally grounded intervention. This study aims to determine whether a multi-component social connection intervention programme (SCIP), informed by the Social Cognitive Theory, can reduce loneliness and social isolation and improve cardiovascular, cognitive and psychosocial outcomes among older adults living in three rural villages participating in a population-based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This quasi-experimental matched-control study will be conducted in Atahualpa (intervention site) and the neighbouring villages of El Tambo and Prosperidad (control sites). Eligible participants are adults aged \u226560 years without disability, dementia or major psychiatric illness. Intervention participants will be matched to controls using variable-ratio propensity score methods. The 12-month SCIP includes monthly community educational activities, peer-support group sessions and individualised coaching (two times per month) focused on skill-building, goal-setting and cognitive-behavioural strategies. Participants in the control villages will receive usual community and primary care services without exposure to SCIP activities. Baseline and 12-month assessments will measure 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. Analyses will use mixed-effects models for continuous and categorical outcomes and Cox proportional hazards models for incident events, adjusting for relevant confounders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>The protocol was approved by the Ethics Committee of Hospital-Clinica Kennedy, Guayaquil. All participants will provide written informed consent. Findings will be disseminated through peer-reviewed publications, conference presentations and community reports. Results may inform scalable strategies to enhance psychosocial well-being and reduce cardiovascular and cognitive risk in underserved rural populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" xlink:href=\"NCT07319663\">NCT07319663<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-118544","type":"journal-article","created":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T13:10:43Z","timestamp":1780319443000},"page":"e118544","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["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"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct07319663","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct07319663","registry":"10.18810\/clinical-trials-gov"}],"author":[{"given":"Victor J","family":"Del Brutto","sequence":"first","affiliation":[{"name":"University of Miami, Miller School of Medicine, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giselle","family":"Leal","sequence":"additional","affiliation":[{"name":"Insight Neurocognitive and Behavioral Center, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robertino M","family":"Mera","sequence":"additional","affiliation":[{"name":"Statistics\/Epidemiology, Freenome Holdings Inc, South San Francisco, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisse A","family":"Rumbea","sequence":"additional","affiliation":[{"name":"Research Center, Universidad de Especialidades Espiritu Santo, Samborondon, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Jose","family":"Abad","sequence":"additional","affiliation":[{"name":"School of Clinical Psychology, Universidad de Especialidades Espiritu Santo, Samborondon, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1917-8805","authenticated-orcid":false,"given":"Oscar H","family":"Del Brutto","sequence":"additional","affiliation":[{"name":"Research Center, Universidad de Especialidades Espiritu Santo, Samborondon, Ecuador"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,1]]},"reference":[{"key":"2026090306254313000_16.6.e118544.1","doi-asserted-by":"publisher","DOI":"10.1161\/circulationaha.123.065717"},{"key":"2026090306254313000_16.6.e118544.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.inhe.2009.02.003"},{"key":"2026090306254313000_16.6.e118544.3","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30045-2"},{"key":"2026090306254313000_16.6.e118544.4","doi-asserted-by":"publisher","DOI":"10.1161\/cir.0000000000001078"},{"key":"2026090306254313000_16.6.e118544.5","doi-asserted-by":"crossref","DOI":"10.3389\/fpsyg.2024.1419731","article-title":"Psychological risk factors and cardiovascular disease","volume":"15","author":"Carola","year":"2024","journal-title":"Front Psychol"},{"key":"2026090306254313000_16.6.e118544.6","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.122.026493","article-title":"Effects of Objective and Perceived Social Isolation on Cardiovascular and Brain Health: A Scientific Statement From the American Heart Association","volume":"11","author":"Cen\u00e9","year":"2022","journal-title":"J Am Heart Assoc"},{"key":"2026090306254313000_16.6.e118544.7","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-023-15967-3","article-title":"The state of loneliness and social isolation research: current knowledge and future directions","volume":"23","author":"Taylor","year":"2023","journal-title":"BMC Public Health"},{"key":"2026090306254313000_16.6.e118544.8","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-308790"},{"key":"2026090306254313000_16.6.e118544.9","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2025-224665"},{"key":"2026090306254313000_16.6.e118544.10","doi-asserted-by":"crossref","unstructured":"Maneemai O , Maneemai K . 2025 Social isolation and loneliness as modifiable risk factors for dementia: Evidence-based interventions and public health implications. 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