Ethical approval
The research protocol received approval from the Ethics Committee of the Universidad Marista de Merida (Reference number CEUMM_002_2017). We provided comprehensive explanations of informed consent and associated documents to all participants during a dedicated group session that cultivated a trustworthy and secure environment open to inquiries. We tailored the explanation to local language nuances. Subsequently, we obtained signed informed consent from all participants. All methods were conducted under the approved protocol and complied with national and international regulations for human research (