Process evaluation of the Yéego! Program to increase healthy eating and gardening among American Indian elementary school children

BACKGROUND

American Indian children are at increased risk for obesity and diabetes. School-based health promotion interventions are one approach to promoting healthy behaviors to reduce this risk, yet few studies have described their implementation and fidelity. We conducted a qualitative process evaluation of the Yéego! Healthy Eating and Gardening Program, a school-based intervention to promote healthy eating among Navajo elementary school children. The intervention included a yearlong integrated curriculum, as well as the construction and maintenance of a school-based garden.

METHODS

Our process evaluation included fidelity checklists completed by program staff and qualitative interviews with program staff and classroom teachers after the intervention was implemented. We used content analysis to identify themes.

RESULTS

We identified several themes related to evidence of delivery adherence, program satisfaction, and lessons learned about delivery. Intervention staff followed similar procedures to prepare for and deliver lessons, but timing, teaching styles, and school-level factors also impacted overall implementation fidelity. Teachers and students had positive perceptions of the program, especially lessons that were highly visual, experiential, and connected to Navajo culture and the surrounding community. Teachers and program staff identified ways to enhance the usability of the curriculum by narrowing the scope, relating content to student experiences, and aligning content with school curriculum standards.

CONCLUSIONS

The program was implemented with moderately high fidelity across contexts. We identified areas where modifications could improve engagement, acceptability, efficacy, and sustainability of the program. Our results have implications for the evaluation and dissemination of school-based health interventions to promote healthy eating among children, especially in American Indian communities.

Agricultural soils of the Animas River watershed after the Gold King Mine spill: An elemental spatiotemporal analysis via portable X-ray fluorescence spectroscopy

In August 2015, 11.3 million L of heavy metal-contaminated water spilled into the Animas River from the Gold King Mine (Colorado, USA). National attention focused on water quality and agricultural production in areas affected by the spill. In response to local concerns, surface soil elemental concentrations were analyzed in three New Mexico agricultural fields to determine potential threats to agronomic production. Irrigated fields in the Animas watershed were scanned using portable X-ray fluorescence (PXRF) spectrometry to monitor the spatiotemporal variability of Pb, As, Cu, and Cr. A total of 175 locations were scanned using PXRF before and after the growing season for 3 yr. The geostatistical model with the lowest RMSE was chosen as the optimal model. The lowest RMSE for the elements ranged from to 0.10 to 0.44 m for As, from 0.50 to 0.98 m for Cr, from 0.15 to 0.91 m for Cu, and from 0.14 to 0.44 m for Pb across the models selected. The spatial dependence between the measured values exhibited strong to moderate autocorrelation for all metals except for As, for which spatial dependence was strong to weak. Some areas in each field exceeded the New Mexico Environment Department soil screening limit of 7.07 mg As kg^-1 . All sampling locations were below the screening limit at last sampling time in 2019. Mixed models used for temporal analysis showed a significant decrease only in As below the screening value at the end of the study. Results indicate that the agricultural soils were below the soil screening guideline values.

Can Community Gardens with Workshops Increase Gardening Behavior? A Navajo Wellness Collaboration

This project evaluated the potential efficacy of a community gardening intervention on the Navajo Nation to increase gardening and healthy eating behaviors, which are potentially important in preventing obesity and related health conditions. Rates of obesity are high among American Indians, including those living on Navajo Nation land. Eating fresh fruits and vegetables is part of healthy eating. However, availability and access to fresh fruits and vegetables are severely limited due to distance and cost. One way to increase both availability and consumption of fresh fruits and vegetables is through community gardening, yet many on the Navajo Nation have limited knowledge and capacity to garden.

METHODS

We used a quasi-experimental pre-post study design to estimate the effect of a community gardening intervention. Primary outcomes of interest were gardening frequency and fruit and vegetable consumption. Community gardens were constructed and planted in two communities on the Navajo Nation. In addition, a series of gardening workshops were held in each community. Community members were recruited to complete surveys at time points before and after the workshops. The time between baseline and follow-up was approximately one year.

RESULTS

We surveyed 169 participants at one time point at least, across both communities, and 25 of these participated in the gardening workshops. Within the 169, there was a cohort of 32 participants completing both baseline and follow-up surveys. For this cohort, interest in gardening increased from 78% to 97% (p=0.014), but none of the changes in gardening self-efficacy, knowledge or gardening frequency reached statistical significance. There were no measurable changes in reported fruit and vegetable consumption, self-efficacy or knowledge. Overall, the reported financial barriers to gardening increased from baseline to follow-up from 4.6 to 5.5 (p=0.035). Among those who completed follow-up, those who attended at least one workshop gardened more frequently than those who did not attend any workshops (21 times per month compared to 10 times per month (p=0.065).

CONCLUSION

Despite enthusiasm for the community garden in both the communities studied and the increased interest in gardening, workshop attendance and participant retention in the study were low. These factors limited our ability to evaluate the potential efficacy of the intervention on gardening and healthy eating behaviors. Nonetheless, we found some evidence that participating in gardening workshops may lead to increased gardening frequency. Future studies should augment the intervention to include explicit efforts to reduce barriers to long term engagement and extend intervention reach.

Heavy metal content of produce grown in San Juan County (New Mexico, USA)

The Animas River Watershed has long received discharges of naturally occurring acid rock drainage; however, on August 5, 2015, three million gallons flowed into the agricultural region of Farmington, New Mexico and the Navajo Nation. Consumers and growers in the region were fearful that produce might absorb heavy metals from contaminated irrigation water originating from these rivers. Samples were collected from the region including corn (n = 30), pumpkin (n = 10), squash (n = 10), and cucumber (n = 10) then processed and tested using inductively coupled plasma-optical emission spectrometry (ICP-OES) for concentrations of nine metals of interest. These include toxic metals: Al, As, and Pb, which were compared to the World Health Organization limits, 18.29 mg d^-1, 0.192 mg d^-1, and 0.05 mg kg^-1, respectively and essential metals: Cr, Fe, Mn, Zn, Ca, and Cu whose levels were compared to the National Academies' dietary references for tolerable upper intake levels. Results indicate that produce grown in the region contained significantly less metal than the allowable limits, except for Pb in two corn samples. This research is the first attempt to monitor and analyze heavy metal absorption of produce in the area.

Gardening for Health: Patterns of Gardening and Fruit and Vegetable Consumption Among the Navajo

American Indians, including Navajo, are disproportionately affected by obesity and diabetes, in part due to diet-related health behaviors. The purpose of this study was to assess the patterns of gardening and fruit and vegetable (FV) consumption among residents in two communities on the Navajo Nation in order to inform a community gardening intervention. We analyzed survey data collected from participants in the Yéego Gardening study conducted in two communities in the Navajo Nation (N = 169). We found that 51% of the sample gardened, and on average participants gardened 8.9 times per month. Lack of time (53%) and financial barriers, such as gas for transportation or irrigation (51 and 49%, respectively), were reported as barriers to gardening. Most participants reported low levels of self-efficacy (80%) and behavioral capability (82%) related to gardening. Those with higher levels of gardening self-efficacy and behavioral capability reported more frequent gardening. Average daily FV consumption was 2.5 servings. Most participants reported high levels of self-efficacy to eat FV daily (64%) and high behavioral capability to prepare FV (66%). There was a positive association between FV consumption and gardening, with those gardening more than 4 times per month eating about 1 more serving of FV per day than those gardening 4 or fewer times per month. Further research is needed to better understand how gardening can increase fruit and vegetable availability and consumption among residents of the Navajo Nation.

Yéego Gardening! A Community Garden Intervention to Promote Health on the Navajo Nation

BACKGROUND

Yéego Gardening! is a community garden intervention to increase gardening behavior, increase access to low-cost fruit and vegetables, and ultimately increase consumption in Navajo communities.

OBJECTIVES

To design a theory-based, culturally relevant intervention with three components: a community garden, monthly workshops on gardening and healthy eating, and community outreach.

METHODS

Gardens were constructed and maintained in collaboration with community-based organizations in two Navajo communities. Monthly workshops were held throughout the growing season and incorporated aspects of Navajo culture and opportunities to build confidence and skills in gardening and healthy eating behaviors. In addition, program staff attended community events to promote gardening and healthy eating.

CONCLUSIONS

Community input was essential throughout the planning and implementation of the intervention. If effective, community gardens may be a way to increase fruit and vegetable availability and intake, and ultimately reduce risk of obesity and diabetes.

Compliance of energy-dense, small volume oral nutritional supplements in the daily clinical practice on a geriatric ward--an observational study

INTRODUCTION

Compliance is important in optimizing the clinical effectiveness of oral nutritional supplements (ONS). Small volume, energy-dense ONS (ED-ONS; ≥ 2 kcal/ml) have been shown to improve compliance in clinical trial settings. However, data from clinical practice is still lacking. The aim of the present study was to evaluate the effect of ED-ONS on the compliance in an observational set-up to obtain data from daily clinical practice on a geriatric ward.

METHODS

Geriatric inpatients, undernourished or at risk of undernutrition received two servings of either ED-ONS (125 ml, 2.4 kcal/ml: Nutridrink Compact Energy, Nutricia) or a standard ONS (S-ONS; 200 ml, 1.5 kcal/ml: Nutridrink) as part of their daily routine care. Patients were allocated to a group according to availability of beds and placement on the ward. Compliance (kcal/day and % of prescribed volume) was assessed by weighing returned bottles. Data were analyzed via Mixed Model for Repeated Measures.

RESULTS

Forty-seven patients received ED-ONS, and 61 patients received S-ONS. Compliance was significantly higher with ED-ONS in geriatric inpatients compared to S-ONS ( 378 ± 14.0 kcal/day vs. 337 ± 13.6 kcal/day (mean ± SEM), p = 0.039, 63.0 ± 2.34% vs. 56.2 ± 2.26%, p = 0.039). Moreover, a trend (p=0.078) was observed towards an increasing difference in compliance over time.

CONCLUSION

This study shows that compliance to ED-ONS is significantly better than to S-ONS in daily clinical practice. Although small, the difference in compliance seems to increase over time, suggesting clinical relevance with longer treatment.