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Mixed-Methods Implementation Study of a Home Garden Intervention in Rural Guatemala Using the RE-AIM Framework

Published:March 08, 2022DOI:https://doi.org/10.1016/j.jand.2022.03.005

      Abstract

      Background

      Home gardening is a strategy to improve nutrition and food security. More information is needed about optimizing gardens in different contexts.

      Objective

      The aim was to identify implementation barriers and facilitators for a home gardening intervention in rural Guatemala and inform future larger-scale interventions in the region.

      Design

      A mixed-methods implementation study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was conducted from January 2019 to July 2020.

      Participants/setting

      Families (n = 70) in rural Guatemala participated in the intervention. Staff (n = 4), families (n = 6), and community stakeholders (n = 3) participated in interviews or focus groups.

      Intervention

      Participating households received seeds and seedlings for 16 crops, garden construction materials, agronomist-delivered education and assistance, and a standard-of-care nutrition program.

      Main outcome measures

      Implementation data were collected from program records and observations, participant surveys, and interviews and focus groups. Crop count and nutritional functional diversity of home gardens were assessed.

      Statistical analyses performed

      Descriptive statistics were calculated for quantitative outcomes. Qualitative data were double-coded and organized into overarching themes.

      Results

      Reach: Ninety percent of eligible households participated. Child nutritional eligibility criteria was a barrier to reach. Effectiveness: Participants and stakeholders felt the intervention improved access to diverse foods. Cultivated crops increased an average of five species (95% confidence interval [CI], 4–6) at 6 months, although not all were consumed. Adoption: The main community adoption barrier was water sourcing for garden irrigation. Implementation: Raised beds were the most common gardening method, with good adoption of agricultural best practices. Gray water filters and flexible implementation were important for participation. Maintenance: Crops failure rates were low. Seed availability was a sustainability challenge. Direct costs were 763 USD per household.

      Conclusions

      Interest and engagement with a home garden intervention in Guatemala were high. Gaps between garden production and consumption, access to water, and seed sourcing should be addressed in future work.
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      Biography

      S. Alajajian is an Applied Global Nutrition Research Fellow, Academy of Nutrition and Dietetics Foundation, Chicago, IL.

      Biography

      A. Guzman-Abril is a licensed nutritionist, Guatemala, and study manager, Wuqu’ Kawoq | Alianza Maya Para la Salud, Tecpán, Chimaltenango, Guatemala.

      Biography

      G. V. Proaño is a research project manager, Academy of Nutrition and Dietetics, Chicago, IL.

      Biography

      E. Yakes Jimenez is a director, Nutrition Research Network, Academy of Nutrition and Dietetics, Chicago, IL, and a research associate professor, Departments of Pediatrics and Internal Medicine and College of Population Health, University of New Mexico Health Sciences Center, Albuquerque, NM.

      Biography

      P. Rohloff is chief medical officer, Wuqu’ Kawoq | Alianza Maya Para la Salud, Tecpán, Guatemala.