Feasibility and acceptability of a gardening-based nutrition education program in preschoolers from low-income,minority populations

Abstract

Garden-based lessons are gaining popularity as a means of increasing fruit and vegetable intake among children. The study objective was to pilot test a garden-based preschool curriculum for feasibility and acceptability in Harris County Department of Education Head Start using qualitative and quantitative methods. A total of 103, 3- to 5-year-old children at two Head Start centers in Harris County, Texas participated. PLANT Gardens (Preschoolers Learn About Nutrition Through Gardens), a theoretically grounded, teacher-led, garden-based nutrition education program for preschoolers was implemented over 8 weeks in spring 2008. Heights and weights were measured on participating children. Data regarding program feasibility and acceptability were obtained through post-intervention focus groups with teachers and parents, weekly lesson plan evaluation forms completed by project staff, and post intervention teacher surveys. Pre−post self-reported parent surveys were used to evaluate the effects of the program on their preschooler’s fruit and vegetable preferences and willingness. The results showed that, overall, 28.4 percent of the Head Start preschooler’s population were overweight or obese, yet only 3 percent of parents perceived their preschooler as overweight. This pilot test revealed strong acceptability and feasibility of the PLANT Gardens program in this Head Start population. Results of the parent surveys (n= 25) indicated a significant increase in their preschooler’s willingness to try new fruits and vegetables (67% at baseline vs 84% post-intervention; p = 0.026). Data were used to further refine the program components. In conclusion, the PLANT Gardens program showed good initial feasibility and acceptability and is a promising program to increase preference and intake of fruits and vegetables in a preschool population. Further evaluation of behavioral outcomes using a larger sample size and a prospective design is needed.

Keywords

early childhood gardening curriculum low-income minority populations nutrition education preschoolers

Introduction

The 2010 USDA Dietary Guidelines for Americans and the American Institute for Cancer Research emphasize the importance of a plant-based diet and the need to increase nutrient dense foods, including fruits and vegetables (F&Vs), to prevent obesity and reduce the risk of developing diet-related chronic diseases (American Institute for Cancer Research, 2010; United States Department of Agriculture, 2011a). Consistent evidence suggests that preschoolers are not meeting dietary guidelines for F&V consumption (Dennison et al., 1998; Kranz et al., 2006; Lino et al., 1999; Nicklas et al., 2001). Disparities exist among low-income Hispanic and African American children who have the lowest intake of these healthful foods as compared with other ethnic groups (Casagrande et al., 2007; Lorson et al., 2009). Moreover, the prevalence of overweight and obesity, defined as body mass index (BMI) at or above the 85th percentile, in US children aged 2 to 5 years during 2007–2008 was 21.2 percent, with the rates disproportionately higher among Hispanic (27.7%) and African American (26.0%) populations (Ogden et al., 2010). Garden-based nutrition education programs are quickly gaining popularity as a feasible and effective method toward increasing F&V intake in children (Robinson-O’Brien et al., 2009). These programs not only promote intake of fresh F&Vs among children but also increase knowledge about plant life cycle and increase outdoor activity and skills for planting, harvesting, and preparing these foods via experiential learning. Several youth-based garden programs are currently being implemented in school and community settings (Heim et al., 2009; McAleese and Rankin, 2007; Morgan et al., 2010; Morris and Zidenberg-Cherr, 2002; Morris et al., 2001; Parmer et al., 2009; Ratcliffe et al., 2011; Robinson-O’Brien et al., 2009; Wang et al., 2010). However, none have targeted preschool-age children, ages 3 to 5, from low-income, Hispanic and African American populations using preschools as a setting to implement the programs. Early childhood is a critical period for the development of eating patterns and food preferences (Larson et al., 2011; Stang, 2006). Preschools are an excellent setting for obesity prevention programs because 56 percent of 2- to 5-year olds attend preschools in the United States where they spend a majority of their waking hours in the day (Pate et al., 2004). Furthermore, only a few of the garden-based nutrition education programs that have been conducted in schools report using a theoretical framework in intervention development (Heim et al., 2009; Morris and Zidenberg-Cherr, 2002; Morris et al., 2001).

The purpose of this article is to (a) present the development, theory, and design of PLANT Gardens (Preschoolers Learn About Nutrition Through Gardens), a preschool-based gardening curriculum for nutrition education and (b) provide the results of the feasibility testing of PLANT Gardens among 3- to 5-year-old children enrolled in Head Start centers in Harris County.

Methods

Study design

The primary purpose of this pilot study was to determine the feasibility of PLANT Gardens, a preschool-based gardening curriculum for nutrition education among 3- to 5-year-old children enrolled in Harris County Department of Education (HCDE) Area 1 Head Start centers. Head Start is a preschool program for low-income families. HCDE Area 1 Head Start enrolls over 1200 children annually in their preschool centers where children spend an average of 7 hours/day at school (7:30 a.m. to 2:30 p.m.). All 3- to 5-year-old children are grouped together in classrooms. All children receive free breakfast, lunch, and one afternoon snack while they are at the preschool. All Head Start centers are mandated to follow the US Department of Agriculture CACFP (Child and Adult Care Food Program) guidelines. CACFP reimburses centers at free, reduced-price, or paid rates for eligible meals and snacks served to enrolled children, targeting benefits to those children most in need. The meal pattern guidelines outlined by CACFP are available at http://www.fns.usda.gov/cnd/care/ProgramBasics/Meals/Meal_Patterns.htm. The typical preschool day is in segments of 20 to 30 minutes each consisting of various indoor and outdoor activities such as circle time, music and movement time, outdoor free play, and so on.

Our study was conducted over the 2008–2009 school year in a convenience sample of two of the 16 HCDE Area 1 Head Start Centers in Texas. The two participating Head Start centers had five classrooms with no more than 25 children, one teacher, and one teaching aid per classroom. Parents were recruited during open enrollment for the 2008–2009 school year using recruitment packets containing an invitation letter and consent forms for themselves and their child to participate in the study. A total of 103 children (Center 1: n = 73; Center 2: n = 54) consented to participate in the study (81% response rate). All enrolled children in the centers received the PLANT Gardens program. However, only those parents and children consenting to participate in the study were included in the evaluation. All teachers and teacher’s aides from the participating centers were recruited to participate in the study (n = 9). Approval for the study was obtained from the Committee for the Protection of Human Subjects at the University of Texas Health Science Center at Houston as well as the HCDE Institutional Review Board. All participating children and teachers received a US $20 gift card to a retail store for their time.

PLANT Gardens program development

The PLANT Gardens program was modeled after the CATCH Early Childhood (Sharma et al., 2011) and the original CATCH (Luepker et al., 1996; Perry et al., 1990) programs. It consists of a teacher-led classroom curriculum including lesson plans with hands-on activities emphasizing gardening and nutrition with the primary goal of increasing preference and intake of F&Vs among preschoolers. This gardening-themed healthy eating curriculum was developed during Spring and Summer 2008 by the investigative team with input from ecologists, behavioral scientists, gardening experts, HCDE Head Start teachers, HCDE Head Start curriculum coordinators, and registered dietitians. As part of this development phase, other gardening curricula such as the Junior Master Gardener Level 1 (Texas AgriLife Extension Service & Texas A&M University System, n.d.) and the gardening curriculum from Urban Harvest (Urban Harvest, n.d.) were examined. Local schools with active elementary gardening programs such as those from Recipe for Success (Recipe for Success, n.d.) were visited to evaluate instructional methods. In addition, the literature on garden-based programs, the National Head Start curriculum guidelines, and the guidelines from the Food Guide Pyramid for Preschoolers (United States Department of Agriculture, 2011b) were examined closely.

Theoretical model

The PLANT Gardens curriculum objectives were developed using the Social Cognitive Theory (SCT; Bandura, 1986) as the theoretical model. This garden-based curriculum was designed to increase (a) knowledge of where F&Vs come from and the health benefits of eating F&Vs; (b) self-efficacy toward increasing F&V intake; (c) expected benefits of eating more F&Vs; (d) active and observational learning; and (e) intentions to increase F&V consumption, all operationalized via strategies such as interactive story-time, songs, dances, container gardening, snack preparation, and taste-testing activities. Table 1 provides a description of the PLANT Gardens program components, objectives, and SCT constructs targeted.

Table 1.

Description of PLANT Gardens program components.

Lesson theme	Behavioral objectives	Coordinating activities	Social Cognitive Theory constructs operationalized
Lesson 1: Just a Buggin’ Around (Program Intro)	To explore and observe bugs and insects for hands-on learning of living creatures. To understand benefits of bugs and introduce the concept of composting.	Lady Bug Larvae; Butterfly garden; Exploring the outdoorsfor bugs and insects	• Knowledge
			• Skills
			• Self-efficacy
			• Expected benefits
			• Active learning
			• Reinforcement
Lesson 2: There’s Lots to be Seen: Plants That Are Green!	To introduce the concept of photosynthesis. To explore plants and other foliage outdoors.	Sprouting in Light v. Dark; Journaling by drawing sprouts; Exploring the outdoors for plants and foliage	• Knowledge
			• Skills
			• Self-efficacy
			• Expected benefits
			• Active learning
			• Reinforcement
Lesson 3: On Your Mark, Get Set: Let’s Make a Salad Bowl!	To make individual salad bowls to use for salads at home. To widen tastes and other senses for produce while enhancing creativity.	Decorating apron, chef hat, salad bowls; sampling veggies from garden	• Knowledge
			• Skills
			• Self-efficacy
			• Active learning
			• Reinforcement.
Lesson 4: I See the Outside, But What’s on the Inside?	To compare the outside of F&Vs with the inside. To learn not to judge foods based on appearance alone. To introduce concept of vitamins and other nutrients.	Cutting and sampling fruits and veggies familiar, unfamiliar, and cultural products	• Knowledge
			• Skills
			• Self-efficacy
			• Expected benefits
			• Active learning
			• Reinforcement
Lesson 5: Sock Puppet Surprise	To promote F&Vs by making sock puppets. To introduce concept that food can be fun as well as healthy.	Creating F&V characters to go with stories	• Knowledge
			• Skills
			• Self-efficacy
			• Expected benefits
			• Active learning
			• Reinforcement
Lesson 6: Growing Herbs and Veggies on Window Ledges	To plant and grow a variety of herbs and vegetables. To explore tastes and scents of produce.To play with soil, seeds and watering personal plants.	Herb garden planting and maintenance; Little Brown Seed song and dance	• Knowledge
			• Skills
			• Self-efficacy
			• Expected benefits
			• Active learning
			• Reinforcement
Lesson 7: One … Two … Three … Let’s Make a Recipe	To learn how to make two healthy recipes for snacks with fresh or dried fruit in a few simple steps. To introduce the concept of professions such as farmer and chef.	Cooking activity wearing chef apron and hat (i.e. fruit and mint salad with mint from garden)	• Knowledge
			• Skills
			• Self-efficacy
			• Expected benefits
			• Active learning
			• Reinforcement
Lesson 8: How What You Ate Got on Your Plate (Program Closure)	To learn where food comes from and how it’s derived from soil and plants. To introduce the concept of “seed to plate.”	Group play with each student representing a part of the growth cycle; creative granola snack preparation	• Knowledge
			• Skills
			• Self-efficacy
			• Expected benefits
			• Active learning
			• Reinforcement

The program components were reviewed and approved by the HCDE Curriculum Coordinators and were implemented for feasibility testing in the two participating centers in Spring 2009 for 8 weeks (February–March 2009). There were a total of eight PLANT Gardens lessons that were implemented one lesson per week over the 8 weeks. Prior to implementing the program, teacher training was conducted by study investigators in January 2009 for all teachers and teaching aides from the two participating centers. All participating centers were provided with all the program components (lesson plans and materials for coordinated activities). In addition, teachers were provided with an 8-week schedule for implementing the program components. All program components were in English but were examined by study investigators and the development team for cultural appropriateness. The curriculum consisted of eight lesson plans and coordinated activities that were taught by the teachers, one lesson per week, during the regular preschool day during circle time or music and movement time. Each lesson plan was designed to be 15 to 20 minutes long followed by coordinated activities for 10 to 15 minutes such as container gardening to grow herbs and greens such as spinach and kale, snack preparation, and taste-testing activities that incorporated the herbs and greens grown in the containers to reinforce the seed-to-plate nutrition concept. Other activities included exploring the outdoors for bugs and insects, plants, and foliage. The curriculum was designed such that it could easily be incorporated into the various Head Start learning centers such as the language, science, or math centers. The children took their plants (in small containers) and other related activities they participated in (e.g. snack preparation and recipes, decorated salad bowls, herbs and vegetables grown in containers) home to share with their families to encourage dialogue between parents and children. There was an end-of-program celebration to which parents were invited for the children to present songs and dances from the program and some of the PLANT Gardens activities they were involved in.

Data collection

The following qualitative and quantitative data were collected from the study participants to conduct feasibility testing of the PLANT Gardens program in the Head Start population.

Child anthropometrics and participant demographics

Height and weight were assessed on participating preschoolers (n = 103) using standard protocols (Sharma et al., 2011) at baseline (prior to program implementation) using digital platform scales with portable stadiometers (Perspective Enterprises Portable Adult Measuring Unit PE-AIM-101) and digital scales (Tanita Professional Digital Scales with Remote Display, BWB-800S), respectively. BMI was calculated from the measurements using the following equation: BMI = (weight in kg)/(height in m)² where kg = kilograms and m = meters. Age and gender-specific BMI percentiles were used to categorize weight status of the children. BMI ≥ 85th and < 95th percentile was categorized as overweight and ≥ 95th percentile was categorized as obese (Centers for Disease Control and Prevention, 2011; Kuczmarski et al., 2002). This provided an estimate of the prevalence of overweight and obesity in this study population and was used for descriptive purposes.

Additional demographic data and participant characteristics on language spoken at home, parent ethnicity, child ethnicity, child gender, parent height and weight, and parent perception of their child’s weight were ascertained from the parents using self-reported HCDE screening form that was administered to consenting Head Start parents (n = 103 parents) at baseline, prior to implementation of PLANT Gardens, by project staff.

Post-intervention focus groups with teachers and parents of participating preschoolers

The overarching purpose of the post-intervention focus groups was to obtain information regarding the feasibility and acceptability of each of the program components and determine important considerations to guide further program revision. Post-intervention structured focus groups were conducted by study investigators with the teachers and parents of the participating children in the two Head Start centers at the end of the 8-week program implementation. Each focus group took approximately 60 minutes to complete and was led by a moderator who asked open-ended questions with probes. All nine teachers and aides participated in four focus groups that were conducted at the Head Start center during regular hours. Teacher focus group objectives included (a) obtaining input regarding feasibility of implementation of PLANT Gardens in their classroom, (b) discussing which lessons and activities they liked and disliked, (c) format of the lesson and activities, (d) discussing teacher training, and (e) suggestions for program improvement.

A total of 27 (22% response rate) parents participated in the focus groups (n = 6 parent focus groups). Interpreters were available for those parents who spoke Spanish. All parent focus groups were conducted in the preschools during regular and after-school hours at a time convenient for the parents. Parent post-intervention focus group objectives included (a) finding out whether the parents were aware of PLANT Gardens being implemented at their child’s preschool, (b) finding out whether they perceived the program to be beneficial for their child, (c) diffusion of concepts learned by preschoolers to their family members, and (d) suggestions for the future.

Teacher post-intervention surveys

A self-report teacher survey was administered post-intervention to assess feasibility and acceptability of the program in their respective classrooms, usability and effectiveness of the various program components, and perceived support for the program in their school and community. See Table 3 for details on survey questions and responses.

Evaluation of classroom lessons and activities

Feasibility and acceptability of the classroom curriculum and activities were done using lesson plan evaluation forms. These evaluation forms were completed by trained project staff who observed the lesson plans in action (n = 20 observer evaluations). A minimum of two observations were conducted per lesson. Each lesson plan evaluation form was specific to each lesson and provided feedback on completion of activities, acceptability of the lessons and activities among the students, changes implemented to the lessons by teachers, and additional comments. This form was adapted from previous CATCH-based studies including CATCH Early Childhood (Sharma et al., 2011).

Parent pre and post-intervention surveys

A self-report survey measuring acceptability and perceived effectiveness of a garden nutrition program in influencing their preschooler’s dietary habits was administered to participating parents at baseline (prior to starting the program) and post-intervention. A total of 25 parents (22% response rate) completed the surveys at both baseline and post-intervention.

Data analysis

SPSS 17.0 (Chicago) was used to calculate the baseline characteristics of the study population. Focus groups were recorded using a digital recorder and transcribed. Two independent reviewers extrapolated themes from focus group transcripts and compared for reliability. Themes that were common were then organized into categories that were reviewed and refined by study investigators. Descriptive analysis including means (SD) and frequency distributions were used to describe the study population as well as the responses on the teacher surveys and the responses on the lesson plan evaluation forms. The Wilcoxon signed-rank test was used to evaluate baseline to post-intervention changes in the responses to the parent survey. Significance was set at p < 0.05.

Results

The sample included approximately equal proportions of male (n = 50, 48.5%) and female (n = 53, 51.5%) children (Table 2). Most children were African American (75%) with 18 percent Hispanic and 11 percent White, Asian, or other. The primary language spoken in the home was English (96%) and 2 percent of parents spoke Spanish. Sixty-one percent of parents reported that they worked full time outside of the home. Although our study was not powered to measure a change in physiological outcomes, at baseline, 71.6 percent of the children were normal or underweight (BMI < 85th percentile), 12.3 percent were overweight (BMI ≥ 85th and < 95th percentile), and 16.1 percent were obese (BMI ≥ 95th percentile). Furthermore, when asked about perception of their children’s weight status, only 3 percent of parents reported that their children were overweight.

Table 2.

Participant characteristics at baseline (n = 103 parent/child dyads), PLANT Gardens 2009.

	N	%
Child gender	103
Male	50	48.5
Female	53	51.5
Household language	98
English	94	95.9
Spanish	2	2.1
Other	2	2
Parent ethnicity	100
African American	72	72
White	8	8
Hispanic	18	18
Other	2	2
Child’s ethnicity	100
African American	75	75
White	5	5
Hispanic	18	18
Other	2	2
Children’s measured BMI pre-intervention	81
Underweight (≤5th percentile)	6	7.4
Normal weight (between 5th and 85th percentile)	52	64.2
Overweight (between 85th and 95th percentile)	10	12.3
Obese (≥ 95th percentile)	13	16.0
Parents’ perception of children’s weight	91
Underweight	9	9.9
Normal weight	79	86.8
Overweight	3	3.3

Teacher focus groups

All nine teachers and teacher’s aides participated in the post-intervention focus groups (n = 8 females, 1 male). The primary theme for the teacher focus groups was that all teachers enjoyed teaching the curriculum and that their students enjoyed the curriculum. Components of the PLANT Gardens program they reported as working well included the simplicity of lessons, the music and songs, and activities that the children enjoyed. For example,

They really liked the hands-on activities. Like with the ladybugs, they liked watching the stages that they grew and they would look every day.

The songs and movements really helped because my kids enjoyed the music side of it.

It’s so important when you’re teaching this age group to have a lot of hands-on stuff. They learn more by seeing.

During focus group sessions with teachers, common methods that teachers stated they used to model healthy behaviors included eating F&Vs in front of students, encouraging them to eat different “veggies” and taste a little of new foods, eating the same food with the children, and reminding them that eating F&Vs keep them strong and healthy. Most teachers reported that they felt that it is important to teach nutrition and that teaching nutrition will improve the children’s health. For example,

Teaching [healthy habits] is very important since there is so much obesity in children in schools.

Teaching nutrition at a young age teaches lifelong healthy eating habits.

Teachers reported observing changes in the children’s nutrition behaviors throughout the study and upon completion of the curriculum, including students trying new F&Vs and eating all their fruit and most of their vegetables at snack and lunch. For example,

I’ve noticed the items we offer at lunch that they were hesitant to try, I’ll be like, “taste it and try it, you’ll never know how it tastes until you try it,” and they’ll be more up to try it now.

Components of the curriculum that did not work well included the length of some stories and complex vocabulary in some lessons:

I had to modify some of the introductions, they were long and some children lost attention.

Suggestions by the teachers for future curriculum or program development included shortening the story length, providing colorful pictures or puppets to go along with the stories, and including mid-point training sessions to go over the gardening activities. Teachers also suggested more hands-on, take-home activities, and provided foods they learn about for additional snack activities. Finally, teachers emphasized the importance of getting parents more involved with the curriculum to reinforce the concepts being taught:

One thing we can’t miss is that we can teach it here at school but it has to be taken home. The parents have to have the training that goes along with this. We can change the child’s mindset but if we don’t change the family members’ mindset then, we are nowhere.

Parent focus groups

The primary theme that evolved from the parent post-intervention focus groups was that all parents agreed that it is important for their children to learn about health at an early age. They also unanimously agreed that teaching children about F&Vs was important and allowing them to try many different types of foods at a young age was good for their health. Parents suggested that healthy behaviors and nutrition should be encouraged both in school and at home. For example,

When kids are 2–4 years old, you have to encourage them to try food because it’s good for them. Then when they do try it, they’ll find out it’s not so bad after all. I think that’s how we develop good eating habits as a child, instead of letting them have their own way.

They don’t know unless they try it (food). And there are different ways you can try it. For instance with celery, you can put peanut butter or sour cream on it and they can try it that way.

Parents were asked about the parent–child dialogue centered around PLANT Gardens and the extent to which the children shared the program with them. Participating parents confirmed that they had heard about the program from their children. Some parents stated that their children came home and shared the activities, songs, and dances they had learned. For example,

One of mine has been singing a song, something about the sun, the water, the earth and the wind, I believe. And she’s been telling me what all it takes to grow a plant.

A majority of the parents also stated that they had noticed changes in the nutrition-related behaviors of their children.

When mine goes to the store now, it’s “I want apples, I want carrots.” I never knew she ate stuff like that but I know she does now. So, I know it’s a good work.

My son never ate that but now it is carrots, celery and even kiwi. I eat it but now he eats it too.

Several parents indicated that their children brought home the healthy snacks they prepared at school, were enthusiastic about the snack preparation activities, and were requesting to make them with their parents. Parents suggested that the children were most excited because the snack that was made as part of the program activity tasted so good and that they were able to make it themselves:

They had one lesson on a healthy snack that consists of stuff like raisins and granola. He loves that. He’s wanted me to make that like 3 times already.

Finally, parents were asked about any changes they planned to make at home as a result of the program. Most parents agreed that they would start shopping for more F&Vs now that their children were requesting them. Some parents also mentioned that they will start cooking together as a family more often now that their children were excited about participating:

Yes, more cooking together. She’s a lot happier to participate now. Before, it’d be “Oh mom, I don’t want to.” Now it’s more of like “Mom, what are we going to cook tonight?” And it’ll be like “Mom, did you get bananas?”

They want to help me cook now. They’re all in the kitchen.

Finally, several parents mentioned starting a home garden with their children:

Oh yeah, we went to get all kinds of little plant seeds and we have them growing out on the porch.

I’ve wanted to do a personal garden. Like herbs and stuff. I will have her do that with me.

Teacher post-intervention survey measures

Seven teachers and two teacher’s aides (100% response rate) completed post-intervention teacher surveys (Table 3). Post-intervention, 56 percent of teachers and aides stated that a garden and nutrition education program is a good idea for children, while 89 percent stated that they thought gardening was an effective way to teach children about nutrition and could alter a preschooler’s eating behavior. Furthermore, 78 percent reported that they could easily incorporate gardening principles and activities in their regular lesson plans and 100 percent reported that they would like to incorporate some or the entire PLANT Gardens program in their existing curriculum. All participating classrooms received the eight lessons by a trained teacher. For program acceptability, 100 percent of the teachers indicated that they enjoyed teaching the lessons and their students enjoyed learning the PLANT Gardens program components. For program feasibility, 100 percent of the teachers indicated that the program is feasible to include in their school and that they were supportive of the program. Moreover, 75 to 100 percent of the teachers reported using various program activities, including taste-testing F&Vs, recipes, gardening activities, and so on, in their classroom.

Table 3.

Teacher post-intervention survey responses (n = 9 teachers and aides), PLANT Gardens 2009.

Question	1st year	2–5 years	6–10 years	> 10 years
	n (%)	n (%)	n (%)	n (%)
How many years have you been teaching?
1. Working in this school	2 (25.0)	4 (50.0)	1 (12.5)	1 (12.5)
2. Teaching	0 (0.0)	2 (28.6)	1 (14.3)	4 (57.1)
3. Teaching preschool	0 (0.0)	4 (44.4)	2 (22.2)	3 (33.3)

	1–2 lessons	3–4 lessons	5–6 lessons	7–8 lessons
	n (%)	n (%)	n (%)	n (%)
How many PLANT Gardens lessons did you teach this semester?	0 (0.0)	1 (11.1)	1 (11.1)	7 (77.8)

Question			Yes	No
			n (%)	n (%)

Did you enjoy teaching the PLANT Gardens Curriculum?			9 (100.0)	0 (0.0)
Did the students enjoy the PLANT Gardens Curriculum?			9 (100.0)	0 (0.0)
Do you think it is feasible to include the PLANT Gardens lessons into your existing curriculum?			8 (100.0)	0 (0.0)
During the current school semester, have you coordinated any of the following activities with PLANT Gardens in your classroom?
a. Taste-testing of fruits and/or vegetables			6 (75.0)	2 (25.0)
b. Key vocabulary words on the word wall			9 (100.0)	0 (0.0)
c. Circle or Center Time activities (including gardening)			8 (100.0)	0 (0.0)
d. Recipes from curriculum made in classroom			7 (87.5)	1 (12.5)
Do you feel that a garden and nutrition education program is a good idea for children?			5 (55.6)	4 (44.4)
Are children in your classroom engaged in your lesson plans?			8 (88.9)	1 (11.1)
Do you think using gardening is an effective way to teach children about nutrition and healthy living?			8 (88.9)	1 (11.1)
Do you think gardening can alter preschooler’s eating behaviors?			8 (88.9)	1 (11.1)
Do you think you could incorporate gardening principles and activities into your lesson plans?			7 (77.8)	2 (22.2)
Would you like to include the PLANT Gardens lessons into your existing curriculum?			9 (100.0)	0 (0.0)

Question			Mean score (SD)
			1 = Not effective at all, 5 = Very Effective

Overall, how effective were the PLANT Gardens curriculum sessions in promoting healthful eating behaviors of your students?			3.67 (0.87)
Please rate the overall effectiveness of the following curriculum activities:			1 = Not effective at all,5 = Very Effective
1. Introduction of each lesson			3.33 (0.50)
2. Stories			3.11 (0.78)
3. Songs			4.00 (0.87)
4. Activities			3.44 (0.53)
5. Closure - Question and Answer sessions			3.33 (0.50)
How would you rate the following			1 = Not at all supportive, 5 = Extremely Supportive
1. Preschool teachers’ support for PLANT Gardens			4.00 (0.50)
2. Teacher’s aides’ support for PLANT Gardens			4.25 (0.46)
3. Parents’ support for PLANT Gardens			3.33 (0.50)
4. The center manager’s support for PLANT Gardens			3.44 (1.01)
5. The Head Start director’s support for PLANT Gardens			3.89 (0.60)

Finally, for overall program effectiveness, on a scale of 1 to 5, most of the teachers perceived the program to be mostly or very effective with mean scores of 3.67 (±0.87). When asked about individual program activities (i.e. songs, stories, activities), on a scale of 1 to 5, the mean scores ranged from 3.11 to 4.00 indicating that overall most teachers perceived these components to be mostly effective.

Lesson plan evaluation forms

Process evaluation data from the individual lesson plan evaluation forms as reported by observers suggest that the PLANT Gardens program components were highly feasible and acceptable in this study population (Table 4). The individual lessons averaged 31.8 minutes (range: 24–45 minutes) each. All program components were completed for five of the eight lessons. Lessons 2, 3, and 4 were the three lessons for which the observers reported as the teachers not being able to complete the entire lesson as planned. These were also the three lessons that took the longest to complete averaging between 31 and 45 minutes in length for the portions taught. The coordinated activities were conducted in addition to the lesson plans.

Table 4.

Results of lesson plan evaluation forms (n = 20), PLANT Gardens 2009.

Question	Lesson 1 (n = 4)	Lesson 2 (n = 2)	Lesson 3 (n = 3)	Lesson 4 (n = 3)	Lesson 5 (n = 2)	Lesson 6 (n = 2)	Lesson 7 (n = 2)	Lesson 8 (n = 2)
	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)	Mean (SD)
How long did the lesson last? (minutes)	26.25 (7.50)	45.00 (0.00)	31.67 (12.58)	45.00 (21.21)	27.50 (17.68)	30.00 (7.07)	24.00 (8.49)	25.00 (7.07)
	Average proportion of activities completed (%)
To what extent the following parts of the lesson was taught to the students^a
Introduction	100%	100%	100%	100%	100%	100%	100%	100%
Activity	100%	100%	100%	66.7%	100%	100%	100%	100%
Lesson/Story	100%	100%	66.7%	66.7%	100%	100%	100%	100%
Session summary	100%	0%	100%	33.3%	100%	100%	100%	100%

Percentage who reported “Completely” or “Mostly,” as compared with “Somewhat” or “Not at all” on the lesson plan evaluation form.

Parent surveys

Results of the parent survey feedback, using a one-group, pretest–posttest evaluation design, at baseline and post-intervention indicated a significant increase in their preschooler’s willingness to try new F&Vs (67% at baseline vs 84% post-intervention; p = 0.026) (Table 5). In addition, there was a trend toward a reported increased intake of a variety of F&V pre- to post-intervention (88% at baseline vs 100% post-intervention). More parents agreed that gardening can alter their preschooler’s eating behavior post-intervention as compared with baseline (96% vs 88%). However, these increases were not statistically significant.

Table 5.

Pre- and post-intervention parent survey responses (n = 25), PLANT Gardens 2009.

Evaluation components
Part I (Likert-type scale)	Pre-test	Post-test	p *
	Mean score^a (SD)	Mean score^a (SD)
How important do you think it is to teach preschoolers about being healthy and active?	3.96 (0.20)	3.92 (0.28)	0.564
How important do you think it is for children to learn about nutrition and eating healthy?	3.96 (0.20)	3.92 (0.28)	0.564

Part II (Yes/No questions)	Yes n (%)	Yes n (%)	p **

Do you feel that a garden and nutrition education program is a good idea for children?	25 (100.0)	25 (100.0)	–
Does your child eat a variety of fruit and vegetables?	22 (88.0)	25 (100.0)	–
Does your child engage in regular physical activity?	23 (92.0)	24 (96.0)	1.000
Does your child like to try new fruits and vegetables?	14 (66.7)	21 (84.0)	0.026*
Do you think using gardening is an effective way to teach children about nutrition and healthy living?	24 (96.0)	25 (100.0)	–
Do you think gardening can alter preschooler’s eating behaviors?	21 (87.5)	23 (95.8)	1.000
Do you typically have fruits and vegetables available at home?	23 (95.8)	24 (100.0)	–

Mean score computed based on the scale of 0 (disagree) to 4 (strongly agree).

Significances computed using related-samples Wilcoxon signed-rank test. The significance level is 0.05.

Significances computed using Fisher’s exact test. The significance level is 0.05.

Discussion

This pilot study determined that implementing PLANT Gardens, a garden-based nutrition education program, is highly feasible and acceptable within a Head Start preschool setting. A total of 28 percent of our study population of 3- to 5-year-old preschool children was overweight or obese. This prevalence estimate is higher than the national average (Ogden et al., 2010). More worrisome is that the literature has shown that Hispanic and African American children are consuming a diet low in F&Vs (Casagrande et al., 2007; Lorson et al., 2009). With the mounting concern regarding childhood obesity and its associated risks for chronic disease development, examining innovative programs that target healthy eating behaviors for childhood obesity prevention is important. Promoting healthy nutrition to preschoolers through garden-based activities will not only facilitate hands-on, cross-curricular learning, but it also has great potential to influence the trajectory of overweight among young children. Since over half of preschool-age children in the United States attend preschools or child care centers where they spend a majority of their waking hours (Pate et al., 2004), using these settings to promote healthy dietary habits would have a far-reaching impact. In addition, it is important for these programs to be easily integrated into the preschool curriculum as part of the children’s regular learning. PLANT Gardens was modeled after the CATCH program with objectives that could be easily incorporated into the curriculum at most preschools. The activities and lesson plans met the Head Start curriculum requirements for math, science, and language that resulted in teachers being able to use them in these various learning centers as part of the regular school day. Results of the teacher focus groups and post-intervention surveys indicated the program to be feasible, acceptable, and fun in this Head Start population.

Enjoyment of program activities is important in a preschool learning environment to ensure that children remain engaged and focused on the learning objectives. Results from teacher focus groups in our study suggested that the children overwhelmingly enjoyed the program hands-on activities including container gardening, snack preparation, and taste-testing. In a recently reported pilot gardening-based project conducted among fourth through sixth graders, enjoyment of the activities was a salient theme (Heim et al., 2009), suggesting that gardening activities offer a fun learning experience by which children can participate in hands-on activities and develop a sense of pride and ownership of their final product. Furthermore, in our pilot study, the parent post-intervention focus groups revealed several themes including awareness of PLANT Gardens being implemented in their child’s preschool, encouraging dialogue between parent and child regarding F&Vs, and increased parent interest in gardening. These results are important because preschoolers are dependent on their parents and caregivers for their everyday needs including nutrition. Studies have shown that parent modeling of healthy behaviors can positively impact children’s behaviors (Birch and Fisher, 1998). Our study did not have a strong parent component but the children took home all the various products from the hands-on activities completed at the preschool (e.g. snacks and recipes, decorated salad bowls, herbs, and vegetables grown in containers). Furthermore, we had strong parent participation at the end-of-program celebration all of which, based on the results of the focus groups, encouraged dialogue regarding the program, F&Vs, and gardening between parent and child. The next phase of the program includes parent–child activities and parent tip-sheets that include nutrition and physical activity recommendations for preschoolers, easy and healthy recipe ideas, and tips.

An interesting finding of our study was the significant discrepancy between child actual weight status (28% overweight or obese) and parental perception of child weight status (3% perceived child to be overweight). Poor awareness of their child weight status among low-income, minority parents has been reported in previous studies (Baughcum et al., 2000; Harnack et al., 2009) and was also demonstrated in our study. These findings, along with the results of the focus groups, emphasize the importance of actively including parents in educational programs that target obesity prevention among children.

Overall, results of the lesson plan evaluation forms showed high feasibility of each of the program components. The study also provided feedback for future revisions to each of the program components. For example, the stories received the lowest scores and were reported to be too lengthy with each lasting up to 15 minutes. The average time for each lesson (32 minutes; range: 24–45 minutes) was reported to be too long by the teachers since lessons also required additional time for the coordinated activities. Lessons 2, 3, and 4 were the three lessons that were the lengthiest. Based on this feedback, we edited the lesson plans for brevity with each lesson no longer than 15 to 20 minutes in length. In addition, now each lesson plan can be broken down and taught through the day or the week in various preschool learning centers (language, math, science, and art centers).

Results of the parent surveys indicated a significant increase in the children’s willingness to try new F&Vs post-intervention as compared with baseline. This finding is consistent with a previous garden-based nutrition education intervention conducted among first graders that reported an increased willingness to taste vegetables (Morris and Zidenberg-Cherr, 2002). Authors of this study suggested that the number of taste-testing opportunities may influence the willingness to try new vegetables. This is in accordance with our focus group feedback from teachers who reported that the more opportunities children had to try the F&Vs as part of the programming, the more they enjoyed them. These results indicate the importance of gardening and other nutrition-based programs to include taste-testing and snack preparation activities as part of the regular programming to increase preference and intake of healthy foods.

Future directions

The results of this pilot feasibility study were used to further refine the PLANT Gardens program components and are now part of the CATCH Early Childhood classroom curriculum (see www.catchinfo.org). The stories to support the gardening concepts have been shortened with emphasis on music, movement, and acting out the learning experiences with puppets. Through this study, it was apparent that preschool teachers and teacher aides have a wide range of educational and experiential backgrounds. Intensive training on areas such as nutrition, gardening, and physical activity is important for such programs to be successful particularly in low income preschool settings. Additional teacher training and detailed lesson preparation sections have been added to guide teachers in setting up the gardening activities. Suggested classroom resources have been included to address the decrease in confidence of teachers in this pilot study to incorporate garden-based lessons in their daily preschool schedule from pre- to post-intervention. Curriculum modifications include a teacher planning rubric for each lesson with preparation guidelines and supplies required for each lesson. The incorporation of lesson extensions to include outdoor gardening beds and parent handouts with recommendations for repeating lessons throughout the year increases the likelihood of diffusion of concepts. Since this study was designed to measure only the feasibility and acceptability of the curriculum, we are unable to report the impact of the program on nutrition-related behaviors. Planning is in progress for a group-randomized controlled trial to evaluate the efficacy of the updated program components on preference and intake of F&Vs and also the effect on weight status. A recent systematic review of the literature regarding the role of child-care settings in obesity prevention including 18 interventions in the preschool setting by Larson et al. found that only two interventions had an effect on weight status (Larson et al., 2011). These authors emphasize the need for well-designed studies of child care–based interventions aimed at promoting healthy eating and physical activity behaviors of preschool children and their parents (Larson et al., 2011). Thus, studies evaluating the efficacy of programs such as PLANT Gardens are needed.

Strengths and limitations

One of the limitations is that this study had a small sample size with no control group. However, the primary purpose of this study was to determine the feasibility and acceptability of implementing a garden-enhanced classroom curriculum in a Head Start setting. It is important to conduct these preliminary studies with process evaluation to inform further refinement of program components prior to efficacy testing. Second, all gardening-related activities were done in container gardens in the classroom due to insufficient funding for outdoor gardens as part of this project. However, this curriculum is designed to be used with or without the presence of outdoor gardens. Finally, the response rate on the parent surveys at post-intervention evaluation was low. While 81 percent of the parents consented to having their child participate in the program, only 22 percent responded to the surveys. Recruitment of parents from low-income populations is especially challenging. This was one of the lessons learned in this pilot study indicating the need for using more effective parent recruitment strategies such as tying incentives to survey responses and perhaps more aggressive follow-up with the parents on the surveys.

Conclusion

This pilot test contributes to a very limited body of literature in the area of garden-based nutrition curriculum evaluation in the preschool population (Larson et al., 2011). Furthermore, few of the garden-based studies that have been conducted to date have pilot tested their curriculum including process evaluation for feasibility prior to efficacy testing. The results of our study allowed us to test the feasibility and acceptability, improve cultural competence, and make further adaptation to the program components. The implementation of a garden-based intervention such as PLANT Gardens shows a lot of promise as a means of promoting preference and intake of F&Vs, especially in a population of Head Start preschoolers that is traditionally underserved.

Footnotes

Acknowledgements

The authors would like to acknowledge Ms Margaret Murray who assisted with the data collection on the project and the Harris County Department of Education Head Start management staff, teachers, and coordinators for their cooperation and assistance with the project.

Declaration of conflicting interests

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Funding

This work was supported by funding from the General Mills, Champions for Healthy Kids grant, the Michael and Susan Dell Center for Healthy Living, and the Pre-doctoral Fellowship, University of Texas School of Public Health Cancer Education and Career Development Program-National Cancer Institute/NIH [Grant #2 R25 CA57712]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute National Institutes of Health.

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