Group Gardening in a Native American Community: A Collaborative Approach

Abstract

Background. There is increasing awareness of the potential health benefits derived from gardening activities. Gardening practices are gaining momentum in Native American (NA) communities, yet no efforts have applied a community-based participatory research approach within a social-ecological model to understand opportunities and barriers for group gardening on an American Indian reservation. Objectives. The primary objective of this study was to identify influences across social-ecological levels that promote or hinder the implementation of community gardens and use of locally grown foods on the reservation; a secondary objective was to assess the feasibility of implementing a group gardening program for NA adults and potential of collecting health outcome measures. Method. Community members and academicians collaborated to develop and implement this study. The study (1) conducted interviews with key stakeholders to identify influences across social-ecological levels that promote or hinder the implementation of community gardens and using locally produced food and (2) assessed the physical and psychological well-being of NA adults participating in a group gardening feasibility study. Results. Major factors influencing using locally grown food and community gardens that emerged from nine interviews included knowledge/experience, self-efficacy, Elders, traditional ways, community values, generational gaps, and local tribal policies. Twenty NA adults with prediabetes or diabetes participated in the feasibility study. The Profile of Mood States Inventory showed consistently positive change in score for participants in the group gardening program versus the comparison group. Conclusions. This study identified key influences for growing locally grown food, and approaches for implementing group gardening programs for NA adults.

Keywords

community-based participatory research health research qualitative research Native American/American Indian minority health rural health health promotion nutrition

Introduction

Native Americans (NAs) have the highest age-adjusted prevalence of type 2 diabetes among all U.S. racial and ethnic groups (Acton, Burrows, Geiss, & Thompson, 2003). Individuals with diabetes experience high rates of mental health problems, including depression and anxiety (Robinson, Coons, Haensel, Vallis, & Yale, 2018). Data suggest that if NAs eat fresh, healthful foods, diet-related diseases such as type 2 diabetes will be reduced (Lopez, Reader, & Wydham, 2001).

The practice of gardening is receiving attention from NA communities as local food system approaches and desires to reconnect with traditional practices that strengthen communities gain momentum (Lombard et al., 2014; Ornelas et al., 2017). Gardening can improve physical activity, mental health, nutritional attitudes, social skills, weight, and self-confidence (Clatworthy, Hinds, & Camic, 2013; Genter, Roberts, Richardson, & Sheaff, 2015; National Gardening Association, 2018; Soga, Gaston, & Yamaura, 2017; Zick, Smith, Kowaleski-Jones, Uno, & Merrill, 2013) and cultivate connections with food, community, and the environment (Robinson-O’Brien, Story, & Hiem, 2009).

In recent years, the number of community gardens in the United States has soared to almost 18,000 (American Community Garden Association, 2016). Local foods efforts have been promoted in some NA communities, and have focused on growing and preserving healthy foods (Armstrong, 2000; Heck, 2011; Lombard, Forster-Cox, Smeal, & O’Neill, 2006), strengthening food sovereignty (Brewer, 2014), and promoting youth interest in gardening (Woodward, 2005). Community gardening efforts on the Bemidji tribe area in Wisconsin grew out of a broader project to promote healthy lifestyles, where community members identified the importance of access to local produce and the health-promoting activities of growing food (Adams, Scott, Prince, & Williamson, 2014). Building on this research, a community garden–focused study on the Navajo reservation used individual and social constructs from the social cognitive theory paired with community input to guide a gardening intervention to improve consumption of fruits and vegetables among residents (Ornelas et al., 2017).

Addressing multiple levels of influence, including individual and environmental levels, may be important to the success of health promotion interventions among NA communities (Gittelsohn & Rowan, 2011). Furthermore, the feasibility of assessing the physical and psychological well-being of NA participants in a group gardening program may help prepare tribal communities to rigorously assess the impact of future gardening interventions on these health-related outcomes. Therefore, we used a community-based participatory approach (CBPR) and the social-ecological model (SEM) of health behavior, which addresses multiple levels of influence to understand opportunities and barriers related to gardening and using locally grown foods on an American Indian (AI) reservation. We also conducted a feasibility study to assess the physical and psychological outcomes of NA adults participating in a group gardening program.

Our study was grounded in the CBPR approach and the SEM. CBPR brings together communities and researchers to improve health collaboratively in the community (Israel, Schulz, Parker, & Becker, 1998). SEM for health promotion focuses on how factors across individual, social, organizational, community, and policy levels influence healthy patterns of living (McLeroy, Bibeau, Streckler, & Glanz, 1988). The SEM is an appropriate approach to improving understanding of factors influencing community garden development and accessibility of fresh vegetables (Armstrong, 2000).

This article describes a qualitative study that identified social-ecological factors that influence the development and use of community garden programs and locally grown foods on an AI reservation and a quantitative study that determined the feasibility of delivering a group gardening program to NA adults and assessing changes in health and psychological factors in the program participants. Collectively, the findings from these studies support scaling up gardening efforts and programs on AI reservations.

Method

This project sought to (1) determine influences that promote or hinder the implementation of community gardens and use of locally grown foods on an AI reservation and (2) assess the feasibility of implementing a group gardening program for NA adults and potential of collecting health outcome measures.

Community Setting and Partnership

The Northern Plains AI reservation community where this project took place is located more than 75 miles from the nearest city of 60,000 residents, and 30 miles from the nearest town of 9,300 residents. The 2010 U.S. Census reports the community had 3,221 residents who were 96% AI/Alaska Native (U.S. Census Bureau, 2015). The reservation’s Tribal College has a Cooperative Extension program and provides postsecondary educational programs to over 400 students, annually. In 2009, Tribal Health staff, Cooperative Extension and Tribal College staff and educators and University of Montana academic researchers met to form a collaborative partnership to explore opportunities and barriers for establishing community gardens and programs. The partnership held a series of meetings during the next 10 months to establish a memorandum of understanding for the partnership and develop a proposal that simultaneously implemented the studies described earlier. A community advisory board (CAB) was established for the project and included tribal diabetes staff and directors, tribal Elders and cultural experts, parents, school food preparation staff, the local extension agent, and a master gardener. The CAB informed all stages of the research project, including identifying key stakeholders for interviews to gain community input, developing the group gardening program, and reviewing the project’s findings. The study was approved by the institutional review board at the University of Montana.

Qualitative Study Exploring Factors Influencing Using Locally Grown Food and Community Gardens

Participant Recruitment

A convenience sample of key stakeholders who were identified by community and CAB members as knowledgeable about gardening, food, and natural resource programs on the reservation were recruited for qualitative interviews. All interviewees were NA and self-identified as educator, school administrator, Tribal Health worker, Elder, natural resource expert, grocery store owner, tribal college student, school food service worker, or extension staff. Recruitment of interview participants occurred over a 3-week period. To be eligible to participate in the interviews, individuals had to be 18 years or older and knowledgeable about gardening, food, and natural resource programs on the reservation. Out of the 12 participants who expressed interest in being interviewed, 9 participated in scheduled interviews (Figure 1). The sample size was limited by the number of participants available and willing to be interviewed; however, it is believed that saturation was reached since no unique themes occurred in the final three interviews.

Figure 1

Study Structure and Participant Flow in Relation to the Social-Ecological Model Theoretical Constructs

Interview Protocol

Qualitative semistructured individual interviews were conducted to gather detailed information on ways to develop and implement community gardens, to get more people interested in growing their own food or using local produce, and to promote the availability of locally grown foods on the reservation. In-person interviews were conducted in private areas at several locations, including the Tribal College, an elementary school, and a senior center. Each 35- to 60-minute interview was audio-recorded. Three academic researchers (BB, LD, and MGP) and one community researcher (MP) conducted all the interviews for consistency. Interviewers had training on qualitative methods and previous experience interviewing community members on the reservation.

The research team and the CAB constructed a moderator’s guide that included open-ended questions based on the research questions, a practice interview, and gaps in the literature, as described above. Interview questions were based on the SEM (McLeroy et al., 1988), and included questions about the development of community gardens and use of locally grown foods on the reservation. Example questions included the following: “How can individuals get more interested in gardening and eating locally grown foods?” “How could schools access and use locally grown foods in school breakfast and lunch programs?” and “How could youth get involved in growing food in community gardens?” All participants received $20 compensation and a voucher for two bags of produce.

Analysis

Interviewee audio-recordings were transcribed verbatim by a professional transcriptionist outside the study team. Transcripts provided the basis for analysis. Researchers used inductive content analysis, a method used to determine patterns within qualitative data through systematic categorization (Eto & Kyngas, 2008; Hsieh & Shannon, 2005). Investigators (LD, MGP) identified broad coding categories based on the SEM (Sallis, Owen, & Fisher, 2015), each category reflecting one level of influence on community adoption of locally grown food and community gardens. Differences in the two coding schemes were reconciled through discussion and consensus, resulting in a final coding scheme applied to all transcripts. The Nvivo 5 qualitative data analysis software package (QSR International Ltd., 2015) was used to group and organize data. Investigators corrected minor grammatical inaccuracies in the quotes presented to illustrate the themes.

Quantitative Feasibility Study of a Group Gardening Program

Development

The partnership collaborated with local agricultural extension and natural resource programs to establish two community gardening areas on the reservation: one near the tribal college and the other by the tribal diabetes clinic. Twenty-two 6’ × 8’ raised beds for gardening were built and installed near the tribal college; eight raised beds were built and installed at the tribal diabetes clinic. The sites were chosen because of community interest in starting new gardens, as well as their proximity to the tribal college and the tribal health center. The diabetes clinic gardening area was used for the feasibility study during the 2011 growing season. In response to concerns about access to water for gardening at the tribal college garden area, community members learned how to install drip irrigation that brought rainwater from catchment cisterns to the raised beds.

The tribal agriculture extension agent and staff members and a local master gardener developed a series of 10 structured gardening and food-related sessions for the feasibility study that included (1) classes and hands-on activities for gardening techniques; (2) hands-on educational activities for food preparation, safety, and preservation techniques using fruits and vegetables; and (3) activities using food commodities and locally grown vegetables to prepare meals.

Group Gardening Program Feasibility Study

We conducted a randomized, two-group, pre- to postintervention feasibility study. A convenience sample of participants who expressed interest in participating in the study were recruited from the tribal diabetes program. To be eligible to participate in the study, NA adults had to be 21 years or older and clinically diagnosed with prediabetes or diabetes. Eligible participants were consented and then randomized to the treatment intervention group (i.e., group gardening program) or comparison group with no treatment. All participants, regardless of group assignment, had received information on diabetes and managing diabetes after diagnosis. After the raised garden beds were constructed, the group gardening program participants prepared the raised garden beds with imported soil and planted and cultivated radishes, potatoes, strawberries, currants, beets, peas, beans, squash, corn, carrots, tomatoes, and peppers in one growing season. Soil was imported for the raised beds because these areas were high in rock and clay. Participants based what they wanted to grow in their raised bed on Northern Zone 4 growing recommendations. Participants weeded and tended their raised garden bed at least once a week during the growing season and took the produce that they grew, home. Diabetes staff watered the garden beds as needed. Participants were encouraged to participate in the structured gardening and food-related sessions, lasting ~90 minutes each, which were implemented semimonthly, May to September 2011. We did not collect data for participation in these sessions. All activities were free of charge, and participants received vegetable seeds and fresh produce for participating in the program. The raised beds, soil, and seeds were paid for by the research grant.

Participants in both groups completed measures at baseline March 2011 and at the end of treatment October 2011. Tribal Health nurses collected blood from the participants and measured blood pressure using standardized procedures. The Dimension EXL 200 Integrated Chemistry System assay at the Tribal Health Clinical Laboratory was used to measure hemoglobin A1C (HgbA1C) levels. Nurses also measured participants’ height and weight using a stadiometer and a calibrated digital scale. Participants completed four self-report surveys: the Profile of Mood States (POMS) Inventory that measured total mood disturbance and six mood factors (tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia, and confusion-bewilderment; McNair, Lorr, & Droppleman, 2003), a modified version of the Center for Epidemiological Studies–Depression Scale (Radloff, 1977) that has been used in adult NA diabetic populations (Bell et al., 2010; Bell, Smithz, & Acury, 2005), the World Health Organization Quality of Life Questionnaire–BREF (WHOQOL-BREF) that was adapted from the WHOQOL-100 (WHOQOL Group, 1995), and a Stages of Change scale that assessed an individuals’ motivation to grow and eat fruits and vegetables.

Analysis

Baseline descriptive data were summarized by treatment group. Health and survey measures were summarized by group using median scores and ranges. Due to the small sample size, Wilcoxon rank sum exact tests were used to compare pre- to postintervention changes in health and survey measures.

Results

Interviews

Interviewed community members indicated 15 distinct themes across five social-ecological levels of influence in community gardening (Table 1). Themes focusing on the individual (knowledge/experience, self-efficacy, Elders, and health/healing beliefs) and interpersonal (traditional ways, community values/pride, incentive, youth, and generational gap) levels were the most emphasized.

Table 1

Major Themes and Supporting Quotes that Influence Community Adoption of Locally Grown Food and Community Gardens as Revealed by Stakeholders

Social-Ecological Level	Theme	Supporting Quotes
Individual: knowledge, attitudes, beliefs	Knowledge/Experience	“I don’t think that they (community members) take that (garden food), into consideration, they’d rather get a can of corn than eat fresh corn on the cob.” “I don’t know very many, not in this community that are interested in (growing food). I just don’t think that they are as well-educated about that, food that you grow in your backyard, is better than anything you could buy at the store.” “Out here, a lot of things are based around food, so if we can show them that there is better food for you out there, that still tastes great, that they might try it.”
	Self-efficacy	“Some people they tried, but after a while they just gave up.” “It’s partly not knowing what to do . . . we want people to come in and show us, work with us, I think, get us started on it.” “Somewhere where they (community members) would be able to actually work in it (a garden), and actually see the benefits of it and be proud of the accomplishment.” “Maybe if they (community members) were around (the garden) more often, they would want to do it themselves.”
	Elders	“And there are ways they (Elders) survived for many years and they could share their knowledge and it would be really helpful.” “They used to have Elders working with the youth in the summer time (in community gardens). And that’s where a lot of it (knowledge) came from.” “If (Elders) were just to share their lives, and not that they were giving it away or sharing it, but just think of it as bettering their young people—helping them grow (food), that would help in the long run, because people would be more knowledgeable on how to survive.”
	Health/Healing	“The earth is healing. Herbs can be healing; plants can be healing.” “I think it’s good to bring the gardens back, it’s soothing, its relaxing, if you are all stressed out about something you go out there and you pull weeds and you think.” “The sun, it radiates so much energy, and it’s really good for people, and it makes them happy and healthy, you know, and work together (on community gardens), and not be afraid of a little bit of work.”
Interpersonal: social and cultural norms	Traditional Ways	“If people are traditional, well it (growing food) should be part of their life. Part of taking care of life, and the earth. It’s working with the earth and taking care of it, and creating, doing life the natural way. That’s what it is.” “We are going full-circle, because (growing our own food) is the way we lived traditionally on this continent, and now we are going back to it.” “For so many years, they (Natives) were treated, as, ‘Oh you don’t know anything and you need to be taken care of,’ this mentality has sort of been passed down. . . . And it hast to quit some place. Somebody has to start saying, ‘No, gardening is a good way to just begin to show people how, what is really required to feed yourself.’”
	Community Pride/Values	“It has to be community appreciation, and community, if that’s what they want, and the kids will come through.” “You have to . . . come together to take care of each other because it’s not just one person than can take care of a village, the whole village takes care of each other.” “If we put a garden in a village where there’s a lot of crime, broken windows, and that ugliness, you know, and it survives and thrives, that says something about the values of that community.”
	Incentive	“They (community gardeners) need to get paid upfront, because we are low-income, really low-income, and I need to get them to the point where they know how to recycle, they know how to compost, so it’s a part of their life.” “Little tiny incentives to get them to come, and then maybe they’ll want to do it themselves.” “We do have a lot of those that need to provide community service in order to receive payments, that (garden program) would be a great use of their time.” “If we are going to have a good turnout, we have to pay them, it’s the bottom line.”
	Youth	“You hardly ever see kids outside. It’s crazy, because they would rather be inside in front of the TV or in front of the Internet.” “The next generation has got to be better, you know, the next generation has got to be better, you have to start somewhere, and sometimes it’s easier to work with youth.” “Get the kids started young, then you can reach them.”
	Generational Gap	“When you plan a garden and you finally see something coming out of the ground . . . it would be a good connection for both the parents and grandparents and children, to interact.” “There’s a really big gap in there (grandparents & grandkids), but I think those are the two groups of people who need each other the most.” “We talk a lot about our young people, their survival skills, they really don’t have any.” “People would rather be on their computers than to be out growing food. You know I think that is one of the big things, that technology is getting in the way of the old ways of doing things.”
Organizational: organizational systems and policies	Nondescript Hierarchy	“If they were to offer it (local food program) in high school . . . to put it in school board meetings and say ‘hey we want this for our children,’ maybe it would happen.” “I could take it upon myself at the beginning of the year . . . ask who should I talk to at this time, or who would I go and see, maybe set up some appointments or schedules, and maybe things will get done.” “I did mention it (farm-to-school program) to a school supervisor but, it just, it was up in the air, and it’s probably still hanging up there somewhere.”
Organizational: organizational systems and policies	Transportation	“A lot of people have a hard time getting over here to take care of their gardens.” “You know a lot of Elders have a lot of time on their hands, most don’t have vehicles and if they do most aren’t driving as much.” “I think if people were to use the (public) transit more often, then they’d be able to come and take care of their gardens.”
Community: leveraging resources and participation of community-level institutions	Intercommunication	“Word of mouth is always the best I think, cause that’s gonna get around.” “We actually have it (signs) at the garden . . . and it says vegetable garden, it shows how to say it, you know what I mean, in Cree.” “And maybe you know the person (community gardener), or maybe you know their cousin, and then eventually you get the ball rolling, and then it’s just fun.”
	Program/Community Integration	“One of the things I like to do with it (produce) is when we have a cultural feast, and we have those quite often around here, and to make the effort to prepare some (local food) and take it to the feast.” “I think that (a food pantry) at school would be a good, and then if you had the garden, and you had people participating and people knew where it was going.” “Have a class, local courses (at the college) on gardening.” “There’s a lot of traffic going on down this road to Headstart, you get some greenhouses down there and it becomes more conspicuous.”
Policy: interpreting and implementing existing policy	Federal and State Policy	“The USDA liaison between the tribes . . . mentioned something along those lines that they wanted to put together a program to get the locally grown foodstuffs to the lunch program.” “It’s easier to use your food stamps and just go buy food.” “There’s no reason why commodities (Temporary Assistance for Needy Families) couldn’t be participating.” “Food prices are already cheap so it’s not worth it (to buy locally grown foods).”
Policy: interpreting and implementing existing policy	Local Policy	“Our tribal government is very interested in furthering the development of the community gardens . . . (but) there was no way to develop a food bank(ing) system.” “Mostly what we developed we targeted individual gardening sites due to watering restrictions.” “Watering is a big deal too, sometimes they cut you off the water.”

Interviewees expressed that, in general, community members are not knowledgeable about growing food. However, a distinct group of individuals (many of whom are Elders) do have experience and skill in gardening and provide a potential pathway for sharing that expertise with the community. The Elders in the community were described as preserving a wealth of knowledge and familiarity with gardening; respondents were enthusiastic about getting Elders involved in teaching and sharing their experiences, particularly with youth.

Individual self-efficacy and knowledge were commonly mentioned together—respondents felt that many community members are not involved in gardening because they lack knowledge, and/or confidence. Increased exposure to gardening was suggested to increase confidence, involvement, and interest.

Participants related the social process of growing food and/or participating in community gardening to traditional ways of being, a motivating factor for several participants who grew their own food. Growing food was frequently described as a way to align with historical ways of living, and the ability to feed oneself and one’s family was viewed as a positive way to establish independence and sustainability within the community. Respondents described how community action is rooted in community values and pride, and how the social process of growing food and/or participating in community gardening can be a way for the community to take care of itself. Financial incentive was the strong consensus for how to motivate individual involvement in growing food. Youth involvement came up frequently as a concern; youth were described as generally unmotivated to be outside or active. A disparity of values/lifestyle between youth and Elders was described; youth were perceived as having a lack of survival skills, and several respondents emphasized the potential relationship and skill-building benefit of youth and Elders working together to grow food.

Organizational-, community-, and policy-level themes were less frequently mentioned; however, several reoccurring issues are notable. With regard to groundwork to catalyze community gardening efforts, many respondents referred to informal, nonhierarchical community pathways such as “collective decision making” for achieving necessary approval and support. This process was described as necessary, but it was often a barrier for gaining momentum at the organizational level. Policy-level themes included anecdotal support for locally grown food efforts from local and tribal governments, along with potential barriers, including the convenience of using food stamps over growing food, and unpredictable tribal water restrictions.

Approaches for developing and implementing community gardening efforts and use of local produce in community programs were identified from the community stakeholder interviews, and organized according to SEM levels.

Group Garden Program Feasibility Study

Thirty-two NA adults met study eligibility criteria and provided consent and enrolled in the pilot study. Of these, six participants dropped out of the study prior to baseline measures and six participants dropped out of the study during the intervention period or prior to the postintervention measures. Reasons for dropout or loss to follow-up included moving off the reservation or frequent travel. At the end of the garden season (end of treatment), there were 8 participants in the treatment group and 12 participants in the comparison group.

Sixteen of the 20 participants (80%) were female, 15 (75%) were 45 to 64 years old, and 5 (25%) were 25 to 44 years old. All participants had some college and eight (40%) had a college degree. Two (10%) had an annual household income of less than $20,000 per year and four (20%) had an annual household income of greater than $60,000 per year. No differences in these demographic distributions were observed between treatment groups.

Changes in pre to post measures are shown in Table 2. There were no differences in between group changes to body mass index, blood pressure, or HgbA1C. The POMS scores showed consistently positive (i.e., lower) change in score for the treatment group versus the comparison group. The summary measure total mood disturbance was the only score that showed a statistically significant difference between groups (p = .049). The domain scores for tension-anxiety (p = .062) and depression-dejection (p = .105) approached significance despite the small sample size. The garden stages of change score improved among the treatment group versus the comparison group (p = .111), but the pre to post fruits and vegetable stages of change and motivation scores were similar in both groups. There were no differences in Center for Epidemiological Studies–Depression or QOL scores between the groups, with the exception of the QOL subscale score for environment that showed a more negative change for the treatment group versus the comparison group (p = .013).

Table 2

Median (Range) Change in Measure From Baseline (March 2011) to Postintervention (October 2011) by Group

Measure	Treatment Group			Comparison Group			p ^b
Measure	n ^a	Baseline, Mdn (Range)	Change, Mdn (Range)	n ^a	Baseline, Mdn (Range)	Change, Mdn (Range)	p ^b
Physiological measures
BMI (kg/m²)	8	26.9 (23.7 to 32.7)	−0.69 (−1.9 to 0.3)	12	25.3 (21.1 to 34.0)	0.02 (−8.5 to 3.2)	.238
SBP (units)	7	119 (106 to 130)	−1.0 (−6.0 to 16.0)	12	125 (114 to 144)	−9.0 (−28 to 24)	.444
DBP (units)	7	78 (62 to 98)	−6.0 (−18.0 to 12.0)	12	82 (70 to 92)	−3.0 (−22 to 10)	.983
HgbA1C (units)	8	5.9 (5.1 to 6.3)	−0.25 (−0.6 to 0.9)	12	7.8 (5.4 to 15.7)	−0.2 (−2.6 to 5.6)	.925
Survey measures
Motivated to Eat Fruits and Vegetables	6	8.0 (5 to 10)	0 (−1.0 to 5.0)	11	10 (6 to 10)	0 (−2.0 to 3.0)	.838
Motivated to Grow Fruits and Vegetables	6	8.0 (3 to 10)	−1.0 (−4.0 to 2.0)	11	8.0 (0 to 10)	0 (−7.0 to 5.0)	.362
Fruits and Vegetables Stages of Change	7	1.0 (0 to 4)	0 (−3.0 to 2.0)	11	1.0 (0 to 4)	0 (−3.0 to 2.0)	.439
Garden Stages of Change	6	1.0 (1 to 1)	2.0 (0 to 3.0)	8	1.0 (0 to 3)	0 (0 to 3.0)	.111
CESD Scale	5	6.0 (2 to 19)	0 (−6.0 to 1.0)	9	6.0 (3 to 15)	0 (−3.0 to 18)	.380
WHOQOL Questionnaire
QOL: psychological	7	17 (14 to 19)	0 (−3.3 to 2.0)	11	16 (12 to 18)	0 (−4.0 to 4.5)	.772
QOL: social	7	18 (12 to 20)	0 (0 to 4.0)	11	16 (12 to 20)	0 (−6.7 to 4.0)	.430
QOL: environment	7	16 (15 to 20)	−1.0 (−1.5 to 0.5)	11	15 (9 to 16)	0 (−0.5 to 4.0)	.013
QOL: physical	7	17 (15 to 20)	−0.6 (−1.7 to 0.6)	11	17 (12 to 19)	−0.6 (−5.1 to 2.9)	.707
POMS Inventory
Total mood disturbance	8	6.5 (−10 to 32)	−2.0 (−16 to 18)	9	9.5 (−6 to 46)	9 (−1.0 to 30)	.049
Tension-anxiety	8	35 (32 to 46)	−2.0 (−7.0 to 6.0)	10	33 (30 to 46)	1.0 (−2.0 to 12.)	.062
Depression-dejection	8	36 (32 to 43)	−0.5 (−4.0 to 6.0)	10	36 (32 to 45)	3.5 (−2.0 to 19)	.105
Anger-hostility	8	42 (36 to 56)	0 (−8.0 to 10)	9	42 (36 to 60)	6.0 (−6.0 to 20)	.180
Vigor-activity	8	60 (45 to 69)	−3.0 (−13 to 13)	9	55 (36 to 67)	0 (−7.0 to 7.0)	.382
Fatigue-inertia	8	40 (30 to 53)	−2.5 (−16 to 7.0)	10	41 (30 to 69)	2.0 (−10 to 21)	.246
Confusion-bewilderment	8	42 (33 to 52)	0 (−4.0 to 6.0)	10	40 (33 to 48)	2.0 (0 to 17)	.119

NOTE: BMI = body mass index; SBP = systolic blood pressure; DBP = diastolic blood pressure; HgbA1C = hemoglobin A1C; CESD = Center for Epidemiological Studies–Depression; WHOQOL = World Health Organization Quality of Life; POMS = Profile of Mood States.

Data missing for some measures. ^bWilcoxon rank sum exact test for difference between groups in change from pre- to post measures.

Discussion

This is the first known group garden study with a Northern Plains AI reservation to apply CBPR principles, acknowledged as the preferred approach for actively engaging NA community members in all aspects of research process and group gardening efforts (Christopher et al., 2011; Draper & Freedman, 2010). The approach was tailored to fit with what the tribal community wanted to accomplish with a funding opportunity that had limited resources (e.g., $40,000) and time to complete the project (e.g., 12 months), while still keeping intact the community’s unique cultural heritage, history, and tribal structure. As a result of this study, the academic–community partnership found new ways of working collaboratively based on mutually agreed-upon principles that established the memorandum of understanding and CAB for the project. The NA community gained confidence of their ownership in the research process and developed trust in the outside researchers’ motives to advance research and group garden program initiatives that were deemed a priority by the community, findings that agree with others (Zoellner, Zanko, Price, Bonner, & Hill, 2012). Throughout the project, the researchers engaged in learning about and valuing the unique needs, strengths, and dynamics of the NA community.

We accomplished our primary objective of identifying various influences across social-ecological levels that promote or hinder the implementation of community gardens and the use of locally grown foods on the reservation. Stakeholders held positive views toward community gardens and identified gardening as a healthy activity and a way for people to work together. These findings are consistent with similar efforts that explored growing food locally in regions with limited access to fresh produce (Lombard et al., 2014; Zoellner et al., 2012). Interview themes showed individuals lacked knowledge/experience and self-efficacy for growing food, and a need for community experts to share knowledge through educational opportunities. This theme is echoed in formative research on the Navajo reservation, where community participants expressed a need for a series of community-level gardening workshops (Ornelas et al., 2017), and among Bemidji area tribes, where community-based CABs identified limited knowledge of gardening and preparing/preserving food as a barrier to healthy living (Adams et al., 2014).

Social-level themes indicated that growing food in traditional ways was important, and many Elders are knowledgeable about and familiar with gardening. These observations explicitly include the importance of having Elders help facilitate garden activities to increase community skills for growing local produce. This approach could also influence connections for parents, grandparents, and children to interact and bridge “generational gaps” that were also identified in the interviews. These findings agree with recent research on the Navajo reservation and Bemidji area tribes and stress the importance of respecting Elders and intergenerational knowledge transfer as important ways of learning traditional gardening techniques(Adams et al., 2014; Lombard et al., 2014; Ornelas et al., 2017).

Thematic results also support the need for organizational systems and policies such as public transportation for people to be able to access, and take care of, community gardens and for local school boards to endorse the need for farm-to-school programs on the reservation. At the level of community resources and institutions, common themes included integrating community gardens into existing community infrastructure, including having garden classes at the local tribal college, using foods grown in the gardens at cultural feasts, starting a food pantry at the school, and building a community garden in a highly visible location to provoke local interest. Many of these suggested organizational- and community-level strategies are similar to gardening activities occurring on other reservations, such as transportation provided to local farmers’ markets, standing committees to lobby for organized support for local produce, implementation of gardening sites in accessible and visible locations, and ongoing gardening workshops (Adams et al., 2014; Ornelas et al., 2017; Woodard, 2013; Woodward, 2005). Finally, at the policy level, common themes showed that existing federal and state policies make it convenient for tribal members to buy cheap processed foods and thus forgo buying/growing local foods. Nonetheless, the local tribal government is interested in developing community gardens. Poor access to water was cited as a major barrier to gardening, as has been indicated elsewhere (Devereaux, 2010; Lombard et al., 2014). Enacting tribal policy to lessen restrictions on using water to irrigate a garden, providing rain catchment, and providing water conservation education are potential community- and policy-level strategies to address this barrier. These results show the need to consider organizational and community resources and systems and policy levels of influence, in addition to understanding individual and interpersonal characteristics for growing food, when adopting locally grown food and community gardens. Results also indicate that the NA community may share overlapping themes across multiple SEM levels with other AI reservations where community garden research has been initiated, suggesting an opportunity for NA communities to collaborate in order to share helpful practices and address common barriers.

We accomplished developing and implementing a feasibility study of a group gardening program for NA adults where tribal health staff collect program measures. Our retention rate to the program was lower than expected (62.5%). A common reason cited for discontinuing the program was frequent travel for family vacations and participating in annual NA ceremonies and celebrations that interfered with being able to regularly participate in the garden program. Future studies should explore ways the program could reach and retain NA individuals who travel often during the summer months. Local project staff and a master gardener who is a community member facilitated the semimonthly garden sessions and reported that participants seemed engaged and interested in the information.

Ninety percent or more of the study participants completed the pre- and posttest outcome measures, indicating high measurement participation rates. No adverse events were reported in collecting the measures. Participants had high motivation to eat and grow vegetables, low depression, moderately high quality of life scores, and good-to-excellent glucose control. These findings indicate that there is a good opportunity for NA adults across the reservation to participate in a group gardening program and study regardless of diabetic status. Collecting these measures established the feasibility of gathering these data among this population as the project partnership advances to more rigorous-efficacy assessment of gardening programs.

That our gardening intervention indicated some improvement in POMS total mood disturbance, tension-anxiety, and depression-dejection scores is notable as NAs experience disproportionate rates of mental health problems (Beals et al., 2005), and death due to depression compared to other racial/ethnic groups (Baldridge, n.d.), and individuals with diabetes suffer high rates of depression and anxiety (Robinson et al., 2018). The improvement in the POMs-measured depression score agrees with another gardening study conducted in underserved adults with diabetes (Nayak et al., 2017). That most of the QOL scores did not improve in the treatment group was not surprising, given the short duration of the garden intervention.

While reports of gardening programs in NA communities can be found on the Internet (Brewer, 2014; Heck, 2011; Woodard, 2013; Woodward, 2005), and in the literature (Armstrong, 2000; Ornelas et al., 2017; Ornelas et al., 2018), to our knowledge, none have reported change in health and psychological measures of participants in a group garden program. However, two studies collected HgbA1c measures in underserved (Nayak et al., 2017) and Indigenous (Weltin, 2013) adults with diabetes participating in gardening programs—populations that are similar to our participants.

Limitations

This study had some limitations. Stakeholder interviewees were community members, which may have increased hesitation to disclose information because of familial or community hierarchical structures. It is difficult to know whether the community researchers’ standing on the reservation influenced the exchange of information. Although the authors sensed that saturation was achieved on themes related to influences on the community adopting locally grown foods and community gardens, we may not have achieved a diverse representation of these issues by interviewing only stakeholders. While the gardening and food-related sessions aimed to build self-efficacy, and behavioral capability about gardening and healthy eating, we did not rigorously assess these outcomes. Assessing these outcomes can help inform future group gardening interventions with structured activities and components. Findings from the feasibility study should be interpreted with caution. The small study size and the sampling frame of adults that were engaged in the tribal diabetes program suggest that these findings would not be representative of all NA adults with diabetes in this community.

Dissemination of Findings

Consistent with the CBPR approach our community–academic team expanded outreach and dissemination beyond the project described here. Such efforts included supporting school-based programs about gardening and eating healthy foods, and establishing two community garden areas. The team also disseminated project outcomes and educational materials through meetings and videos. The team continues to partner with the community on proposals to fund local gardening programs and food systems work. Since the study ended, the tribal government has allocated ~40 acres of prime agricultural land for community members to use for growing potatoes, watermelons, and other vegetables and fruits.

Footnotes

Authors’ Note:

The authors thank all members of the American Indian reservation for their commitment to advance interest and participation in community gardening projects and related activities. The authors further acknowledge the help provided by Douglas Krebs and Mary Ruth St. Pierre for assistance in facilitating communication between Chippewa Cree Tribal Health and Stone Child Community College in implementing the study components, Fawn Tadios and Jacquie Meyers for assistance in facilitating communication between the University of Montana, Chippewa Cree Business Committee and Council, and Chippewa Cree Tribal Health; and Karen Meyers for her assistance in the collection and organization of diabetes clinical measures. Finally, the authors thank Hunter Bo Hessian and Tanya Olson for their expertise in assisting community members in building raised boxes for gardening on the reservation.

ORCID iD

Blakely Brown

References

Acton

K. J.

Burrows

N. R.

Geiss

L. S.

Thompson

(2003). Diabetes prevalence among American Indians and Alaska Natives and the overall population—United States, 1994-2002. Morbidity and Mortalality Weekly Report, 52, 702-704.

Adams

A. K.

Scott

J. R.

Prince

R. J.

Williamson

(2014). Using community advisory boards to reduce environmental barriers to health in American Indian communities, Wisconsin, 2007- 2012. Preventing Chronic Disease, 11. doi:10.5888/pcd11.140014

American Community Garden Association. (2016). Frequently asked questions (FAQs). Retrieved from https://communitygarden.org/resources/faq/

Armstrong

D. L.

(2000). A community diabetes education and gardening project to improve diabetes care in a Northwest American Indian tribe. The Diabetes Educator, 26, 113-120.

Baldridge

(n.d.). Diabetes and depression among American Indian and Alaska Native elders. Retrieved from https://www.cdc.gov/aging/pdf/hap-issue-brief-aian.pdf

Beals

Novins

D. K.

Whitesell

N. R.

Spicer

Mitchell

C. M.

Manson

S. M.

(2005). Prevalence of mental disorders and utilization of mental health services in two American Indian reservation populations: mental health disparities in a national context. American Journal of Psychiatry, 162, 1723-1732.

Bell

R. A.

Andrews

J. S.

Arcury

T. A.

Snively

B. M.

Golden

S. L.

Quandt

S. A.

(2010). Depressive symptoms and diabetes self-management among rural older adults. American Journal of Health Behaviors, 34, 36-44.

Bell

R. A.

Smithz

S. L.

Acury

T. A.

(2005). Prevalence and predictors of depressive symptoms among rural older African Americans, Native Americans and whites with diabetes. Diabetes Care, 28, 823-829.

Brewer

(2014). Cheyenne River Youth Project promotes health sovereignty with organic gardening programs. Indian Country Today.

10.

Christopher

Saha

Lachapelle

Jennings

Cooper

Cummings

Webster

(2011). Applying indigenous community-based participatory research principles to partnership development in health disparities reserach. Family & Community Health, 34, 246-255.

11.

Clatworthy

Hinds

J. M.

Camic

(2013). Gardening as a mental health intervention: A review. Mental Health Review, 18.

12.

Devereaux

(2010). A recipe for change on the Navajo Nation: community-based strategies to address obesity for Native American youth. Childhood Obesity, 6, 237-239.

13.

Draper

Freedman

(2010). Review and analysis of the benefits, purposes, and motivations associated with community gardening in the United States. Journal of Community Practice, 18, 458-492.

14.

Eto

Kyngas

(2008). The qualitative content analysis process. Journal of Advanced Nursing, 62, 107-115.

15.

Genter

Roberts

Richardson

Sheaff

(2015). The contribution of allotment gardening to health and wellbeing: a systematic review of the literature. British Journal of Occupational Therapy, 78, 593-605.

16.

Gittelsohn

Rowan

M. T.

(2011). Preventing diabetes and obesity in American Indian communities: the potential of environmental interventions. American Journal of Clinical Nutrition, 93(Suppl.), 1179S-1183S.

17.

Heck

(2011). Potawatomi traditional gardener promotes growing healthy foods to prevent diabetes. Indian County Today. Retrieved from https://indiancountrymedianetwork.com/news/potawatomi-traditional-gardener-promotes-growing-healthy-foods-to-prevent-diabetes/

18.

Hsieh

Shannon

(2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15, 1277-1288.

19.

Israel

B. A.

Schulz

A. J.

Parker

E. A.

Becker

A. B.

(1998). Review of community-based research: assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202.

20.

Lombard

K. A.

Beresford

S. A.

Ornelas

Topaha

Becenti

Thomas

Vela

J. G.

(2014). Healthy Gardens/Healthy Lives: Navajo perceptions of growing food locally to prevent diabetes and cancer. Health Promotion Practice, 15, 223-231.

21.

Lombard

K. A.

Forster-Cox

Smeal

O’Neill

M. K.

(2006). Diabetes on the Navajo nation: What role can gardening and agriculture extension play to reduce it? Rural and Remote Health, 6(4), 640.

22.

Lopez

Reader

Wydham

(2001). The impact of food assistance programs on the Tohono O’odham food system: An analysis and recommendations. Retrieved from https://data.ers.usda.gov/FANRP-ridge-project-summaries.aspx?type=2&summaryId=143

23.

McLeroy

K. R.

Bibeau

Streckler

Glanz

(1988). An ecological perspective on health promotion programs. Health Educator Quarterly, 15, 351-377.

24.

McNair

D. M.

Lorr

Droppleman

L. F.

(2003). Profile of Mood States (POMS). Statistics Solutions. Retrieved from http://www.statisticssolutions.com/profile-of-mood-states-poms/

25.

National Gardening Association. (2018). About the National Gardening Association. Retrieved from https://garden.org/about/intro/

26.

Nayak

P. R.

Snyder

Stephens

N. M.

Jonaus

S. A.

Ing

S. W.

(2017). Community gardening for patients with diabetes mellitus in an underserved community: A pilot study. Practical Diabetology, 36(1), 4-9.

27.

Ornelas

Deschenie

Jim

Bishop

Lombard

K. A.

Beresfor

S. A.

(2017). Yéego Gardening! A community garden intervention to promote health on the Navajo Nation. Progress in Community Health Partnerships, 11, 417-425. doi:10.1353/cpr.2017.0049

28.

Ornelas

Osterbauer

Woo

Bishop

Deschenie

Beresford

S. A.

Lombard

(2018). Gardening for health: Patterns of gardening and fruit and vegetable consumption among the Navajo. Journal of Community Health, 43, 1053-1060. doi:10.1007/s10900-018-0521-1

29.

QSR International Ltd. (2015). NVivo qualitative data analysis software (Version 11).

30.

Radloff

L. S.

(1977). The CES-D scale: A self-report depression scale for research in general populations. Applied Psychological Measurement, 1, 385-401.

31.

Robinson

D. J.

Coons

Haensel

Vallis

Yale

(2018). Diabetes and mental health. Canadian Journal of Diabetes, 42, S130-S141.

32.

Robinson-O’Brien

Story

Hiem

(2009). Impact of garden-based youth nutrition intervention programs: A review. Journal of the Academy of Nutrition and Dietetics, 109, 273-280.

33.

Sallis

J. F.

Owen

Fisher

E. B.

(2015). Ecological models of health behavior. In Glanz

Rimer

B. K.

Viswanath

(Eds.), Health behavior and health education: Theory, research and practice (4th ed., pp. 465-486). San Francisco, CA: Jossey-Bass.

34.

Soga

Gaston

K. J.

Yamaura

(2017). Gardening is beneficial for health: A meta-analysis. Preventive Medicine Reports, 5, 92-99.

35.

U.S. Census Bureau. (2015). QuickFacts Montana. Retrieved from http://www.census.gov/quickfacts/table/PST045216/30

36.

Weltin

(2013). A community garden: Helping patients with diabetes to better care for themselves. American Journal of Nursing, 113(11), 59-62.

37.

WHOQOL Group. (1995). The World Health Organization Quality of Life assessment (WHOQOL): Position paper from the World Health Organization. Social Science & Medicine, 41, 1403-1409.

38.

Woodard

(2013). Dig It! Northern Plains gardeners grow food, health and sovereignty. Indian Country Today.

39.

Woodward

(2005). Plant a traditional foods garden. Indian Country Today.

40.

Zick

C. D.

Smith

K. R.

Kowaleski-Jones

Uno

Merrill

B. J.

(2013). Harvesting more than vegetables: The potential weight control benefits of community gardening. American Journal of Public Health, 103, 1110-1115.

41.

Zoellner

Zanko

Price

Bonner

Hill

(2012). Exploring community gardens in a health disparate population: Findings from a mixed methods pilot study. Progress in Community Health Partnerships, 6, 153-165.