Effectiveness of Home Gardening in Reducing Food Insecurity and Improving Health in Chacraseca, Nicaragua: A Pilot Study
Type of DegreePhD Dissertation
Nutrition, Dietetics and Hospitality Management
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Nicaragua has a high rate of food insecurity determined by factors such as, poverty, employment, education, social capital and climate change. Home gardening and nutrition education can decrease food insecurity and improve community health. There is a need to evaluate garden-based nutrition education to determine its effectiveness in improving food security and health in Nicaragua. It is also important to engage stakeholders at all stages of community research studies as it may lead to improved outcomes. The objective for this study was to evaluate the effectiveness of home gardening and nutrition education in improving food security, health, nutrition knowledge and nutrient intake among residents in Chacraseca, a small farming community in Nicaragua. A community needs assessment was conducted using focus group discussions and key-informant interviews to determine home gardening and nutrition education as priority interventions to improve food security and health in Chacraseca. Participants from Chacraseca were randomly recruited into the intervention and control groups. The intervention participants were recruited from residents previously involved in activities with JustHope, Inc., whereas the control group included participants not engaged in JustHope, Inc. activities. A longitudinal study design was used to promote and evaluate the effectiveness of home gardening and nutrition education in improving food security, health, nutrition knowledge and nutrient intake. Research tools including food security questionnaires, anthropometry and blood pressure measures were used to collect baseline data on food security and health. After a year of promoting home gardening to the intervention participants, the same survey tools used at baseline were used to determine changes in food security and health at post-study. Concurrent with home gardening, a longitudinal study of nutrition education was conducted to determine the effect of garden-based nutrition education in improving nutritional knowledge and nutrient intake. Nutrition education questionnaires and 24-hr recalls were used to collect baseline data on food intake and nutrition knowledge. After collection of baseline data, the intervention participants also involved in home gardening received six nutrition education lessons using the community nutrition education model. A year later, nutrition knowledge questionnaires and 24-hr surveys were used to determine changes in nutrition knowledge and nutrient intake. Qualitative data was analyzed using ATLAS.ti version 8.2.4 for iOS, whereas quantitative data was analyzed using SAS version 9.4. Fifty participants were recruited into the intervention and control groups. At post-study, there were no significant changes in body mass index (p = 0.99), systolic blood pressure (p = 0.13), and diastolic blood pressure (p = 0.92) between the intervention and control groups. The average BMI for the intervention and control participants at baseline and post-study was within the overweight range (BMI between 25 and 29.9). The control group showed a greater percentage increase in participants with normal blood pressure (40%, n =18 at baseline to 60%, n = 27 at post-study) compared to the intervention group (48%, n = 23 at baseline to 54%, n = 26 at post-study). In households with children, at baseline and post-study, there was a decline in percentage of participants categorized as having low food security from 52% (n = 26) to 44% (n = 22) in the intervention group. Both the intervention and control groups showed improvements in participants categorized as having high food security from 2% (n = 1) to 6% (n = 3) in the intervention group and from 0% to 8.3% (n = 4) in the control group. At post-study, participants in the intervention group had significant improvement in nutrition knowledge scores. There were non-significant changes in nutrient intake between the intervention and control groups except for vitamin A (p = 0.04) and sodium (p = 0.03). However, there were observed non-significant increase in nutrient intake that were not specific to either the intervention or the control group. Although there was not enough evidence to demonstrate that home gardening improves health status, non-significant evidence pointed to an increase in number of participants with normal blood pressure. This, together with the slight improvement in food security and the significant improvement in nutrition knowledge demonstrated the potential of home gardening to improve health, food security and nutrient intake. Future researchers should focus on using several food security indicators in the evaluation, recruit larger sample sizes and should evaluate older home gardening projects. In addition, future research studies should last longer and include more intensive nutrition education and gardening training.