Growing Healthy Hearts: a Single-arm Feasibility Study of a Digitally Delivered Gardening, Cooking, and Nutrition Intervention for Adults with Risk Factors for Cardiovascular Disease

Overview

Journal Pilot Feasibility Stud

Publisher Biomed Central

Date 2023 Aug 31

PMID 37653532

Authors

Susan Veldheer

Maxfield Whitehead-Zimmers

Candace Bordner

Olivia Weinstein

Hena Choi

Kira Spreenberg-Bronsoms

Jason Davis

David E Conroy

Kathryn H Schmitz

Christopher Sciamanna

Affiliations

Soon will be listed here.

Abstract

Background: Food gardening may positively influence cardiovascular disease (CVD) risk-related behaviors. However, the vast majority of existing gardening interventions have used an in-person delivery model which has limitations for scalability. It is not known whether a digitally delivered gardening intervention would be feasible or acceptable to participants. The purpose of this pilot study was to assess the feasibility of a digitally delivered gardening intervention in three domains: participant acceptability, demand, and practicality.

Methods: A single-arm, pre-post-study design was used. Participants (n = 30) were aged 20 + with no plans to garden in the coming season and had at least 1 CVD risk factor. The intervention included ten 1-h video-conferencing sessions, written materials, and access to a study website. Content focused on gardening skills, cooking skills, and the Dietary Approaches to Stop Hypertension (DASH) diet. Feasibility outcomes included acceptability (post-program ratings), demand (session attendance rate), and practicality (ability to start a garden and grow F&V). The study was considered feasible if the following criteria were met: ≥ 70% rated the intervention as good or excellent, overall session attendance rate was ≥ 70%, and > 70% were able to start a garden and grow F&V. We also assessed pre-post-program changes in behavioral mediators (gardening confidence, gardening enjoyment, cooking confidence, and nutrition knowledge). Descriptive statistics were calculated. Pre-post differences were evaluated with means and 95% confidence intervals (95% CI). Effect sizes were calculated (Cohen's d).

Results: All feasibility criteria were met. A total of 93.3% of participants rated the intervention as good or excellent, 96% started a garden and grew F&V, and the overall session attendance rate was 81%. The largest mean pre-post changes were in gardening confidence (pre 7.1 [95% CI: 6.4, 7.9], post 9.0 [95% CI: 8.6, 9.5], Cohen's d = 1.15), gardening enjoyment (pre: 6.3 [95% CI: 5.9, 6.7], post: 7.5 [95% CI: 7.1, 7.9], Cohen's d = 1.69), and cooking self-efficacy (pre: 4.7 [95% CI: 4.3, 5.1], post: 7.7 [95% CI: 7.3, 8.0], Cohen's d = 3.0).

Conclusion: A digitally delivered gardening intervention was feasible, acceptable to participants, and they had meaningful changes in behavioral mediators. The next step is to evaluate the impact of the intervention in a future randomized controlled trial.

Citing Articles

Assessment of Validated Instruments for Measuring Cooking Skills in Adults: A Scoping Review.

Lins M, Botelho R, Romao B, Torres M, Guimaraes N, Zandonadi R Foods. 2024; 13(23).

PMID: 39683005 PMC: 11640902. DOI: 10.3390/foods13233933.

References

Zick C, Smith K, Kowaleski-Jones L, Uno C, Merrill B . Harvesting more than vegetables: the potential weight control benefits of community gardening. Am J Public Health. 2013; 103(6):1110-5. PMC: 3698715. DOI: 10.2105/AJPH.2012.301009. View

Liu H, Cella D, Gershon R, Shen J, Morales L, Riley W . Representativeness of the Patient-Reported Outcomes Measurement Information System Internet panel. J Clin Epidemiol. 2010; 63(11):1169-78. PMC: 2943555. DOI: 10.1016/j.jclinepi.2009.11.021. View

Haven J, Rihane C, Britten P, Johnson-Bailey D, Lino M, Rahavi E . Healthy eating on a budget at ChooseMyPlate.gov. J Acad Nutr Diet. 2014; 114(6):834-837. DOI: 10.1016/j.jand.2014.04.009. View

Cohen S, Kamarck T, Mermelstein R . A global measure of perceived stress. J Health Soc Behav. 1983; 24(4):385-96. View

Winthorst W, Bos E, Roest A, de Jonge P . Seasonality of mood and affect in a large general population sample. PLoS One. 2020; 15(9):e0239033. PMC: 7489524. DOI: 10.1371/journal.pone.0239033. View

Veldheer S, Winkels R, Cooper J, Groff C, Lepley J, Bordner C . Growing Healthy Hearts: Gardening Program Feasibility in a Hospital-Based Community Garden. J Nutr Educ Behav. 2020; 52(10):958-963. DOI: 10.1016/j.jneb.2020.07.006. View

Bowen D, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D . How we design feasibility studies. Am J Prev Med. 2009; 36(5):452-7. PMC: 2859314. DOI: 10.1016/j.amepre.2009.02.002. View

Andersen L, Corazon S, Stigsdotter U . Nature Exposure and Its Effects on Immune System Functioning: A Systematic Review. Int J Environ Res Public Health. 2021; 18(4). PMC: 7913501. DOI: 10.3390/ijerph18041416. View

Lancaster G, Dodd S, Williamson P . Design and analysis of pilot studies: recommendations for good practice. J Eval Clin Pract. 2004; 10(2):307-12. DOI: 10.1111/j..2002.384.doc.x. View

10.

Michie S, van Stralen M, West R . The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6:42. PMC: 3096582. DOI: 10.1186/1748-5908-6-42. View

11.

Soga M, Gaston K, Yamaura Y . Gardening is beneficial for health: A meta-analysis. Prev Med Rep. 2016; 5:92-99. PMC: 5153451. DOI: 10.1016/j.pmedr.2016.11.007. View

12.

Sim J, Lewis M . The size of a pilot study for a clinical trial should be calculated in relation to considerations of precision and efficiency. J Clin Epidemiol. 2011; 65(3):301-8. DOI: 10.1016/j.jclinepi.2011.07.011. View

13.

Beets M, VON Klinggraeff L, Weaver R, Armstrong B, Burkart S . Small studies, big decisions: the role of pilot/feasibility studies in incremental science and premature scale-up of behavioral interventions. Pilot Feasibility Stud. 2021; 7(1):173. PMC: 8431920. DOI: 10.1186/s40814-021-00909-w. View

14.

Landry M, van den Berg A, Hoelscher D, Asigbee F, Vandyousefi S, Ghaddar R . Impact of a School-Based Gardening, Cooking, Nutrition Intervention on Diet Intake and Quality: The TX Sprouts Randomized Controlled Trial. Nutrients. 2021; 13(9). PMC: 8471386. DOI: 10.3390/nu13093081. View

15.

Monroy M, Keltner D . Awe as a Pathway to Mental and Physical Health. Perspect Psychol Sci. 2022; 18(2):309-320. PMC: 10018061. DOI: 10.1177/17456916221094856. View

16.

Ainsworth B, Haskell W, Herrmann S, Meckes N, Bassett Jr D, Tudor-Locke C . 2011 Compendium of Physical Activities: a second update of codes and MET values. Med Sci Sports Exerc. 2011; 43(8):1575-81. DOI: 10.1249/MSS.0b013e31821ece12. View

17.

Appel L, Champagne C, Harsha D, Cooper L, Obarzanek E, Elmer P . Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial. JAMA. 2003; 289(16):2083-93. DOI: 10.1001/jama.289.16.2083. View

18.

Svetkey L, Sacks F, Obarzanek E, Vollmer W, Appel L, Lin P . The DASH Diet, Sodium Intake and Blood Pressure Trial (DASH-sodium): rationale and design. DASH-Sodium Collaborative Research Group. J Am Diet Assoc. 1999; 99(8 Suppl):S96-104. DOI: 10.1016/s0002-8223(99)00423-x. View

19.

Arigo D, Jake-Schoffman D, Wolin K, Beckjord E, Hekler E, Pagoto S . The history and future of digital health in the field of behavioral medicine. J Behav Med. 2019; 42(1):67-83. PMC: 6644720. DOI: 10.1007/s10865-018-9966-z. View

20.

Browne R . On the use of a pilot sample for sample size determination. Stat Med. 1995; 14(17):1933-40. DOI: 10.1002/sim.4780141709. View