Building Sustainable Community-Academic Partnerships while Implementing a Nutrition-Based Blackberry Garden Program at a Senior Center

Abstract

Due to limited access to and consumption of fruits and vegetables, older adults are at increased risk of worsening or developing chronic diseases.

This paper describes a community-academic partnership that provides a sustainable source of blackberries to attendees of a rural senior center.

Qualitative research evaluated the partnership following implementation of a blackberry program. Focus groups and interviews included partners from a senior center, Cooperative Extension Service, and a detention center.

Main themes: group power dynamics influenced communication between research and community leadership teams; unexpected project barriers emerged; and community leadership team suggested strategies to promote project longevity.

Introduction

Driven by aging Baby Boomers, the older adult population, 65+ years, is growing rapidly and expected to outnumber children by 2035.¹ The population is projected to nearly double from 52 million (16%) older adults in 2018 to approximately 95 million (23%) by 2060.² Kentucky’s aging population is among the nation’s least healthy, ranking 49^th.³ Fruit and vegetable consumption among older Kentuckians is bleak with only 26.6% of those aged 65 years and older consuming two or more fruits per day, and 9.6% consuming three or more vegetables per day.^{3, 4} To promote healthy aging in older adults, the Older Americans Act Elderly Nutrition Program offers services through provision of nutritious meals and social programs. Title IIIC of the Act authorizes access to healthy meals, nutrition education, and nutrition counseling free of charge to adults 60 years or older while specifically targeting those with the greatest social and economic need.⁵ Within a state, counties typically have a senior center which provides meals and social programs to community-dwelling older adults. In Kentucky, the Family and Consumer Science Cooperative Extension Service (FCS CES) is one community entity that can provide monthly nutrition education lessons to the 150 Kentucky senior centers, as directed by the Act.

Operating at the county level, CES is strategically positioned to influence all spheres (individual, interpersonal, organizational, community, and systems/policy) of the Social-Ecological Model for behavior change.^{6, 7} Implementing multiple changes at various Social-Ecological Model levels is effective in improving eating and physical activity behaviors.⁸ As conduits of the land-grant institution, CES educators serve as liaisons between community members, organizations, and academic researchers. Importantly, CES educators are trusted members of the community that are critical to forming community-academic partnerships that foster implementation of community interventions grounded in evidence-based research. Such partnerships allow cutting-edge research to travel beyond publication and into the communities that are in most need ⁹. In theory, the position and role of CES educators is a needed bridge for successful partnerships between academic and community entities because it allows for the research generated in academia to be applied in real-world community settings.¹⁰ Often times, community partners are not invested in the research of their academic partners because the research purpose is perceived by community partners as misaligned and a gap in knowledge of the true needs of the community remains.^{11, 12} If CES educators are appropriately utilized and their voices heard, there is great potential for the true needs of a community to be understood, thus fostering the development of a sustainable partnership. Benefits of a good community and academic partnership allows for a multifaceted approach to address an issue because of the various resources that come with each partner, as well as the establishment of lasting programs that considers the needs of the primary partners.¹⁰

To promote healthy aging among older adults, researchers leveraged the educational and health engagement activities of the CES with programming at one senior center to implement the BerryCare program. BerryCare includes a nutrition and environmental pollution-focused education series along with a community blackberry garden to provide a free, sustainable source of blackberries to participants. Blackberries were chosen because they grow well throughout Kentucky and when properly cared for yield berries for 8 to 15 years. Blackberries are also a rich source of phytonutrients that are found in plant matter. When consumed regularly, phytonutrients help protect against chronic disease.^11–14 Phytonutrients have both anti-inflammatory and antioxidant properties beneficial to human health,¹⁰ including reducing toxicological insults associated with environmental pollutants.^13–16

For this project, cross-collaboarative partnerships were established with a senior center, a detention center, and CES educators to provide blackberries and hands-on nutrition education to a vulnerable community-dwelling older adult population. The blackberries contributed to total fruit and vegetable intake of the older adults, an important outcome given the limited fruit and vegetable intake of Kentuckians aged 65 years and older.¹⁷ In this feasibility study, we employed implementation science-based methods using formative evaluation to characterize perceptions of our community partners as they implemented a nutrition and environmental pollution-focused program to understand the dynamics of the community-academic partnership, and used results to adjust our implementation approach. The National Cancer Institute defines implementation science as “the study of methods to promote the adoption and integration of evidence-based practices, interventions, and policies into routine health care and public health settings to improve the impact on population health.”¹⁸ Our implementation strategy fell into Waltz et al.’s cluster of “use evaluative and iterative strategies” which is characterized by assessing readiness and identifying barriers and facilitators; auditing and providing feedback; and purposefully reexamining implementation.¹⁹ Here we describe the partnerships, barriers, and solutions associated with bringing the BerryCare program to an older adult population attending a rural county senior center.

Methods

In 2016, the community-academic partnership was formed when the research team initiated conversations with a director of a rural senior center in central Kentucky (county population: 30,060)²⁰ to gauge his interest in participating in the BerryCare program. This particular senior center was asked to participate based on proximity to the University, green space to plant blackberry bushes and the presence of both FCS and horticulture extension educators with a history of strong partnership with one another as well as with the senior center director. The university Office of Research Integrity IRB approved all study procedures.

The community leadership team was comprised of the senior center director, senior center manager, and horticulture and FCS extension educators (Table 1). The research team consisted of registered dietitians, experts in community-engaged nutrition program development, an expert in environmental pollution and nutrition, a CES Specialist in horticulture with expertise in growing brambles, and a CES Specialist with expertise in developing FCS Extension programs focused on healthy aging. The research team developed the nutrition education lessons (Table 2), created and tested six blackberry-themed recipes²¹, purchased the blackberry bushes and supplies necessary to care for the bushes for the first year, and provided technical assistance for proper blackberry care and nutrition education.

Table 1:

Roles and responsibilities of the BerryCare community leadership team members.

Community Leadership Team Member	Roles and Responsibilities
Senior Center Director	• provided leadership and support on behalf of the senior center for the project  • advertised BerryCare lessons to Senior Center participants  • announced when the research team would collect data from consented participants  • reviewed manuscript
Senior Center Manager	• advertised BerryCare lessons to Senior Center participants  • announced when the research team would collect data from consented participants  • showed program support by being present at all BerryCare lessons to ensure lessons were not interrupted by other senior center activities
Family and Consumer Sciences Extension Educator	• delivered monthly BerryCare lessons  • provided blackberry-themed recipe samples  • collected pre- and post-lesson evaluations  • reviewed manuscript
Horticulture Extension Educator	• provided technical assistance and training on topics such as weeding, watering, and picking blackberries  • provided advanced horticulture activities including preparing the soil for planting, fertilizing, pest management, pruning, and identifying pest invasion problems.  • reviewed manuscript

Table 2:

BerryCare lesson titles.

Lesson Title	Lesson Description
Building a Blackberry Community	Outlines the responsibilities involved that a group of people taking on a blackberry garden need to consider.
Make Your Plate a Rainbow	Provides information about the health benefits of predominant phytonutrients found in various fruits and vegetables.
Protection from Pollution with Phytonutrient-Rich Berries	Explains different sources of environmental pollution, their negative effects on health and how phytonutrients may help reduce the detrimental health effects of pollutants.
When Blackberries and Other Berries are in Season	Describes methods to preserve berries.
Blackberry Varieties and Plant Establishment	Provides considerations to choosing the right site and blackberry variety to meet consumer needs and increase the viability of the bushes.
Blackberry Growth and Maintenance	Maintenance tips are provided in order to properly care for blackberry bushes that promote a good harvest and longevity of the bushes.

The BerryCare nutrition education series was developed and piloted with an end goal of being incorporated into FCS Extension programming statewide. The BerryCare curriculum included two Extension publications from the established Body Balance: Protect Your Body from Pollution with a Healthy Lifestyle Extension series which focused on nutrition protecting against the detrimental effects of environmental pollution.²² Educating older adults about this topic is critical because older adults are particularly vulnerable to the detrimental health effects of environmental pollution. They are at increased risk of incurring cell damage when exposed to environmental pollution due to the natural aging process altering the ability of the body to safely detoxify pollutants, as well as the fact that older adults have lived longer thereby being exposed to more environmental pollutants.²³ The remaining Extension publications focused on aspects of sustainability including establishment of a committee to oversee the care and maintenance of the bushes; considerations in planting site and blackberry bush variety selection; blackberry preservation options; and maintaining blackberry bushes. Each member of the community leadership team approved lesson topics and content (Table 1). The BerryCare curriculum then went through the University of Kentucky’s Extension review process, which includes blind peer-review by two to three external reviewers with content and Extension expertise.

For our feasibility study, senior center staff invited and encouraged the 20 – 25 community-dwelling older adults who regularly attended the center to participate in the 15-minute BerryCare lessons delivered by the FCS educator. The horticulture educator provided technical and hands-on assistance with planting, maintaining, and harvesting blackberries. A previous partner of the senior center, the county detention center, became involved by expanding their volunteer gardening initiative to include the blackberry bushes. Volunteer inmates who previously cleared, tilled, planted, and harvested a large community garden at the center took on the blackberry bushes that were planted next to the garden. The blackberry bushes were easily incorporated into existing garden maintenance and harvesting schedules.

Data Collection

In spring 2017, forty-three, thorn-less, semi-erect blackberry bushes, consisting of three different varieties, were planted by research and community team members at the senior center. The community leadership team decided how many bushes and which varieties to plant. As anticipated, bushes yielded fruit in summer 2018.

Qualitative data was collected in September 2017 and 2018. Focus group and interview scripts aligned with implementation science-based strategies of formative evaluation by specifically collecting information about facilitators and barriers to program implementation as well as collecting information to gain an understanding of the community leadership team’s process, their perception of the positive and negative aspects of delivering BerryCare, and general program feedback.

The two focus groups lasted approximately 60-minutes, took place at the county extension office, and were conducted by the research team program manager, moderated by a graduate student, and supported by one student observer (see Table 3 for questions). The first focus group was conducted in September 2017 before the bushes yielded berries. Participants included the senior center director and FCS and horticulture Extension educators. Data collected in September 2018 followed the first harvest and included a joint interview with the FCS educator and senior center manager, as well as a focus group with the senior center director, horticulture Extension educator, and the director of the inmate work program.

Table 3:

Focus group script used with BerryCare program community partners.

Share a story about what has happened as a result of the project

How have your attitudes changed following the project?

How have your behaviors changed following the project?

Did you make any new connections with other people or organizations?

What barriers did you encounter with the project and what did you do about them?

What made the project successful and how?

What word best describes the impact of the project?

What advice would you have to another county that wanted to implement this project?

Data Analysis

Focus groups and interviews were transcribed verbatim. Two members of the research team conducted stratified coding by question to determine thoughts about the project and any issues in the execution. Codes were compared across transcripts and organized into themes to elucidate commonalities and differences between participants. The coders met to resolve discrepancies in codes and to compare and finalize themes (presented below). ^{24, 25} Qualitative data analysis was conducted using Microsoft Excel and Microsoft Word.

Results

Three main themes emerged: group power dynamics influenced communication between the research and community leadership teams; unexpected project barriers emerged; and the community leadership team suggested strategies to promote the longevity of the project.

Power Dynamics and Project Planning

In 2017, the community leadership team expressed frustration regarding the way in which the project was developed. As one member of the team said: “It was kind of plopped into our lap and we’re doing our best at it, but I wish there would have been more talk ahead of it.” The community leadership team members expressed the desire for group collaboration when determining the intervention for a population that they work closely with every day.

Because honestly, I love that [university researchers] provide us with all these wonderful ideas and stuff and just drop that in the county, it’s great they want to be involved in that way but not a lot of forethought is put into: is this actually going to work? is this going to be good for this community? is this going to be feasible at the location?

These quotations illustrate the multiple and layered power dynamics inherent to multi-institutional partnerships. On an immediate level, the horticulture extension educator (a young female) was working towards a graduate degree at the time of early project discussions in the same department as the Horticulture Extension Professor (an older male) of the research team. As a young female graduate student, the county extension educator occupied a considerably less powerful position than the older male Horticulture Faculty Specialist. However, importantly, the horticulture educator understood the daily realities of the community within which she lived and worked, as well as possessing the expertise in both plant growth and maintenance. To exemplify the point of the power dynamics at play; during a 2016 in-person planning meeting, at which both the horticulture educator and Horticulture Extension Professor were present, no concerns were voiced about planting blackberry bushes. In 2017, however, during a focus group (in which the Extension Professor was absent) the horticulture educator laid out the amount of work that fell to her, without having any perceived support. In other words, from the faculty member’s longer term and somewhat distanced perspective, blackberry plants would provide berries to the center for over a decade; from the agent’s everyday perspective, the blackberry plants were another task added to her already daunting daily to-do list. This drawn-out explanation illustrates the complexity of power relationships inherent to community-based work.

A second layer of the inherent power dynamic in this group emerges from the funding realities of operating a senior center. Senior centers must cobble together resources from a range of local, regional, and national sources. In this context of underfunding, increased demand for services, and competition for resources, partnering with a university (from which additional research funds may eventually come) to provide fresh fruits for older adults would reflect positively on the senior center. In short, turning down an opportunity like BerryCare, even if there were unspoken doubts, may not have seemed like a possibility to overworked and underfunded senior center leadership.

These realities are also complicated by what is pointed out in the above quotation; namely, previous experiences of the community leadership group when interacting with University researchers. Whether it was previous researchers’ intentions or not, they gave the impression of pushing projects onto community leadership that the community felt powerless to refuse and seemed to feel that BerryCare was no exception. These concerns were raised during a focus group led by the research team program manager. As a mediator between the community and research team, both sides were comfortable expressing doubts and frustrations to the program manager that they would not have expressed to one another. Given their history with researchers, the community leadership team felt hesitant to contribute during early project initiation and felt unsure of the project purpose and outcomes. In this way, the initial focus groups provided the research team with valuable information about how to better include the community leadership team in the project development phase.

Project Barriers

The community leadership team felt that they lacked the materials and resources they believed were necessary to be successful, including personnel, time, and assistance from the seniors attending the center. Some of these concerns were alleviated via the successful collaboration with the detention center’s volunteer gardening program in 2018.

The second focus group took place after the first blackberry harvest in 2018. Labor needs remained a barrier identified by the community leadership team, specifically the technical horticulture labor needs. The partnership with the detention center provided low-skill labor, such as weeding and harvesting berries, and is the likely reason why labor needs cited in 2018 pertained more to technical labor. Members of the focus group expressed that they do not have enough individuals to help with the technical horticulture responsibilities such as fertilizing, spraying, and pruning. Without this support, the project would not survive, which led to feelings of stress and frustration. To fulfill the technical labor needs and save time, the Horticulture educator holds trainings as needed to teach graduate students how to prune, fertilize, and identify pest and blight issues that may affect blackberry bushes. A method of communication was also established that involved the graduate students taking photographs of anything that looked unusual or concerning and sending the photographs to the Horticulture educator to review. This system freed up time to allow the Horticulture educator to be able to take care of the spraying needs.

The community leadership team also expressed frustration with the project timeline because lessons and blackberry recipes were delivered the same year that the blackberries were planted (2017), but not bearing fruit because blackberry bushes do not produce fruit until the year after they are planted. However, once the bushes were fruitful in 2018, the community leadership team had a much more positive outlook on the project. The successful 2018 harvest shifted the perception and understanding of the project from one of anxiety and trepidation to hope and positive engagement. “I think it has a lot of potential,” a member of the leadership team said in 2018, “now that we understand what we’re facing I’m going to try and work that into my programming for the year.” The FCS educator spread the positivity to the older adults attending the center by sharing blackberry-themed recipe samples with them using the fresh berries from their bushes. Seniors were also given berries to take home. Along with the recipe samples, the FCS educator also presented the nutrition-focused Extension education lessons.

Longevity Strategies

Collaboration and communication were key to properly maintain the bushes, pick the blackberries, and provide them to the seniors. In 2018, the community leadership team successfully communicated among organizations, which contributed to feelings of self-sufficiency and the confidence to continue the project with less assistance from researchers.

Meetings early-on between the community and research teams revealed that the older adults attending this particular senior center would likely not be interested and/or physically capable of maintaining and harvesting the blackberry bushes despite the research team choosing thorn-less semi-erect varieties to ease the burden of berry picking. Therefore, the senior center needed help with the picking and maintenance of the bushes, which they acquired through their ongoing relationship with the county detention center. Coordination between these three organizations allowed for picking to occur at the proper time and for the harvested blackberries to be tracked accurately and incorporated into congregate meals, recipe demonstrations, and nutrition lessons when possible.

Discussion

The purpose of this study was to characterize the dynamics of a community-academic partnership while establishing the feasibility of building programming into existing infrastructure offered by a senior center and the CES to provide a sustainable and accessible source of phytonutrient-rich blackberries and nutrition education to older adults attending a rural senior center. Guided by implementation science, formative evaluation took place using qualitative research to understand from our community partners’ viewpoint, BerryCare program delivery and perceived barriers and successes. The data was used to address concerns of community partners; build on strengths with the intention of fostering sustainable community-academic partnerships; and use lessons learned to improve BerryCare implementation in other communities.

Our results showed that despite the research team’s best efforts to gain trust of the community partners and involve them in the decision-making process at project initiation, unplanned power dynamics between the research and community leadership teams led to minor frustrations. The community leadership team was stifled in voicing their concerns regarding the selection of blackberry bushes as the perennial crop due to inter-group power differentials, limited senior center funding, and the community leadership team’s past experiences with the University. In our situation, the inter-group power differentials occurred between a young female graduate student and an older well established male professor. The research team was first made aware of this dynamic during the formative evaluation process. Unfortunately, past research has demonstrated that the power dynamics at play in our study does occur in academia in relation to gender^{26, 27} and in regards to relationships between graduate students and departmental faculty^{28, 29}. Fortunately, however, our early formative evaluation methods revealed the angst of the community leadership in September 2017 and allowed for a reaction by the research team well before the fruit-bearing summer of the 2018 blackberry season. The strong foundation of our partnership allowed for productive discussions regarding project challenges, potential solutions moving forward, project purpose, and re-visiting the roles and responsibilities of the community leaders and research team. Going through this process of compromise and feedback contributed to the strengthening of the community-academic partnership. A sense of self-sufficiency and ownership over the bushes on the part of the community leadership team emerged from the 2018 focus group/interviews, which is also an attribute associated with successful community-academic partnerships³⁰.

Throughout BerryCare program delivery, communication between the community and research teams allowed for constant evaluation with respective modifications to take place. Consistent revision and adjustment to programs that caters to the uniqueness of the target population has been found to increase participation and retention rates as well as increased program involvement among stakeholders³¹. In the current study, modifications were made throughout BerryCare implementation to decrease frustrations experienced by the community leadership team regarding blackberry bush maintenance. An adjustment made, although expected, was identification of a new source of non-technical labor. Once it was evident that senior center attendees were not physically capable or motivated to assist in crop maintenance or berry picking, the community leadership team utilized their resources and found assistance through the detention center volunteer gardening project to provide non-technical horticulture labor. This inclusion of the detention center was mutually beneficial as it provided a community outreach opportunity to fit into extant rehabilitation programming that is offered at the senior center. Overall, in 2018, it was the strong communication between community organizations that generated the seamless system of weekly blackberry harvest by volunteer inmates and utilization by the senior center.

Conclusion

BerryCare was purposefully built into existing systems and partnerships among community organizations to generate a sustainable and scalable model that can be adopted by other senior centers or community entities partnering with CES. Carefully designating future community partners and using lessons learned from the current study is a critical step in scaling up this model¹¹. In spring 2020, in a separate county, the university researchers partnered with the CES and a different senior center to implement the BerryCare program. Additionally, the research and community leadership team has disseminated the BerryCare program through oral and poster presentations and as an Interdepartmental Cooperative Extension education series available to the public and county Extension educators across Kentucky. As with all community garden programs, dedicated partners are needed to maintain a viable garden, or in this case a blackberry garden, each year. Furthermore, the formalized use of a mediator early and often throughout the planning and implementation stages of a project might ease tensions and help navigate the various power dynamics at play in any organizational partnership. To-date, our community-academic team has successfully maintained the original blackberry garden for five years, which we attribute to building into existing community infrastructure and formative evaluation of our partnership early-on and throughout the project while being responsive to the concerns of community partners.