Lessons Learned From Implementing of Garden Education Program in Early Child Care

Abstract

Background.

Early childhood is a critical life period for promoting health behaviors, and early child care and education centers (ECECs) are critical settings, as 60% of U.S. children attend ECECs. Yet few programs or curricula that promote physical activity and nutrition in this setting exist. This study explored the acceptability, feasibility, and sustainability of the Sustainability via Active Garden Education (SAGE) program.

Method.

Preintervention interviews were conducted to inform the design of SAGE and postintervention interviews were conducted to evaluate the implementation of SAGE in the ECEC setting. A constant comparison approach was used to capture emergent themes on acceptability, feasibility, and sustainability from interviews.

Participants.

ECEC directors (N = 10, 90% female, 20% Hispanic, 30% African American).

Results.

Directors expressed that SAGE was acceptable and feasible as it was age-appropriate, engaging, and aligned with existing curricula and accreditation standards. Most directors reported that SAGE improved activity and nutrition related knowledge while building other social and academic skills (e.g., expanding vocabulary) that are critical to this important developmental period. Suggestions for improving the sustainability of the program included stronger parental involvement and opportunities for ECEC staff trainings.

BACKGROUND

The trajectory toward obesity is set as early as the age of 5 years (Salbe et al., 2002; Whitaker, Pepe, Wright, Seidel, & Dietz, 1998). In the Institute of Medicine’s 2011 Early Childhood Obesity Prevention Policies Report, early child care and education centers (ECECs) were identified as ideal settings for early intervention, as 60% of U.S. children attend ECECs (Fuligni, Brooks-Gunn, & Berlin, 2003; Kagan & Newman, 2000; McGuire, 2012). However, there has been little progress in developing programming or curricula that incorporate physical activity (PA) and diet guidelines, national policies, and ECEC standards (Pate, Pfeiffer, Trost, Ziegler, & Dowda, 2004; Stellefson, Dipnarine, & Stopka, 2013).

The complexity of childhood obesity requires a multisector, collaborative approach (Lee & Cubbin, 2009; Spence & Lee, 2003). Over the course of 3 years, our research team developed an academic–community partnership that included community and health organizations, ECEC staff, and parents [NICHD:5U13HD063190] (Lee et al., 2014; Mama, Soltero, Ledoux, Gallagher, & Lee, 2014). This partnership led to the conceptualization of the Sustainability via Active Gardening Education (SAGE) project, a garden-based PA and nutrition curriculum (Mama et al., 2014). The curriculum was developed using national PA and diet guidelines, Institute of Medicine policies on childhood obesity prevention, and standards from a national ECEC accreditation association. This study demonstrates the use of collaborative partnerships to leverage community insight and resources to tailor obesity prevention strategies to the ECEC context, standards, and policies (Mama et al., 2014). This type of approach can increase the cultural relevance and sustainability of health promotion interventions (Correa et al., 2010; Wilcox, Parra-Medina, Felton, Poston, & McClain, 2010).

This purpose of this article is to present qualitative findings from in-depth interviews conducted before and after the implementation of the program. This manuscript describes the insight gained from preintervention interviews conducted with ECEC directors on the needs and challenges to effectively implementing a garden-based education program within the ECEC context. Findings from postintervention interviews describe the degree to which the program addressed these needs and challenges by describing the acceptability, feasibility, and potential sustainability of the program within the ECEC setting.

METHOD

Design and Setting

SAGE is a 12-week, garden-based PA and nutrition program for preschoolers that incorporates outdoor activities (e.g., working in the garden) and developmentally appropriate cognitive and social indoor activities (e.g., interactive songs) to promote PA and fruit and vegetable intake while reducing sedentary time (Lee et al., 2019). The SAGE program is rooted in the ecologic model of physical activity, which is a theoretical framework that holds that health behaviors are affected by physical and social environmental factors, processes, and linkages at multiple levels of influence (Spence & Lee, 2003). In the ECEC context, these factors include accreditation policies at the macro level, the center itself or the home at the microlevel, and exo- and meso-environmental linkages including relationships between children, their parents, and staff within the ECEC. These environmental factors are particularly important for young children who are entirely dependent on their immediate social and physical environment. The 12-week program was delivered in participating ECECs twice a week in 1-hour sessions by trained research assistants. The program consists of songs, games, and interactive learning activities involving garden maintenance and taste tests, which have been previously described in detail (Lee et al., 2019).

Participants and Centers

Directors of child care centers (N = 40) within a 10-mile radius of the University of Houston were invited to participate in preintervention interviews via postcards, phone calls, and e-mails. A convenience sample of the first 10 directors to respond were included in preintervention interviews. Following the preintervention interviews, all 10 directors expressed interest in participating in the intervention; however, due to limitations in resources, only four centers were enrolled in the program. On completion of the intervention, directors from the four participating ECECs participated in postintervention interviews to provide feedback on the implementation of the SAGE program.

Measures

The semistructured interview guide for preintervention interviews consisted of eight open-ended questions (Table 1) aimed at gaining insights on the potential acceptability, feasibility, and sustainability of a program like SAGE. Information gleaned from preintervention interviews was used to inform the planning, design, and delivery of SAGE. The semistructured interview guide for postintervention interviews consisted of 10 open-ended questions (Table 1) that evaluated the acceptability, feasibility, and sustainability of SAGE.

TABLE 1.

Semistructured Interview Questions From Pre- and Postintervention Interviews With Center Directors

Preintervention Interview Questions		Postintervention Interview Questions
1.	Please walk me through a typical day for a preschooler at the center.	1.	Describe your experience in the SAGE project.
		2.	Describe your favorite part about participating in the SAGE project.
2.	Please tell me about any food- or nutrition-related components at the center.
		3.	Describe your least favorite part about participating in the SAGE project.
3.	Please tell me about any physical activity (PA) or physical education components at the center.
		4.	Tell me about the impact that participating in the SAGE project had on students in your child care center.
4.	Tell me about the type of certification and/or training that child care workers at this center may have.
		5.	Tell me about the impact that participating in the SAGE project had on the staff at your child care center.
5.	Please tell me how you feel about PA and nutrition education in the child care setting.
		6.	Describe your interaction with the SAGE research team members.
6.	Please tell me how you feel about training or educating child care workers on things like nutrition and PA.
		7.	Tell me about some of the challenges to participating in the SAGE project.
7.	Please tell me your thoughts on the use of school or community gardens in child care settings as a tool to promote nutrition and PA.
		8.	Describe how appropriate the SAGE project curriculum was for students in your child care center.
8.	Is this project something that your center would be interested in being a part of?	9.	What recommendations or changes would you make to the SAGE project?

NOTE: SAGE = Sustainability via Active Gardening Education.

Data Collection

Pre- (N = 10) and postintervention interviews (N = 4) were scheduled at the ECEC directors’ convenience. Interviews were approximately 60-minutes long and participants were compensated with a $25 gift card.

Qualitative Data Analysis

Interviews were transcribed using a professional transcription service and analyzed by two coders using thematic content analysis with a constant comparison approach in a qualitative analysis software program (NVivo Version 11, QSR International, 2015; Ryan & Bernard, 2003). Each coder developed a codebook and identified repeated ideas and quotes while reading independently. Coders met 3 times to compare code-books and revise or reject codes. Codes were organized to create a list of emergent themes and subthemes.

RESULTS

Nine of the 10 (90%) ECEC directors were women. Two directors self-identified as Hispanic (20%), three as African American (30%), and five as White (50%). All centers that participated in SAGE were accredited through the National Association for the Education of Young Children (NAEYC; n = 3) or licensed through the Department of Family and Protective Services (n = 1). All centers employed full- and part-time staff members, offered full- and half-day service, and had an after-school program. The themes, subthemes, and quotes below were classified into the overarching themes of acceptability, feasibility, and sustainability.

Preintervention Interviews

Potential Acceptability

Desire to implement active gardening education.

Directors consistently expressed their desire to improve their current health education and science curricula. The majority of directors stated that a program like SAGE had the potential to complement and enhance existing curricula through creative, hands-on activities.

If we could create a program where they’re able to plant, water, weed, and see the growth … that’s science right there. They can measure what’s happening. … Those kinds of things would only enhance the child. (Hispanic, male director, low-income, minority ECEC)

Another director commented on the potential for an active gardening program to benefit multiple areas of child development.

It’s just so many different things that gardening can instill. It’s not just something for a temporary basis but for a lifetime … self-esteem building skills, interaction skills, language-building. It just covers all areas of development—bending, squatting—all of it. It’s all in one package, but it’s fun because it’s not direct—it’s indirect. That’s what children love. (African American, female director, low-income, minority ECEC)

Need for resources and training to implement health curricula and meet existing licensure and accreditation standards.

Centers are governed by accreditation and licensure standards that influence curricula and teaching practices. For example, current NAEYC standards require that centers meet specific health standards including health education (NAEYC, 2011). However, most directors admitted that a lack of resources is a significant barrier to expanding their health education curricula and meeting these standards.

Nutrition and health [are] very important, because we need to start teaching them at the youngest age. … That’s something that I wish we could do more and have more resources to pull from. (White, female director, high-income ECEC)

Directors noted that in addition to training opportunities for ECEC staff, there is a desire for training and education opportunities for parents.

If we could find more training opportunities for the staff, for nutritionist[s] to come in, or for leaders in the community who are leading gardening projects—people that can come talk to not only our staff but our parents—that you can do some of these things at home—would be great. (White, female director, middle-income ECEC)

Potential Feasibility

Parent Engagement.

Center directors underscored the importance of engaging parents so that information learned in the ECEC is transferred to the home. Directors discussed parent workshops and parents’ nights as existing center activities that could serve as potential avenues for engaging parents.

We do usually 3 or 4 parent workshops a year—parent education workshops … I know that at least 2 or 3 times we have had a nutritionist come in … parents wanted to know how to help their children eat healthy. (White, female director, high-income ECEC)

Potential Sustainability

The need for early intervention in the ECEC setting in helping to promote health and reduce academic disparities.

All center directors were aware of the important role that center staff play in helping children develop healthy behaviors.

[The children are] here with us the majority of the day, so we have an opportunity to work on the nutrition. We feed them two out of the three meals. … So, it’s really important that [our staff members] know how important water, food, and all those things are. (Hispanic, male director, low-income, minority ECEC)

Another director added the importance of intervening early.

It’s an ideal time to begin setting the stage and the foundation for educating them on the importance of physical activity, the importance of eating right and nutrition, and how those habits get formed. (African American, female director, low-income, minority ECEC)

Many directors explained that their primary goal was to equip preschoolers with the social, academic, and developmental skills needed to enter kindergarten. One director stressed that programs like SAGE could be particularly important for children that face academic and developmental barriers.

One of the opportunities we have here is that we’re able to level the playing field. A child who may come from a low socioeconomic background, here we can work on their nutrition. We can work on their social skills, and we can work on their academic skills so that when they go to kindergarten—because that’s what we do, we get them kindergarten-ready so they’re able to go to a better school … (Hispanic, male director, low-income, minority ECEC)

Postintervention Interviews

Acceptability

The SAGE curriculum improved nutrition knowledge.

Directors consistently highlighted how the SAGE activities reinforced nutrition knowledge and positive dietary behaviors among children.

I think it made them more aware of where food comes from and got them to start thinking about what they’re eating. If it’s good or not for their bodies. (African American, female director, low income, minority ECEC)

Another director observed evidence of improved nutrition knowledge among children.

They’re starting to see more—like more, healthy foods, you know? They can really distinguish the good food and the junk food now. (White, female director, high-income ECEC)

One of the most well-liked aspects of the program was exposing children to fruits and vegetables through tastings in each session.

The tasting of the foods was good too. … Just the experience of letting them know what an eggplant was. They had never in their lives experienced an eggplant. (White, female director, low-income, minority ECEC)

The SAGE curriculum improved opportunities for PA.

SAGE garden activities provided additional structured and unstructured opportunities for PA.

It is very important that they stay physical. We do take them outside. But this really, with the gardening, hoeing, and the raking and all that, it was really good. (Hispanic, female director, low-income, minority ECEC)

Another director observed the children being more active after participating in the garden activities.

They’re more active now. … They’re actually out playing instead of just sitting there. And then also, they love to be around that garden. (White, female director, high-income ECEC)

The SAGE curriculum is age-appropriate, interactive, and engaging.

Directors consistently agreed that SAGE was age-appropriate, engaging, and interactive.

It was appropriate because there were songs and body movement. That is what they want. … It wasn’t like just coloring inside the lines on a page. (Hispanic, female director, low-income, minority ECEC)

SAGE promoted development opportunities outside of nutrition and PA.

Two directors mentioned that SAGE expanded children’s vocabulary, which can assist them in being kindergarten ready.

It was nice for their vocabulary to be expanded. Just because they are little, it doesn’t mean that they can’t learn words like “blossoms.” If they see that on a standardized test in kindergarten, most other kids don’t know that a blossom is a small flower. (African American, female director, low-income, minority ECEC)

SAGE provides important opportunities for parent involvement.

Directors provided examples of children sharing information from SAGE lessons with parents, suggesting that knowledge and skills learned through SAGE were translated to the home.

They were so proud. They would go home and talk to their parents about it. … I know that they talk to their parents about it because the parents would ask them what they ate and tasted. (Hispanic, female director, low-income, minority ECEC)

Feasibility

SAGE was easily integrated into existing curricula.

All directors noted that SAGE fit well within existing curricula and teachers were able to reinforce information children learned during SAGE lessons throughout the week.

I think it had a positive impact. It was something we really looked forward to on Mondays and Fridays. It was fun. It gave us a framework that we could just build on that during the week. (White, female director, high-income ECEC)

Logistical challenges to program delivery.

Even with high implementation into ECECs, there were still logistical challenges that needed to be addressed. One director highlighted space as a logistical issue that required weekly attention.

The songs where we did the physical stuff with their bodies, we had to make sure that the tables and chairs were away so that when the children did the moves they wouldn’t fall into the table. (Hispanic, female director, low-income, minority ECEC)

Another director highlighted time constraints as a potential barrier to continuing the SAGE program.

It’s a time thing. We have shorter hours than most public schools, but we have to cover the same amount of material. So, it’s kind of tricky scheduling everything. (White, female director, high-income ECEC)

Sustainability

The SAGE program enhances the ECEC learning environment.

Directors felt that the SAGE curriculum was easily integrated into the existing curricula in ECECs, helping make it a sustainable program instead of a singular unit or activity.

To watch it grow from a plant to harvest was a very good extension of their science learning and learning about nature. (African American, female director, low-income, minority ECEC)

All directors mentioned that SAGE was highly engaging and provided an interactive learning environment.

My favorite part was seeing the kids get excited about the gardening and get really involved. Just their reactions to what was going on in the garden and what the foods tasted like. And then making the connections between the harvest and being something that we could eat and it being good for our bodies. (White, female director, high-income ECEC)

One director commented specifically on the nutrition-related conversations that the SAGE program sparked between children and ECEC teachers throughout the week, providing opportunities for staff members to reinforce nutritional knowledge.

… it can stir conversation about who has a vegetable in their lunch. Who has a fruit in their lunch? Just opening up the discussions of food groups and is what we’re eating the best thing we can eat for our body? (White, female director, high-income ECEC)

Impact of SAGE on ECEC staff.

As center staff observed the program, they too were exposed to the nutrition and health information taught during SAGE lessons. One director commented that participating in the SAGE program affected her own dietary habits.

And so—just making more of a point—like on Sunday night I’ll cut up tons of fruit and make little fruit salads for all through the week and have those for snacks instead of grabbing something that I shouldn’t. (White, female director, high-income ECEC)

Suggestions for improving sustainability.

While directors agreed that the SAGE program was sustainable, they made suggestions that could further improve sustainability (Figure 1). To start, according to directors, ECEC staff would be willing to participate in trainings, helping to make the program more sustainable.

FIGURE 1. Pre- and Postintervention Interview Themes and Constructs Identified by Directors That Can Be Leveraged to Develop and Improve the Sustainability of Health Programming in the ECEC Setting.

NOTE: ECEC = early child care and education center; PA = physical activity.

If you would come in and do a healthy training with the whole school staff, all schools need training hours. If y’all could develop a program where someone from your staff came in and did a training and offer that to the schools I think that would go off very well. (African American, female director, low-income, minority ECEC)

Several directors noted a lack of financial resources as a challenge to long-term sustainability.

… I think that it is very beneficial for the kids in so many developmental ways and just to have a support system to facilitate that is what is going to make it be a hit … we just don’t have the financial resources to keep it. (African American, female director, low-income, minority ECEC)

Another suggested increasing garden and sciencespecific vocabulary in the SAGE curriculum to expand program reach beyond health education, thus increasing sustainability.

Our children fail on standardized tests because of vocabulary. I try to use as much vocabulary as I can with them. I would add more vocabulary, more complicated words for them to understand. They will use them. That is one place that I would expand in that area. (African American, female director, low-income, minority ECEC)

DISCUSSION

The purpose of this study was to gain insight from ECEC directors and staff on the acceptability and feasibility of a garden-based curriculum and to identify factors that influenced the implementation and sustainability of SAGE. Insight provided by directors indicated that stronger health programming was desirable and that programs like SAGE are feasible and have potential for sustainability. SAGE was perceived as acceptable and easy to deliver and enhanced existing center curricula. Staff members perceived the program as age-appropriate, interactive, and engaging. Staff noted improved PA and nutrition knowledge among children, and directors viewed the garden as complementary to existing science curricula. This is consistent with previous findings that have documented directors’ enthusiasm regarding the engaging, hands-on learning opportunities that school gardens provide (Cosco, Moore, & Smith, 2014). In addition to improving health knowledge and expanding science lessons, staff found that SAGE improved other academic skills, such as vocabulary. This is consistent with previous studies that have found that embedding learning opportunities in physical activities can improve academic skills and even improved attention and concentration (Castelli, Hillman, Buck, & Erwin, 2007; Kirk & Kirk, 2016).

SAGE also highlighted the important roles that parents and ECEC staff have in shaping and influencing health behaviors in children. SAGE created opportunities for parent involvement via newsletters, and children shared information they learned in the program at home. Other qualitative evaluations of school-based obesity prevention have found that parental involvement is a key ingredient for success as it promotes consistent messaging around health behaviors and empowers parents to make positive changes at home (Clark, 2013). Directors mentioned that participation in SAGE led to nutrition conversations at lunch between the staff and children and even led to changes in staff health behaviors. ECEC staff are role models and discussing and modeling healthy PA and dietary habits can have a significant influence on children’s health behaviors (Vanderloo & Tucker, 2015).

Given that ECEC staff are important role models for health behaviors, there is a critical need for more health training and resources for staff (Tucker, Vanderloo, Burke, Irwin, & Johnson, 2015). Studies have found that child care providers frequently rely on their own knowledge of nutrition and PA to teach children about healthy lifestyle habits opposed to established guidelines or evidence-based policies (American Academy of Pediatrics, American Public Health Association, & National Resource Center for Health and Safety in Child Care and Early Education, 2010). ECEC staff are generally required to complete a set amount of training hours per year, which provide opportunities to develop workshops aimed at strengthening health knowledge and improving efficacy for teaching and delivering health promotion interventions. Future studies should take advantage of these existing staff training opportunities within centers.

Challenges to implementing the SAGE program may represent overarching challenges to working with ECECs to implement health-related programs. Directors noted schedule conflicts as a challenge. Accreditation standards and academic achievement goals, such as preparing children for kindergarten, make ECECs a highly regulated environment (Tucker et al., 2015). Pressure to fulfill standards and meet academic goals creates competing demands and often leave little flexibility in the schedule for adding health and intervention activities. Similarly, concerns regarding space may be based on safety concerns and existing rules that are designed to limit indoor activity to keep order and prevent injury (Tucker et al., 2015). However, because ECECs are important environments for PA, it is critical that centers develop and dedicate space where children can be active (Henderson, Grode, O’Connell, & Schwartz, 2015). ECEC staff can encourage or limit PA among children through their direct connections with children or through the manner in which they set up and control the ECEC environment. Training ECEC staff to provide safe and effective opportunities for PA and developing programs with their input and buy-in is thus critical to addressing perceived barriers and effectively implementing the program (Copeland, Kendeigh, Saelens, Kalkwarf, & Sherman, 2012).

The acceptability and feasibility of the SAGE program demonstrate the potential for sustainability of programs like SAGE. The SAGE program was easily adapted into existing center activities and curricula. Resources have been a barrier that has limited health education in ECECs, directors felt that centers often lack curricula resources, finances, and training opportunities needed to implement quality health education. Overall, participation in SAGE assisted the ECECs in completing their own mission-derived programming by aiding them in the fulfillment of accreditation standards such as health, community, and parent engagement, and satisfied parent’s desire for health education. Implementation of healthy eating PA policies and practices in ECECs has been poor; however, SAGE provided centers with a readily available curriculum to assist with the implementation of policies further strengthening the center’s health education offerings (Yoong et al., 2015). Furthermore, SAGE’s ability to improve academic, social, and development skills in addition to health behaviors, may encourage institutionalize of the program. SAGE’s ability to improve other skills beyond health (e.g., increased vocabulary) and to connect with parents shows potential for continuation of benefits that extend beyond SAGE.

CONCLUSION

Examining acceptability and feasibility before implementing the SAGE program allowed us to tailor the intervention to the needs and context of the ECEC. As a result, the curriculum was easy to deliver, integrated smoothly into existing center curricula, and assisted ECECs in meeting accreditation standards while integrating national guidelines on PA and nutrition. These factors contribute to the potential for long-term sustainability of SAGE within ECECs, including ECECs that serve predominantly low-income, minority families.