Sustainability via Active Garden Education (SAGE): results from two feasibility pilot studies

Abstract

BackgroundLow physical activity (PA) and fruit and vegetable (F&V) consumption in early childhood are continued public health challenges. This manuscript describes outcomes from two pilot studies for Sustainability via Active Garden Education (SAGE), a program designed to increase PA and F&V consumption among 3 to 5 year old children.MethodsSAGE was developed using community-based participatory research (CBPR) and delivered to children (N = 89) in early care and education centers (ECEC, N = 6) in two US cities. Children participated in 12 one-hour sessions that included songs, games, and interactive learning activities involving garden maintenance and taste tests. We evaluated reach, efficacy, adoption, implementation, and potential for maintenance of SAGE following the RE-AIM framework. Reach was evaluated by comparing demographic characteristics among SAGE participants and residents of target geographic areas. Efficacy was evaluated with accelerometer-measured PA, F&V consumption, and eating in the absence of hunger among children, parenting practices regarding PA, and home availability of F&V. Adoption was evaluated by the number of ECEC that participated relative to the number of ECEC that were recruited. Implementation was evaluated by completion rates of planned SAGE lessons and activities, and potential for maintenance was evaluated with a parent satisfaction survey.ResultsSAGE reached ECEC in neighborhoods representing a wide range of socioeconomic status, with participants’ sociodemographic characteristics representing those of the intervention areas. Children significantly increased PA during SAGE lessons compared to usual lessons, but they also consumed more calories in the absence of hunger in post- vs. pre-intervention tests (both p < .05). Parent reports did not suggest changes in F&V consumption, parenting PA practices, or home F&V availability, possibly due to low parent engagement. ECEC had moderate-to-high implementation of SAGE lessons and curriculum. Potential for maintenance was strong, with parents rating SAGE favorably and reporting increases in knowledge about PA and nutrition guidelines for young children.ConclusionsSAGE successfully translated national PA guidelines to practice for young children but was less successful with nutrition guidelines. High adoption and implementation and favorable parent reports suggest high potential for program sustainability. Further work to engage parents and families of young children in ECEC-based PA and nutrition programming is needed.

Design and methodology of a cluster-randomized trial in early care and education centers to meet physical activity guidelines: Sustainability via Active Garden Education (SAGE)

“…Using sample size simulation tools for cluster-randomized trials along with intraclass correlation (ICC, an index of within-ECEC clustering) and variance estimates derived from our pilot data, we found that a complete-case sample size of 280 child-caregiver dyads yielded estimated power > 0.83 to detect small changes of 2.75 min/h MVPA and 4.50 min/total physical activity under relatively low clustering (ICCs = 0.11, 0.19) and modest changes (4.25 min/h MVPA, 6.50 min/ h total physical activity) under strong clustering (ICCs = 0.55, 0.60) at α = 0.05. These differences are smaller than those seen in our pilot data (MVPA differences = 3 min/h, 11 min/h; total physical activity differences = 5 min/h, 12 min/h) [24]. Given ICC and variance estimates derived from our pilot data, this sample size also afforded power > 0.85 to detect differences in combined fruit and vegetable consumption of 1.20 servings/day.…”

“…Collaborative intervention development meant that the intervention and comparison group strategies, materials and protocols were meaningful and relevant for not only testing a novel intervention strategy to move the science forward but also bestowing great benefit to the community who was served by SAGE: easy to implement, fun for everyone, and an engaging learning experience. In addition, including ECEC staff in the pilot studies developing SAGE helped to infuse the importance of meeting educational standards into the curriculum, in addition to meeting federal guidelines for health behaviors in young children [24].…”

“…Formative interviews with ECEC directors identified the need for an innovative curriculum that focused on health and dietary habits to comply with accreditation guidelines. The scientific team took this information along with information from existing garden-based curricula and protocols to be adapted and integrated for use in a SAGE feasibility trial [24,[38][39][40]. The scientific team also reviewed research to conceptualize a developmentally appropriate and center-based protocol to train children on hunger and fullness cues [41][42][43][44][45].…”

“…The PRIME principles were created specifically for SAGE following extensive formative research done in the pilot studies [24] and best practice guidelines [56]. The PRIME acronym was embraced to signify Promoting positive experiences, Room management, Improvement directed reinforcement, Modeling appropriate behaviors, and…”

“…SAGE was developed in a 3-year CBPR partnership development project, refined and pilot tested in two small scale studies in Houston and Phoenix in an additional 3-year CBPR project, and then refined once more in a third pilot test in Phoenix, for a total of 7 years of careful development. These experiences have led to the study presented herein that merged the best of science and community [5,24]. The primary objective of the SAGE cluster-randomized controlled design trial is to determine the impact, transfer, and delivery of a garden-based ECEC physical activity and fruit and vegetables promotion intervention to improve health habits in HL children aged 3-5 years.…”