Evaluating Implementation Outcomes of a Home Garden Intervention in Rural Guatemala Using the RE-AIM Framework

Abstract

ObjectivesTo identify implementation barriers and facilitators for a home gardening intervention in rural Guatemala. MethodsHouseholds were eligible if they had a child 6–24 months of age with stunting. Households received seeds and seedlings for 16 crops, garden construction materials, agronomist-delivered education and technical assistance, and a standard-of-care nutrition program for 6 months. A mixed-methods implementation study was conducted from January 2019 to July 2020 using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Data were collected from program records, staff observations, household surveys (n = 70), and interviews or focus groups with staff (n = 4), participants (n = 6) and community stakeholders (n = 3). Descriptive statistics were calculated for quantitative outcomes and qualitative data were organized into themes. ResultsReach: Seventy of 78 (90%) eligible households participated. Many households in the community expressed interested in participating but did not have a young child with stunting. Effectiveness: Participants and stakeholders felt the intervention increased access to diverse foods. Over the six-month period, households cultivated, on average, an additional 5 species of crops (95% CI: 4–6) overall and 2 species (95% CI: 1–3) that they self-reported consuming. Adoption: Concerns about water use for garden irrigation were a barrier, with only 1 of 4 candidate communities authorizing the project. Implementation: There was good adoption of agricultural best practices (e.g., fencing, staggered planting, adding organic material, saving seeds, intercropping). Gray water filters (facilitating use of recycled water for garden irrigation) and flexible implementation promoted participation. Maintenance: At 6 months, crops failure rates were low, with only 3 of the 16 crops having failure rates above 25%. Costs for garden materials and program delivery were ∼773 USD per household. There were concerns about seed access outside of the project. ConclusionsInterest and engagement with a home garden intervention in rural Guatemala were high. Future projects should plan to address gaps between garden production and consumption, water use, and seed sourcing. Funding SourcesAcademy of Nutrition and Dietetics Foundation.