Mixed-Methods Implementation Study of a Home Garden Intervention in Rural Guatemala Using the RE-AIM Framework

Abstract

BackgroundHome gardening is a strategy to improve nutrition and food security. More information is needed about optimizing gardens in different contexts. ObjectiveThe aim was to identify implementation barriers and facilitators for a home gardening intervention in rural Guatemala and inform future larger-scale interventions in the region. DesignA mixed-methods implementation study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was conducted from January 2019 to July 2020. Participants/settingFamilies (n = 70) in rural Guatemala participated in the intervention. Staff (n = 4), families (n = 6), and community stakeholders (n = 3) participated in interviews or focus groups. InterventionParticipating households received seeds and seedlings for 16 crops, garden construction materials, agronomist-delivered education and assistance, and a standard-of-care nutrition program. Main outcome measuresImplementation data were collected from program records and observations, participant surveys, and interviews and focus groups. Crop count and nutritional functional diversity of home gardens were assessed. Statistical analyses performedDescriptive statistics were calculated for quantitative outcomes. Qualitative data were double-coded and organized into overarching themes. ResultsReach: Ninety percent of eligible households participated. Child nutritional eligibility criteria was a barrier to reach. Effectiveness: Participants and stakeholders felt the intervention improved access to diverse foods. Cultivated crops increased an average of five species (95% confidence interval [CI], 4–6) at 6 months, although not all were consumed. Adoption: The main community adoption barrier was water sourcing for garden irrigation. Implementation: Raised beds were the most common gardening method, with good adoption of agricultural best practices. Gray water filters and flexible implementation were important for participation. Maintenance: Crops failure rates were low. Seed availability was a sustainability challenge. Direct costs were 763 USD per household. ConclusionsInterest and engagement with a home garden intervention in Guatemala were high. Gaps between garden production and consumption, access to water, and seed sourcing should be addressed in future work.