Group Randomized Trial of Healthy Eating and Gardening Intervention in Navajo Elementary Schools (Yéego!)

ABSTRACT

Introduction: Few healthy eating, school-based interventions have been rigorously evaluated in American Indian communities. Gardening and healthy eating are priorities in the Navajo Nation. Collaborations between researchers and local partners supported the design and implementation of this project. Study Design: The Yéego! Healthy Eating and Gardening Study was a group randomized controlled trial to evaluate a school-based healthy eating and gardening intervention in six schools on the Navajo Nation. Schools were randomized 12 to intervention or comparison. Setting/Participants: The Shiprock and Tsaile/Chinle areas on the Navajo Nation were selected. Elementary schools were screened for eligibility. All students in 3rd and 4th grades were invited to participate in the assessments. Intervention Delivered during one school year in the intervention schools, the intervention included culturally relevant nutrition and gardening curriculum and a school garden. Main outcome measures: Student self-efficacy for eating fruits and vegetables (F&V) and for gardening, and student healthy foods score from a modified Alternative Healthy Eating Index were assessed in 3rd and 4th graders at the beginning and end of a school year affected by the COVID pandemic. Primary analyses used repeated measures linear mixed models accounting for students nested within schools to estimate the intervention effect and 95% Confidence Intervals (CI). Results: Student self-efficacy for eating F&V was 0.22 higher (95%CI 0.04,0.41) in the intervention compared with comparison schools Although the student healthy foods score increased in the intervention schools, 2.0 (95%CI 0.4,3.6), the differential change was modest 1.7 (95%CI -0.3,3.7). The self-efficacy to grow F&V in the school garden increased among those in the intervention schools (OR=1.92 95%CI 1.02,3.63), but not significantly more than in the comparison schools. (OR=1.29 95%CI 0.60,2.81). Conclusions: The intervention was efficacious in improving self-efficacy for eating F&V among 3rd and 4th grade students over a school year. The findings warrant further evaluation of the intervention in larger group randomized trials with schools in Navajo communities.