Implementation of an adapted garden‐enhanced nutrition curriculum for use among fourth‐grade students in an urban city in Mexico: A feasibility study
Authors: Rodriguez‐Jordan Jazmin , Vera‐Becerra Luz Elvia , Smith Nathan Billings , Zidenberg‐Cherr Sheri 
Published: November 2023

Most school‐based nutrition intervention programs have been developed for and in developed countries. Rather than re‐inventing programs and tools to address childhood obesity, more research is required to assess processes to adapt existing, successful, nutrition programs for use among developing countries. The objective of this pilot study was to assess the feasibility of implementing a linguistically and culturally adapted garden‐enhanced nutrition curriculum, called Nutrition to Grow On (NGO), and relevant assessment tools among fourth‐grade students in León, Mexico. Two, low‐income urban, public schools meeting study criteria were selected to participate as the intervention or control school. Formative research was conducted to inform appropriate modifications to the curriculum and to assess the reliability and quality of assessment tools consisting of a nutrition knowledge (NKQ) and a questionnaire assessing vegetable recognition and identification (VPQ). A second test‐retest reliability analysis was conducted for the NKQ subsequent to additional modifications. Assessment tools were administered before and after the 18‐week intervention period at both the control (n= 64) and intervention school (n=72). Only the intervention site participated in alternating in‐class nutrition and garden lessons administered delivered once per week for 60 minutes. Parent newsletters were sent home with students' families to reinforce concepts taught in class. Pre/post changes were analyzed using paired t‐tests, and Pearson's correlation and intraclass coefficient were used to assess reliability. Analysis of covariance was used to compare posttest scores between the control and intervention school, using pretest scores as the covariate. Test‐retest reliability and intraclass correlation for the nutrition knowledge questionnaire were moderate (n= 54, r = 0.47, p < 0.001; ICC = 0.46, p< 0.001). Among the intervention group, mean NKQ total scores out of 33 points significantly increased (3.13 ± 3.07, t(47)=7.05, p<0.001). When controlling for pretest scores on the NKQ, there was a significant difference in post‐test scores between the control and intervention group (n= 48, F(1)= 8.94, p= 0.004), suggesting that the nutrition curriculum was successful in increasing nutritional knowledge. A combined score for vegetable recognition and identification was calculated for each student. On average, there was a significant increase in total vegetable recognition and identification among the intervention (0.58 ± 1.24, t(25)=2.38, p=0.03) but not the control group (0.35 ±1.32, t(25)=1.33, p= 0.195). Overall, it was feasible to adapt and implement the NGO curriculum in a Mexican population. Consistent with previous results, the NGO curriculum improved nutrition knowledge and vegetable recognition and identification. However, nutrition knowledge results need to be interpreted with caution given the tool was found to have moderate reliability.Support or Funding InformationFunding was provided by the 2014 UC Mexus Dissertaion Research Grant, 2015 UC Davis and Humanities Research Award, 2015 Alfred and Alice Lachmann International Travel Award, 2014 Henry A. Jastro Graduate Research Award.