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

Background: Home gardening is a strategy to improve nutrition and food security. More information is needed about optimizing gardens in different contexts.

Objective: The 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.

Design: A mixed-methods implementation study using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was conducted from January 2019 to July 2020.

Participants/setting: Families (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.

Intervention: Participating 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 measures: Implementation 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 performed: Descriptive statistics were calculated for quantitative outcomes. Qualitative data were double-coded and organized into overarching themes.

Results: Reach: 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.

Conclusions: Interest 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.